Gregory Woodhouse wrote:
>
> major new language. Do the people having the skills to build complex
> software systems have the expertise to know what to build?
isn't the usual wisdom that there is only one pre-requisite - to have no
idea of the true magnitide of the task before starting ?-)
> disadvantages of a design might be. VistA was initially built by
> health care professionals who learned how to program, and many of the
> most active participants in the hardhats community are practitioners.
I am on a mission against IT-only people trying to build such systems! I
have had the good fortune to work very closely with Dr Sam Heard for
over 10 years on GEHR, openEHR, and quite closely with a number of other
clinical people. On the other hand, many clinicians have crossed over
into IT, but of course know what they want in clinical terms.
I have found over the years that even with some familiarity of health
processes etc, IT people cannot build such systems on their own - they
always underestimate the messiness of it - the often end up building
quite large systems that have core functional and semantic gaps. On the
other hand, clinicians with only ad hoc programming experience won't do
a brilliant job either - they often build quite nice little systems that
just don't scale, and don't have a proper separation of back-end,
front-end, middleware, business logic etc - they almost always
under-estimate the complexity of large systems.
I remain convinced that building good health systems requires teams of
clinical and professional IT/engineering people working together, and a
methodology to allow them to do so (e.g. our reference model/knowledge
model separation in openEHR is one way of doing that). Without these
basics, I don't expect long-lived results. It's a big ask of course.
>
> > But
> > - I think it is still fair to ask questions about interoperability.
>
> I do, too. Right now, the demand doesn't seem to be there -- at least
> to the degree needed to motivate the necessary work. But if VistA is
> widely adopted, it will become a necessity. Now, yes, VistA does have
> interfaces with a number of external systems. It does make extensive
> use of HL7. But at risk of offending others, I might add that many of
> the existing solutions are of a rather ad hoc nature (in the true
> sense of the term: they are designed to solve specific, immediate
> problems), and much less has been done to solve the wider problems of
> the type I believe you have in mind
yes...well, systemic solutions to interoperability require systemic
changes to the architecture, not ad hoc additions on the outside. You
have to be consciously designing for interoperability (along with the
other 28 incredibly complex things you have to design for in health.
I'll work out the list of these one day;-)
- thomas
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