FW: Meaningful Use and Beyond - O'Reilly press - errata
at oceaninformatics.commailto:thomas.be...@oceaninformatics.com Subject: Re: Meaningful Use and Beyond - O'Reilly press - errata To: openehr-technical at openehr.orgmailto:openehr-technical at openehr.org Message-ID: 4F402FB0.6010706 at oceaninformatics.commailto:4F402FB0.6010706 at oceaninformatics.com Content-Type: text/plain; charset=iso-8859-1 Fred, that's pretty much it. We can disagree whether we should solve the sem-interop problem now (us; harder, longer) or later (you; get more going faster), but that's not a real debate - in some places our view makes more sense, in others yours is the practical sensible approach. Our main aim is to enable /intelligent computing/ on health data; doing that means semantic interoperability has to be solved. Otherwise, there is no BI, CDS or medical research based on data. My only worry about not taking account of semantic / meaning issues now is that it will cost more later, than if it were included now. I still think that there is synergy to be explored in the coming 12m-2y between the openEHR community and the open source health Apps community (if I can call it that). - thomas On 18/02/2012 20:55, fred trotter wrote: (please, no flame wars, below I am just trying to explain _my_ point of view to Fred;-) There is no need to worry about a flame war. I am certainly dubious, but I take what you guys are doing and saying very seriously. It seems like you are taking a totally different approach to semantic interoperability than I generally favor. My view is that semantic interoperability is simply a problem we do not have yet. It is the problem that we get after we have interoperability of any kind. This is why I focus on things like the Direct Project (http://directproject.orghttps://web.nhs.net/owa/redir.aspx?C=e070771f1cb04f3c913c799823a7b732URL=http%3a%2f%2fdirectproject.org) which solve only the connectivity issues. In my view once data is being exchanged on a massive scale, the political tensions that the absence of true meaning creates will quickly lead to the resolution of these types of problems. The OpenEHR notion, on the other hand, is to create a core substrate within the EHR design itself which facilitates interoperability automatically. (is that right? I am trying to digest what you are saying here). Trying to solve the same problem on the front side as it were. Given that there is no way to tell which approach is right, there is no reason why I should be biased against OpenEHR, which is taking an approach that others generally are not. If that is the right core value proposition (and for God's sake tell me now if I am getting this wrong) then I can re-write the OpenEHR accordingly. Regards, -FT * 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
Meaningful Use and Beyond - O'Reilly press - errata
Hi Fred, Thanks for coming along here. It has been an interesting discussion. I just wanted to pick up on one point you made .. In my view once data is being exchanged on a massive scale, the political tensions that the absence of true meaning creates will quickly lead to the resolution of these types of problems. Whilst I agree that you need to take one step at a time and get simple connectivity going first, our experience from the UK is that once this is established, the small trickle of demand for semantics grows very quickly. In the absence of some kind of agile mechanism/ framework to meet this demand and quickly reconcile differences across very different communities and specific use cases, projects and vendors just resort to doing their own thing. So in the UK, in spite of full connectivity, adherence to syntactic standards, and some local successes with semantic exchange, we have at least 8 different semantically incompatible expressions of 'GP Medication' having to be dealt with by producers/consumers of messages. Getting this right is extremely difficult but I believe the 'archetype' approach of openEHR/ CIMI and tools like CKM, are the only realistic way of getting a handle on this. This has much in common with the PCAST idea of 'molecules' - see Wes Rishel's excellent summary http://blogs.gartner.com/wes_rishel/2011/02/13/pcast-documents-vs-atomic-data-elements/ Regards, Ian Dr Ian McNicoll office +44 (0)1536 414 994 fax +44 (0)1536 516317 mobile +44 (0)775 209 7859 skype ianmcnicoll ian.mcnicoll at oceaninformatics.com Clinical Modelling Consultant,?Ocean Informatics, UK Director/Clinical Knowledge Editor openEHR Foundation ?www.openehr.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care ?www.phcsg.org On 18 February 2012 20:55, fred trotter fred.trotter at gmail.com wrote: (please, no flame wars, below I am just trying to explain _my_ point of view to Fred;-) There is no need to worry about a flame war. I am certainly dubious, but I take what you guys are doing and saying very seriously. It seems like you are taking a totally different approach to semantic interoperability than I generally favor. My view is that semantic interoperability is simply a problem we do not have yet. It is the problem that we get after we have interoperability of any kind. This is why I focus on things like the Direct Project (http://directproject.org) which solve only the connectivity issues. In my view once data is being exchanged on a massive scale, the political tensions that the absence of true meaning creates will quickly lead to the resolution of these types of problems. The OpenEHR notion, on the other hand, is to create a core substrate within the EHR design itself which facilitates interoperability automatically. (is that right? I am trying to digest what you are saying here). Trying to solve the same problem on the front side as it were. Given that there is no way to tell which approach is right, there is no reason why I should be biased against OpenEHR, which is taking an approach that others generally are not. If that is the right core value proposition (and for God's sake tell me now if I am getting this wrong) then I can re-write the OpenEHR accordingly. Regards, -FT -- Fred Trotter http://www.fredtrotter.com ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical
Meaningful Use and Beyond - O'Reilly press - errata
Hi Fred, Apropos to Tom I'd say openEHR is also equally to do with software maintainability; thanks to the dual or multi-level modelling and model driven development. This is my main research area as well as open source software. I agree with Tom's comments that being open source by itself is not enough (for any software quality aspect I believe) and must be accompanied with open standards. If I was asked to explain openEHR to my mother I'd probably say: 'it is about getting information right in healthcare'. I usually find this statement as the starting point when talking to other audiences such as computer scientists and developers. Perhaps you'll find useful as well. Cheers, -koray From: openehr-technical-bounces at openehr.org [mailto:openehr-technical-boun...@openehr.org] On Behalf Of fred trotter Sent: Saturday, 18 February 2012 1:27 p.m. To: For openEHR technical discussions Subject: Re: Meaningful Use and Beyond - O'Reilly press - errata Thomas, This is quit usable critique and I will certainly draw from it in future revisions of the work. You make the argument that OpenEHR is primarily for interoperability, and I can accept that fundamental argument. It is difficult to swallow however, when I hear the HL7 v3 wonks talking about how HL7 RIM is the solution to semantic interoperability. Are they confused or are you confused, because you are saying basically the same thing. From my perspective as in implementer it looks awefully like a blueray vs HDDVD war and it looks like OpenEHR is losing. But at the same time I keep hearing that HL7 RIM is compatible with and might be merged with HL7 RIM. Very confusing, and I have yet to see something compelling that can be done in OpenEHR that cannot be done with HL7 RIM. Having said that, HL7 RIM is a proprietary ontology/model and OpenEHR, is not. That gives OpenEHR some usefulness even as an alternative model. Is that where I should see the value? Here is an information model that delivers semantic interoperability but is not proprietary? On Fri, Feb 17, 2012 at 6:15 AM, Thomas Beale thomas.beale at oceaninformatics.commailto:thomas.beale at oceaninformatics.com wrote: Hi Fred, I think you are missing the point. The key thing we are working on in openEHR is interoperability, not open source. Open source health applications have historically not made any difference to interoperability, intelligent computing or anything else - they are the same as closed source systems that don't do any of these things. This is not to say that they aren't better quality software / solutions in other ways - some are very nice. But in general they have the same proprietary data formats and service interfaces as commercial solutions (making such definitions openly available doesn't change anything). Solving interoperability and intelligence in e-health (as for other domains) is very hard indeed, and solutions based on simple approaches only have marginal benefit. What matters to clinical people and actual health delivery is interoperability, regardless of closed or open source: open standardised (= widely agreed) information models, service interfaces and knowledge formalisms. Of course open source, done the right way does have a lot to offer, and can make the economics better, but it doesn't specifically address the interoperability problem. What I think you will see in the future is intelligent health computing platforms based on openEHR, or something like it (as you noted, Tolven also does not have much penetration today, but it also is a sophisticated solution that takes semantic interoperability seriously). See the CIMI forumhttp://informatics.mayo.edu/CIMI/index.php/London_2011 to get some idea of the international backing for knowledge-driven architecture. Without these kind of model-driven architectures, semantic interoperability will remain a dream, as will any serious industry around decision support, business intelligence and data-based medical research, and any other application wanting to use computable patient-centred health data. Because of the time it has taken to mature the openEHR - and other related, and even competing - health computing platforms, solutions based on these platforms are only just starting to make serious inroads. I have no problem with your view of openEHR in terms of limited penetration (today), but what I think would be a little more positive would be for the open source sector to actually take part in solving interoperability, rather than continuing to add to the problem. There are real synergies to be explored. Much of the new work in openEHR and related architectures is coming out open source. It would be great if existing open source health application developers were to get involved - e.g. by working with us and others (e.g. HL7 HSSP, IHE etc) on e-health service modelshttp://www.openehr.org/wiki/display/spec/openEHR+Service+Model. We on the other hand
