Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On 29/10/2010 17:18, pablo pazos wrote: Hi Thomas, My opinion is the grade of adoption of a standard depend in some aspects of goverment agencies, in some of the industry and some of the academy. DICOM is a good example of an open standard heavily supported by the industry, that's the point of it success. Can't be OpenEHR a de-facto standard for EHRs? Like DICOM is for imaging. I think yes, but the progress of OpenEHR to solve real the problems and make it usable, is slow. I think OpenEHR is strong on the academy area. It has poor industry penetration (I mean enterprises developing tools and aplying a good part of the OpenEHR specification in their systems, and that these systems where used in some hospitals). I don't know what's the penetration of OpenEHR on goverment agencies. There are some open tools but there is some stillness on making improvements on them. For example, here in Latin America, almost nobody knows about OpenEHR in the industry area, and very very few knows about it in the academy area. There are some ideas that may help de difusion and adoption of OpenEHR: - I think that regional OpenEHR communities are needed to empower the adoption and spreading of the standard. In 2009 I send a message to the mailing lists, but I get no answer from the community (this mail is below). Now we have 36 members from Uruguay, Argentina, Chile, Colombia, Spain, and more. They work on goverment agencies, big enterprises (like IBM), developers and physicians. I think the international OpenEHR community needs to support these regional communities, providing guidelines, general objectives, and following their work. Here in South America, only few people know about OpenEHR, that's a shame. People in goverment are making decissions, without knowing that are good and open standards out there. - Formal training and education in OpenEHR is needed. It's very hard to the newcomer to understand how to use OpenEHR, and people interested on the main ideas of OpenEHR may be dissapointed when they try to use it in a real-world software application. People in the industry must be trained, but how many OpenEHR trainers are out there? not enough yet ;-) But there are two things that will improve the situation: * with the arrival of better, more open tooling for templates and operational templates, and downstream transformations, much of the need to understand the mechanics of openEHR goes away; software developers can use the generated products, which could be openEHR XSDs, or even HL7v2 message definitions. * in the future we would aim for more web-available self learning material In Set-2010 I've done a hands-on OpenEHR tutorial in Argentina, and people (medics and TIC people) where amazed about building their archetypes and having a tool that generates the EHR (this is my degree project). This was done in the context of the Argentine Congress of informatics and Health 2010. Now, the organizers want to make more time to discuss OpenEHR and its posibilities. This is just an example that great things can happen if someone has interest. Regional OpenEHR communities can build courses fucused on the regional needs, may be made some money to support the open tool development (*). this is the key; to get the money, authorities need to be convinced it is a) going to do what they need and b) not going to isolate them. They are very scared of the second, even though it is not rational (since most of the standards in their comfort zone really don't work that well, and not at all together). - Building and supporting open tools. The current tools have no regular updates. We need developers to build new tools and improve the current tools. We can use the money of the training courses (*) to pay developers to do this job. If this depends only on the free time we have, tools just can die before they are implemented. actually, the ADL workbench and Archetype Editor are constantly being updated. However, I only just realised that the link for the latter is not visible. I will look into this. - In order to help any goverment adoption of OpenEHR, the decission makers have some questions that today OpenEHR can't answer. - What is the state of the standard? - Is it stable? - Wich parts are stable? should be fairly clear from the release page, http://www.openehr.org/releases/1.0.2/roadmap.html - Is there any return of investment study done on efective use of OpenEHR? that's a harder question ;-) - Or just, how much time and money I have to spend to effectively use OpenEHR in a real world application? (I have to train people to make things happen, not in an investigation project, but in a production project) - What real world products are using OpenEHR? - How these products are using OpenEHR? (they adopt the RM? the AOM? the SM?) There is page on who is using OpenEHR in the portal, but it is outdated. My proposal is to do regular polls on the community in order to know: who
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On 29/10/2010 17:18, pablo pazos wrote: Hi Thomas, My opinion is the grade of adoption of a standard depend in some aspects of goverment agencies, in some of the industry and some of the academy. DICOM is a good example of an open standard heavily supported by the industry, that's the point of it success. Can't be OpenEHR a de-facto standard for EHRs? Like DICOM is for imaging. I think yes, but the progress of OpenEHR to solve real the problems and make it usable, is slow. I think OpenEHR is strong on the academy area. It has poor industry penetration (I mean enterprises developing tools and aplying a good part of the OpenEHR specification in their systems, and that these systems where used in some hospitals). I don't know what's the penetration of OpenEHR on goverment agencies. There are some open tools but there is some stillness on making improvements on them. For example, here in Latin America, almost nobody knows about OpenEHR in the industry area, and very very few knows about it in the academy area. There are some ideas that may help de difusion and adoption of OpenEHR: - I think that regional OpenEHR communities are needed to empower the adoption and spreading of the standard. In 2009 I send a message to the mailing lists, but I get no answer from the community (this mail is below). Now we have 36 members from Uruguay, Argentina, Chile, Colombia, Spain, and more. They work on goverment agencies, big enterprises (like IBM), developers and physicians. I think the international OpenEHR community needs to support these regional communities, providing guidelines, general objectives, and following their work. Here in South America, only few people know about OpenEHR, that's a shame. People in goverment are making decissions, without knowing that are good and open standards