Antw: Re: [GPCG_TALK] Archetype Maintenance
Bert Verhees wrote: You refer to machine computer system interfaces and that these might be proprietary. Yes they could and will. But when the holy grail is about plug-and-play interoperability then these interfaces (archetypes) must be free to use. Gerard, how about SNOMED-tables, they are expensive, and many other terminology-tables? Will there be free replacement for that? One of the design aims for archetypes, from years ago, is that they had to work _with no external terminology_ if need be. They do this, and you can have an archetyped system that works perfectly well, even if you have no access to Snomed or ICD10. Mappings to such terminologies can be included in the archetypes, and if you don't have the terminologies locally available, you can keep working, even though you might well enter something that is not conformant to the terminology in a value field. However, in the future, I foresee archetypes being pre-processed into operational archetypes that include the value sets extracted from various terminologies in the archetype, so that if you don't have ICD10 say, the operational form of the archetype will include the relevant value sets (e.g. infectious respiritory diseases). This question is also relevant for third world countries, or health-information-systems used by poor organisations, f.e. free health care systems for illegal immigrants in Europe and the USA. They may be able to read messages, because messages probably have beside the code, also the description, but they cannot produce messages, because they will not be able to code their content the above approach would allow this, but I agree that the legality and licensing is not clear at this stage. However, I believe that if small extracted value sets (with no structure) cannot be used for free from Snomed, ICD, LOINC etc, then there is little long term future for the use of these terminologies outside rich countries (and even there, they won't work unless national level licensing is used, since otherwise you are up for some ridiculous micro-licensing model based on your use of 28 snomed terms in one of your archetypes). Hopefully common sense will prevail here... - thomas Thanks Bert -- ___ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http://www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org)
Antw: Re: {Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
Williamtfgoossen at cs.com wrote: www.zorginformatiemodel.nl has about 85 stroke patient related archetypes. unfortunately most are in Dutch, but we have translated about 10 to English now, most the simple ones or the ones that explain the approach also in more technical way. Key is the binding knowledge, variables, vocabulary, value set and unique coding for each element or node. William William, these are not archetypes, they are HL7v3 RMIMs. It is confusing to people if you call these archetypes - they don't obey the archetype model, aren't expressed in the archetype language (ADL) and aren't processible by the archetype toolsso I suggest we refer to them by their real name...(of course, if they were archetypes, that would be much nicer - we could share them outside the v3 message environment). - thomas -- ___ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http://www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org)
Antw: Re: {Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
Thomas Beale wrote: Williamtfgoossen at cs.com wrote: www.zorginformatiemodel.nl has about 85 stroke patient related archetypes. unfortunately most are in Dutch, but we have translated about 10 to English now, most the simple ones or the ones that explain the approach also in more technical way. Key is the binding knowledge, variables, vocabulary, value set and unique coding for each element or node. William William, these are not archetypes, they are HL7v3 RMIMs. It is confusing to people if you call these archetypes - they don't obey the archetype model, aren't expressed in the archetype language (ADL) and aren't processible by the archetype toolsso I suggest we refer to them by their real name...(of course, if they were archetypes, that would be much nicer - we could share them outside the v3 message environment). OK, I know this is an openEHR list, but nevertheless I don't think that openEHR can claim exclusive use of the word archetype to refer only to artefacts which are expressed in openEHR ADL. From such a claim it is a slippery slope to having to refer to them as archetypes?, archetypes(TM) or archetypes?. Strictly speaking, an archetype is not a set of specifications or constraints at all but rather (according to WordNet) an original model on which something is patterned - that is, the master **instance** of a thing, a prototype, from which specifications can be derived. openEHR seems to be using the term archetype in the later, Jungian sense of an inherited pattern of thought or symbolic image that is derived from the past collective experience of humanity and is present in the unconscious of the individual. My practice has been to refer to openEHR Archetypes to clearly distinguish them from other uses of the English language word archetype. Perhaps on this and other openEHR lists, the term archetype could be taken to mean OpenEHR Archetype, and other types of archetype could be distinguished as necessary by suitable qualification, including the generic non-openEHR archetype. But alternative uses of the term archetype should not be denied. Tim C
{Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