Meaningful Use and Beyond - O'Reilly press - errata
Op 18-02-2012 1:26, fred trotter schreef: Very confusing, and I have yet to see something compelling that can be done in OpenEHR that cannot be done with HL7 RIM. It is not that I want to interfere between you and Thomas. I am happy to leave the interoperability discussion with you. Just want to exercise my mind with following statement. OpenEHR is a system-specification, you can simulate a HL7 v3 RIM machine on an OpenEHR kernel. And also you can simulate a EN13606 machine on an OpenEHR-kernel. And also, in the Netherlands we invented OranjeHIS (long time ago, but still working to get it implemented), which is a datamodel for GP-systems. You can use an OpenEHR-kernel to simulate this datamodel. Not that you should do that, but it might be possible, but maybe you run against some detail-problems and you will need some software-logic to overcome them. Maybe even, adjust the Reference Model. Regards Bert Verhees
Meaningful Use and Beyond - O'Reilly press - errata
Fred, On 18/02/2012 00:26, fred trotter wrote: Thomas, This is quit usable critique and I will certainly draw from it in future revisions of the work. You make the argument that OpenEHR is primarily for interoperability, and I can accept that fundamental argument. It is difficult to swallow however, when I hear the HL7 v3 wonks talking about how HL7 RIM is the solution to semantic interoperability. Are they confused or are you confused, because you are saying basically the same thing. From my perspective as in implementer it looks awefully like a blueray vs HDDVD war and it looks like OpenEHR is losing. But at the same time I keep hearing that HL7 RIM is compatible with and might be merged with HL7 RIM. (please, no flame wars, below I am just trying to explain _my_ point of view to Fred;-) well there is an age-old debate there... Put it this way: we did not use the HL7 RIM because the RIM + refinement method used in HL7 doesn't do what we think is needed, which is the following: * a single reference model http://www.openehr.org/releases/1.0.2/roadmap.html for all data - the openEHR RM. This is about 100 classes, including data types. Data from any openEHR system anywhere can interoperate with another openEHR-enabled system o HL7 RIM is not a model of data, it is a model from which other concrete message doc schemas are derived by the refinement method; people are now trying to use the RIM directly for this purpose, but it isn't easy, because it was not designed for that * a defined formalism in which models of content that control configurations of RM instances - the archetype language and object model http://www.openehr.org/wiki/pages/viewpage.action?pageId=196633. * actual models of content (archetypes templates), defined using this formalism, e.g. these ones http://www.openehr.org/knowledge/ on openEHR.org, and these ones http://dcm.nehta.org.au/ckm/ in use by the Australia government. * A toolchain for making these archetypes, and also generating downstream artefacts for direct programmer use * a portable query language http://www.openehr.org/wiki/display/spec/Archetype+Query+Language+Description based on the archetypes * standard service interface definitions, e.g. these EHR services http://www.openehr.org/wiki/display/spec/EHR+Service+Specification (being standardised into one ultimately) The architecture overview http://www.openehr.org/svn/specification/TAGS/Release-1.0.1/publishing/html/architecture/overview/Output/overviewTOC.html gives a pretty good picture of how it all fits together in openEHR. Very confusing, and I have yet to see something compelling that can be done in OpenEHR that cannot be done with HL7 RIM. see above. Having said that, HL7 RIM is a proprietary ontology/model and OpenEHR, is not. That gives OpenEHR some usefulness even as an alternative model. Is that where I should see the value? Here is an information model that delivers semantic interoperability but is not proprietary? Well, although HL7 technically does charge for use of the standard, I would not call it proprietary - it is easy enough to obtain online at HL7.org. The substantive differences from our point of view are mainly in the difficulty of using the HL7 RIM because of the way it was designed, which differs from normal object-oriented modelling practices. If you want to compare something in HL7 to the openEHR reference model, the CDA is closer. HL7 are now working on a newer simplified modelling approach called Fast Health Interoperability Resources (FHIR) http://www.healthintersections.com.au/fhir/introduction.htm (and also on CDA release 3 I think). Although I have a lot of technical problems with the HL7v3 approach, one thing I can say is that they did conceive of the problem to be solved and its solution at an appropriate level of complexity. I think they got some technical detals wrong, and I think this is agreed in HL7 now, hence the FHIR activity. The bottom line is: the hard work on the openEHR interoperability 'stack' has been done - we have a decent modelling formalism (internationally accepted - by ISO CIMI), reference model (of course, still evolving a bit), query language and emerging service models. The current priority is to standardise the downstream products for programmers, generated from templates. These are XSDs and APIs. There have been versions running in production for about 3 years now, and they need to be described in specifications. These last artefact types close the circle between clinician-designed archetypes terminology, to developer artefacts, enabling truly semantically enabled applications to be built by normal developers. The overall ecosystem is a platform concept, not a silo concept, and very well suited to specialist groups building small (and large) open source components and apps (and
Meaningful Use and Beyond - O'Reilly press - errata
(please, no flame wars, below I am just trying to explain _my_ point of view to Fred;-) There is no need to worry about a flame war. I am certainly dubious, but I take what you guys are doing and saying very seriously. It seems like you are taking a totally different approach to semantic interoperability than I generally favor. My view is that semantic interoperability is simply a problem we do not have yet. It is the problem that we get after we have interoperability of any kind. This is why I focus on things like the Direct Project ( http://directproject.org) which solve only the connectivity issues. In my view once data is being exchanged on a massive scale, the political tensions that the absence of true meaning creates will quickly lead to the resolution of these types of problems. The OpenEHR notion, on the other hand, is to create a core substrate within the EHR design itself which facilitates interoperability automatically. (is that right? I am trying to digest what you are saying here). Trying to solve the same problem on the front side as it were. Given that there is no way to tell which approach is right, there is no reason why I should be biased against OpenEHR, which is taking an approach that others generally are not. If that is the right core value proposition (and for God's sake tell me now if I am getting this wrong) then I can re-write the OpenEHR accordingly. Regards, -FT -- Fred Trotter http://www.fredtrotter.com -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120218/0a9b3010/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
Hi Fred, The OpenEHR notion, on the other hand, is to create a core substrate within the EHR design itself which facilitates interoperability automatically. (is that right? I am trying to digest what you are saying here). Trying to solve the same problem on the front side as it were. I think that's more acurated, but substrate is a little ambiguous here, I rather say that openEHR propose a generic standarized architecture based on the dual model (separate software from custom domain concepts). That architecture enables/simplifies interoperability later because the information to be interchanged between systems is formally defined (by archetypes: http://www.openehr.org/knowledge/). So any communication protocol and data format could be used for interoperability, and systems could interchange not only data, but the information definition too. The key here is that within an openEHR based system, other standards like HL7, DICOM, SNOMED, MeSH, UMLS, ICD10, ... could be implemented to, each one for it's own task. Hope that helps. -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120218/90d1a760/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