out there. - Formal training and education in OpenEHR is needed. It's very hard to the newcomer to understand how to use OpenEHR, and people interested on the main ideas of OpenEHR may be dissapointed when they try to use it in a real-world software application. People in the industry must be trained, but how many OpenEHR trainers are out there? not enough yet ;-) But there are two things that will improve the situation: * with the arrival of better, more open tooling for templates and operational templates, and downstream transformations, much of the need to understand the mechanics of openEHR goes away; software developers can use the generated products, which could be openEHR XSDs, or even HL7v2 message definitions. * in the future we would aim for more web-available self learning material In Set-2010 I've done a hands-on OpenEHR tutorial in Argentina, and people (medics and TIC people) where amazed about building their archetypes and having a tool that generates the EHR (this is my degree project). This was done in the context of the Argentine Congress of informatics and Health 2010. Now, the organizers want to make more time to discuss OpenEHR and its posibilities. This is just an example that great things can happen if someone has interest. Regional OpenEHR communities can build courses fucused on the regional needs, may be made some money to support the open tool development (*). this is the key; to get the money, authorities need to be convinced it is a) going to do what they need and b) not going to isolate them. They are very scared of the second, even though it is not rational (since most of the standards in their comfort zone really don't work that well, and not at all together). - Building and supporting open tools. The current tools have no regular updates. We need developers to build new tools and improve the current tools. We can use the money of the training courses (*) to pay developers to do this job. If this depends only on the free time we have, tools just can die before they are implemented. actually, the ADL workbench and Archetype Editor are constantly being updated. However, I only just realised that the link for the latter is not visible. I will look into this. - In order to help any goverment adoption of OpenEHR, the decission makers have some questions that today OpenEHR can't answer. - What is the state of the standard? - Is it stable? - Wich parts are stable? should be fairly clear from the release page, http://www.openehr.org/releases/1.0.2/roadmap.html - Is there any return of investment study done on efective use of OpenEHR? that's a harder question ;-) - Or just, how much time and money I have to spend to effectively use OpenEHR in a real world application? (I have to train people to make things happen, not in an investigation project, but in a production project) - What real world products are using OpenEHR? - How these products are using OpenEHR? (they adopt the RM? the AOM? the SM?) There is page on who is
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101030/cdb87e4a/attachment.html
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Hi Hugh, I think that there is beginning to be serious industry penetration in many parts of the world. We are seeing this in the Asia Pacific region as well as many countries across Europe. Do you have any concrete examples? I mean, do you know who is working on what? As I say, we need to make some polls to know what people is working, where are this people, and how they are using OpenEHR. With this information updated we can set links between projects and improve collaboration. In Brazil there is work on 13606, and some work on OpenEHR, but now they want to make their own standard based on OpenEHR. In Argentina, Uruguay, Colombia and some other countries here in South Amercia, nobody knows more than the name of OpenEHR, and that's a shame. I think that we will soon start to see a lot more interest in South America as well - certainly there is more than academic interest in Chile and Brazil I believe. Is the OpenEHR boards doing something for this to happen? Or this is just a feeling? I think real actions must take place here to reach success. I think that we will start to see a growing number of enterprise development tools - there are certainly a number of commercial and open source development platforms that are available now and are quite mature. What are those tools you mentions? How do you know they are mature? There are tools, I use them, 1. some have a lot of problems, 2. some are not being updated for a while. I don't want to sound rude, but with feelings and thoughts we can't convince goverments to look at OpenEHR, we need facts and numbers. Soon or later we must focus on formalize this standard. I'm convinced that we need regional groups to focus on regional needs, with action lines provided by the international community. This will empower the standard all around the globe, but we need support. Cheers, Pablo. http://informatica-medica.blogspot.com/ Date: Sat, 30 Oct 2010 22:35:08 +1100 From: hugh.les...@oceaninformatics.com To: openehr-technical at openehr.org Subject: Re: Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc Hi Pablo I think that there is beginning to be serious industry penetration in many parts of the world. We are seeing this in the Asia Pacific region as well as many countries across Europe. I think that we will soon start to see a lot more interest in South America as well - certainly there is more than academic interest in Chile and Brazil I believe. I think that we will start to see a growing number of enterprise development tools - there are certainly a number of commercial and open source development platforms that are available now and are quite mature. regards Hugh On 30/10/2010 2:18 AM, pablo pazos wrote: Hi Thomas, My opinion is the grade of adoption of a standard depend in some aspects of goverment agencies, in some of the industry and some of the academy. DICOM is a good example of an open standard heavily supported by the industry, that's the point of it success. Can't be OpenEHR a de-facto standard for EHRs? Like DICOM is for imaging. I think yes, but the progress of OpenEHR to solve real the problems and make it usable, is slow. I think OpenEHR is strong on the academy area. It has poor industry penetration (I mean enterprises developing tools and aplying a good part of the OpenEHR specification in their systems, and that these systems where used in some hospitals). I don't know what's the penetration of OpenEHR on goverment agencies. There are some open tools but there is some stillness on making improvements on them. For example, here in Latin America, almost nobody knows about OpenEHR in the industry area, and very very few knows about it in the academy area. There are some ideas that may help de difusion and adoption of OpenEHR: - I think that regional OpenEHR communities are needed to empower the adoption and spreading of the standard. In 2009 I send a message to the mailing lists, but I get no answer from the community (this mail is below). Now we have 36 members from Uruguay, Argentina, Chile, Colombia, Spain, and more. They work on goverment agencies, big enterprises (like IBM), developers and physicians. I think the international OpenEHR community needs to support these regional communities, providing guidelines, general objectives, and following their work. Here in South America, only few people know about OpenEHR, that's a shame. People in goverment are making decissions, without knowing that are good and open standards out there. - Formal
