Why is OpenEHR adoption so slow?

[Thomas Beale]

I should have added earlier that the openEHR Java project is a pretty 
good example of the meritocracy Tim wants to see. It has 16 committers, 
and the list remains as active as ever, with a large number of 
subscribers.  Although currently under-resourced, it works in exactly 
the way it should, not only that, its history is typical. The original 
core of code was written by Rong Chen and his small company, as part of 
a system to deploy at Karolinska Institute in Stockholm. Like everything 
else, the core initial code needed to be built by a very small number of 
people, with a very clear and complete idea of openEHR, and what they 
wanted to build. Large additions have been done by the people at Zilics, 
Seref at UCL, and various others. Many other programmers are using the 
code and constantly improving it. None of them do so unless it aids them 
in solving a problem they are working on.

There is nothing stopping more people joining either. The limitation 
that I would say this project has is not lack of volunteers or 
enthusiasm, it is dedicated paid time to:

* do proper architecting of large changes / enhancements
* do better project management (admittedly, this could be improved
  today for free by making better use of the openEHR Jira issue
  tracking system)
* get together physically and meet.

It is hard to do some of this stuff well with no financial sponsors. 
Nevertheless what has been achieved is an excellent piece of work, and 
it continues to grow. One day I believe it will be as indispensable as 
Apache to those that need an EHR.

- thomas



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Why is OpenEHR adoption so slow?

[Thomas Beale]

I should have added earlier that the openEHR Java project is a pretty 
good example of the meritocracy Tim wants to see. It has 16 committers, 
and the list remains as active as ever, with a large number of 
subscribers.  Although currently under-resourced, it works in exactly 
the way it should, not only that, its history is typical. The original 
core of code was written by Rong Chen and his small company, as part of 
a system to deploy at Karolinska Institute in Stockholm. Like everything 
else, the core initial code needed to be built by a very small number of 
people, with a very clear and complete idea of openEHR, and what they 
wanted to build. Large additions have been done by the people at Zilics, 
Seref at UCL, and various others. Many other programmers are using the 
code and constantly improving it. None of them do so unless it aids them 
in solving a problem they are working on.

There is nothing stopping more people joining either. The limitation 
that I would say this project has is not lack of volunteers or 
enthusiasm, it is dedicated paid time to:

* do proper architecting of large changes / enhancements
* do better project management (admittedly, this could be improved
  today for free by making better use of the openEHR Jira issue
  tracking system)
* get together physically and meet.

It is hard to achieve some of this stuff with no financial sponsors.

- thomas



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Why is OpenEHR adoption so slow?

[Erik Sundvall]

Hi!

> On 16/11/2010 12:44, Tim Cook wrote:
> Democratizing innovation / Eric von Hippel. ISBN 0-262-00274-4

On Wed, Nov 17, 2010 at 16:51, Thomas Beale
 wrote:
> this is an interesting looking book, I downloaded it.
> However, as I and I imagine others won't get through 220 pages instantly,
> do you want to summarise what you see as the lessons from it,
>while this discussion is still warm?

The first chapter, 17 pages of easily-read book text, actually seems
to be a summary of the book, offered by the author.
Chapter 1 pdf: http://web.mit.edu/evhippel/www/books/DI/Chapter1.pdf

Under the title "Users? Innovate-or-Buy Decisions" on page 6 in the
chapter-pdf above one gets some hints regarding "agent costs" that
might explain why most apache-hosted project contributors are working
at real "user"-companies and are not agents for the end users funded
by the foundation.

Regarding the need for funded development, I think there is a
misunderstanding in this list discussion - I don't think anybody has
said that developers don't need funding for a project at the scale of
openEHR, neither has anybody said that full-time position for
developers would be bad. The underlying issue is rather
future-proofing the role of a foundation in this puzzle in order to
allow larger entities to trust it and a proper community thinking to
evolve. I won't go into details over again but you can probably get
some hints by re-reading the discussion and the links with this in
mind.

On Wed, Nov 17, 2010 at 23:19, Seref Arikan
 wrote:
> I personally see this big bootstrapping requirement as a unique problem of
> this domain [...]

Seref, calling it a "bootstrapping" problem was a good way to put it,
I think it (for techies at least) describes the present openEHR
situation in an excellent way.

If e.g. IHTSDO now has seen this problem and wants to help out with
the initial bootstrapping, then perhaps they can temporarily
themselves employ people like Tom for a while to work on open source
tooling and documentation according to IHTSDOs requirements and at the
same time inspire the foundation to transition into a more open and
sustainable form in order to survive the changed requirements that
will likely become even more apparent when the bootstrapping phase is
over. I don't know if that's what the openEHR-IHTSDO talks are about,
they seem to be pretty secret and cut of from any community
discussion.

Back to the book, links to all chapters and the entire book:
http://web.mit.edu/evhippel/www/democ1.htm

What I have read so far is very interesting, and it seems to avoid
becoming yet another political pamphlet, rather it seems to be a
theoretical framework based on empirical findings, so thanks for the
book recommendation. I think the openEHR approach in the long run can
inspire and allow a lot of end user innovation (as described in the
book) without loosing interoperability and transcending into total
chaos.

Best regards,
Erik Sundvall
erik.sundvall at liu.se http://www.imt.liu.se/~erisu/? Tel: +46-13-286733

Why is OpenEHR adoption so slow?

[Thomas Beale]

Tim,

a few points by way of response:
1. the NCSA web server (which I used to administer in one company) was 
built by normal paid engineers in jobs where they were directed to build 
that tool - i.e. dedicated paid time.

2. there has been no barrier that I am aware of to people wanting to 
come and work on any openEHR project, indeed it is and has always been 
highly encouraged. If you think there is some barrier, please let us know.

3. with respect to Sam, you are doing him a disservice. Sam is a medical 
doctor, and people technical here sometimes forget that the main game in 
the real world for doctors is giving care: seeing patients individually; 
improving methods of care; sometimes working at policy level to change 
health care systems. From that point of view, the ideology of software 
is pretty uninteresting; people in this position are heavily oriented 
toward /solving the problem/. As a GP familiar with computers, Sam was 
using Windows to built desk-top tools 20 years ago, and even 10 years 
ago, it was the only realistic way to built desktop applications. There 
was no way for small companies to easily build a desktop app out of C++ 
or other such engineering languages. So the choice of using (today) .Net 
has nothing to do with the ideology of open source or otherwise; it was 
just about using tools that were available to solve the problem.

