Re: Two-level modelling diagram

[Gunnar Klein]

I liked much of the figure but why do you have to cylinders for value sets.
Should be better with one like for templates.
kind regards
gunnar

Den ons 28 nov. 2018 13:23 skrev Thomas Beale :

>
> This diagram
> (SVG)
> is a replacement for an old one used in a lot of papers. People who want a
> better diagram might like this one, from a more recent version of the
> Architecture Overview.
>
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Re: Nation wide EHR project by openEHR/ISO13606 got fund in Japan.

[Gunnar Klein]

My sincere congratulations to Shinji.

Very promising development. Now - Good luck!

Best regards

Gunnar Klein


Den 2015-10-08 kl. 14:20, skrev Shinji KOBAYASHI:

Dear openEHR colleagues,

We are happy to announce that Japan Medical Network Association(JMNA) 
was designated to implement nation wide EHR with openEHR/ISO 13606 
information models in competitive bid by Japan agency for medical 
research and development.
To the next March, JMNA will implement EHR system with vendors in 
Japan by this budget, about 5 million USD.

We, openEHR Japan, will contribute to make models for this EHR project.
I wish this achievement would make happy waves to your countries.

Best Regards,
Shinji KOBAYASHI


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Re: openEHR is open but ISO may offer some other advatages

[Gunnar Klein]

I mean the submission of certain openEHR specs to ISO can be made with 
the present formal status of the Foundation being tied to UCL. To 
further gain acceptance also by governmental bodies around the globe 
where people may like openEHR but may hesitate to invest in such an 
informal body success, I think that a true international organisation 
without any ties to a specific university may be of some (not big but 
some) benefit. Also avoid criticisms of the Freriks type.


Best regards

Gunnar

Den 2015-09-04 kl. 09:56, skrev Bert Verhees:

On 04-09-15 09:31, Gunnar Klein wrote:
Irrespective of this, I argued a year ago for the foundation to take 
steps towards becoming a true international non profit foundation 
breaking its ties witht the UCL as a founder. It is an anomaly in 
today's world.

Gunnar,

Can you explain what the advantage is of the foundation breaking its 
ties with UCL?


Although, sticked to the end of your message with the word 
"Irrespective" It seems a key sentence in your message, and I miss the 
explanation.


Thanks
Bert

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openEHR is open but ISO may offer some other advatages

[Gunnar Klein]

Dear friends,

I do not think a semantic discussion on the origin and meanings of the 
word proprietary is helpful. To me, also an advocate of formal standards 
in CEN and ISO, it is clear that we should regard openEHR artefacts as 
non-proprietary in line with other communitites in the world of open 
standards and open source sharing. I am amazed that some people have 
questioned this. The main reasons are two-fold: a) The specs are openly 
available free of charge to read and to use and b) The organisation that 
develops and maintains them (The OpenEHR foundation) is open for anybody 
with a very low modest membership fee and in addition we have always 
taken onboard sound technical change requests even from people that are 
not voting members.


However, the formal standards bodies with its often special status in 
national legislation (and in international agrrements like the European 
Union and World Trade Agreement have an advantage in some respects to 
informal bodies like openEHR. Firstly, ISO is important as a federation 
of national standards bodies, legislation e.g. on public procurement 
usually refer primarily to formal national standards, that in many cases 
are just endorsements of ISO standards. I believe that many people in 
the information systems world are underestimating the status and value 
of ISO (and IEC) standards because there are so many examples of new 
informal consortias or open organisations that are formed that play 
important roles. However, for products like EHR systems that are 
becoming more and more regulated by medical device legislation in the 
world and where interoperability becomes a very important 
characteristic, I think a status as a formal ISO stadnard would be 
beneficial for openEHR at some point. Having said this I am by no means 
suggesting to close openEHR as an organisation for development and 
sharing of artefacts but I think we should carefully consider to submit 
some of the specifications for endoresements as ISO standards in much 
the same way as DICOM or HL7 or IEEE have done. The IPR issues are 
complicated but does not have to mean that there is not an ownership 
that remains by the openEHR foundation. However, I think it would 
benefit the strength of our case if a certain version of the AOM is 
available as a national/ISO standard with an independent life of the 
rather small organisation with the obscure link to UCL.


Irrespective of this, I argued a year ago for the foundation to take 
steps towards becoming a true international non profit foundation 
breaking its ties witht the UCL as a founder. It is an anomaly in 
today's world.