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Hi Thomas, My opinion is the grade of adoption of a standard depend in some aspects of goverment agencies, in some of the industry and some of the academy. DICOM is a good example of an open standard heavily supported by the industry, that's the point of it success. Can't be OpenEHR a de-facto standard for EHRs? Like DICOM is for imaging. I think yes, but the progress of OpenEHR to solve real the problems and make it usable, is slow. I think OpenEHR is strong on the academy area. It has poor industry penetration (I mean enterprises developing tools and aplying a good part of the OpenEHR specification in their systems, and that these systems where used in some hospitals). I don't know what's the penetration of OpenEHR on goverment agencies. There are some open tools but there is some stillness on making improvements on them. For example, here in Latin America, almost nobody knows about OpenEHR in the industry area, and very very few knows about it in the academy area. There are some ideas that may help de difusion and adoption of OpenEHR: - I think that regional OpenEHR communities are needed to empower the adoption and spreading of the standard. In 2009 I send a message to the mailing lists, but I get no answer from the community (this mail is below). Now we have 36 members from Uruguay, Argentina, Chile, Colombia, Spain, and more. They work on goverment agencies, big enterprises (like IBM), developers and physicians. I think the international OpenEHR community needs to support these regional communities, providing guidelines, general objectives, and following their work. Here in South America, only few people know about OpenEHR, that's a shame. People in goverment are making decissions, without knowing that are good and open standards out there. - Formal training and education in OpenEHR is needed. It's very hard to the newcomer to understand how to use OpenEHR, and people interested on the main ideas of OpenEHR may be dissapointed when they try to use it in a real-world software application. People in the industry must be trained, but how many OpenEHR trainers are out there? In Set-2010 I've done a hands-on OpenEHR tutorial in Argentina, and people (medics and TIC people) where amazed about building their archetypes and having a tool that generates the EHR (this is my degree project). This was done in the context of the Argentine Congress of informatics and Health 2010. Now, the organizers want to make more time to discuss OpenEHR and its posibilities. This is just an example that great things can happen if someone has interest. Regional OpenEHR communities can build courses fucused on the regional needs, may be made some money to support the open tool development (*). - Building and supporting open tools. The current tools have no regular updates. We need developers to build new tools and improve the current tools. We can use the money of the training courses (*) to pay developers to do this job. If this depends only on the free time we have, tools just can die before they are implemented. - In order to help any goverment adoption of OpenEHR, the decission makers have some questions that today OpenEHR can't answer. - What is the state of the standard? - Is it stable? - Wich parts are stable? - Is there any return of investment study done on efective use of OpenEHR? - Or just, how much time and money I have to spend to effectively use OpenEHR in a real world application? (I have to train people to make things happen, not in an investigation project, but in a production project) - What real world products are using OpenEHR? - How these products are using OpenEHR? (they adopt the RM? the AOM? the SM?) There is page on who is using OpenEHR in the portal, but it is outdated. My proposal is to do regular polls on the community in order to know: who is working on what, and how they're using OpenEHR. - Formal links with formal SDOs are needed. I think that OMG is in tune with the way OpenEHR do things. They have the COAS standard, and OpenEHR RM is mapped to COAS. This is a good starting point to have something in common. I think there are very good posibilities in the OpenEHR adoption on the industry adn goverment areas, but we need to build improve the lines of action of the community to reach that. Just my humble opinions. Best regards, - Pablo. Hi, We're trying to build an spanish-speakers community about openEHR , I just create a google group: http://groups.google.com/group/openehr-es We want to translate some docs and presentations to generate enough knowledge to spread the word about OpenEHR, and other EHR related concepts between latin-american and spanish people. Best regards Pablo Pazos Gutierrez http://pablo.swp.googlepages.com/ Date: Fri, 22 Oct 2010 20:19:29 +0100 From: thomas.be...@oceaninformatics.com To: openehr-technical at openehr.org Subject: Re: Articles on
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
In all other industries, the quality of standards is measured initially against public safety and then against criteria of effectiveness and economic qualities. it seems you mean, by market testing. If not, do you have an example? In all other industries that i know of, standards are created by a process whose inputs are already developed and productised offerings from companies I presume you refer to non-it industries. In IT the picture is rather more mixed. You certainly aren't describing the omg process, or the itu process, or the w3c process here. A truly valid comparison would be with IT standards in other vertical markets. Insurance always strikes me as applicable. Do you have any examples from these spaces? Grahame
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
