Hi Daniel,
I read most of your thesis, it is fascinating (it's one of those things
that requires contemplation, so I have not read it straight through). I
recommend others to have a look
<https://www.zotero.org/groups/openehr/items/collectionKey/7R6VHGSD/itemKey/HFEWDHSX>.
One thing that I think we can say about efforts like openEHR, and indeed
any large-ish ecosystem project (including SDOs like HL7 etc): there is
the intended / understood sociological analysis on the part of the
builders (we who make something in openEHR) and then there is reality.
How we think it should work in the real world can easily be wrong-footed
by sociopolitical realities, and these latter are ill-defined. Thus, if
we are naive (we almost certainly have been in some ways), we get some
things wrong and then are surprised when the world doesn't work in what
we consider the most rational way (it rarely does). This is what happens
around 'adoption' - things get twisted by shifting government policies,
changing funding programmes, enterprise amnesia and many other
phenomena. The world is always more complicated than we think it should
be, and than our abstractions would imply...
Regarding ABD, I won't report too much just yet because I need to be
sure of what the group leads want to do in terms of presenting their
thinking over time, i.e. not jump the gun. When I am able, I'll post
something.
- thomas
On 01/04/2016 12:38, Daniel Curto-Millet wrote:
Hi all,
I’ve been a long-time lurker in the lists while doing my PhD and I
still try to keep tabs with what openEHR is doing. I wanted to react
and take part in this discussion particularly because their paper
resonated with me in some points (and not in others). I think the
paper has merit and I’m interested (and quite jealous of too) that
they did what I had wanted to do eventually with openEHR had time been
kinder: to look and compare the global openEHR and the local openEHR(s).
The paper’s finding that you cannot separate social issues from
technology is not new; and there is an inherent tension between a
computer system that is based on simplification and closure
(determinate states), from desires of freedom and flexibility usually
associated with the social (yet, has anyone not felt the
functional-driven approach set by bureaucracy without the need of any
technology). So, although their point on the illusion of separation
between the social and technical is correct; it is also true for every
information system there is, past, present, and no doubt, future. This
includes the accounting books from the middle-ages which tried to
settle down some concepts (money in; money out), while giving
flexibility to other concepts (varying prices of cereals; intangible
assets, etc.).
When I researched the global openEHR (in contrast to implementing
ones), I found that the project had harnessed open source in ways
which made the modelling of ambiguous requirements possible precisely
because there was no concept of determinacy. I remember a long series
of discussion (Nov 2010?) between Thomas and Ed regarding openEHR’s
way of thinking about requirements, contrasting it with the notion of
design by committee behind (relatively) closed doors. The public space
that open source affords openEHR is not just a trendy word, but it can
create what Chris Kelty refers as ‘recursive commons’, a sort of space
that respects certain values and logics (in his study, Free software)
that can function with relative independence from competing logics
that threaten its own existence (in his study, closed software).
As an open source project, openEHR is quite special in what it does.
Whereas open source usually puts the ability for local populations
(schools, architects, etc.) to collaboratively ‘own’ methods of
productions (otherwise in the hands of those who have the key to
closed software). openEHR creates this ownership ability at a
conceptual level, necessarily /removed/ (but never quite so) from
local contexts. I remember a discussion between Heather and Ian (in
2010?) on an allergen-related archetype with a doctor who was
particularly concerned for personal reasons and what constituted a
‘good’ archetype relative to templates and local concerns (thus taking
local concerns into account at this global level).
What ‘good’ means is extremely ambiguous in all cases, but that’s the
point and openEHR’s greatest contribution and greatest challenge: the
global project has purposefully put the definition of ‘good’ in that
very public space of the open source world, and I don’t think it would
be inaccurate to say that openEHR has thought this through already
(e.g. governance change) and will continue to do so (e.g. local
ambassadors). In this sense, I don’t see at all that openEHR is
technologically deterministic, on the contrary. Yet the implementation
side requires some forms of simplifications and closures (Luhmann’s
concepts, not mine), not necessarily at odds. The question I think,
becomes one of building bridges between the diverse communities
involved (whether level—national, or context—small clinic, etc.) in
processes of community engagement. How this can take place is
extremely challenging involving both strategic and tactical thinking.
Strategic: how to create a coherent whole (e.g. that openEHR’s mission
is shared and adapted by the various levels), and tactical: how to
involve clinicians more easily (e.g. the use of soft systems
methodologies to understand local worlds).
By the way Thomas, I’m really interested in what you have to say
regarding the ABD. There are theories in information systems regarding
activity theory and I’m curious to see if there are any connections
with that.
Daniel
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