As it happens, Sam is very interested in open source, and the Archetype 
Editor was open source since day 1. It turns out that the world at large 
is not interested in helping write even this tool. It may be that unless 
something is written in Java, Python, PHP etc, it is not seen as open 
source. For the other tools built by Ocean, the priority was always to 
build something economically that solved the problem most efficiently.

4. There is nothing stopping other companies being particularly open 
source oriented. Indeed, Zilics did it some years ago, building on 
Rong's original Java openEHR code. This also didn't magically make 
hoards of programmers come on board (in fact only the programmers from 
their company worked on it). The same thing can be said about the CHIME 
Opereffa project. As Seref said, this is largely because any such 
project that actually is open sourced, is not perceived to be 
sufficiently relevant to other parties in solving their problems that 
they should start work on it. So they don't, the write some other 
software of their own. This in my view is an indicator not of the 
bloody-mindedness of people, but of the massive complexity and diversity 
of the field. Its needs just can be solved by building a single tool 
like an Apache server.

5. One key difference between the kind of solutions being built in this 
domain and Apache is that Apache is ubiquitously useful - to everyone. 
It's like running water - everyone wants it. So of course it is easy to 
get bazaar-style open source taking off in that situation. Same with 
Linux. In the e-health area, it is much much harder, and that's what 
history shows. The various attempts to set up and run communities, 
cannot be said to have succeeded - even with hundreds of individuals 
available and apparently motivated to make something happen. Yet, no 
real open source EHR solution has appeared. I suggest that this is because:

* it is intellectually hard, and is not a problem that can be solved
  by jumping into code before doing some serious design work
* many people have different, incompatible ideas of what an EHR is,
  and therefore don't agree on what to build anyway
* it requires interoperability as a key feature, and
  interoperability requires agreement. It is extremely hard to get
  meaningful agreement on technical standards for e-health, and the
  poor results of the official bodies (using completely the wrong
  algorithm and business model) are evidence of this. Open source,
  as a movement, has made practically no useful contribution to
  interoperability, so clearly, it is a problem that has to be
  solved elsewhere - in my view, as you know, by a dedicated
  engineering/development group.

In hindsight, what was probably needed was an IBM to spend $30m 
developing an EHR stack and then giving it away through Eclipse or so. 
Nevertheless, progress is happening, and it will not be long before more 
open source tools are available.

- thomas



On 18/11/2010 00:29, Tim Cook wrote:
> On Wed, 2010-11-17 at 22:19 +, Seref Arikan wrote:
>> I personally see this big bootstrapping requirement as a unique
>> problem of this domain,
> Compared to creating your own world class web server in the mid 1990's?
>
> RE: http://www.apache.org/foundation/how-it-works.html
> =
> Unlike other software development efforts done under an open source
> license, the Apache Web Server was not initiated by a single developer
> (for example, like the Linux Kernel, or the Perl/Python languages), but

Why is OpenEHR adoption so slow?

[Tim Cook]

On Wed, 2010-11-17 at 22:19 +, Seref Arikan wrote:
> I personally see this big bootstrapping requirement as a unique
> problem of this domain, 

Compared to creating your own world class web server in the mid 1990's?

RE: http://www.apache.org/foundation/how-it-works.html 
=
Unlike other software development efforts done under an open source
license, the Apache Web Server was not initiated by a single developer
(for example, like the Linux Kernel, or the Perl/Python languages), but
started as a diverse group of people that shared common interests and
got to know each other by exchanging information, fixes and suggestions.

As the group started to develop their own version of the software,
moving away from the NCSA version, more people were attracted and
started to help out, first by sending little patches, or suggestions, or
replying to email on the mail list, later by more important
contributions.

When the group felt that the person had "earned" the merit to be part of
the development community, they granted direct access to the code
repository, thus increasing the group and increasing the ability of the
group to develop the program, and to maintain and develop it more
effectively.

We call this basic principle "meritocracy": literally, government by
merit.
=

At that point in history there wasn't an Apache Foundation.  It was
people working together.  Openly, based on their interest and merit they
were given access to participate.  Right now the BUS FACTOR for the
openEHR Specifications is ONE! Same as it has been since the beginning.
I won't repeat Erik's points about archetype licensing.  But as you can
see; the only thing 'open' in openEHR are the specifications as
published and handed to you.  [Okay, there are a couple of tools but no
one has created a community around any of them.]  If you want to
translate the specifications to another language check to see what hoops
you have to jump through and software you have to purchase.  Want to
setup your own local CKM?  It is open source right?  Well, all except
for the fact you have to purchase the proprietary engine it runs on.  

> and that's why I've been suggesting the things I've been writing. 
> I know that there are many paths an open source initiative and
> business model can take, but I'd like to have that discussion with
> clear suggestions/list for work items, and people who will be
> responsible with it. 

I agree.  Of course you get to decide what you consider responsible
also. :-)

I have a story for you that I like to call; "The Tale of Two Companies".

Two "open"? companies; and their differences. I personally know the CEOs
of both. 

The first is Rob Page of Zope Corp.  He doesn't like or even today
really understand open source.  However, he did listen to his advisors
and investors and open sourced what he considered to be their most
prized possession.  He did not try to control where the technical
aspects of the specifications for the product went as far as overall
design.  He let the community and his internal engineers collaborate
openly and even went on to later release Zope Enterprise Objects (ZEO)
as open source.  Today, the Zope Tool Kit is a huge robust library of
tools used and supported by a large international community.  Something
that one small company could have never accomplished. 