And none of your examples are vertical industry IT standards. Mark Bezzina for Stds Australia pointed out to me that IT vertical standards are a totally different thing to every other kind of standard. You're trying to portray Health IT as some kind of bizarre exemption, in that things are totally done in a weird way. But I don't think it's an exemption: I think most IT verticals have the same problem, which is that standards are being used as a stalking horse for research. Grahame On Thu, Oct 28, 2010 at 10:13 AM, Thomas Beale thomas.beale at oceaninformatics.com wrote: On 27/10/2010 22:32, Grahame Grieve wrote: Well, your specific comments certainly don't back your general statement up. Looking at the question of the other industries, what specific standard would you point to as an example we should follow, and how was it developed? - safety goggles and other personal safety equipment - nearly every part of a modern car that has safety implications for passengers - all telecoms signalling standards, including over radio, microwave tightbeam, and cable - any physical digital media, including DVD, Bluray, DAT, etc - nearly every thing to do with the motherboard and disk bus in a PC - VMEbus (http://en.wikipedia.org/wiki/VMEbus) - standards for energy efficiency of building materials - standards for nearly all building components, including steel beams, concrete and so on - etc None of the standards used in these areas were developed in a committee room with a random assortment of people who turned up a few times a year. Instead, companies (e.g. Ericsson, Morotola, Toshiba, Philips, BMW, etc) created products and brought them to market, and then brought the relevant interoperability specifications to standards forums. E-health should follow the lead of e.g. the telecoms and computer components industries and standardise on things that actually have been shown to work. As I said earlier, it doesn't just have to be companies that make things that work. Linux, Apache and the IETF standards came from different places. But in all of these situations, the relevant standards were first validated by implementation, deployment before being proposed as a standard. What is happening in e-health is just bizarre. And the results show it. - thomas Grahame On 28/10/2010, at 8:25, Thomas Beale thomas.beale at oceaninformatics.com wrote: On 27/10/2010 21:10, Grahame Grieve wrote: In all other industries, the quality of standards is measured initially against public safety and then against criteria of effectiveness and economic qualities. it seems you mean, by market testing. If not, do you have an example? well yes and no. Products produced by big companies of course have to undergo all kinds of testing to do with safety. With respect to fitness for purpose, the market will certainly sort a lot out. But to get to market, you have to have completely implemented and productised the offering - which means going way past the paper stage. By the time standards agencies see these things, they are guaranteed to 'work', the only question is to do with what they interoperate with. In all other industries that i know of, standards are created by a process whose inputs are already developed and productised offerings from companies I presume you refer to non-it industries. In IT the picture is rather more mixed. You certainly aren't describing the omg process, or the itu process, or the w3c process here. IT in recent decades has become quite poor, no doubt about it. Older standards (e.g. older network standards) tended to have hardware implications, and they simply could not be issued without having being implemented somewhere. In more recent times, W3C does at least manage some implementations of what it issues, but is mainly helped by major tech companies implementing the standards. Nevertheless, standards like XML Schema are still horrible, very weak formal underpinning, and hardly fit for purpose (being a document-based idea trying to satisfy data representation requirements). See http://en.wikipedia.org/wiki/XML_Schema_Language_Comparison . OMG has better process than any SDO in e-health, but the output is not always that inspiring. UML 2 is awful (try reading the 'infrastructure' and 'superstructure' specs - you really have to wonder what drugs they were taking), as is XMI. Which is why the Eclipse Modelling Framework (EMF) sprung up in the modelling space - to provide a usable alternative to XMI. A truly valid comparison would be with IT standards in other vertical markets. Insurance always strikes me as applicable. Do you have any examples from these spaces? * * I know a bit about investment, and there is to be sure, less to standardise. The interesting comparisons I think are in construction, mobile telephony, automotive, telecomms, etc. Standards just don't get issued as paper with no products behind them in these
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On Thu, 2010-10-28 at 21:25 +1100, Grahame Grieve wrote: You're trying to portray Health IT as some kind of bizarre exemption, in that things are totally done in a weird way. But I don't think it's an exemption: I think most IT verticals have the same problem, which is that standards are being used as a stalking horse for research. I am getting mixed signals from what Tom is saying. I am not sure if he is suggesting that Health IT (as in EHR/EMR, DSS, CPOE, etc.) should go through the same rigorous government controlled testing that drugs and biomedical equipment go through? Or, if he is saying that an implementation proves usefulness? I think that there is a good case for the former. Sure it would increase costs, but at least they would work as advertised. :-) --Tim -- next part -- A non-text attachment was scrubbed... Name: signature.asc Type: application/pgp-signature Size: 198 bytes Desc: This is a digitally signed message part URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101028/55e2d532/attachment.asc
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On Thu, 2010-10-28 at 12:13 +0100, Thomas Beale wrote: I would certainly agree with this last statement for e-health - and it is a terrible way to do research. I have not encountered it in any other IT area, though. Might want to re-think that one Tom. Can we start with DARPA? :-) --Tim -- next part -- A non-text attachment was scrubbed... Name: signature.asc Type: application/pgp-signature Size: 198 bytes Desc: This is a digitally signed message part URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101028/c882585a/attachment.asc
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On 28/10/2010 12:22, Tim Cook wrote: On Thu, 2010-10-28 at 12:13 +0100, Thomas Beale wrote: I would certainly agree with this last statement for e-health - and it is a terrible way to do research. I have not encountered it in any other IT area, though. Might want to re-think that one Tom. Can we start with DARPA? :-) --Tim * I don't think DARPA developed their work by sitting around tables talking about it - thomas * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101028/df5b0414/attachment.html
