Hi,
Andrew wrote that
> The debate, therefore, is between those who believe one should setup
> committees and spend millions to formulate a comprehensive set of
> "reserved words" and mandate exclusive use of the resulting "word-list".
>
> Vs. starting with a small and incomplete set but allow users to build as
> they go.
I agree 100% with the latter approach with regard to most health info
systems.
A similar strategy has been followed in the development of the Internet, by
the way (start small and lean, use it in practice, allow
decentralised growth).
I prefer not to use the term "building" or even "development" for such
prototyping
processes, though - I prefer the term "cultivation" because of its complex
socio-cultural aspects. Every step users take are usually mired in
contradictions, conflicts, discussions, negotiations and compromises. (I've
usually found a dialectic perspective to fit these processes well, but
that's another discussion.)
Another crucial issue, though, is that there must be structures in place
that allow (read: compel) users to share what they have built/cultivated
with other users, and that such shared information gradually is turned into
'toolboxes' and standards. In other words, innovation rooted in actual use
AND standardisation must go hand in hand.
I have a good example of this from South Africa: The National Health
Information Systems / SA committee decided already in 1994, with WHO
support, to develop a National Data Dictionary along the lines of
Australia's.
The problem was that most dominant players believed that a "real" Data
Dictionary must consist of at least 4-5,000 items - otherwise it was not a
"real" Data Dictionary - and that this therefore had to be developed by a
national
"authorised" workgroup. End result: The Data Dictionary workgroup struggled
for years,
consulted with every conceivable party on every item big and small (most
managers regrettably perceived it as a
technical project of little interest to them), and managed to define only
30-40
data elements before it disintegrated. These defined elements were also not
used
in practice since there was no vehicle in place to bring them out to users.
Last year the Health Information Systems Programme developed a simple Data
Dictionary tool as part of our District Health Information Software, and
initially included around 700-800 data elements from the national/provinical
Essential Data Sets. Since the Data Dictionary despite its implementation in
a rather primitive prototype now was firmly linked to a piece of software in
daily use countrywide AND based on the provinces own data sets, we have seen
a rapid growth in the number of people working on the definitions etc of
THEIR OWN Essential data elements.
Final point: In my opinion, most large-scale "building" of ontologies and
coding schemes are either outright proprietary or they are turned into
somebody's "private" domain. That's something is "open source" in the
standard meaning of the words does not hinder active gatekeeping in
practice.
I have lately, for instance, had discussions with various WHO managers about
getting access to the source code of their "free" software, or in some cases
tried to just get a copy of the compiled versions. I've had very little
success, which again just shows that WHO is no different from other UN
Organisations: They are happy to provide support to developing countries,
but only on their own terms.
Regards
calle
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Calle Hedberg
3 Pillans Road,
7700 Rosebank, SOUTH AFRICA
Tel/fax (home): +27-21-685-6472; Cell: +27-82-853-5352
Email: [EMAIL PROTECTED]
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