Sam Heard of Ocean Informatics. Again a software company CEO that
doesn't like or understand open source.  He was convinced to open the
specifications.  But he controlled his internal staff so that they only
produced tools that run on Windows platforms.  With the exception being
the ADL Workbench and that was by accident, not by design. If you look
at the openEHR Foundation Board of Directors and the Architecture Review
Board (ARB) you can see that it is heavily controlled by Ocean
Informatics and their close associates. None of whom are or ever have
been involved in open source/open content in anyway outside of the
foundation. Changes to the specifications always come out of experience
from the commercial software that they produce.  The ARB is a closed
decision making, invited members only group. The implementations of the
specifications are of two kinds (with one exception); closed source
commercial companies and short term academic projects left to die after
the thesis is completed. 

Both of these companies have been in existence for approximately the
same length of time. 

So what is the difference? It is "community".  That is where MLHIM comes
in.  As I said, I did not embark on this lightly.  I spent a lot of
uncompensated time, money and energy trying to change the openEHR
Foundation from the inside out over the past ten years. I didn't invent
open source.  I simply recognize what works. It is impossible with the
current structure and the control issues the foundation exercises.


These are my thoughts and opinions.  I hope someone finds them more
valu

Why is OpenEHR adoption so slow?

[Seref Arikan]

Hi Erik,
This bit:
> and there are very few
> instututions who let their intangible assets go into public domain.

is written in the context of openEHR.

openEHR may end up in a relationship with big vendors, similar to some of
the examples you have provided.
For this to happen, what we have out there has to pass a certain threshold,
and this is where we are having the trouble. In order to convince strong
supporters, we have to provide actual working software, which proves at
least our key points, and with openEHR this is a big task.

This is where we absolutely agree: we need implementations freely available,
and we are pushing for that as hard as we can. As you can see from the
comments, this is not enough, and even with lots of effort, we are facing a
chicken and egg problem here. Here is how it goes:

Capable, open source demonstrator is required to gather interest and
support, but this is a big work item, so we fail to develop it to the extend
it would help us prove the point, people say it is not there yet, and we go
back to starting position. At CHIME, we are trying to break this with the
incremental approach, and I'd say it works quite good, but still not good
enough to demonstrate every key capability the specs provide.

I personally see this big bootstrapping requirement as a unique problem of
this domain, and that's why I've been suggesting the things I've been
writing.
I know that there are many paths an open source initiative and business
model can take, but I'd like to have that discussion with clear
suggestions/list for work items, and people who will be responsible with it.


Best Regards
Seref


On Wed, Nov 17, 2010 at 7:49 PM, Erik Sundvall  wrote:

> On Wed, Nov 17, 2010 at 16:27, Seref Arikan
>  wrote:
> > Let me specialize Tom's argument: as far as I know, no member of the
> openEHR
> > community who is putting his/her work out there for others to used
> freely,
> > is getting paid just for doing so.
>
> We don't get any extra up front payment for putting things out freely,
> but certainly many of us (probably including you and Tom) have had
> some kind funding that at times allows us to do openEHR related stuff
> on paid time. It's actually easier to get certain kinds of funding if
> you let your work out freely, sometimes it's more or less a
> requirement. (I don't say that it's easier to get _private_ investor
> money for open source, but enough of the big openEHR end users will be
> governments and public health care providers in the long run.)
>
> In cases when openEHR work is funded by taxpayer money (like EU- and
> national projects) then I personally think it's bad manners not giving
> results away for free, but I know others that probably will disagree.
>
> > People's work
> > on openEHR in their own companies, environments are not relevant unless
> they
> > end up being available to the rest of the community,
>
> True.
>
> I tried to use similar thoughts as an explanation of how things go a
> bit slower when that road is taken. Any wider dissemination of
> implementation experiences will then depend on the goodwill and
> available time of the people in such companies. Even if the goodwill
> is there, then there is still a dissemination bandwidth problem when
> doing research and development primarily in closed instead of open
> environments. We all understand that there are other more pressing
> needs in a company, needs that must be prioritized over documenting
> and sharing your implementation findings with the general public. That
> is a reason to aim for shared open research and development if speed
> is an issue and if any good business model allows it.
>
> > and there are very few
> > instututions who let their intangible assets go into public domain.
>
> Not true.
>
> http://developers.facebook.com/opensource/
> http://developer.yahoo.com/hadoop/
> http://code.google.com/hosting/search?q=label:google
> http://code.google.com/webtoolkit/overview.html
> http://developer.apple.com/opensource/ (e.g. http://webkit.org/)
> http://oss.oracle.com/
> http://www.ibm.com/developerworks/opensource/newto/#9
> (While at IBM, some might like the heading "Open Standards Are Not
> Born; They Evolve" at
> http://www.ibm.com/ibm/governmentalprograms/ipos.html )
>
> Why do you think these giants often cooperate in open projects? One
> reason is that open source is a very clever way to share risks and
> talent. Would it really be better for the Yahoo and Facebook
> brainshare in e.g. the hadoop project to just fund the Apache
> foundation to employ some hadoop developers and maintainers rather
> than having their own Yahoo and Facebook employed engineers actively
> contribute?
>
> Yahoo and Facebook surely do sponsor the Apache foundation in general,
> but the invested time is a lot bigger sponsoring. See who sponsors...
> http://www.apache.org/foundation/thanks.html
> ...plus the amounts, _and what the money is used for_...
> http://www.apache.org/foundation/sponsorship.html
> ...it isn't

Why is OpenEHR adoption so slow?

[Erik Sundvall]

On Wed, Nov 17, 2010 at 16:27, Seref Arikan
 wrote:
> Let me specialize Tom's argument: as far as I know, no member of the openEHR
> community who is putting his/her work out there for others to used freely,
> is getting paid just for doing so.

We don't get any extra up front payment for putting things out freely,
but certainly many of us (probably including you and Tom) have had
some kind funding that at times allows us to do openEHR related stuff
on paid time. It's actually easier to get certain kinds of funding if
you let your work out freely, sometimes it's more or less a
requirement. (I don't say that it's easier to get _private_ investor
money for open source, but enough of the big openEHR end users will be
governments and public health care providers in the long run.)

In cases when openEHR work is funded by taxpayer money (like EU- and
national projects) then I personally think it's bad manners not giving
results away for free, but I know others that probably will disagree.

> People's work
> on openEHR in their own companies, environments are not relevant unless they
> end up being available to the rest of the community,

True.