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On 25/10/2010 21:59, William Goossen wrote: Interesting comment Thomas, I think official standards have nothing to do with obsession, but with governments that have a legal obligation to ascertain some equality on markets, regulations, and ensuring free access and opportunities for all. Maybe I miss a few here, but I am convinced that at least in democratic societies, it is what we as citizens want. E.g. EHR laws do require official and public accessible standards from official SDO's with formal balloting and procedures in place in which all parties concerned can participate. In particular the obsession might be on market dominance. I am currently working on an ISO standard. One of the member countries was commenting that choosing one particular approach in this standard might favor that approach, hence blocking free trade. I take your points, but there is a clear priority for quality, not just equality. In all other industries, the quality of standards is measured initially against public safety and then against criteria of effectiveness and economic qualities. No standard gets through (or if it does, survives long) if it a) endangers the public or b) doesn't do its purported job properly. In all other industries that i know of, standards are created by a process whose inputs are already developed and productised offerings from companies (or sometimes other entities, e.g. universities). The process is usually one of choosing or it may be one of a compromise agreement. Whatever the detail, the outcome is usually dependable, certainly in modern times. An 'obsession' with standards of this kind would be reasonable. However, this is not what are produced in health informatics. In our domain, the standards are created in committee rooms, and are issued, pretty much untested, with no real proof of public safety, utility, fitness for purpose, maturity or value for money. And yet the governments who run e-health programmes remain attached to these de jure standards, despite their obvious shortcomings. People working for such programmes have trouble engaging with organisations that produce implementation validated outputs, because use of such materials is not sanctioned. Until this underlying problem in e-health is resolved by a major reform in how standards are actually produced, validated, and maintained, I don't see much hope for efficient progress in this domain. - thomas* * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101027/253de472/attachment.html
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On 27/10/2010 21:10, Grahame Grieve wrote: In all other industries, the quality of standards is measured initially against public safety and then against criteria of effectiveness and economic qualities. it seems you mean, by market testing. If not, do you have an example? well yes and no. Products produced by big companies of course have to undergo all kinds of testing to do with safety. With respect to fitness for purpose, the market will certainly sort a lot out. But to get to market, you have to have completely implemented and productised the offering - which means going way past the paper stage. By the time standards agencies see these things, they are guaranteed to 'work', the only question is to do with what they interoperate with. In all other industries that i know of, standards are created by a process whose inputs are already developed and productised offerings from companies I presume you refer to non-it industries. In IT the picture is rather more mixed. You certainly aren't describing the omg process, or the itu process, or the w3c process here. IT in recent decades has become quite poor, no doubt about it. Older standards (e.g. older network standards) tended to have hardware implications, and they simply could not be issued without having being implemented somewhere. In more recent times, W3C does at least manage some implementations of what it issues, but is mainly helped by major tech companies implementing the standards. Nevertheless, standards like XML Schema are still horrible, very weak formal underpinning, and hardly fit for purpose (being a document-based idea trying to satisfy data representation requirements). See http://en.wikipedia.org/wiki/XML_Schema_Language_Comparison . OMG has better process than any SDO in e-health, but the output is not always that inspiring. UML 2 is awful (try reading the 'infrastructure' and 'superstructure' specs - you really have to wonder what drugs they were taking), as is XMI. Which is why the Eclipse Modelling Framework (EMF) sprung up in the modelling space - to provide a usable alternative to XMI. A truly valid comparison would be with IT standards in other vertical markets. Insurance always strikes me as applicable. Do you have any examples from these spaces? * * I know a bit about investment, and there is to be sure, less to standardise. The interesting comparisons I think are in construction, mobile telephony, automotive, telecomms, etc. Standards just don't get issued as paper with no products behind them in these industries. - thomas -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101027/f1d217de/attachment.html
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On Sat, Oct 23, 2010 at 05:26:48AM +0100, Derek Meyer wrote: I don't claim that all old information is useless. My hypothesis is that clinical care generates vast amounts of information, and very little of this vast amount is useful.? Make that ... at any one time. a) converts real patient records into facts, and the counts the number of facts, b) requires patients to be seen without a written health record and a treatment plan formulated, c) reviews the treatment plans in the light of the written record, and d) counts facts which result in changes to the treatment plan, e) calculates the ratio of facts that were useful in altering the treatment plan compared with the total number of facts.) Once it was said If human beings were alike medicine could become a natural science. That is why the above plan is doomed to fail. This is an economic problem, Health is NOT an economic problem. Care can be, but health is not. