Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-11-03 Thread Thomas Beale

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

2010-11-02 Thread Thomas Beale
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

2010-10-30 Thread Hugh Leslie
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-30 Thread pablo pazos

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

2010-10-29 Thread pablo pazos




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

2010-10-28 Thread Grahame Grieve
 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

2010-10-28 Thread Grahame Grieve
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

2010-10-28 Thread Tim Cook
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




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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-28 Thread Tim Cook
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


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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-28 Thread Thomas Beale
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
*
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-27 Thread Thomas Beale
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*
*
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-27 Thread Thomas Beale
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

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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-25 Thread Karsten Hilbert
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

2010-10-25 Thread Thomas Beale

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/


*
*
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-25 Thread Ricardo Correia
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

2010-10-24 Thread Thomas Beale

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/


*
*
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-24 Thread Karsten Hilbert
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

2010-10-23 Thread Derek Meyer
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-22 Thread Shannon Tony (Leeds Teaching Hospitals NHS Trust)
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.
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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 
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-22 Thread Derek Meyer
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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-22 Thread William E Hammond
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





___
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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

2010-10-22 Thread Tim Cook
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 

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Articles on Healthcare, Complexity, Change, Process, IT and the role of openEHR etc

2010-10-22 Thread Thomas Beale

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.
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-- 
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/


*
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