I tried to use similar thoughts as an explanation of how things go a
bit slower when that road is taken. Any wider dissemination of
implementation experiences will then depend on the goodwill and
available time of the people in such companies. Even if the goodwill
is there, then there is still a dissemination bandwidth problem when
doing research and development primarily in closed instead of open
environments. We all understand that there are other more pressing
needs in a company, needs that must be prioritized over documenting
and sharing your implementation findings with the general public. That
is a reason to aim for shared open research and development if speed
is an issue and if any good business model allows it.

> and there are very few
> instututions who let their intangible assets go into public domain.

Not true.

http://developers.facebook.com/opensource/
http://developer.yahoo.com/hadoop/
http://code.google.com/hosting/search?q=label:google
http://code.google.com/webtoolkit/overview.html
http://developer.apple.com/opensource/ (e.g. http://webkit.org/)
http://oss.oracle.com/
http://www.ibm.com/developerworks/opensource/newto/#9
(While at IBM, some might like the heading "Open Standards Are Not
Born; They Evolve" at
http://www.ibm.com/ibm/governmentalprograms/ipos.html )

Why do you think these giants often cooperate in open projects? One
reason is that open source is a very clever way to share risks and
talent. Would it really be better for the Yahoo and Facebook
brainshare in e.g. the hadoop project to just fund the Apache
foundation to employ some hadoop developers and maintainers rather
than having their own Yahoo and Facebook employed engineers actively
contribute?

Yahoo and Facebook surely do sponsor the Apache foundation in general,
but the invested time is a lot bigger sponsoring. See who sponsors...
http://www.apache.org/foundation/thanks.html
...plus the amounts, _and what the money is used for_...
http://www.apache.org/foundation/sponsorship.html
...it isn't really for research and development costs is it?

> We need to do a huge amount of work, and I personally don't see this work
> being done in any other way than a properly funded, planned, and managed
> approach.

One of the best things that can happen to open source projects (and
probably also to open specification projects) is that a big
financially strong users (preferably more than one) start using it and
invest time and engagement.(See e.g. the Hadoop story at
http://cutting.wordpress.com/2009/08/10/joining-cloudera/ ) In the
case of openEHR such users could be national health IT-programs and
local health care providers with their own IT staff.


Probably openEHR interest will remain a bit low until there are more
and better free demo systems though, and until then risks are that
funding will be at the same low levels as now. (I hope to be proven
wrong about the difficulty in getting monetary funding directly to the
foundation in it's current form.) So perhaps I really should try to
shut up and code+publish instead to speed up my part of demo
development.


Just one more try with the most urgent openEHR problem before I stop:

On Mon, Nov 15, 2010 at 22:45, Sam Heard  
wrote:
> [...] the world of
> archetypes (the 99% of standardisation that is yet to be carried out!). The
> corollary is that only when there are enough high quality archetypes freely
> available does the argument for this separation is compelling.

I agree with Sam that most of the interoperability work, the archetype
development, is still left to do (and agree with most other things
said in that well formulated mail). That's why I and many others (e.g.
Thomas Beale, Andrew Patterson, Martin van der Meer) have tried to be
very clear on the risks of not opening up the licence of the
archetypes to CC-BY rather than the curren

Why is OpenEHR adoption so slow?

[Tim Cook]

Hi Tom,

On Wed, 2010-11-17 at 15:51 +, Thomas Beale wrote:
> 
> Tim,
> 
> this is an interesting looking book, I downloaded it. However, as I
> and I imagine others won't get through 220 pages instantly, 

Well, that is all a matter of personal cost/benefit; isn't? :-)

> do you want to summarise what you see as the lessons from it, while
> this discussion is still warm?

Nope, not on my todo list nor in a consulting contract.  I only offered
the information there for those that think it might be helpful.  Reading
a book is a context sensitive thing anyway.

Cheers,
Tim



> - thomas
> 
> On 16/11/2010 12:44, Tim Cook wrote: 
> > Hi Tom,
> > 
> > On Mon, 2010-11-15 at 16:25 +, Thomas Beale wrote:
> > > a few points informally (I am not on any boards of any organisations,
> > > so these are my own thoughts):
> > >   * any organisation like openEHR needs some core paid people to
> > > execute key functions, and to maintain continuity. There is an
> > > 'officers' level, which runs any organisations, including
> > > admin and other support staff, and there is an operational
> > > level.
> > >   * for the operational level, there are typically posts like CTO,
> > > CMO, infrastructure management, project coordination, and so
> > > on. If the organisation is to do properly what its members
> > > want - typically 2 things: a) manage specifications/standards,
> > > including member involvement in this, and b) manage open
> > > source projects, potentially largely staffed by volunteers -
> > > then it has to have a few dedicated posts. Otherwise it
> > > becomes no-one's responsibility to actually coordinate things,
> > > keep infrastructure running etc. 
> > If these are the thoughts of, whom I consider to be, the most open
> > source/content aware person within the openEHR Foundation.  Then I
> > *highly* recommend:
> > 
> > Hippel, Eric von.
> > Democratizing innovation / Eric von Hippel.
> > ISBN 0-262-00274-4
> > 
> > (available in PDF via a CC license; btw)
> > 
> > Also, you may want to re-visit your comments about Linux.org and
> > Apache.org.  The history of how they became organizations is more
> > important than the fact that they exist today.
> > 
> > I hope you find this useful.
> > 
> > Regards,
> > Tim
> > 
> > 
> > 
> > 
> > ___
> > 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
> 
> Chair Architectural Review Board,
> openEHR Foundation 
> Honorary Research Fellow,
> University College London 
> Chartered IT Professional Fellow,
> BCS, British Computer Society 
> Health IT blog 
> 
> 
> 
> ___
> openEHR-technical mailing list
> openEHR-technical at openehr.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical

-- 
***
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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Why is OpenEHR adoption so slow?

[Thomas Beale]

Tim,

this is an interesting looking book, I downloaded it. However, as I and 
I imagine others won't get through 220 pages instantly, do you want to 
summarise what you see as the lessons from it, while this discussion is 
still warm?