Op 18-02-2012 22:24, pablo pazos schreef: The key here is that within an openEHR based system, other standards like HL7, DICOM, SNOMED, MeSH, UMLS, ICD10, ... could be implemented to, each one for it's own task. Supplementary to what Pablo wrote, I have a real life example. In the Netherlands, HL7v3 messaging would have become mandatory for every Health-related-system, from the kitchen in a health-institution, a GP-system, or a medical-specialist system. The idea was (very simply said) to create a message-oriented network where all these systems should connect. Every health-related system was expected to run Hl7v3 messaging on top of it, or the system would be excluded from this network and, as a result, possibly also excluded from business in healthcare. So the pressure was big, and most systems succeeded in producing and reading HL7 messages. Most systems, of a big variety, architectural, platform, etc, can now implement HL7v3 messaging, an OpenEHR-system, with all its flexibility can also. --- At last the HL7v3 network failed, because of privacy-reasons (simply stated), but maybe it gets a second chance, but that will take some years to the next senate-change, and it will not be easy. Then a strange thing happened in the Netherlands. Now the HL7v3 network failed, for reasons which have nothing to do with HL7v3, many systems hurried to go back to the messaging standards they used before. That is mainly Edifact messages and HL7 v 2.x. Defined 15 years ago or more. The old working horses. (an OpenEHR system can also produce these messages, like any system can) Why is that, the switching back? Is it for technical reasons? HL7v3 is from semantical point of view much better than the legacy-messaging-systems. So why not use it if the law doesn't force it and the implementation was for most systems ready? Why switch back to these old legacy-systems, often implemented with errors? I don't know for sure. I think, one reason, it is because the new network did not come to live, and the organisations had to revalue to their old systems, and those only could run on the legacy-message-standards. --- What we can see is that from market perspective in the Netherlands, HL7v3-messaging is not getting implemented. The old working horses do the job more or less satisfactory. Dutch technicians value the American saying: If it ain't broke, don't fix it. And how about OpenEHR? There are several projects where it is getting implemented, some large companies are involved, some universities too. The main reason? The flexibility it offers to build systems and the ease to connect to messaging standards and non (or defacto) standardized messaging protocols. Bert
Meaningful Use and Beyond - O'Reilly press - errata
Fred, that's pretty much it. We can disagree whether we should solve the sem-interop problem now (us; harder, longer) or later (you; get more going faster), but that's not a real debate - in some places our view makes more sense, in others yours is the practical sensible approach. Our main aim is to enable /intelligent computing/ on health data; doing that means semantic interoperability has to be solved. Otherwise, there is no BI, CDS or medical research based on data. My only worry about not taking account of semantic / meaning issues now is that it will cost more later, than if it were included now. I still think that there is synergy to be explored in the coming 12m-2y between the openEHR community and the open source health Apps community (if I can call it that). - thomas On 18/02/2012 20:55, fred trotter wrote: (please, no flame wars, below I am just trying to explain _my_ point of view to Fred;-) There is no need to worry about a flame war. I am certainly dubious, but I take what you guys are doing and saying very seriously. It seems like you are taking a totally different approach to semantic interoperability than I generally favor. My view is that semantic interoperability is simply a problem we do not have yet. It is the problem that we get after we have interoperability of any kind. This is why I focus on things like the Direct Project (http://directproject.org) which solve only the connectivity issues. In my view once data is being exchanged on a massive scale, the political tensions that the absence of true meaning creates will quickly lead to the resolution of these types of problems. The OpenEHR notion, on the other hand, is to create a core substrate within the EHR design itself which facilitates interoperability automatically. (is that right? I am trying to digest what you are saying here). Trying to solve the same problem on the front side as it were. Given that there is no way to tell which approach is right, there is no reason why I should be biased against OpenEHR, which is taking an approach that others generally are not. If that is the right core value proposition (and for God's sake tell me now if I am getting this wrong) then I can re-write the OpenEHR accordingly. Regards, -FT * * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120218/33c7f8b1/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
Hi Fred, I think you are missing the point. The key thing we are working on in openEHR is /interoperability/, not open source. Open source health applications have historically not made any difference to interoperability, intelligent computing or anything else - they are the same as closed source systems that don't do any of these things. This is not to say that they aren't better quality software / solutions in other ways - some are very nice. But in general they have the same proprietary data formats and service interfaces as commercial solutions (making such definitions openly available doesn't change anything). Solving interoperability and intelligence in e-health (as for other domains) is very hard indeed, and solutions based on simple approaches only have marginal benefit. What matters to clinical people and actual health delivery is interoperability, regardless of closed or open source: open standardised (= widely agreed) information models, service interfaces and knowledge formalisms. Of course open source, done the right way does have a lot to offer, and can make the economics better, but it doesn't specifically address the interoperability problem. What I think you will see in the future is intelligent health computing platforms based on openEHR, or something like it (as you noted, Tolven also does not have much penetration today, but it also is a sophisticated solution that takes semantic interoperability seriously). See the CIMI forum http://informatics.mayo.edu/CIMI/index.php/London_2011 to get some idea of the international backing for knowledge-driven architecture. Without these kind of model-driven architectures, semantic interoperability will remain a dream, as will any serious industry around decision support, business intelligence and data-based medical research, and any other application wanting to use computable patient-centred health data. Because of the time it has taken to mature the openEHR - and other related, and even competing - health computing platforms, solutions based on these platforms are only just starting to make serious inroads. I have no problem with your view of openEHR in terms of limited penetration (today), but what I think would be a little more positive would be for the open source sector to actually take part in solving interoperability, rather than continuing to add to the problem. There are real synergies to be explored. Much of the new work in openEHR and related architectures is coming out open source. It would be great if existing open source health application developers were to get involved - e.g. by working with us and others (e.g. HL7 HSSP, IHE etc) on e-health service models http://www.openehr.org/wiki/display/spec/openEHR+Service+Model. We on the other hand have a lot to learn about e-health applications. Finally, I would guess that e-health is about 10% of the way to a truly useful full-featured intelligent and open e-health platform of the future. That means that books like yours should potentially be educating readers on the likely future, not the status quo. - thomas On 17/02/2012 01:12, fred trotter wrote: Hi, Fred Trotter here, one of the two authors of the book in question. I wrote the portion covering OpenEHR, so I believe your complaints will ultimately come to rest with me. Generally however, let me put forward a note on how we are thinking at O'Reilly . This book has been very popular, and we are pretty happy with it. But it important to understand who this book is targeted to. We intended the book to be focused towards O'Reilly's primary readership, which is IT professionals and programmers. People who have no health IT experience. We have been pleased that clinical types have enjoyed it, but we were not aiming at them. We are also not currently selling the book in book stores. It is available only on the web and it has been overwhelmingly a e-book seller. This is the trend generally at O'Reilly and has been changing how we think about book publishing. I hope that give a little context here. With that in mind, we wrote the book very quickly and with an aim at overviewing everything that an IT generalist needs to know about health IT. That means we intended it to be a mile wide and an inch thick. That inch needs to right however, and we will be fixing all of the real errors that we find. O'Reilly has realized that book publishing in the e-book era is alot more like software publishing than anything Gutenberg might have envisioned. We use software tools for revisioning, for tracking errata (bugs) for making changes and for pushing those changes out automatically to our readers. We also use what amounts to a free beta release process where we put the manuscript online for free for people to comment on in its pre-production state. Our book had the dubious honor of receiving more feedback during this process than any other O'Reilly book
Meaningful Use and Beyond - O'Reilly press - errata