Williamtfgoossen at cs.com wrote: In een bericht met de datum 8-1-2006 21:31:57 West-Europa (standaardtijd), schrijft gfrer at luna.nl: Information is exchanged in communities.All clinical information belongs to the healthcare domain. When clinical concept models (Archetypes) are expressed using an Open International Standard like the CEN/tc251 Archetypes, both the Archetype expression and the constituting clinical concept models are not owned in a commercial sense. Gerard Sorry to be late in response, but this comment is only partly true. After having made about 150 archetypes for use in HL7 v3 messages (technical transition being no issue at all, clinical material is), we have encountered several issues. Hi William, I didn't know anyone had made archetypes for HL7v3 (except our one test archetype). Can you provide a URL to them? Not all clinical information belongs to the healthcare domain. Many instruments and scales are copyrighted and require a licencing fee. Use in EHR or message is in that case no different from paper versions or dedicated software. This is similar to use of vocab which is or is not copyrighted. Can you give an example of such a problem? Use of CEN / ISO or OpenEHR does not solve this issue, neither does HL7: the clinical content can be owned in commercial sense. - thomas beale
{Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
Je suis absente du bureau jusqu'au jeudi 4 mai 2006. Sandrine Villaeys
Antw: Re: {Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
www.zorginformatiemodel.nl has about 85 stroke patient related archetypes. unfortunately most are in Dutch, but we have translated about 10 to English now, most the simple ones or the ones that explain the approach also in more technical way. Key is the binding knowledge, variables, vocabulary, value set and unique coding for each element or node. William -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060503/1b45b4db/attachment.html
Antw: Re: [GPCG_TALK] Archetype Maintenance
Dear William, My answer is: The moment clinical concepts as defined by groups of clinicians are proprietary it will be impossible to have any conversation. The moment clinical concepts as defined by groups of clinicians using archetypes it will be impossible to have any semantic interoperability between computer systems. Proprietary archetypes used in computer systems are the same as words for concepts used in daily life in discussions between persons. Since the EHR is about documenting by a healthcare provider in ones own words what has happened, they must be able to use all concepts and words, that express them, used in normal speech. You refer to machine computer system interfaces and that these might be proprietary. Yes they could and will. But when the holy grail is about plug-and-play interoperability then these interfaces (archetypes) must be free to use. In my mind users must pay for the use of the machine and demand completely open system interfaces. Information (entered, stored, retrieved and exchanged) must be freed from any influence by the IT industry. Information must be owned and controlled by the users. Information must never be expressed as code in software. Information must never be exchanged in proprietary ways. Without this, generic semantic interoperability between computer systems never will be possible. Gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 On 2-mei-2006, at 12:59, Williamtfgoossen at cs.com wrote: In een bericht met de datum 8-1-2006 21:31:57 West-Europa (standaardtijd), schrijft gfrer at luna.nl: Information is exchanged in communities.All clinical information belongs to the healthcare domain. When clinical concept models (Archetypes) are expressed using an Open International Standard like the CEN/tc251 Archetypes, both the Archetype expression and the constituting clinical concept models are not owned in a commercial sense. Gerard Sorry to be late in response, but this comment is only partly true. After having made about 150 archetypes for use in HL7 v3 messages (technical transition being no issue at all, clinical material is), we have encountered several issues. Not all clinical information belongs to the healthcare domain. Many instruments and scales are copyrighted and require a licencing fee. Use in EHR or message is in that case no different from paper versions or dedicated software. This is similar to use of vocab which is or is not copyrighted. Use of CEN / ISO or OpenEHR does not solve this issue, neither does HL7: the clinical content can be owned in commercial sense. It is stil questionable if the model representation of such clinical information e.g. in a HL7 message model, or a CEN / OpenEHR archetype format is not a breach of copyright regulations. Same with terminology: we bind variables and values to terminologies: leaving the decision to the clinician which to use, but to make sure that each element has at least one unique code that is maintained and governed over the centuries. I do agree that once the source material copyrights are sorted out, then the representation in models and storage of clinical data for a patient, or aggregations to group level data from this can be handled open source like, but then we have the consent issue of the patient to exchange information, or to re-use clinical information for managerial or policy reasons. Sincerely yours, Dr. William T.F. Goossen Senior Researcher and Consultant Health and Nursing Informatics Acquest Research, Development and Consulting, Koudekerk aan den Rijn, the Netherlands http://www.acquest.nl/ Adjunct Associate Professor in the College of Nursing, faculty in the Organizations, Systems and Community Health Area of Study, the University of IOWA, Iowa City, Iowa, USA. http://www.nursing.uiowa.edu/facstaff/adjunct.htm Co-chair Patient Care Technical Commission, Health Level Seven, Ann Arbor, MI, USA. http://www.hl7.org Country Representative for the Netherlands in the Special Interest Group Nursing Informatics, IMIA. http://www.infocom.cqu.edu.au/imia-ni/ Member Evaluation Committee International Classification for Nursing Practice, Geneva, ICN. International Council of Nurses http://www.icn.ch/ and http:// www.icn.ch/icnp.htm Associate Professor, Adjunct on the faculty of the School of Nursing, University of Colorado Health Sciences Center, Denver, USA. http://www2.uchsc.edu/son/sonweb.asp Bestuurslid Vereniging voor Medische en Biologische Informatieverwerking http://www.vmbi.nl/ Teacher in health and nursing informatics, MBA Health Management University of Applied Sciences, Osnabr?ck, Germany. http://www.wiso.fh-osnabrueck.de/aktuelle-lehre.html Fellow of the Centre for Health Informatics Research and Development
Antw: Re: [GPCG_TALK] Archetype Maintenance