Kind regards

Gunnar
---
Gunnar O Klein, professor of eHealth
Örebro University, Sweden

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Antw: Re: AW: HL7 templates/archetypes

[Gunnar Klein]

I very much agree with Tom that "transformation" even if desirable in some 
circumstances shall not be taken lightly and it is not going to be a piece 
of cake, possibly dangerous. Therefore strategies should focus on avoiding 
it.

Cheers

Gunnar
- Original Message - 
From: "Thomas Beale" 
To: "For openEHR technical discussions" 
Sent: Monday, October 16, 2006 12:43 PM
Subject: Re: Antw: Re: AW: HL7 templates/archetypes


> Williamtfgoossen at cs.com wrote:
>> In een bericht met de datum 15-10-2006 23:54:28 West-Europa
>> (zomertijd), schrijft gfrer at luna.nl:
>>
>>
>>> What might be possible in a way, is to transform from CEN to HL7 and
>>> back again when a R-MIM is used that is an agreed mapping of the
>>> CEN/tc251 EN13606 part 1 Reference Model using the RIM. Part 5 of the
>>> CEN EN13606 standard will contain such an R-MIM, is the expectation.
>>> Why is such an undertaking of mapping between EN13606 and HL7v3
>>> interesting?
>>
>>
>> Yes, I say this transformation is possible.
>> Why interesting? We face multiple approaches and since sorting out the
>> clinical stuf is more costly than transformations, we face a large
>> reuse of models and reduction of overall development costs.
>>
>>
> William,
>
> one element I think are you underestimating the importance of is the
> dangers of a) excessive data transformation and b) bugs in software due
> to loose and/or over-complicated standards specifications. Either can
> cause patient safety issues, and ultimately injury or death; they
> already have, and will continue to do so.
>
> Data transformations are absolutely to be avoided as much as possible;
> they are however of course not totally avoidable. The main factor that
> aggravates the problems of data transformation is the semantic gap
> between the relevant formalisms.
>
> So while it is clearly good economics to re-use semantic models, the
> economic costs of data transformations, particularly poorly specified
> ones should not be ignored; they are the costs most related to patient
> safety in the health information infrastructure.
>
> I used to work in the control system industry, where the software
> controlled power stations, trains, gas pipelines and so on - places
> where bugs could cause injury, death and massive capital losses. We made
> sure there were no bugs in the software by clean clear design, and heavy
> use of version control, heavy reviewing, and disciplined unit and system
> testing. There were no data transformations of the kind I see people
> casually assuming in the healthcare environment. To be honest, the way I
> hear people speak about how the software will transform into this and
> that form all over the place, as if to suit the whims of modellers,
> standards politics etc, and with little regard for the consequences to
> patients - positively scares me. I hope I never end up in a hospital
> containing the solutions some people are speaking about today.
>
> And the runtime performance costs of transformation cannot be ignored
> either. Processing just prescription messages for a country of 60m
> people incurs serious costs of computing hardware and bandwidth.
>
> Complexity and excessive data transformation might keep some people
> amused and employed, but in my view, both are the enemies of safe
> computing, and in health, of patient safety. They both have to be 
> minimised.
>
> openEHR is designed from the outset to do this, and to provide the
> needed semantics for health computing.
>
> - thomas beale
>
>
>
>
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No religion, but discussion based on argumentation, dealing with the real issues

[Gunnar Klein]

Dear William,

I have great sympathy for your serious ambition to find the best of all worlds 
and see how we can learn from each other and create bridges where necessary. 
However, I also think there is a time to decide on a strategic path for the EHR 
sharing which can not be all models at the same time. I think (and my company 
Cambio Healthcare Systems have this policy) that there is a lot of compelling 
facts that the 13606/openEHR model foundation has much more potential than 
current HL7v3. This does not mean that you can do some useful work with 
integration to other V3 derived artefacts for limited scope just as you  can 
with v2 or a long range of other syntaxes which are used to express standard 
healthcare messages in different countries and contexts.

Since you are mentioning "the Swedish work with HL7 which started recently 
because the existing standards work did not bring all solutions." and I think I 
am rather well aware of what goes on here, I would like to ask you which work 
are you referring to. There are a variety of acitvities going on in different 
contexts but not even the HL7 Sweden has decided to endorse and promote any HL7 
spec yet. Some of the national projects have used the GPICs which are RIM 
derived but none of these are approaching the task of really sharing EHRs. That 
will be done in a new national activity started up by the National Board of 
Health that got a new government yesterday, so what will really happen and when 
is a bit hard to say right now.