- thomas

On 16/11/2010 12:44, Tim Cook wrote:
> Hi Tom,
>
> On Mon, 2010-11-15 at 16:25 +, Thomas Beale wrote:
>> a few points informally (I am not on any boards of any organisations,
>> so these are my own thoughts):
>>* any organisation like openEHR needs some core paid people to
>>  execute key functions, and to maintain continuity. There is an
>>  'officers' level, which runs any organisations, including
>>  admin and other support staff, and there is an operational
>>  level.
>>* for the operational level, there are typically posts like CTO,
>>  CMO, infrastructure management, project coordination, and so
>>  on. If the organisation is to do properly what its members
>>  want - typically 2 things: a) manage specifications/standards,
>>  including member involvement in this, and b) manage open
>>  source projects, potentially largely staffed by volunteers -
>>  then it has to have a few dedicated posts. Otherwise it
>>  becomes no-one's responsibility to actually coordinate things,
>>  keep infrastructure running etc.
> If these are the thoughts of, whom I consider to be, the most open
> source/content aware person within the openEHR Foundation.  Then I
> *highly* recommend:
>
> Hippel, Eric von.
> Democratizing innovation / Eric von Hippel.
> ISBN 0-262-00274-4
>
> (available in PDF via a CC license; btw)
>
> Also, you may want to re-visit your comments about Linux.org and
> Apache.org.  The history of how they became organizations is more
> important than the fact that they exist today.
>
> I hope you find this useful.
>
> Regards,
> Tim
>
>
>
>
>
> ___
> 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 
*

Chair Architectural Review Board, /open/EHR Foundation 

Honorary Research Fellow, University College London 

Chartered IT Professional Fellow, BCS, British Computer Society 

Health IT blog 


*
*
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Why is OpenEHR adoption so slow?

[Seref Arikan]

Greetings,
I can see a specific pattern emerging in the recent mails of this thread, to
which I'd like to response, and contribute.
I will repeat my point I've made some time ago in this discussion, and by
doing so I will insist on it. To deliver what openEHR is capable of, there
is a significant requirement for time and money.
Therefore I agree with Tom's points about posts and funding, and disagree
with Erik and Tim, if I'm getting what they've been saying right.

There is a consensus one can identify, about what is actually demanded from
the openEHR standard. All the names heavily involved in this domain have
discussed these requirements in time, some seeing a larger set of
requirements than the others. At a very simplistic level, hours is what we
need indeed. But there is a threshold for the amount of hours me, you, or
anybody else needs to put into openEHR to deliver what is clearly demanded.
With such a complex problem, we need lots and lots of hours, and the
threshold which turns the required work into a full time position is reached
very quickly with openEHR.

The perception of this cost is different for everyone. Going back to the
anology I've used, everyone is asking for what they need, which is way
smaller than the total demand, and this is mostly likely to be the reason
for people to say "how hard can it be?, I'm just asking for XYZ!" Delivering
what a party asks for, without breaking the consistency of the solution
(which makes it a solution in the first place), requires a lot of work and
coordination. As in many things in life, people (including me) are only
interested in what they're looking for, and if it is not there, than it does
not matter to them if there is huge amount of work and promise out there. I
do the very same thing every day.

But there is also another side to this fact: when you contribute, your
contribution does not necessarily solve a lot of others' problems.  You may
think that individuals each committing a limited amount of time into the
solution may develop what we all ask for, but you simply can not. You need
to set priorities of tasks, based on the actual impact of the outcome of the
tasks, and unless everybody who puts input in any way knows absolutely
everything about everybody else's requirement, you can not do this.

So often I see this necessity either neglected, or its very existence not
accepted. Many of the other works so often referred to are similar in one
way or another to our project(s) here, but in my opinion that similarity is
not strong enough to suggest that what has worked in other foundations,
projects would also work with openEHR. Size and scope of the task at hand,
the problem domain, the commercial space around the domain all matter in
success or failure of initiatives like openEHR, and just looking at outcomes
and only including one or two of the factors which led to those outcomes do
not produce meaningful examples.

Just like many other groups out there, openEHR is suffering from an
asymetry. The input regarding the requirements and what should exist is
gigantic, compared to input to deliver the results. Also, the cost of making
a request is much lower than actually responding to that request.. This is
not a bad thing, not a complain or rant, this is just a fact of this kind of
organization. It is just that you need to acknowledge this situation to
solve the problem, and develop a way to solve the problem with this picture
in mind.

Whereever we are with openEHR, this is where we are now. This is the
solution we have in our hands, which reached this point as a result of
whatever happened in the past, which will never ever change. openEHR was
born in its own way, grew its own way, and due to million things effecting
its domain, ended up where it is now. Looking at the history of other works
won't change this. Their evolution brought them to where they are, better or
worse, and openEHR's brought us here.

Let me specialize Tom's argument: as far as I know, no member of the openEHR
community who is putting his/her work out there for others to used freely,
is getting paid just for doing so. To tackle the tasks I've outlined above,
there should be people who are funded to perform these tasks. People's work
on openEHR in their own companies, environments are not relevant unless they
end up being available to the rest of the community, and there are very few
instututions who let their intangible assets go into public domain.

We need to do a huge amount of work, and I personally don't see this work
being done in any other way than a properly funded, planned, and managed
approach. You can't break down all tasks and diffuse it into some good
intention based completely democratic virtual work force. openEHR has lots
of tasks with this nature at hand, and many things which has worked in other
scenarios won't work here because of this.

Best Regards
Seref


On Tue, Nov 16, 2010 at 12:44 PM, Tim Cook wrote:

> Hi Tom,
>
> On Mon, 2010-11-15 at 16:25 +, T

Why is OpenEHR adoption so slow?

