Question on the role of EHR reference models for achieving functional interoperability
Dear Georg, -1- When interpreting text from standards it is a useful practice to look at the definitions. 3.9 electronic health record (EHR) - for integrated care (ICEHR) a repository of information regarding the health status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users. It has a standardised or commonly agreed logical information model which is independent of EHR systems. Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent, and prospective 3.10 electronic health record (EHR) ? basic generic form a repository of information regarding the health status of a subject of care, in computer processable form NOTE The definition of the EHR for integrated care in 3.9 should be considered the primary definition of an electronic health record. The definition of a basic-generic EHR is given only for completeness and to acknowledge that there are still currently many variants of the EHR in health information systems which do not comply with the main (ICEHR) EHR definition (e.g. a CDR complies with the basic-generic EHR definition but not with the ICEHR definition) 3.27 shareable EHR an EHR with a commonly agreed logical information model NOTE 1 The shareable EHR per se is an artefact between a basic-generic EHR and the Integrated Care EHR (ICEHR) which is a specialisation of the shareable EHR. The shareable EHR is probably of little use without the additional clinical characteristics which are necessary for its effective use in an integrated care setting. NOTE 2 Whilst the ICEHR is the target for interoperability of patient health information and optimal patient care, it should be noted that the large majority of EHRs in use at present are not even shareable let alone having the additional characteristics required to comply with the definition of an Integrated Care EHR. A definition of a basic-generic EHR has therefore been included to acknowledge this current reality. It is clear to me that they defined the EHR as what is called the 'Sharable EHR'. Within the light of this definition to have the Reference Model is a requirement. -2- 3.25 semantic interoperability the ability for information shared by systems to be understood at the level of formally defined domain concepts Semantic Interoperability is more than functional interoperability. For the latter a piece of written paper or a PDF is enough. In ISO 20514 one is clearly dealing about full semantic interoperability -3 When a thing is required most often this is not sufficient by itself. Other requirements have to be fulfilled in addition. For semantic interoperability we need terminologies and ways to express sensible things in a context (archetypes and templates). We need in addition a syntax and this is the Reference Model. -4- What they actually write and describe as pre-requisites is: In order to achieve semantic interoperability of EHR information, there are four prerequisites, with the first two of these also being required for functional interoperability: a) a standardised EHR reference model, i.e. the EHR information architecture, between the sender (or sharer) and receiver of the information, b) standardised service interface models to provide interoperability between the EHR service and other services such as demographics, terminology, access control and security services in a comprehensive clinical information system, c) a standardised set of domain-specific concept models, i.e. archetypes and templates for clinical, demographic, and other domain-specific concepts, and d) standardised terminologies which underpin the archetypes. Note that this does not mean that there needs to be a single standardised terminology for each health domain but rather, terminologies used should be associated with controlled vocabularies. In the context of all definitions I read that EHR-systems that have only a Reference Model and Service Interface models can interoperate at the functional level. And this is true. When systems store information using the CEN/openEHR Reference Model there is enough information from the RM to represent the data in a for humans understandable way. It then acts exactly as a PDF! Humans when reading PDF's can interpret only because of their shared implicit underlying Reference Model that we know by the name: Syntax of language. WIth regards, Gerard Freriks On 24, Jun, 2008, at 12:16 , Georg Duftschmid wrote: Dear all, I would like to ask you for your opinion on a statement in ISO/DTR 20514 (Definition, scope and context of the EHR), which says that [...] a standardised EHR reference model is required for achieving functional interoperability [...] (page 7 of ISO 20514). Functional interoperability is defined as the ability of two or more systems to exchange
Question on the role of EHR reference models for achieving functional interoperability
Georg Duftschmid wrote: So I have the impression that an EHR reference model helps to achieve some kind of advanced functional interoperability, but I would not say that it is REQUIRED to achieve functional interoperability (refering to the PDF-exchange as a counter-example). * no reference model = no computability, including queryability. To overcome that, if you use PDFs, plain text etc, you need structured meta-data. As soon as you need that (e.g. like IHE) you need a model of it. As soon as it tries to be more sophisticated, the model becomes more complex. If we want queryable, computable data (e.g. for decision support, research), you have to have models. Otherwise the software doesn't know what the data mean. - thomas beale *
Question on the role of EHR reference models for achieving functional interoperability
Dear all, I would like to ask you for your opinion on a statement in ISO/DTR 20514 (Definition, scope and context of the EHR), which says that [...] a standardised EHR reference model is required for achieving functional interoperability [...] (page 7 of ISO 20514). Functional interoperability is defined as the ability of two or more systems to exchange information (so that it is human readable by the receiver). I am now wondering why an EHR reference model is seen to be REQUIRED for achieving functional interoperability. If I exchange bare PDF-documents (without any describing metadata) between two EHR systems, then I would say there is a good chance that these docs are readable by a human receiver and thus functional interoperability should be achieved although clearly an EHR reference model is not used. I agree that an EHR reference model alone is not enough to achieve semantic interoperability (agreed archetypes and terminology are missing) and therefore by using an EHR reference model alone one can still only achieve functional interoperability. However, this seems to me as some kind of advanced functional interoperability, where the receiving EHR system knows the basic components (the RM classes and their attributes) from which EHR information is composed. So I have the impression that an EHR reference model helps to achieve some kind of advanced functional interoperability, but I would not say that it is REQUIRED to achieve functional interoperability (refering to the PDF-exchange as a counter-example). What do you think? Thank you for any comments and best regards, Georg -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20080624/4cd095f3/attachment.html