Kind regards

Gunnar Klein


  - Original Message - 
  From: Williamtfgoossen at cs.com 
  To: openehr-technical at openehr.org ; gfrer at luna.nl 
  Cc: grahame at jivamedical.com 
  Sent: Sunday, September 17, 2006 10:47 PM
  Subject: No religion, but discussion based on argumentation,dealing with the 
real issues



  Dear Gerard, 

  Thank you very much for bringing up the point of religious fanatism in 
relation to standards development and application. 

  It is a word from my hearth in this ongoing debate with you. :-) 

  I want to analyse both standards (13606/OpenEHR and HL7 v3), look at each 
strenght and weakness and make sure that we achieve semantic interoperability 
in an intelligent way, by applying scientifically derived methods, evaluating 
approaches and results, and harmonize the work on standards. Work that I have 
been supporting and carrying out for quite some time now. Nice that you point 
to my PhD, if you have read my about 40 papers that appear in Medline and the 
more than 100 that do not appear in Medline, you would have known that I take 
the scientific approach where possible and where methods are available, or when 
it is a position statement paper, that I analyse the raw material in a way that 
allows scientific debate and discussion. As you will be aware I am the last 
person to accept dogmatic positions, especially in the world of standards, see 
the ongoing discussion on terminologies in the Netherlands where I analyse and 
test them for purpose. I would like to point at the evaluation of three 
terminologies relevant for the Netherlands applying the CEN Nursys (now ISO 
standard 18104), which has been reported to CEN and ISO. 
  Similarly, I appreciate your valuable contributions at the medical 
informatics conferences of this decade. 

  In this respect I see valuable work ongoing in both the OpenEHR and CEN 13606 
environment and in the HL7 v3 environment. Despite the work on 13606 / OpenEHR, 
the first feasible method to express clinical content in a consistent and 
machine operable manner proved for us the HL7 v3 approach, following the USAM 
work underpinning it. You cannot deny this, we have been working together on 
trying to get this working with OpenEHR tools in this period and failed at that 
time, also because there was no funding available. 
  Thus, in 2002 when the Dutch projects started (see: Goossen WTF, Jonker M, 
Kabbes BL (2002). Electronic Patient Records: Dutch Domain Information Model 
Perinatology. In Surj?n G, Engelbrecht R, McNair P (Eds.) Health Data in the 
Information Society. Proceedings of Medical Informatics Europe 2002. Amsterdam 
(etc.) IOS Press, 366-370.), there was no other option available. Since then 
many things go easier, better, the specifics have been modeled out in favour of 
a less clinical specific domain model towards one that is reusable in other 
domains (see: Goossen WTF. (2004). Model once, use multiple times: reusing HL7 
domain models from one domain to the other. In: Fieschi M, Coiera E & Jack Li, 
YC: (Eds). Proceedings of the 11th World Congress on Medical Informatics 
Medinfo 2004. Amsterdam etc. IOS Press, 366-370.). Ongoing work in patient care 
is moving even further this direction and is a perfect host for archetypes if 
you can see through the current method of expressing them in R-MIM format, 
which has been and still is the only way to get the clinical content rightly in 
HL7 v3 XML message, waiti

Archetype editor status

[Gunnar Klein]

Dear Tom,
Any chance of a new Archetype-editor emerging out of the dust of application 
writing?
Best regards

Gunnar
- Original Message - 
From: "Thomas Beale" 
To: "Openehr-Technical" 
Sent: Monday, March 07, 2005 9:34 PM
Subject: Archetype editor status


>
> Dear all,
>
> there is an anomaly in the openEHR software as of Friday. The ADL 
> reference parser, archetype workbench, and archetype valdiator have been 
> rebuilt with small improvements to the dADL handling code, and with 
> corrected handling of paths, which now must commence with a '/' in all 
> cases. The archetypes have also been upgraded. All of these changes are in 
> the usual places on the openEHR website.
>
> Unfortunately, there is a small problem in the Ocean Archetype Editor when 
> it was rebuilt with the changes, which we have yet to resolve. Any current 
> version of this editor, including any version you download today from the 
> OceanInformatics.biz website WILL NOT WORK with the current archetypes, 
> and should not be used. Normally such a problem would have been corrected 
> instantly, but right now, many of us are stretched to the limit with other 
> work, in particular FP6 EU project proposals in Europe, which have a 
> deadline of Mar 22.
>
> We expect to have the problem righted in a day or two, at which point a 
> new version will be announced. Apologies for any inconvenience, and thanks 
> for your understanding.
>
> - thomas beale
>
> -- 
> ___
> Research Fellow, University College London (http://www.chime.ucl.ac.uk)
> Chair Architectural Review Board, openEHR (http://www.openEHR.org)
> CTO Ocean Informatics (http://www.OceanInformatics.biz)
>
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> please send a message to d.lloyd at openehr.org
> 