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Sorry, I was not clear enough. I meant: if it could be shown that certain patters over time corresponded to certain morbidities, then in new patients (as yet undiagnosed) these patterns could be detected early on. - thomas On 24/10/2010 21:30, Karsten Hilbert wrote: On Sun, Oct 24, 2010 at 11:58:31AM +0100, Thomas Beale wrote: I think that the 'pebbles nuggets' characterisation is probably right, although I don't think anyone knows what the balance is, It isn't even easy to (sometimes not even possible) to know what are the pebbles and what are the nuggets. In fact, pebbles may turn into nuggets. I think that what will be needed in the future is a way of filtering out the useless pebbles on the way so to speak. Perhaps when data were archived onto slower media. I wonder if anyone has seen research to indicate how far back data might be useful based on specific morbidities? That probably wouldn't be useful because we don't yet know which morbidities are going to be relevant for a given not-yet-patient. Karsten -- Ocean Informatics *Thomas Beale Chief Technology Officer, Ocean Informatics http://www.oceaninformatics.com/* Chair Architectural Review Board, /open/EHR Foundation http://www.openehr.org/ Honorary Research Fellow, University College London http://www.chime.ucl.ac.uk/ Chartered IT Professional Fellow, BCS, British Computer Society http://www.bcs.org.uk/ Health IT blog http://www.wolandscat.net/ * * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101025/17f6b8fc/attachment.html -- next part -- A non-text attachment was scrubbed... Name: ocean_full_small.jpg Type: image/jpeg Size: 5828 bytes Desc: not available URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101025/17f6b8fc/attachment.jpg
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Dear all, I have spent some time studying how doctors used an EPR using log data (Determinants of frequency and longevity of hospital encounters` data usehttp://www.biomedcentral.com/1472-6947/10/15/abstract ). I must say that some of our results were not so expected, namely the difference on the usage of past information according to patient age (reports of children and older are less used much faster). I am currently leading a research team to repeat the same study on other logs and so I am very interested in collaborations. Regards Ricardo Correia On Sun, Oct 24, 2010 at 11:58 AM, Thomas Beale thomas.beale at oceaninformatics.com wrote: I think that the 'pebbles nuggets' characterisation is probably right, although I don't think anyone knows what the balance is, i.e. at what point it ceases to be worthwhile to trawl back in time. The trouble is you get patients like a 12 yo child with a history of chronic tonsilitis that is only visible by looking at say 10 years of data. Or try the other end of the spectrum - notes by GPs over some years may turn out to be indicative of alzheimers, but only when a diagnostic guideline is applied to say 5 or even 10 years of data. So how far is far enough? I think that what will be needed in the future is a way of filtering out the useless pebbles on the way so to speak. Perhaps when data were archived onto slower media. I wonder if anyone has seen research to indicate how far back data might be useful based on specific morbidities? - thomas beale On 23/10/2010 05:26, Derek Meyer wrote: Tim, I don't claim that all old information is useless. My hypothesis is that clinical care generates vast amounts of information, and very little of this vast amount is useful. (This is an empirical hypothesis, and so could be measured, although I don't know of a study that has. Perhaps a study that a) converts real patient records into facts, and the counts the number of facts, b) requires patients to be seen without a written health record and a treatment plan formulated, c) reviews the treatment plans in the light of the written record, and d) counts facts which result in changes to the treatment plan, e) calculates the ratio of facts that were useful in altering the treatment plan compared with the total number of facts.) My hunch is that there are gold nuggets in historical records, but we have to capture and store too many pebbles to get the nuggets we need. If there was zero cost to capture and storage this wouldn't matter, but unfortunately this is not the case with current technology. This is an economic problem, and the solution is to look for economic benefits at the other side of the time spectrum. If information could be sent to the person who needs it quickly, this time saving could justify the cost of capturing and structuring the information. Once data are structured and captured, it becomes cost effective to do a large number of other things with these data. This is not an argument against openEHR - just another way of using openEHR. Best, Derek. On 22/10/10, *Tim Cook * timothywayne.cook at gmail.comtimothywayne.cook at gmail.comwrote: On Fri, 2010-10-22 at 17:12 +0100, Derek Meyer wrote: Tony, This is very impressive piece of work. Every since I first came across openEHR I have intuitively felt that it is closer to the 'solution' than more static attempts at standardization. So why is progress so slow? I've appplied some lateral thinking to this, and come up with what many people on this list may (at best) think contrarian - but at the risk of being flamed The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. (I'll go get my hard hat now...) All I can say Derek; is that if you think my past medical, mental and social history older than six months is useless information. Much less my familial history of a few generations. I am very happy that you are not my physician. Maybe if you had all of that information in a meaningful semantically connected network. You could practice better preventive healthcare as opposed to band-aid, reactive medicine??? :-) Cheers, Tim -- *** Timothy Cook, MSc Project Lead - Multi-Level Healthcare Information Modeling http://www.mlhim.org LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook Skype ID == timothy.cook Academic.Edu Profile: http://uff.academia.edu/TimothyCook You may get my Public GPG key from popular keyservers or from this link http://timothywayne.cook.googlepages.com/home ___ openEHR-technical mailing listopenEHR-technical at openehr.orghttp://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- [image: Ocean Informatics] *Thomas Beale Chief Technology Officer, Ocean Informaticshttp://www.oceaninformatics.com/ * Chair Architectural
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