On 17-02-12 14:39, Rene Spronk (Ringholm) wrote: However, as Thomas points out, to state that openEHRs primary focus on software design wouldn't do it justice: that's a means to an end. The raison d'etre is achieving interoperability. Allow me to introduce my two cents. For my personal point of view, the raison d'etre is the low costs involved with software design and change-design. To say it short, just create an archetype (and a GUI or other means of data-entry) and you are in business, when working in niches, this is a strong advantage. Then, when breaking out of the niche, when connecting to other systems, or devices, it is easy to write a layer to adapt to the data-constellations which are offered or wanted. When interoperability comes to it, via templates it is possible to come to all sort of message-formats or message-standards, the software-logic needed is less complicated then when in legacy-systems. I have some experience in working with message-layers for legacy. Very often, one has to forget all good habits of software-development. Many legacy systems have become ugly in software-code. That is why changes in legacy are often very expensive to implement and that is why, often, errors occur. OpenEHR offers a healthy base on which it is possible to keep your future software-extensions simple and clean. This is because, it happens all in the archetypes (and GUI's or other means of data-entry), not in the kernel. It is important to realize that the kernel-specifications have hardly changed for almost ten years. Compare this with a legacy-system where changes hack deep into all layers of code, even to the heart, the database-model. regards Bert Verhees
Meaningful Use and Beyond - O'Reilly press - errata
Hi Fred, If your target audience for the book is IT professionals and programmers, you'd probabily like to be accurate in your statements. Since you've asked for corrections, let me try to explain what does not look right here. Let's take a look at the following excerpts shall we? *OpenGALEN and OpenEHR are both attempts to promote open source ontology con- cepts. Both of the projects have been maturing but some view these as unnecessary additions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certain jurisdictions.* First of all, what is open source ontology concepts? openEHR has links to ontologies, but even with the extensive use of the term ontology, I would not call openEHR an ontology based specification. It is more of an information model, quite similar to HL7 V3 in some ways. So I think you're classifying openEHR in the wrong way, putting it next to OpenGalen. Second: what do you mean by open source? openEHR is a specification, just like HL7. If what you are referring to computer software licensing when you use the term open source, then you are not talking about openEHR specification. You're addressing the implementation(s) of the specification, which means you're talking about actual software. If that is not the case, I don't understand what the term open source ontolology concepts that defines both OpenGalen and openEHR according to your words actually means. Third: Who are the parties who view these as unnecessary alternatives to SNOMED+UMLS (both are efforts close to ontology approach btw) If you can't name them fine. But what aspects of openEHR and OpenGalen are unnecessary extensions? Again, you're talking about ontology/terminology focused initiatives. As a professional in this domain, I'd see openEHR much closer to HL7 then UMLS or SNOMED So in my opinion, these statements are positioning openEHR at the wrong spot in health IT, hence they are not correct. Now to the next part: *OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go.* There is nothing in the openEHR specification related to user interfaces. There are bits that are likely to become relevant to UI related implementation tasks, and this may have been mentioned at a fews spots (though I'm not sure), but openEHR specification does not offer or describe an approach to apply knowledge engineering to UI. Again, you classify openEHR as an ontologic approach, then comes the next bit: Many health informaticists disagree on the usefulness of openEHR. Again, you don't give links or references to more detailed discussions of these many health informaticists, but could you at least mention the factors that diminish openEHR's usefulness for your readers who are going to make decisions based on the information you're giving them in your book? Should the professionals reading your book take HL7 RIM as a more comprehensive IM than openEHR RM? Do you mean that openEHR's knowledge management level is too high? Compositions, EHR etc are too abstract? If so, I'd like to know why? Not because I'm trying to defend openEHR, but because I'd like a comprehensive, justified analysis before arriving technical conclusions, which you seem to be doing here (the conclusion, not the analysis). For your information: the rest of your message after the parts I've discussed above is not really relevant to the critism you've received. You've put some effort into explaining why openEHR can't be considered as a widely adopted standard, but that is not the reason you're being critized, the correctness of statements about openEHR is what readers are disagreeing with you, not openEHR's adoption. Honestly, your long bits read as: be happy that you've been mentioned in a book published by a big publisher, because you're never going to make it Please try to see that what is expected from you is your statements to be correct and as precise as possible when you're addressing people about a technical topic. You're not asked to dedicate a chapter to openEHR, you're asked to do it properly even if you write a single sentence about it. By all means, please do correct my mistakes, and put the corrections in your next edition, which would deliver something useful for everyone. Kind regards Seref -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120217/30ecfb97/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
Thomas, This is quit usable critique and I will certainly draw from it in future revisions of the work. You make the argument that OpenEHR is primarily for interoperability, and I can accept that fundamental argument. It is difficult to swallow however, when I hear the HL7 v3 wonks talking about how HL7 RIM is the solution to semantic interoperability. Are they confused or are you confused, because you are saying basically the same thing. From my perspective as in implementer it looks awefully like a blueray vs HDDVD war and it looks like OpenEHR is losing. But at the same time I keep hearing that HL7 RIM is compatible with and might be merged with HL7 RIM. Very confusing, and I have yet to see something compelling that can be done in OpenEHR that cannot be done with HL7 RIM. Having said that, HL7 RIM is a proprietary ontology/model and OpenEHR, is not. That gives OpenEHR some usefulness even as an alternative model. Is that where I should see the value? Here is an information model that delivers semantic interoperability but is not proprietary? On Fri, Feb 17, 2012 at 6:15 AM, Thomas Beale thomas.beale at oceaninformatics.com wrote: Hi Fred, I think you are missing the point. The key thing we are working on in openEHR is *interoperability*, not open source. Open source health applications have historically not made any difference to interoperability, intelligent computing or anything else - they are the same as closed source systems that don't do any of these things. This is not to say that they aren't better quality software / solutions in other ways - some are very nice. But in general they have the same proprietary data formats and service interfaces as commercial solutions (making such definitions openly available doesn't change anything). Solving interoperability and intelligence in e-health (as for other domains) is very hard indeed, and solutions based on simple approaches only have marginal benefit. What matters to clinical people and actual health delivery is interoperability, regardless of closed or open source: open standardised (= widely agreed) information models, service interfaces and knowledge formalisms. Of course open source, done the right way does have a lot to offer, and can make the economics better, but it doesn't specifically address the interoperability problem. What I think you will see in the future is intelligent health computing platforms based on openEHR, or something like it (as you noted, Tolven also does not have much penetration today, but it also is a sophisticated solution that takes semantic interoperability seriously). See the CIMI forum http://informatics.mayo.edu/CIMI/index.php/London_2011 to get some idea of the international backing for knowledge-driven architecture. Without these kind of model-driven architectures, semantic interoperability will remain a dream, as will any serious industry around decision support, business intelligence and data-based medical research, and any other application wanting to use computable patient-centred health data. Because of the time it has taken to mature the openEHR - and other related, and even competing - health computing platforms, solutions based on these platforms are only just starting to make serious inroads. I have no problem with your view of openEHR in terms of limited penetration (today), but what I think would be a little more positive would be for the open source sector to actually take part in solving interoperability, rather than continuing to add to the problem. There are real synergies to be explored. Much of the new work in openEHR and related architectures is coming out open source. It would be great if existing open source health application developers were to get involved - e.g. by working with us and others (e.g. HL7 HSSP, IHE etc) on e-health service modelshttp://www.openehr.org/wiki/display/spec/openEHR+Service+Model. We on the other hand have a lot to learn about e-health applications. Finally, I would guess that e-health is about 10% of the way to a truly useful full-featured intelligent and open e-health platform of the future. That means that books like yours should potentially be educating readers on the likely future, not the status quo. - thomas On 17/02/2012 01:12, fred trotter wrote: Hi, Fred Trotter here, one of the two authors of the book in question. I wrote the portion covering OpenEHR, so I believe your complaints will ultimately come to rest with me. Generally however, let me put forward a note on how we are thinking at O'Reilly . This book has been very popular, and we are pretty happy with it. But it important to understand who this book is targeted to. We intended the book to be focused towards O'Reilly's primary readership, which is IT professionals and programmers. People who have no health IT experience. We have been pleased that clinical types have enjoyed it, but we were not aiming at them.