Question on the role of EHR reference models for achieving functional interoperability
Dear Georg, Op 24-jun-2008, om 12:16 heeft Georg Duftschmid het volgende geschreven: I am now wondering why an EHR reference model is seen to be REQUIRED for achieving functional interoperability. If I exchange bare PDF-documents (without any describing metadata) between two EHR systems, then I would say there is a good chance that these docs are readable by a human receiver and thus functional interoperability should be achieved although clearly an EHR reference model is not used. Theoretically you're right; there is a good change that these docs are readable by human. The real question is: are these usable? Maybe such documents are usable between two health care providers who know and trust each-other. But now I receive such a document from somebody I don't/ superficially know. Am I willing to use (potentially critical) information in the treatment of my patient without knowing the proper context. By doing so I'll take over the responsibility. So if now my patient dies based on wrong interpretation of the incomplete information I'm liable for the death of that patient So I would never use that information and do everything all over again. Why shouldn't I, I'm getting paid for this double work as well (as least here in the Netherlands this holds true and this is what we call 'perverse incentives'). Thing is that if we leave room to doubt the quality of the information and/or are not able to create insight in the responsibilities and the transfer thereof, people won't use it. In that case what's the use of an EHR in the first place? Cheers, Stef -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20080624/468ec8fc/attachment.html
Question on the role of EHR reference models for achieving functional interoperability
Hi Georg, I agree with your argument. Distinguishing advanced functional interoperability from PDF like functional interoperability is helpful as the information can be presented in a more or less customised way leveraging the underlying RM classes - Ocean's EHRview (https://wiki.oceaninformatics.com/confluence/display/ocean/EhrView+Demonstration - unfortunately currently unavailable) is an example for such a generic display mechanism. Obviously if the archetypes are known as well more sophisticated customization is possible. Every clinical information system could implement a similar mechanism to display openEHR data (even without archetypes) more or less adapted to their environment. However, this is only helpful for read-only interfaces. To be able to edit the data the archetypes have to be known! Cheers, Thilo On Tue, Jun 24, 2008 at 12:16 PM, Georg Duftschmid georg.duftschmid at meduniwien.ac.at wrote: Dear all, I would like to ask you for your opinion on a statement in ISO/DTR 20514 (Definition, scope and context of the EHR), which says that [...] a standardised EHR reference model is required for achieving functional interoperability [...] (page 7 of ISO 20514). Functional interoperability is defined as the ability of two or more systems to exchange information (so that it is human readable by the receiver). I am now wondering why an EHR reference model is seen to be REQUIRED for achieving functional interoperability. If I exchange bare PDF-documents (without any describing metadata) between two EHR systems, then I would say there is a good chance that these docs are readable by a human receiver and thus functional interoperability should be achieved although clearly an EHR reference model is not used. I agree that an EHR reference model alone is not enough to achieve semantic interoperability (agreed archetypes and terminology are missing) and therefore by using an EHR reference model alone one can still only achieve functional interoperability. However, this seems to me as some kind of advanced functional interoperability, where the receiving EHR system knows the basic components (the RM classes and their attributes) from which EHR information is composed. So I have the impression that an EHR reference model helps to achieve some kind of advanced functional interoperability, but I would not say that it is REQUIRED to achieve functional interoperability (refering to the PDF-exchange as a counter-example). What do you think? Thank you for any comments and best regards, Georg ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical
Question on the role of EHR reference models for achieving functional interoperability
hi Thilo I would like to ask you for your opinion on a statement in ISO/DTR 20514 (Definition, scope and context of the EHR), which says that [...] a standardised EHR reference model is required for achieving functional interoperability [...] (page 7 of ISO 20514). Functional interoperability is defined as the ability of two or more systems to exchange information (so that it is human readable by the receiver). I am now wondering why an EHR reference model is seen to be REQUIRED for achieving functional interoperability. If I exchange bare PDF-documents (without any describing metadata) between two EHR systems, then I would say there is a good chance that these docs are readable by a human receiver and thus functional interoperability should be achieved although clearly an EHR reference model is not used. well, not so fast. If you are exchanging pdf documents, you need some rules about how they are exchanged, and when, and then what happens as a consequence. These can be rather informal, but nevertheless, they must exist. And once they do, aren't you on the way to have an EHR reference model? Then there's the question of interoperability. Generally what you describe is *integration* not interoperability. Picking these two apart is a fun game, but generally inteoperability is more about plug-n-play where as integration is about two systems made to work together. As you move your example from two to many systems, you'll be increasingly moving towards a standardised EHR reference model. And there's no semantic anything in sight yet! Grahame