[Tim Cook]

Hi Tom,

On Mon, 2010-11-15 at 16:25 +, Thomas Beale wrote:
> a few points informally (I am not on any boards of any organisations,
> so these are my own thoughts):
>   * any organisation like openEHR needs some core paid people to
> execute key functions, and to maintain continuity. There is an
> 'officers' level, which runs any organisations, including
> admin and other support staff, and there is an operational
> level.
>   * for the operational level, there are typically posts like CTO,
> CMO, infrastructure management, project coordination, and so
> on. If the organisation is to do properly what its members
> want - typically 2 things: a) manage specifications/standards,
> including member involvement in this, and b) manage open
> source projects, potentially largely staffed by volunteers -
> then it has to have a few dedicated posts. Otherwise it
> becomes no-one's responsibility to actually coordinate things,
> keep infrastructure running etc. 

If these are the thoughts of, whom I consider to be, the most open
source/content aware person within the openEHR Foundation.  Then I
*highly* recommend:

Hippel, Eric von.
Democratizing innovation / Eric von Hippel.
ISBN 0-262-00274-4

(available in PDF via a CC license; btw)

Also, you may want to re-visit your comments about Linux.org and
Apache.org.  The history of how they became organizations is more
important than the fact that they exist today.

I hope you find this useful.

Regards,
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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Why is OpenEHR adoption so slow?

[Sam Heard]

Hi All

The adoption of all health standards is very slow; and it is universally so.
Government eHealth programs have embraced HL7v3 or CDA or openEHR or 13606 -
at great cost. Still things go slowly. The fact is that until people want a
shared logical model of the actual EHR (rather than a message or a document)
openEHR will not be centre stage.

Why have openEHR at the centre of a national program? There are a number of
reasons that are potentially persuasive.

1. The core platform as implemented does not describe clinical information.
This allows changes to clinical information to take place in the world of
archetypes (the 99% of standardisation that is yet to be carried out!). The
corollary is that only when there are enough high quality archetypes freely
available does the argument for this separation is compelling. There are
close to 300 archetypes of good quality now available and we are going to
see a rush of validation coming soon.

2. Adopting an EHR service allows applications to come and go without
losing/changing/adapting the health records. For patients, hospitals and
major providers this is a massive benefit - you can keep your health records
for a lifetime. It does, on the other hand, require enough high quality
applications to be available to provide solutions for providers. There is a
growing number - nursing, paediatric hospital, field hospital, infection
control, cancer research - but there is still some way to go.

3. The recording model in openEHR fits with the business process of
healthcare. A lot of things work out of the box from a medico-legal
perspective in a distributed environment. The coherent management of
workflow over a range of applications and services is the next step in this
process and the one that Ocean is concentrating on.

Even if the first argument is only accepted as a logical model for EHR
services, the tooling available now makes it possible to produce different
artefacts for different systems. On this basis people are becoming more
willing to invest resources in developing archetypes through open
collaboration on the internet. The second and third arguments are bringing
some institutions and software vendors along.

Seref is doing a wonderful job and Ocean has some experience in real
implementations to which Seref is party - so he does not make the same
mistakes! Where simplification is beneficial let's do it.

The reality is that openEHR proposes a massive shift in emphasis - from the
message to the EHR. More than 7000 vendors in the USA have invested in their
own data model - which they maintain. Until it is quicker, cheaper and
easier to build a system using openEHR, uptake will be slow. But I guarantee
you, the alternatives will get slower and more expensive by the day. That is
why we should continue: health information is highly complex AND 'you ain't
seen nothing yet'.

Cheers, Sam



> -Original Message-
> From: openehr-technical-bounces at openehr.org [mailto:openehr-technical-
> bounces at openehr.org] On Behalf Of Erik Sundvall
> Sent: Monday, 15 November 2010 11:29 PM
> To: For openEHR technical discussions
> Subject: Re: Why is OpenEHR adoption so slow?
> 
> Hi!
> 
> On Fri, Nov 5, 2010 at 10:03, Thomas Beale
>  wrote:
> > there are zero paid openEHR people, full-time or part-time.
> 
> That is not such a useful way of looking at openEHR funding. There are
> a lot of people working with openEHR on paid time during working
> hours. They are just not funded by the openEHR foundation. This
> situation is the same for many open source projects etc.
> 
> If you define "openEHR people" as people funded by the foundation you
> are automatically excluding most of the community from being "openEHR
> people". That might not be the smartest thing to do.
> 
> Too often I hear "openEHR needs funding" with the accompanying thought
> that the foundation itself needs a lot of money. Yes the foundation
> might need a little money for server & maintenance costs (if we don't
> want to use "free" services) and for trademark registrations etc. But
> the real need is working hours, not money.
> 
> Certain organisational behaviours make people and companies donate
> working time, while other behaviours do the opposite. Some behaviours
> get the time donations ending up within the original project, other
> behaviours result in related projects more using and indirectly
> contributing to the project via related but organisationally
> independent projects.
> 
> Many other volunteer organisations understand this difference better
> than what the openEHR foundation seems to do, at least judging from
> the few signals one can receive from the not-so-community-present
> foundation board that has nobody to formally answer to but themselves.
> In a volunteer project it can be quite

Why is OpenEHR adoption so slow?

[Thomas Beale]

One further point I omitted - a key activity that has to be done by orgs 
like openEHR is education, dissemination and communication. This is also 
normally related to one or more paid posts in such organisations, 
because it is so critical.

- thomas

Why is OpenEHR adoption so slow?

[Thomas Beale]

Erik,

a few points informally (I am not on any boards of any organisations, so 
these are my own thoughts):

* any organisation like openEHR needs some core paid people to
  execute key functions, and to maintain continuity. There is an
  'officers' level, which runs any organisations, including admin
  and other support staff, and there is an operational level.
* for the operational level, there are typically posts like CTO,
  CMO, infrastructure management, project coordination, and so on.
  If the organisation is to do properly what its members want -
  typically 2 things: a) manage specifications/standards, including
  member involvement in this, and b) manage open source projects,
  potentially largely staffed by volunteers - then it has to have a
  few dedicated posts. Otherwise it becomes no-one's responsibility
  to actually coordinate things, keep infrastructure running etc.
* currently openEHR Foundation pays no-one. Therefore, all attempts
  at the above work are performed by people on the payrolls of other
  organisations, each having their own raison d'?tre and agenda.
  Compare this with IHTSDO, HL7, CEN, OASIS, Linux.org, Apache.org
  etc - they all have core paid posts to enable the organisation to
  do its work.
* if we say that openEHR (for some odd reason) should not try to get
  funding for such posts, but it would be ok to get time instead,
  then all we are saying is that some other organisation(s) should
  essentially loan people to the Foundation to do this work and pick
  up the cost. This is equivalent to them just paying that amount of
  money into the organisation. There may be tax benefits, but
  otherwise the basic argument does not change.
* If on the other hand, other orgs provide some of their people,
  some of the time, for limited periods, to do specific tasks on
  projects, this is inevitably because it is in that organisation's
  interest to do so. Many orgs, like the NHS, VHA, as well as
  universities, do this already. But these people aren't performing
  core Foundation work, they are trying to execute some project on
  their own agenda. So this doesn't actually help the Foundation get
  more organised.
* as far as I can see, the wide experience in non-profit orgs of any
  kind shows that core paid posts (whether by direct funding or
  other means) are essential for good functioning.