You refer to machine computer system interfaces and that these might be proprietary. Yes they could and will. But when the holy grail is about plug-and-play interoperability then these interfaces (archetypes) must be free to use. Gerard, how about SNOMED-tables, they are expensive, and many other terminology-tables? Will there be free replacement for that? This question is also relevant for third world countries, or health-information-systems used by poor organisations, f.e. free health care systems for illegal immigrants in Europe and the USA. They may be able to read messages, because messages probably have beside the code, also the description, but they cannot produce messages, because they will not be able to code their content Thanks Bert
Antw: Re: [GPCG_TALK] Archetype Maintenance
Bert, The example of SNOMED is a good one. Looking at SNOMED we must ask the question: Are words in a dictionary proprietary? Do we have to pay for the use of these words in our conversations? Of course the answer is: NO. We have to pay for the medium: the book, the CD-ROM, the application. The maintenance of the words used in any language is most often paid for by the State. Language is a free commodity. SNOMED is a Reference Terminology. When local users map their local codes to SNOMED codes only the Terminology Server that does translations using SNOMED needs a licence. In its proposed pricing scheme SNOMED will ask more money from rich countries (millions) and very small amounts (ten-hundred Euro;'s) from poor countries. The are very sensible and indexed to the Gross National Product. Gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 On 3-mei-2006, at 11:23, Bert Verhees wrote: You refer to machine computer system interfaces and that these might be proprietary. Yes they could and will. But when the holy grail is about plug-and-play interoperability then these interfaces (archetypes) must be free to use. Gerard, how about SNOMED-tables, they are expensive, and many other terminology-tables? Will there be free replacement for that? This question is also relevant for third world countries, or health-information-systems used by poor organisations, f.e. free health care systems for illegal immigrants in Europe and the USA. They may be able to read messages, because messages probably have beside the code, also the description, but they cannot produce messages, because they will not be able to code their content Thanks Bert -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060503/0032b207/attachment.html
{Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
Je suis absente du bureau jusqu'au jeudi 4 mai 2006. Sandrine Villaeys
{Fraud?} {Disarmed} Antw: Re: [GPCG_TALK] Archetype Maintenance
In een bericht met de datum 8-1-2006 21:31:57 West-Europa (standaardtijd), schrijft gfrer at luna.nl: Information is exchanged in communities.All clinical information belongs to the healthcare domain. When clinical concept models (Archetypes) are expressed using an Open International Standard like the CEN/tc251 Archetypes, both the Archetype expression and the constituting clinical concept models are not owned in a commercial sense. Gerard Sorry to be late in response, but this comment is only partly true. After having made about 150 archetypes for use in HL7 v3 messages (technical transition being no issue at all, clinical material is), we have encountered several issues. Not all clinical information belongs to the healthcare domain. Many instruments and scales are copyrighted and require a licencing fee. Use in EHR or message is in that case no different from paper versions or dedicated software. This is similar to use of vocab which is or is not copyrighted. Use of CEN / ISO or OpenEHR does not solve this issue, neither does HL7: the clinical content can be owned in commercial sense. It is stil questionable if the model representation of such clinical information e.g. in a HL7 message model, or a CEN / OpenEHR archetype format is not a breach of copyright regulations. Same with terminology: we bind variables and values to terminologies: leaving the decision to the clinician which to use, but to make sure that each element has at least one unique code that is maintained and governed over the centuries. I do agree that once the source material copyrights are sorted out, then the representation in models and storage of clinical data for a patient, or aggregations to group level data from this can be handled open source like, but then we have the consent issue of the patient to exchange information, or to re-use clinical information for managerial or policy reasons. Sincerely yours, Dr. William T.F. Goossen Senior Researcher and Consultant Health and Nursing Informatics Acquest Research, Development and Consulting, Koudekerk aan den Rijn, the Netherlands A HREF=http://www.acquest.nl/;http://www.acquest.nl//A Adjunct Associate Professor in the College of Nursing, faculty in the Organizations, Systems and Community Health Area of Study, the University of IOWA, Iowa City, Iowa, USA. http://www.nursing.uiowa.edu/facstaff/adjunct.htm Co-chair Patient Care Technical Commission, Health Level Seven, Ann Arbor, MI, USA. http://www.hl7.org Country Representative for the Netherlands in the Special Interest Group Nursing Informatics, IMIA. http://www.infocom.cqu.edu.au/imia-ni/ Member Evaluation Committee International Classification for Nursing Practice, Geneva, ICN. A HREF=http://www.icn.ch/;International Council of Nurses http://www.icn.ch//A and http://www.icn.ch/icnp.htm Associate Professor, Adjunct on the faculty of the School of Nursing, University of Colorado Health Sciences Center, Denver, USA. http://www2.uchsc.edu/son/sonweb.asp Bestuurslid Vereniging voor Medische en Biologische Informatieverwerking A HREF=http://www.vmbi.nl/;http://www.vmbi.nl//A Teacher in health and nursing informatics, MBA Health Management University of Applied Sciences, Osnabr?ck, Germany. http://www.wiso.fh-osnabrueck.de/aktuelle-lehre.html Fellow of the Centre for Health Informatics Research and Development (CHIRAD), School of Social Sciences, Kings Alfred's, Winchester, UK. A HREF=http://www.chirad.org.uk/;www.chirad.org.u/Ak -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060502/832ae184/attachment.html
