Mike, I don't remember what was in the Berlin presentation by Gunnar, I think.
It is a fair list of reasons why the uptake is slow. But what can one expect within a few years? It took more than 6 years before a CEN standard on ECG-signals was used all over the world. What is used of HL7 version 2.2 or 2.3, I expect. And both CEN and HL7 have a lot of optionalities, since the approach is generic. The re-engineering of systems is the case with standards used in implementations in systems. And the EHR standard could be implemented in systems it is not only a messaging standard. Since Berlin we learned of several European implementations of the EHR standard in systems and messages. The implemented standard was a pre norm (ENV 13606) that after 3 years of use is now up for revision. This revision will take on board the GEHR Australia en USL work via the OpenEhr proposed Models. Talking about narrative in Medicine. The narrative is always subjective. It is what the narrator wants to write. Most often it is the healthcare provider. What he writes is not THE TRUE STORY it is the story as told by .... Facts are recorded, interpreted, used or ignored and placed in certain contexts. The highly subjective recorded result is what I call the Pati?nt Record. Fact and fiction. The EHR is the electronic version of this story based on selected re-arranged facts. The free text plus facts is the real stuff what medicine is about. And the more that is stored in a structured way the better the EHR is computer processable. Free text expressing the thoughts, the doubts, the professional expertise, are not debris at all. Medicine is more than recorded facts and pseudo facts. Facts? Artefacts is a better phrase. Gerard On 2002-06-09 11:59, "Mike Mair" <mikemair at es.co.nz> wrote: > > Dear Gerhard, > > You said: > >> Why the focus on HL7 only? CEN/TC251 has started work on the EN 13606 and > is precisely what you want. HL7 version 3 and >CDA will be to unstable for > some time to come. HL7 doesn't adopt the GEHR (CEN) two model approach. >> Artifacts based on the present HL7 version 3 RIM will prove to be > unimplementable as a system or object. > > We can be very encouraged that you may get together with HL7 on this. > However you (or was it Gunnar Klein) did say in your ?Berlin CEN meeting > 2002 presentation (the presentation has disappeared from the > www.openehr.org. site) that EN 13606 had limited uptake because it was: > > a) incomplete or have offered only partial coverage of the healthcare > domain; > b) unnecessarily complex; > c) too generic, leaving the various implementations too much variability in > how the models are applied to a given domain; > d) flawed, with some classes and attributes not implementable as published; > e) requiring expensive re-engineering of systems; > f) containing features not required by the > purchasers of clinical systems. > > The time is evidently ripe for a synthesis. I agree about the importance of > narrative: > You said: > >> It is a narrative for personal usage. >> When information is to be shared the author will select and rewrite parts >> of his notes in order to meet a specific request by an other healthcare > provider. >> This is the way people work. This is the way healthcare providers know how >> to work with using paper systems. > > Perhaps the record is a resource to make stories out of? The original > 'syntagm' is just the first, and even that was an interpretation.The 'true' > story is unknowable. > >> I can see that objective information (orders, test results) can be shared > by >> all without real problems. But people (good healthcare) will need > subjective >> narrative as recorded in their personal Medical Records. > > Free text remains indispensable, structured data is just the debris left > behind - it's a point of view... > > Regards > > Mike Mair > > > > > -- <private> -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