I think that the 'pebbles nuggets' characterisation is probably right, although I don't think anyone knows what the balance is, i.e. at what point it ceases to be worthwhile to trawl back in time. The trouble is you get patients like a 12 yo child with a history of chronic tonsilitis that is only visible by looking at say 10 years of data. Or try the other end of the spectrum - notes by GPs over some years may turn out to be indicative of alzheimers, but only when a diagnostic guideline is applied to say 5 or even 10 years of data. So how far is far enough? I think that what will be needed in the future is a way of filtering out the useless pebbles on the way so to speak. Perhaps when data were archived onto slower media. I wonder if anyone has seen research to indicate how far back data might be useful based on specific morbidities? - thomas beale On 23/10/2010 05:26, Derek Meyer wrote: Tim, I don't claim that all old information is useless. My hypothesis is that clinical care generates vast amounts of information, and very little of this vast amount is useful. (This is an empirical hypothesis, and so could be measured, although I don't know of a study that has. Perhaps a study that a) converts real patient records into facts, and the counts the number of facts, b) requires patients to be seen without a written health record and a treatment plan formulated, c) reviews the treatment plans in the light of the written record, and d) counts facts which result in changes to the treatment plan, e) calculates the ratio of facts that were useful in altering the treatment plan compared with the total number of facts.) My hunch is that there are gold nuggets in historical records, but we have to capture and store too many pebbles to get the nuggets we need. If there was zero cost to capture and storage this wouldn't matter, but unfortunately this is not the case with current technology. This is an economic problem, and the solution is to look for economic benefits at the other side of the time spectrum. If information could be sent to the person who needs it quickly, this time saving could justify the cost of capturing and structuring the information. Once data are structured and captured, it becomes cost effective to do a large number of other things with these data. This is not an argument against openEHR - just another way of using openEHR. Best, Derek. On 22/10/10, *Tim Cook * timothywayne.cook at gmail.com wrote: On Fri, 2010-10-22 at 17:12 +0100, Derek Meyer wrote: Tony, This is very impressive piece of work. Every since I first came across openEHR I have intuitively felt that it is closer to the 'solution' than more static attempts at standardization. So why is progress so slow? I've appplied some lateral thinking to this, and come up with what many people on this list may (at best) think contrarian - but at the risk of being flamed The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. (I'll go get my hard hat now...) All I can say Derek; is that if you think my past medical, mental and social history older than six months is useless information. Much less my familial history of a few generations. I am very happy that you are not my physician. Maybe if you had all of that information in a meaningful semantically connected network. You could practice better preventive healthcare as opposed to band-aid, reactive medicine??? :-) Cheers, Tim -- *** Timothy Cook, MSc Project Lead - Multi-Level Healthcare Information Modeling http://www.mlhim.org LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook Skype ID == timothy.cook Academic.Edu Profile: http://uff.academia.edu/TimothyCook You may get my Public GPG key from popular keyservers or from this link http://timothywayne.cook.googlepages.com/home ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- Ocean Informatics *Thomas Beale Chief Technology Officer, Ocean Informatics http://www.oceaninformatics.com/* Chair Architectural Review Board, /open/EHR Foundation http://www.openehr.org/ Honorary Research Fellow, University College London http://www.chime.ucl.ac.uk/ Chartered IT Professional Fellow, BCS, British Computer Society http://www.bcs.org.uk/ Health IT blog http://www.wolandscat.net/ * * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101024/e8cc9e5f/attachment.html -- next part -- A non-text attachment was scrubbed... Name: ocean_full_small.jpg Type: image/jpeg Size: 5828 bytes Desc: not available URL:
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On Sun, Oct 24, 2010 at 11:58:31AM +0100, Thomas Beale wrote: I think that the 'pebbles nuggets' characterisation is probably right, although I don't think anyone knows what the balance is, It isn't even easy to (sometimes not even possible) to know what are the pebbles and what are the nuggets. In fact, pebbles may turn into nuggets. I think that what will be needed in the future is a way of filtering out the useless pebbles on the way so to speak. Perhaps when data were archived onto slower media. I wonder if anyone has seen research to indicate how far back data might be useful based on specific morbidities? That probably wouldn't be useful because we don't yet know which morbidities are going to be relevant for a given not-yet-patient. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101023/3d76e449/attachment.html -- next part -- A non-text attachment was scrubbed... Name: dmeyer.vcf Type: text/x-vcard Size: 184 bytes Desc: Card for Derek Meyer dmeyer at sgul.ac.uk URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101023/3d76e449/attachment.vcf
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Late last year I said I would work on some material to help explain openEHR in the wider context of healthcare change during 2010. It has taken me longer that I originally planned but I've recently shared some articles online towards that end. http://frectal.com/book/ The articles explore issues such as Healthcare under pressure, Complexity of healthcare+management+IT, Change and the elements within Aligning process improvement efforts with IT In the final articles I explore healthcare change going forward, the need for better IT and particularly why I believe openEHR has the potential to tackle the complexity and diversity of healthcare.. http://frectal.com/book/healthcare-change-the-way-forward/ http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ In the spirit of evolutionary change, they are up in draft form for now, so comments on any article are welcome.. Hope you find it of some interest/value in explaining openEHR's place in the wider world. Please feel free to share.. Kind regards Tony Dr Tony Shannon Consultant in Emergency Medicine, Leeds Teaching Hospitals Clinical Lead for Informatics, Leeds Teaching Hospitals Chair, Clinical Review Board, openEHR Foundation tony.shannon at nhs.net +44.789.988.5068 This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSI recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101022/536b2a15/attachment.html -- next part -- A non-text attachment was scrubbed... Name: dmeyer.vcf Type: text/x-vcard Size: 184 bytes Desc: Card for Derek Meyer dmeyer at sgul.ac.uk URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101022/536b2a15/attachment.vcf
