thomas,
if there already were facile electronic heath record software with
semantically rich interoperability and a user interface that my
physicians want then i would be madly installing it. if it exists
and i don't know about it, please tell me. until then i plan to
continue rooting for projects like yours to bring semantically
advanced solutions to market while i install merely facile solutions
which lack rich semantic interoperability.
i can't speak for other communities, but i can speak authoritatively
for rural california when i say that the current medical EHR software
options are clearly underwhelming to 90% of physician practices of 5
or fewer providers, which is where 60% of our primary care takes
place. and which is why EHR adoption is still anemic even after 20
years of TEPR. besides, the EHR software already installed in the
larger care delivery settings is not semantically interoperable
anyway, or at least not without an unjustifiable dose of
infrastructure and complexity (such as IHE/XDS, an old paradigm with
as much baggage as HL7).
meanwhile, substantial administrative simplification can be achieved
in ordinary clinical care work flow simply by organizing medical
communities to collaborate intelligently and to leverage off the
shelf internet technology that can improve the practice of medicine
even if the clinical charting is still paper based.
in other words, in my neighborhood a bunch of electronic clinical
documents that are easily organized, securely stored and safely
shared is an improvement over the current regime of inaccessible
paper and electronic silos. and when semantically interoperable
solutions arrive, we can consider them, if they are practical and
suit the site level business processes of primary care.
with best regards,
[wr]
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On Nov 27, 2006, at 1:17 PM, Thomas Beale wrote:
> Will Ross wrote:
>> thomas,
>>
>> i appreciate your concern for what you allege is dr. grove's naivete,
>> but i share dr. grove's concern that when it comes to intelligent
>> health information systems, the perfect is the enemy of the good.
>> in the age of wikis, soa, voip, wifi and rfid there is no reason we
>> cannot leverage existing secure internet transport and composing
>> capabilities to substantially improve the interoperability of
>> existing clinical text and image files.
> well, that is just IHE/XDS, i.e. computing with no semantics - the
> interoperability is only between humans, not computable. So, yes, the
> information is a bit more avialable, but it is not integrated,
> searchable (beyond simplistic meta-data), computable (in the sense of
> being able to do longitudinal queries on an EHR or across EHRs), it is
> not versioned, mergeable...in short, it is not any kind of
> patient-centric EHR, just a bunch of documents.
>> when i look at where dr.
>> grove's fire is directed -- at overpriced enterprise packages that
>> deliberately build new proprietary silos -- i find an ally who is
>> saying the right disruptive things to people who would never listen
>> to me.
>>
> sure - proprietary silos are of no interest, no doubt about that. But
> just saying "let's use all the modern technology" isn't going to solve
> anything much. It has to be applied in a solution that actually
> addresses the problem.
>
> - thomas
>
>
>
>
>
> Yahoo! Groups Links
>
>
>
>
[wr]
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will ross
project manager
mendocino informatics
216 west perkins street, suite 206
ukiah, california 95482 usa
707.462.6369 [office]
707.462.5015 [fax]
www.minformatics.com
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"Getting people to adopt common standards is impeded by patents."
Sir Tim Berners-Lee, BCS, 2006
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