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Instance Identifier (II) and OIDs

[Gunnar Klein]

Dear Open EHR friends,

It appears there are many uncertaintities on the use of OIDs and it has been 
difficult to find good information about it.

http://asn1.elibel.tm.fr/oid/



There is a very informative web site I discovered recently which explains a 
lot about the total systema nd seems to have updated lists of assigned OIDs. 
In relation to the use as intended by CEN and OpenEHR specifications, I 
recommend that you make sure you have an organisation in your country 
related to health that should have a registered OID the easiest should be 
through your National standards body NEN to obtain one. Search on this to 
find also contact person.

Then you need to assign specifics for the types of identifiers useed in your 
country. I agree we should try to get a global registry but it is not the 
most urgent but to get it to work nationally with the globally unique 
identifiers. Many people seem to think that there is only a number version 
of the OID but the international registration system does provide a textual 
form also used in eg ASN.1. See more on the web. For example the Swedish 
local Town Skeleftea appears as:
{iso(1) member-body(2) se(752) skelleftea(89)} or just: 1.2.752.89. Not all 
have been appropirately registered with a name however. It also appears from 
this web site that NEN has only registered one OID but maybe it is not 
updated.

Anyway good luck with your implementations.

Gunnar
Gunnar Klein (CEN/TC 251 chariman) 


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New version of Systems of Concepts to Support Continuity of Care

[Gunnar Klein]

Dear openEHR friends,

The link Arild sent out for the ENV 13940 was for the now old prestandard. 
Recently the revision of the standard with a few changes and some added 
concepts in preparation for the vote to a full standard is available at:

http://www.centc251.org/WGII/N-04/WGII-N04-18-prEN13940_2004E_041107.pdf

Use that. A word file is also available should you want to use that

Best regards

Gunnar

Gunnar Klein
CEN/TC 251 chairman
- Original Message - 
From: "Arild Faxvaag" 
To: "Openehr-Technical Technical" 
Sent: Thursday, December 02, 2004 8:56 AM
Subject: Systems of Concepts to Support Continuity of Care


> Seen this:
>
> http://www.centc251.org/TCMeet/Doclist/TCdoc00/N00-053.pdf
>
> Arild FAxvaag
>
>
> -
> If you have any questions about using this list,
> please send a message to d.lloyd at openehr.org
> 


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{SPAM?} Ignore virus alert . Hoax

[Gunnar Klein]

Dear Mario and Openehr,
The mail you sent is an example of a hoax. A warning for a threat that is not 
real. Removing the file proposed destorys a normal microsoft java component. see
http://www.symantec.com/avcenter/venc/data/jdbgmgr.exe.file.hoax.html
  Best regards
  Gunnar
  Today ISO/TC 215/WG 4 security convenor

  - Original Message - 
  From: Mario Cortolezzis 
  To: openehr-technical at openehr.org 
  Sent: Saturday, January 18, 2003 12:51 PM
  Subject: IMPORTANT : VIRUS ALERT




  Hi !

  THIS IS URGENT!!!

  A virus has been passed on to me by a contact. My address book in turn has 
  been infected. Since you are in my address book there is a chance that you 
  will find it in your computer too.

  I followed the instructions below and eradicated the virus easily.

  The virus (called jdbgmgr.exe) is not detected by Norton or McAfee 
  anti-virus system. This virus sits quietly for 14 days before damaging the 
  system. It is sent automatically by messenger and the address book, whether 
  or not you send emails to your contacts.

  Here's how to check for the virus and get rid of it:

  1.  Go to start, Find or Search option
  2.  In the file/folders option, type the name: jdbgmgr.exe
  3.  Be sure you search your C-drive and all the sub-folders and any other 
  drives you may have.
  4.  Click: "Find now"
  5.  The virus has a grey teddy bear icon with the name jdbgmgr.exe- DO NOT 
  OPEN IT
  6.  Go to edit (on the menu bar) and choose SELECT ALL to highlight the file 
  without opening it.
  7.  Now go to the File (on the menu bar) and select DELETE. It will then go 
  the recycle bin.
  8.  Go to the Recycle Bin and delete it there as well.