Meaningful Use and Beyond - O'Reilly press - errata
On Fri, Feb 17, 2012 at 10:15 AM, Seref Arikan serefarikan at kurumsalteknoloji.com wrote: First of all, what is open source ontology concepts? openEHR has links to ontologies, but even with the extensive use of the term ontology, I would not call openEHR an ontology based specification. It is more of an information model, quite similar to HL7 V3 in some ways. So I think you're classifying openEHR in the wrong way, putting it next to OpenGalen. I will correct the mistake of putting it next to OpenGalen. It literally is just next to OpenGalen without an intention to imply that they are similar in any way. Moreover, I am using ontology in the losest and most general way here. I suppose I should start strictly delineating between the notions of model and ontology but in reality openEHR is a good example of why that might not be such a good idea. It has some parallels with HL7 RIM and some parallels with SNOMED. Second: what do you mean by open source? openEHR is a specification, just like HL7. If what you are referring to computer software licensing when you use the term open source, then you are not talking about openEHR specification. Open Source licenses can and frequently do apply to anything, including specifications, data, software sourcecode, images, 3d models, etc etc. As I understand it, the OpenEHR specification is licensed under FOSS licenses. (am I wrong about that?) and that in my mind is a significant advantage. HL7 is a proprietary ontology that can be expensive. You're addressing the implementation(s) of the specification, which means you're talking about actual software. If that is not the case, I don't understand what the term open source ontolology concepts that defines both OpenGalen and openEHR according to your words actually means. Third: Who are the parties who view these as unnecessary alternatives to SNOMED+UMLS (both are efforts close to ontology approach btw) If you can't name them fine. In all honesty almost every standards person I discuss this with is either A. clearly affiliated with the OpenEHR project or B. either disinterested or unaware of OpenEHR. Granted it is still a small sample size, probably only 20 people total, but it is certainly bigger than most of my readers ability to get access to real experts to sample... But what aspects of openEHR and OpenGalen are unnecessary extensions? Again, you're talking about ontology/terminology focused initiatives. As a professional in this domain, I'd see openEHR much closer to HL7 then UMLS or SNOMED So in my opinion, these statements are positioning openEHR at the wrong spot in health IT, hence they are not correct. I can see that my positioning is incorrect, and that much, at least will be corrected... Now to the next part: *OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go.* There is nothing in the openEHR specification related to user interfaces. There are bits that are likely to become relevant to UI related implementation tasks, and this may have been mentioned at a fews spots (though I'm not sure), but openEHR specification does not offer or describe an approach to apply knowledge engineering to UI. I think any model has to have some kind of reasonable expectation, either explicit or not, that a UI would have certain inclusions and exclusions. My understanding previously was that OpenEHR went much further in making these requirements explicit. Am I wrong about this? It was once presented to me as a benefit of OpenEHR vs others. Again, you classify openEHR as an ontologic approach, then comes the next bit: Many health informaticists disagree on the usefulness of openEHR. Again, you don't give links or references to more detailed discussions of these many health informaticists, but could you at least mention the factors that diminish openEHR's usefulness for your readers who are going to make decisions based on the information you're giving them in your book? The whole point here is that the thing that diminishes the usefulness of OpenEHR the most is its lack of adoption. (I am aware of the catch 22 here. I am unwilling to promote the technology to potential adopters, because I feel that it is not adopted) Should the professionals reading your book take HL7 RIM as a more comprehensive IM than openEHR RM? No, but it does seem to be more relevant. Do you mean that openEHR's knowledge management level is too high? Compositions, EHR etc are too abstract? If so, I'd like to know why? Not because I'm trying to defend openEHR, but because I'd like a comprehensive, justified
Meaningful Use and Beyond - O'Reilly press - errata
Hi Fred, some comments between your lines. Hope we can help you to get the v2.0 of the book soon :D -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: fred.trot...@gmail.com Date: Thu, 16 Feb 2012 19:12:13 -0600 Subject: Re: Meaningful Use and Beyond - O'Reilly press - errata To: openehr-technical at openehr.org As Thomas said, openEHR is not about open source, is about an open standard for globally interoperable EHR architecture. ... I also state in the book: OpenGALEN and OpenEHR are both attempts to promote open source ontology con- cepts. Both of the projects have been maturing but some view these as unnecessary additions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certain jurisdictions. Then I wrote: OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go. Now, these are complex statements about OpenEHR. I am sure I might have gotten some of the details about OpenEHR wrong here. If I have done that, then please help correct me. I am all ears. The problem here is about context. Comparing adoption for things that are not comparable is not a good thing for any of the SDOs behind the standards and for your readers. People could be really confused about those statements. I agree, and that is a fact, that HL7 RIM is more used than openEHR RM. But what really matters is: what are they used for? Comparing a model that was designed for creating messages with an standard that is more than an information model, as openEHR, is nonsense. Also comparing openEHR vs. SNOMED+UMLS (how an EHR architecture could be compared with a vocabulary?). Again, yes, those other standards are being used more than openEHR, but openEHR was not meant for the area of application of those other standards, in fact openEHR+HL7+SNOMED+UMLS can be implemented all together in the same system to solve different problems. Just an argument to this point: this is like comparing the use level of Ethernet with the use level of HTTP, yes Ethernet is used more because is behind a big part of the network communications, but Eth and HTTP are for different things. Here is the bottom line reality: the Open Source EHR space has matured dramatically in the last 10 years. There are handful of projects that I know of that have literally hundreds of installations worldwide: the VistA variants, OpenMRS, OpenEMR, and ClearHealth. There are some other important projects that have potential, like Tolven, that I know of, but they simply have not garnered hundreds of installations. I would be very happy to be proven wrong here, but as far as I know, there is no Open Source EHR that has been installed at even over 100 sites that has been based on the OpenEHR. openEHR is not about open source: there are openEHR open source EHRs and propietary openEHR EHRs.http://www.openehr.org/shared-resources/usage/commercial.html ... At this point my mental summary for OpenEHR is one of the many technically right but will never be adopted technology ideas. I cannot write a book which is intended to warn IT people about all of the fruitless investments that they should expect to see all over the place in Health IT and give OpenEHR a free pass because I know and like some of the founders. I agree in the idea of giving facts instead of oppinions (likes/dislikes). The problem is that you are giving wrong facts, not on the adoption side of the coin, but on the current definition, scope and goals of openEHR. IMO the way you are describing openEHR now diminishes what openEHR is and what is intented for. The main idea behind giving facts is not to promote or demean a standard, is all about facts. When I talk about standards, and I do talks not only on openEHR, I try to give context on what problems we have on Health IT and how those standars fit to solve each problem. And the public of those talks are not health IT experts. IMHO, if a book is written about health IT and mention standards, those standards should be in a framework of 1. what are the current problems, 2. what standards apply for each problem, that should suffice for general IT professionals (not healthcare specific). About adoption: adoption is a process, and our community is walking forward. Is a fact that TODAY the adption level is poor, but as Thomas said, we need to look for what we'll do tomorrow. Is OpenEHR a relevant technology or an interesting foot note