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Tony, I agree thanks for the work and for sharing. W. Ed Hammond, Ph.D. Director, Duke Center for Health Informatics Derek Meyer dmeyer at sgul.ac.u k To Sent by: For openEHR technical discussions openehr-technical openehr-technical at openehr.org -bounces at openehr. cc org Subject Re: Articles on Healthcare, 10/22/2010 12:16 Complexity, Change, Process, IT PMand the role of openEHR etc Please respond to For openEHR technical discussions openehr-technica l at openehr.org Tony, This is very impressive piece of work.? Every since I first came across openEHR I have intuitively felt that it is closer to the 'solution' than more static attempts at standardization. So why is progress so slow? I've appplied some lateral thinking to this, and come up with what many people on this list may (at best) think contrarian - but at the risk of being flamed The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. (I'll go get my hard hat now...) Best wishes, Derek. On 22/10/10, Shannon Tony (Leeds Teaching Hospitals NHS Trust) tony.shannon at nhs.net wrote: Late last year I said I would work on some material to help explain openEHR in the wider context of healthcare change during 2010. It has taken me longer that I originally planned but I've recently shared some articles online towards that end. http://frectal.com/book/ The articles explore issues such as Healthcare under pressure, Complexity of healthcare+management+IT, Change and the elements within Aligning process improvement efforts with IT In the final articles I explore healthcare change going forward, the need for better IT and particularly why I believe openEHR has the potential to tackle the complexity and? diversity of healthcare.. http://frectal.com/book/healthcare-change-the-way-forward/ http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ In the spirit of evolutionary change, they are up in draft form for now, so comments on any article are welcome.. Hope you find it of some interest/value in explaining openEHR's place in the wider world. Please feel free to share.. Kind regards Tony Dr Tony Shannon Consultant in Emergency Medicine, Leeds Teaching Hospitals Clinical Lead for Informatics, Leeds Teaching Hospitals Chair, Clinical Review Board, openEHR Foundation tony.shannon at nhs.net +44.789.988.5068 This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSI recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical[attachment dmeyer.vcf deleted by William E Hammond/Dept_CFM/mc/Duke]
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
On Fri, 2010-10-22 at 17:12 +0100, Derek Meyer wrote: Tony, This is very impressive piece of work. Every since I first came across openEHR I have intuitively felt that it is closer to the 'solution' than more static attempts at standardization. So why is progress so slow? I've appplied some lateral thinking to this, and come up with what many people on this list may (at best) think contrarian - but at the risk of being flamed The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. (I'll go get my hard hat now...) All I can say Derek; is that if you think my past medical, mental and social history older than six months is useless information. Much less my familial history of a few generations. I am very happy that you are not my physician. Maybe if you had all of that information in a meaningful semantically connected network. You could practice better preventive healthcare as opposed to band-aid, reactive medicine??? :-) Cheers, Tim -- *** Timothy Cook, MSc Project Lead - Multi-Level Healthcare Information Modeling http://www.mlhim.org LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook Skype ID == timothy.cook Academic.Edu Profile: http://uff.academia.edu/TimothyCook You may get my Public GPG key from popular keyservers or from this link http://timothywayne.cook.googlepages.com/home -- next part -- A non-text attachment was scrubbed... Name: signature.asc Type: application/pgp-signature Size: 198 bytes Desc: This is a digitally signed message part URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101022/1e675adc/attachment.asc
Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc
Hi Derek, it is very simple. Not being an official standard has been a real problem for government agencies, obsessed with official standards. - thomas beale On 22/10/2010 17:12, Derek Meyer wrote: Tony, This is very impressive piece of work. Every since I first came across openEHR I have intuitively felt that it is closer to the 'solution' than more static attempts at standardization. So why is progress so slow? I've appplied some lateral thinking to this, and come up with what many people on this list may (at best) think contrarian - but at the risk of being flamed The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. (I'll go get my hard hat now...) Best wishes, Derek. On 22/10/10, *Shannon Tony (Leeds Teaching Hospitals NHS Trust) * tony.shannon at nhs.net wrote: Late last year I said I would work on some material to help explain openEHR in the wider context of healthcare change during 2010. It has taken me longer that I originally planned but I've recently shared some articles online towards that end. http://frectal.com/book/ The articles explore issues such as Healthcare under pressure, Complexity of healthcare+management+IT, Change and the elements within Aligning process improvement efforts with IT In the final articles I explore healthcare change going forward, the need for better IT and particularly why I believe openEHR has the potential to tackle the complexity and diversity of healthcare.. http://frectal.com/book/healthcare-change-the-way-forward/ http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%e2%80%99s-potential-to-handle-complexity-diversity/ In the spirit of evolutionary change, they are up in draft form for now, so comments on any article are welcome.. Hope you find it of some interest/value in explaining openEHR's place in the wider world. Please feel free to share.. Kind regards Tony Dr Tony Shannon Consultant in Emergency Medicine, Leeds Teaching Hospitals Clinical Lead for Informatics, Leeds Teaching Hospitals Chair, Clinical Review Board, openEHR Foundation tony.shannon at nhs.net +44.789.988.5068 This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSI recipients NHSmail provides an email address for your career in the NHS and can be accessed anywhere For more information and to find out how you can switch, visit www.connectingforhealth.nhs.uk/nhsmail ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- Ocean Informatics *Thomas Beale Chief Technology Officer, Ocean Informatics http://www.oceaninformatics.com/* Chair Architectural Review Board, /open/EHR Foundation http://www.openehr.org/ Honorary Research Fellow, University College London http://www.chime.ucl.ac.uk/ Chartered IT Professional Fellow, BCS, British Computer Society http://www.bcs.org.uk/ Health IT blog http://www.wolandscat.net/ * * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101022/de54b247/attachment.html -- next part -- A non-text attachment was scrubbed... Name: ocean_full_small.jpg Type: image/jpeg Size: 5828 bytes Desc: not available URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101022/de54b247/attachment.jpg