The only thing to understand about Ocean is that (10 years ago) it 
didn't decide to work in the Java space, which is the natural 
environment of open source these days. In the ICT industry today, there 
might be 1/3 of all companies oriented to Java (1/3 .Net, 1/3 everything 
else), and of that fraction, maybe 10-20% making their source code 
openly available. Ocean doesn't happen to be in that demographic, along 
with probably 80% of all companies in ICT (and health ICT). Ocean's 
mission is therefore not to build open source Java implementations of 
anything. Nevertheless, Ocean has donated significant time to openEHR 
specification projects, open sourced/ing its subsequent specification 
work, and open sourced 2 key tools (which incidentally attract no 
external coder activity, proving the point that if it isn't Java, PHP, 
Python etc, it is not seen as open source). I don't think there are any 
commercial archetype editors at all.

If we look at where the main implementation work that has been done open 
source, and in Java, the bulk came from Rong's original (small!) company 
A-code, and since then Cambio has financed his further efforts. This 
work, like the specification work, was significant, and as far as I 
know, never reimbursed - it was done because the relevant people thought 
it was a useful thing to do. Significant additions have since been done 
to the EHR Java code base, including by Zilics, a Brazilian company with 
a commercial openEHR implementation, other Brazilian companies, Ocean, 
as well as many universities, including CHIME, Link?ping, and many 
others (the proper list visible on SVN of course). Likewise to the Java 
tool base, including Link?ping's archetype editor, no longer currently 
maintained.

I can't answer for CHIME specifically, but universities are of course 
100% welcome to put as much time as they want in some openEHR-related 
activity, and that is certainly happening. The CHIME Opereffa project is 
specifically an open source reference implementation built on Rong's 
earlier platform. With more resources, this project could certainly make 
faster progress. But with everyone working on their own main job (PhD, 
company project, lecturing etc), today it is done just with little 
pieces of time as they are available. There is really no avoiding the 
problem of funding here: no matter whether it is done on the openEHR 
side, or by some other organisation, it just costs money for dedicated 
analyst/architect/

Why is OpenEHR adoption so slow?

[Erik Sundvall]

Hi!

On Fri, Nov 5, 2010 at 10:03, Thomas Beale
 wrote:
> there are zero paid openEHR people, full-time or part-time.

That is not such a useful way of looking at openEHR funding. There are
a lot of people working with openEHR on paid time during working
hours. They are just not funded by the openEHR foundation. This
situation is the same for many open source projects etc.

If you define "openEHR people" as people funded by the foundation you
are automatically excluding most of the community from being "openEHR
people". That might not be the smartest thing to do.

Too often I hear "openEHR needs funding" with the accompanying thought
that the foundation itself needs a lot of money. Yes the foundation
might need a little money for server & maintenance costs (if we don't
want to use "free" services) and for trademark registrations etc. But
the real need is working hours, not money.

Certain organisational behaviours make people and companies donate
working time, while other behaviours do the opposite. Some behaviours
get the time donations ending up within the original project, other
behaviours result in related projects more using and indirectly
contributing to the project via related but organisationally
independent projects.

Many other volunteer organisations understand this difference better
than what the openEHR foundation seems to do, at least judging from
the few signals one can receive from the not-so-community-present
foundation board that has nobody to formally answer to but themselves.
In a volunteer project it can be quite OK with natural self appointed
leaders, often the founders, but it then has to be matched with other
attitudes or safeguards such as...
- being very good at communicating and willing to actively explain and
discuss decisions
- the ability for any participant to branch of and take (a copy) of
invested time (work) with them, if the leadership becomes poor
...and so on.

> The people who
> currently put some effort into openEHR, such as myself, are working on
> exactly the same basis as anyone else in the community. We are just crazy
> enough to spend more time on it;-)

There are a lot of completely sane reasons for investing time in
openEHR. I for example believe Ocean Informatics would not at all have
been getting assignments all around the globe if it had not chosen to
invest time in open specifications. Very few would have heard of that
little Australian company. (On the other hand, it could probably have
been an even bigger company if everybody, not just a few, within that
company understood open source business models better.)

To get back to the real issue of "slow" openEHR adoption, I believe
Seref is closest to the problem: a system trying to do everything
openEHR tries to in a well engineered way, really becomes an
"elephant".

It takes time to properly implement an elephant from scratch,
especially including all supporting systems.

The two organisations that could have provided a real working open
implementation of that elephant first would probably have been UCL and
Ocean Informatics. Now, instead of joining forces on that, they have
both been running their own competing commercial closed source
implementation projects (OK UCLs were probably more 13606 than
openEHR, but you get the point). They are of course both fully
entitled to do so, and it's great that the specifications themselves
are open, but I believe it has delayed the arrival of an open
demonstrator platform that people can use to try openEHR ideas on and
are willing to invest time in. On the other hand it has left the field
completely open for both competing commercial and open source efforts,
which in the long run, after this delay, might show to be beneficial
for the world at large (but probably less beneficial for Ocean and UCL
than it could have been). UCL by the help of Seref and whoever
supports him, now seem to be getting the point of an open
demonstrator, so things seem to be changing there.