Meaningful Use and Beyond - O'Reilly press - errata
Hi, Fred Trotter here, one of the two authors of the book in question. I wrote the portion covering OpenEHR, so I believe your complaints will ultimately come to rest with me. Generally however, let me put forward a note on how we are thinking at O'Reilly . This book has been very popular, and we are pretty happy with it. But it important to understand who this book is targeted to. We intended the book to be focused towards O'Reilly's primary readership, which is IT professionals and programmers. People who have no health IT experience. We have been pleased that clinical types have enjoyed it, but we were not aiming at them. We are also not currently selling the book in book stores. It is available only on the web and it has been overwhelmingly a e-book seller. This is the trend generally at O'Reilly and has been changing how we think about book publishing. I hope that give a little context here. With that in mind, we wrote the book very quickly and with an aim at overviewing everything that an IT generalist needs to know about health IT. That means we intended it to be a mile wide and an inch thick. That inch needs to right however, and we will be fixing all of the real errors that we find. O'Reilly has realized that book publishing in the e-book era is alot more like software publishing than anything Gutenberg might have envisioned. We use software tools for revisioning, for tracking errata (bugs) for making changes and for pushing those changes out automatically to our readers. We also use what amounts to a free beta release process where we put the manuscript online for free for people to comment on in its pre-production state. Our book had the dubious honor of receiving more feedback during this process than any other O'Reilly book before us. Why? because doing a comprehensive book on health IT is extraordinarily difficult. We are covering lots and lots of technology issues that have deeply specialized medical-technical hybrid experts working on them and those experts, with all due respect to those of you in academia, are mostly disconnected from the boots on the ground programmers (which both David and I are) who have been actually implementing widely used systems for years. We took a tremendous amount of productive criticism from both sides of that river and we hope the book was made better for it. Firstly is the claim by one of the authors, David Uhlman, that he was CTO of openEHR in 2001 - a claim which Thomas Beale denies. Those less likely to believe that we would make outragous resume claims are quite correct. After much debate late in the book, David and I decided to go exclusively with the term EHR, rather than EMR. We believe (and we argue in the book) that the industry uses these terms interchangeably (whether or not they are right to is another question), but ONC had been clear... http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/ that they were focused on EHR systems, based on their reasoning that EHR systems were intended to be interoperable and EMRs were not. (of course that entirely depends on your definition of the two acronyms). We decided to bow to the ONC position on the term and replace all mentions of the term EMR with the term EHR. This decision came very late in the editing process and I decided to do a find and replace on the text. Obviously I made a mistake and replaced Davids OpenEMR experience with OpenEHR. In short, this mistake is a typo. Thanks for pointing it out to us. I also state in the book: *OpenGALEN and OpenEHR are both attempts to promote open source ontology con- cepts. Both of the projects have been maturing but some view these as unnecessary additions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certain jurisdictions.* Then I wrote: *OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go.* Now, these are complex statements about OpenEHR. I am sure I might have gotten some of the details about OpenEHR wrong here. If I have done that, then please help correct me. I am all ears. Still, I find it interesting how you can claim that they are blatantly false statements and/or Pot-shots and misstatements about OpenEHR. These are just asides regarding OpenEHR. They need to be correct, and if they are not we are happy to fix them. But OpenEHR at this stage, only deserves a few paragraphs of coverage in a generalist focused Health IT book. I am not convinced that OpenEHR is a relevant technology, and I believe David's assessment would be even more dour. Here is
Meaningful Use and Beyond - O'Reilly press - errata
I agree with Dr. Ed Hammond. I think that Uhlman point of view, is not totally wrong or right. Yes, as a software architect designing a EHR you know that the concept of separating the framework from data structure, urges a completely different design and OpenEHR abstracted it in a nice way. It can be considered as a best known practice to bridge ontology (or ontology like constructs like SNOMED CT) to real database and application design while it is impacted by RDBMS concepts and can be more enhanced by Object Oriented or Graph Theory thinking. OpenEHR IM is more clear, more coherent and integrated than HL7 RIM, yet it needs redesign for better abstraction and less exceptions. I think that those can not be considered as misstatement, but criticism that may lead us to new enhancements. On Mon, Feb 13, 2012 at 5:30 PM, Dr Ed Hammond, Ph.D. william.hammond at duke.edu wrote: For the most part, I find that people who write negative remarks most often know little about the subject. I for one have never viewed openEHR as controversial. I think openEHR is competitive as is HL7, IHE and most other organizations. Some of the competition is based on our belief that we are right; some on protection of our history and proprietary interests. Actually, much of our life is based on competition, and I don?t think it is a bad thing. Pot-shots and misstatements like in this book are actually a sign of success for openEHR. Don?t sweat it. ** ** ** ** W. Ed Hammond Director, Duke Center for Health Informatics 2424 Erwin Rd, 12th Floor, Room 12053 Phone: 919.668.2408 Fax: 919.668.7868 Assistant: Naomi Pratt Email: naomi.pratt at duke.edu Phone: 919.668.8753 ** ** *From:* openehr-technical-bounces at openehr.org [mailto: openehr-technical-bounces at openehr.org] *On Behalf Of *Thomas Beale *Sent:* Sunday, February 12, 2012 8:01 AM *To:* openehr-technical at openehr.org *Subject:* Re: Meaningful Use and Beyond - O'Reilly press - errata ** ** It would be interesting to see what US-based list members think of what Michael has quoted below. Is openEHR really seen as 'controversial' in the US? (Controversy can be good - at least it means debate). The quote below about David Uhlman being CTO of openEHR in 2001 is certainly incorrect - I imagine it is supposed to read 'OpenEMR', going by what I see here http://en.wikipedia.org/wiki/ClearHealth in Wikipedia (in any case, openEHR has never had a 'CTO' position). That's a surprisingly bad fault in O'Reilly editing; worse, the author page for David Uhlman http://www.oreillynet.com/pub/au/4766 on the O'Reilly website repeats the same error. This reviewhttp://shop.oreilly.com/product/0636920020110.do#PowerReviewon the same website seems to confirm a complete lack of review or editing of the original manuscript. O'Reilly obviously is missing basic mechanisms for quality control. But the more interesting question is: are the opinions in this book about openEHR representative of a US view? - thomas On 12/02/2012 11:22, Michael Osborne wrote: I read the recently released O'Reilly book Meaningful Use and Beyond on Safari books today and found the following errors and some quite blatantly false statements about OpenEHR. ** ** ** ** Firstly is the claim by one of the authors, David Uhlman, that he was CTO of openEHR in 2001 - a claim which Thomas Beale denies. ** ** *David Uhlman is CEO of ClearHealth, Inc., which created and supports ClearHealth,* *the first and only open source, meaningful use-certified, comprehensive, ambulatory* *EHR David entered health-care in 2001 as CTO for the OpenEHR project. * * One of the first companies to try commercializing open source healthcare systems* *, OpenEHR met face first with the difficult realities of bringing proven mainstream* *technologies into the complicated and some-* *times nonsensical world of healthcare.