Sam, Well said.
We have for many years been operating under the ideas of 'interoperability' and whilst tools such as HL-7 have been very successful in getting us through these times the issue of EHR interoperability will be something else yet again. Source system interoperability is one thing however (mostly constrained within a controlled environment) but receiving systems such as EHRs will have to be truly interoperable if they are to be effective. The EHR is not a messaging system as some would have us believe (in some incantations it could be seen to be just that) but it must be a system that clinicians can rely on to be accurate and reflect 'real life'. If it has to rely heavily on 'real time' messaging then the vagaries of our telecommunications systems will have a significant impact on that level of acceptance -----Original Message----- From: Sam Heard [mailto:sam.he...@flinders.edu.au] Sent: Tuesday, June 11, 2002 10:07 AM To: openehr-technical at openehr.org Subject: RE: The concept of contribution Dear All There is no doubht that the solution will have a degree of complexity - just look at HL7 v3 which is aimed at messaging. I believe that the HL7 and CEN EHR approaches will align - and will include the level 3 CDA demands - though it will take some time and must arise through implementation experience. The time for smoked filled rooms and EHR standards is over for us at openEHR and Ocean Infomatics. It is very helpful to have lots of ideas, but unless people are working on an implementation it is almost impossible to contribute in a major way. I have put the challenge to CEN to have some pilot implementations of Clinical Applications to GEHR (using our current trial implementations) and see what the implications are of our current approach. At least 2 European companies are interested. I also believe that the EHR demands an information model designed specifically for that purpose - the interoperability of EHRs. The fantacy that sharing information based on different information models will be straight forward is evolving - one only has to look at the difficulty of sharing a word document amongst different software - it is often close. The order of magnitude of complexity with health information is far greater. So let us address the difficulties of information models, of clinical models in a two level approach and work to create an EHR that is genuinely interoperable. It will take resources - but to have it working as a sharable component will take 0.1% of about 3 countries health IT development budget and 10 good minds. I think it is really starting to happen! Cheers, Sam ____________________________________________ Dr Sam Heard The Good Electronic Health Record Ocean Informatics, openEHR 105 Rapid Creek Rd Rapid Creek NT 0810 Ph: +61 417 838 808 sam.heard at flinders.edu.au www.gehr.org www.openEHR.org __________________________________________ > > >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 > > > > > > - > If you have any questions about using this list, > please send a message to d.lloyd at openehr.org > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org -------------- next part -------------- An embedded and charset-unspecified text was scrubbed... Name: InterScan_Disclaimer.txt URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20020611/e337c44e/attachment.txt>