  IF YOU FIND THE VIRUS, you must contact all the people in your address book, 
  so they can eradicate it in their own address books.

  To do this:

  1.  Open a new email message

  2.  Click the icon of the address book next to the "To"

  3.  Highlight every name and add to "BCC"

  4.  Copy this message, enter subject and paste to email, and send

  REMEMBER YOU HAVE TO DO THIS VERY QUICKLY.


  THANKS/RGARDS



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Re Ownership

[Gunnar Klein]

Dear EHR friends,

I agree very much with David Guest's opinion that it less fruitful to speak
about ownership of information though it is done a lot in the debate in many
countries. It is clearly different from access rights which Gerard is
speaking about and like David is saying for Australia, in Sweden there is
usually very little point in trying to distinguishing differnt parts of
records as less relevant for the patient. i certainly think the
classification suggested by Gerard in four types of data does not hold.

Different from the access rights themselves are the rights to decide access
rights which is quite complicated and varies in different situations. In
many countries today, the patient concerned always has an overriding right
of deciding that "his/her" record should be released for reading to a
specific person or any person. We have an interesting debate in Sweden right
now on the issue if it is possible to ask the patient to give consent to
access to records not yet recorded. Some very official legal experts claim
it is not allowed according to the secrecy act to give a permission to an
unknown piece of information for the future whereas other legal advisors to
healthcare organisations are de facto supporting what is built in some cases
where the patient gives the consent to future relaeases of information to be
recorded in the future. One example being a centralised list of all currrent
medication. For standards we have to accept that this type of serrvice will
be required by some user groups whereas in other legal contexts it will not
be possible.

Yet another aspect of "ownership" is the issue of destruction of the whole
or parts of an EHR. In our legislation as I believe in many others no
healthcare provider has that right by itself, only a special national body,
in our case the National Board of Health working directly under the ministry
of Health can make a decision that allows it and in fact mandate that it
shall be done usually based on a request by a patient that find that errors
have been made or harmful opinions expressed by less careful professionals.
Since many EHR systems installed do not really have a function to do a
removal of data, these rare situations cause special consultancy services by
the EHR manufacturer often at high costs 5-15000 EUR.

Of course a standard requirement shoudl allow for deletion but it is not a
matter for EHR communication. However, the important thing to note is that
when records actually shall be deleted it shlould be all copies also sent to
other providers. Thus, the record need to store logs of record transfers and
there may be a need to communicate electronically the instruction to the
recieveing end to delete. However, from a Swedish point of view these
deletion issues are so rare that it is not an important requirement that
this should be communicated electronically, one reason is that the
instruction to another system need to convey also the proof (a paper
decision for now and a long time to come) of the Authority decision that the
record can/shall be deleted.

Best regards

Gunnar Klein
- Original Message -
From: "David Guest" 
To: "Gerard Freriks" 
Cc: 
Sent: Wednesday, June 12, 2002 7:44 AM
Subject: Re: The concept of contribution - first post :-)


> Hi Gerard
>
> I have been sitting here in the OpenEHR since February and all of sudden
> last month someone put through a cyberhighway and the din from traffic
> has increased enormously. For those who have transferred from other
> lists I apologise if my ponderings are too facile or have already been
> covered ad nauseam.
>
> I have never understood the concept of data ownership. I can understand
> the ownership of things, like hard drives and CD-ROMs, but not data.
> Data seems to me like a mathematical algorithm or poetry. You can create
> it, you can interpret it and you can store it. You can also send it on
> to someone else and these days the electronic copy you send is the same
> as the original.
>
> Medical data is collected from patients by health care professionals.
> Each of them has specified read / write permissions but, at least in
> Australia, not deletion rights. If you introduce third parties (HMOs,
> governments, employers) you also need to define their rights.
>
> Having worked under the Australian "open system" since a change to the
> Privacy Act six months ago, I find that there are hardly any times when
> you need to withhold information from the patient. I cannot see the
> point in restricting access to "private" opinions. My letters of
> referral, which the patient can read in full, contain a copy of my
> clinic notes. The consultant pyschiatrist soon fathoms out my diagnosis
> of "voices for investigation" and the patient is painfully aware of the
> symptom.
>
> I do agree that any appendi