* ** ** Secondly, a nonsensical statement about openEHR in the book... p.161 *OpenGALEN and OpenEHR are both attempts to promote open source ontology con-* *cepts. Both of the projects have been maturing but some view these as unnecessary* *additions or alternatives to SNOMED+UMLS. However, they are available under open* *source licensing terms might make them a better alternative to SNOMED for certain* *jurisdictions.* ** ** And this, p163... ** ** *OpenEHR is a controversial approach to applying knowledge engineering principles* *to the entire EHR, including things like the user interfaces. You might think of Open-* *EHR as an ontology for EHR software design. Many health informaticists disagree on* *the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive* *nature, is the highest level to which formal clinical knowledge managing needs to go.* ** ** I'm beginning to lose all respect
Meaningful Use and Beyond - O'Reilly press - errata
Considering the incorrect reference to openEHR in the author's CTO position, without knowing conext of were it is done, perhaps all references were intended to be to openEMR? Heath On 12/02/2012 11:31 PM, Thomas Beale thomas.beale at oceaninformatics.com wrote: It would be interesting to see what US-based list members think of what Michael has quoted below. Is openEHR really seen as 'controversial' in the US? (Controversy can be good - at least it means debate). The quote below about David Uhlman being CTO of openEHR in 2001 is certainly incorrect - I imagine it is supposed to read 'OpenEMR', going by what I see here http://en.wikipedia.org/wiki/ClearHealth in Wikipedia (in any case, openEHR has never had a 'CTO' position). That's a surprisingly bad fault in O'Reilly editing; worse, the author page for David Uhlman http://www.oreillynet.com/pub/au/4766 on the O'Reilly website repeats the same error. This reviewhttp://shop.oreilly.com/product/0636920020110.do#PowerReviewon the same website seems to confirm a complete lack of review or editing of the original manuscript. O'Reilly obviously is missing basic mechanisms for quality control. But the more interesting question is: are the opinions in this book about openEHR representative of a US view? - thomas On 12/02/2012 11:22, Michael Osborne wrote: I read the recently released O'Reilly book Meaningful Use and Beyond on Safari books today and found the following errors and some quite blatantly false statements about OpenEHR. Firstly is the claim by one of the authors, David Uhlman, that he was CTO of openEHR in 2001 - a claim which Thomas Beale denies. * David Uhlman is CEO of ClearHealth, Inc., which created and supports ClearHealth, the first and only open source, meaningful use-certified, comprehensive, ambulatory EHR David entered health-care in 2001 as CTO for the OpenEHR project. One of the first companies to try commercializing open source healthcare systems , OpenEHR met face first with the difficult realities of bringing proven mainstream technologies into the complicated and some- * *times nonsensical world of healthcare.* * * Secondly, a nonsensical statement about openEHR in the book... p.161 *OpenGALEN and OpenEHR are both attempts to promote open source ontology con-* *cepts. Both of the projects have been maturing but some view these as unnecessary* *additions or alternatives to SNOMED+UMLS. However, they are available under open* *source licensing terms might make them a better alternative to SNOMED for certain* *jurisdictions.* And this, p163... *OpenEHR is a controversial approach to applying knowledge engineering principles* *to the entire EHR, including things like the user interfaces. You might think of Open-* *EHR as an ontology for EHR software design. Many health informaticists disagree on* *the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive* *nature, is the highest level to which formal clinical knowledge managing needs to go.* * * I'm beginning to lose all respect for O'Reilly press. It's been all downhill since the camel book. Cheers Michael Osborne * * -- Michael Osborne ___ openEHR-technical mailing listopenEHR-technical at openehr.orghttp://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 -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120214/7925255b/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
Crowdsourcing = Errata submission perhaps here http://oreilly.com/catalog/errata.csp?isbn=0636920020110 Of the reviews I read there was reference to 'rushed' missing chapters, and poor proof reading. Tom Seabury From: openehr-technical-bounces at openehr.org [mailto:openehr-technical-boun...@openehr.org] On Behalf Of Thomas Beale Sent: 12 February 2012 13:01 To: openehr-technical at openehr.org Subject: Re: Meaningful Use and Beyond - O'Reilly press - errata It would be interesting to see what US-based list members think of what Michael has quoted below. Is openEHR really seen as 'controversial' in the US? (Controversy can be good - at least it means debate). The quote below about David Uhlman being CTO of openEHR in 2001 is certainly incorrect - I imagine it is supposed to read 'OpenEMR', going by what I see herehttp://en.wikipedia.org/wiki/ClearHealth in Wikipedia (in any case, openEHR has never had a 'CTO' position). That's a surprisingly bad fault in O'Reilly editing; worse, the author page for David Uhlmanhttp://www.oreillynet.com/pub/au/4766 on the O'Reilly website repeats the same error. This reviewhttp://shop.oreilly.com/product/0636920020110.do#PowerReview on the same website seems to confirm a complete lack of review or editing of the original manuscript. O'Reilly obviously is missing basic mechanisms for quality control. But the more interesting question is: are the opinions in this book about openEHR representative of a US view? - thomas On 12/02/2012 11:22, Michael Osborne wrote: I read the recently released O'Reilly book Meaningful Use and Beyond on Safari books today and found the following errors and some quite blatantly false statements about OpenEHR. Firstly is the claim by one of the authors, David Uhlman, that he was CTO of openEHR in 2001 - a claim which Thomas Beale denies. David Uhlman is CEO of ClearHealth, Inc., which created and supports ClearHealth, the first and only open source, meaningful use-certified, comprehensive, ambulatory EHR David entered health-care in 2001 as CTO for the OpenEHR project. One of the first companies to try commercializing open source healthcare systems , OpenEHR met face first with the difficult realities of bringing proven mainstream technologies into the complicated and some- times nonsensical world of healthcare. Secondly, a nonsensical statement about openEHR in the book... p.161 OpenGALEN and OpenEHR are both attempts to promote open source ontology con- cepts. Both of the projects have been maturing but some view these as unnecessary additions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certain jurisdictions. And this, p163... OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go. I'm beginning to lose all respect for O'Reilly press. It's been all downhill since the camel book. Cheers Michael Osborne -- Michael Osborne ___ openEHR-technical mailing list openEHR-technical at openehr.orgmailto:openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical 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 -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120213/b719d214/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
For the most part, I find that people who write negative remarks most often know little about the subject. I for one have never viewed openEHR as controversial. I think openEHR is competitive as is HL7, IHE and most other organizations. Some of the competition is based on our belief that we are right; some on protection of our history and proprietary interests. Actually, much of our life is based on competition, and I don't think it is a bad thing. Pot-shots and misstatements like in this book are actually a sign of success for openEHR. Don't sweat it. W. Ed Hammond Director, Duke Center for Health Informatics 2424 Erwin Rd, 12th Floor, Room 12053 Phone: 919.668.2408 Fax: 919.668.7868 Assistant: Naomi Pratt Email: naomi.pratt at duke.edumailto:naomi.pratt at duke.edu Phone: 919.668.8753 From: openehr-technical-bounces at openehr.org [mailto:openehr-technical-boun...@openehr.org] On Behalf Of Thomas Beale Sent: Sunday, February 12, 2012 8:01 AM To: openehr-technical at openehr.org Subject: Re: Meaningful Use and Beyond - O'Reilly press - errata It would be interesting to see what US-based list members think of what Michael has quoted below. Is openEHR really seen as 'controversial' in the US? (Controversy can be good - at least it means debate). The quote below about David Uhlman being CTO of openEHR in 2001 is certainly incorrect - I imagine it is supposed to read 'OpenEMR', going by what I see herehttp://en.wikipedia.org/wiki/ClearHealth in Wikipedia (in any case, openEHR has never had a 'CTO' position). That's a surprisingly bad fault in O'Reilly editing; worse, the author page for David Uhlmanhttp://www.oreillynet.com/pub/au/4766 on the O'Reilly website repeats the same error. This reviewhttp://shop.oreilly.com/product/0636920020110.do#PowerReview on the same website seems to confirm a complete lack of review or editing of the original manuscript. O'Reilly obviously is missing basic mechanisms for quality control. But the more interesting question is: are the opinions in this book about openEHR representative of a US view? - thomas On 12/02/2012 11:22, Michael Osborne wrote: I read the recently released O'Reilly book Meaningful Use and Beyond on Safari books today and found the following errors and some quite blatantly false statements about OpenEHR. Firstly is the claim by one of the authors, David Uhlman, that he was CTO of openEHR in 2001 - a claim which Thomas Beale denies. David Uhlman is CEO of ClearHealth, Inc., which created and supports ClearHealth, the first and only open source, meaningful use-certified, comprehensive, ambulatory EHR David entered health-care in 2001 as CTO for the OpenEHR project. One of the first companies to try commercializing open source healthcare systems , OpenEHR met face first with the difficult realities of bringing proven mainstream technologies into the complicated and some- times nonsensical world of healthcare. Secondly, a nonsensical statement about openEHR in the book... p.161 OpenGALEN and OpenEHR are both attempts to promote open source ontology con- cepts. Both of the projects have been maturing but some view these as unnecessary additions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certain jurisdictions. And this, p163... OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go. I'm beginning to lose all respect for O'Reilly press. It's been all downhill since the camel book. Cheers Michael Osborne -- Michael Osborne ___ openEHR-technical mailing list openEHR-technical at openehr.orgmailto:openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120213/7ae6d954/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
Comparing openEHR with SNOMED is plain wrong. Yes, part of the openEHR standard is an ontology of concepts, but this are high level concepts to model generic information structures, in the other hand SNOMED models fine grain concepts, with almost no structure. Certainly here is a place to collaboration since fine grain concepts could be use onside the generic model structures. So, here is no competition, is realy a good collaboration ground. Cheers,Pablo. Secondly, a nonsensical statement about openEHR in the book... p.161OpenGALEN and OpenEHR are both attempts to promote open source ontology con-cepts. Both of the projects have been maturing but some view these as unnecessaryadditions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certainjurisdictions. And this, p163... OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open-EHR as an ontology for EHR software design. Many health informaticists disagree onthe usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go. I'm beginning to lose all respect for O'Reilly press. It's been all downhill since the camel book. CheersMichael Osborne -- Michael Osborne ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120213/344e2b7f/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
I think we should strengthen arguments that Pablo proposed as promoters of openEHR in the U.S., with scientific arguments and constructive criticism openEHR initiative is and will be very competitive. Regards. Carlos. Carlos Luis Parra Calderon Hospital Universitario Virgen del Roc?o Enviado desde mi iPad El 13/02/2012, a las 15:46, pablo pazos pazospablo at hotmail.com mailto:pazospablo at hotmail.com escribi?: Comparing openEHR with SNOMED is plain wrong. Yes, part of the openEHR standard is an ontology of concepts, but this are high level concepts to model generic information structures, in the other hand SNOMED models fine grain concepts, with almost no structure. Certainly here is a place to collaboration since fine grain concepts could be use onside the generic model structures. So, here is no competition, is realy a good collaboration ground. Cheers, Pablo. Secondly, a nonsensical statement about openEHR in the book... p.161 OpenGALEN and OpenEHR are both attempts to promote open source ontology con- cepts. Both of the projects have been maturing but some view these as unnecessary additions or alternatives to SNOMED+UMLS. However, they are available under open source licensing terms might make them a better alternative to SNOMED for certain jurisdictions. And this, p163... OpenEHR is a controversial approach to applying knowledge engineering principles to the entire EHR, including things like the user interfaces. You might think of Open- EHR as an ontology for EHR software design. Many health informaticists disagree on the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive nature, is the highest level to which formal clinical knowledge managing needs to go. I'm beginning to lose all respect for O'Reilly press. It's been all downhill since the camel book. Cheers Michael Osborne -- Michael Osborne ___ openEHR-technical mailing list openEHR-technical at openehr.org mailto:openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical ___ openEHR-technical mailing list openEHR-technical at openehr.org mailto:openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120213/d26e7335/attachment.html
Meaningful Use and Beyond - O'Reilly press - errata
I read the recently released O'Reilly book Meaningful Use and Beyond on Safari books today and found the following errors and some quite blatantly false statements about OpenEHR. Firstly is the claim by one of the authors, David Uhlman, that he was CTO of openEHR in 2001 - a claim which Thomas Beale denies. * David Uhlman is CEO of ClearHealth, Inc., which created and supports ClearHealth, the first and only open source, meaningful use-certified, comprehensive, ambulatory EHR David entered health-care in 2001 as CTO for the OpenEHR project. One of the first companies to try commercializing open source healthcare systems , OpenEHR met face first with the difficult realities of bringing proven mainstream technologies into the complicated and some- * *times nonsensical world of healthcare.* * * Secondly, a nonsensical statement about openEHR in the book... p.161 *OpenGALEN and OpenEHR are both attempts to promote open source ontology con-* *cepts. Both of the projects have been maturing but some view these as unnecessary* *additions or alternatives to SNOMED+UMLS. However, they are available under open* *source licensing terms might make them a better alternative to SNOMED for certain* *jurisdictions.* And this, p163... *OpenEHR is a controversial approach to applying knowledge engineering principles* *to the entire EHR, including things like the user interfaces. You might think of Open-* *EHR as an ontology for EHR software design. Many health informaticists disagree on* *the usefulness of OpenEHR. Some believe that HL7 RIM, given its comprehensive* *nature, is the highest level to which formal clinical knowledge managing needs to go.* * * I'm beginning to lose all respect for O'Reilly press. It's been all downhill since the camel book. Cheers Michael Osborne * * -- Michael Osborne -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20120212/f523bb25/attachment.html