One should not deny that there might be a similar competition between
open source efforts, but I believe cross-pollination of ideas between
such projects can be pretty fruitful and efficient (look at Archetype
editors for example), and thus less effort might be wasted than in
commercial competition. (To add to the open source confusion some of
us are thinking of alternative ways (http REST) to slice the elephant
implementation and let smaller parts cooperate (or compete if you
wish) in implementations - but that should be a separate post later.)

I hope this mail did not sound too complaining, I more aimed at
explaining (from my particular point of view). I like both UCL- and
Ocean-people, that's one reason to try and be honest with them. :-)

Best regards,
Erik Sundvall
erik.sundvall at liu.se http://www.imt.liu.se/~erisu/? Tel: +46-13-286733

Why is OpenEHR adoption so slow?

[pablo pazos]

Hi Erik,

> Hi!
> 
> On Fri, Nov 5, 2010 at 10:03, Thomas Beale
>  wrote:
> > there are zero paid openEHR people, full-time or part-time.
> 
> That is not such a useful way of looking at openEHR funding. There are
> a lot of people working with openEHR on paid time during working
> hours. They are just not funded by the openEHR foundation. This
> situation is the same for many open source projects etc.

Also, there are a lot of people working with openEHR with no payment at all, 
and the difficulties of having to study the specs, and little tooling and open 
projects that are not updated with some frequency. That was the whole point of 
the discution.

There were a lot of people that start working with openEHR, but the cost of 
understand the specifications, trying software (incomplete or not updated), and 
the complexity of building something based on openEHR that realy works, just 
discourages people. And we need to do something to change this reality (if we 
want openEHR be widely adopted).

> 
> If you define "openEHR people" as people funded by the foundation you
> are automatically excluding most of the community from being "openEHR
> people". That might not be the smartest thing to do.

Is just people (like us) that works with openEHR.

> 
> Too often I hear "openEHR needs funding" with the accompanying thought
> that the foundation itself needs a lot of money. Yes the foundation
> might need a little money for server & maintenance costs (if we don't
> want to use "free" services) and for trademark registrations etc. But
> the real need is working hours, not money.

We need people that update the tools and software projects with some 
regularity. Yes, it's working hours, that must be payed some way... not 
everyone works on a university that pays people to investigate on openEHR.

> 
> Certain organisational behaviours make people and companies donate
> working time, while other behaviours do the opposite. Some behaviours
> get the time donations ending up within the original project, other
> behaviours result in related projects more using and indirectly
> contributing to the project via related but organisationally
> independent projects.

Not every organization can do this. The reality in here in South America is 
very diferent to the one you mention. There are things that simply cannot be 
made without funding, in the other hand, we can't wait to see when openEHR is 
got to be widely adopted, so I start this discution to see: 1. where are we 
going? 2. is it worth to invest my free time in this standard or I have to look 
elsewhere?

> 
> Many other volunteer organisations understand this difference better
> than what the openEHR foundation seems to do, at least judging from
> the few signals one can receive from the not-so-community-present
> foundation board that has nobody to formally answer to but themselves.
> In a volunteer project it can be quite OK with natural self appointed
> leaders, often the founders, but it then has to be matched with other
> attitudes or safeguards such as...
> - being very good at communicating and willing to actively explain and
> discuss decisions
> - the ability for any participant to branch of and take (a copy) of
> invested time (work) with them, if the leadership becomes poor
> ...and so on.
> 

I agree.

> > The people who
> > currently put some effort into openEHR, such as myself, are working on
> > exactly the same basis as anyone else in the community. We are just crazy
> > enough to spend more time on it;-)
> 
> There are a lot of completely sane reasons for investing time in
> openEHR. I for example believe Ocean Informatics would not at all have
> been getting assignments all around the globe if it had not chosen to
> invest time in open specifications. Very few would have heard of that
> little Australian company. (On the other hand, it could probably have
> been an even bigger company if everybody, not just a few, within that
> company understood open source business models better.)
> 

Not everyone that is investing free time on openER works in a company that can 
made some kind of profit.

> To get back to the real issue of "slow" openEHR adoption, I believe
> Seref is closest to the problem: a system trying to do everything
> openEHR tries to in a well engineered way, really becomes an
> "elephant".
> 
> It takes time to properly implement an elephant from scratch,
> especially including all supporting systems.
> 
> The two organisations that could have provided a real working open
> implementation of that elephant first would probably have been UCL and
> Ocean Informatics. Now, instead of joining forces on that, they have
> both been running their own competing commercial closed source
> implementation projects (OK UCLs were probably more 13606 than
> openEHR, but you get the point). They are of course both fully
> entitled to do so, and it's great that the specifications themselves
> are open, but I believe it has delayed the arrival of an op

Why is OpenEHR adoption so slow?

[Ann Wrightson (NWIS - Technical)]

Just to set the record straight, HL7 membership includes access to the 
standards IP, there are no additional access or purchase fees.

Country affiliate level participation in HL7 carries all IP benefits and for 
HL7 UK costs ?650 +VAT for organization membership.

Having said that, I agree with Thomas's overall point regarding needing 
resource to work effectively.

Regards,

Ann W.

Ann M Wrightson
Pensaer TG | Technical Architect
Gwasanaeth Gwybodeg GIG Cymru | NHS Wales Informatics Service
Symudol/Mobile: 07535 481797
Llanelwy | St Asaph:   WHTN: 1815 8232 Ff?n/Tel : 01745 448232
Pencoed: WHTN: 1808 8930 Ff?n/Tel: 01656 778940





From: openehr-technical-bounces at openehr.org 
[mailto:openehr-technical-boun...@openehr.org] On Behalf Of Thomas Beale
Sent: 04 November 2010 18:59
To: Openehr-Technical; For openEHR clinical discussions
Subject: Re: Why is OpenEHR adoption so slow?


There are many things that can be improved in openEHR, no doubt about it. Some 
comments. First of all, HL7 charges membership fees, meeting attendance fees 
and purchase fees for the standards; a small company can easily spend $10,000 - 
$20,000 per annum just on the cash outlay. Larger companies routinely spend 
$100k per annum when you take into account meeting attendance expenses and 
opportunity costs. These fees, plus donations by some large companies, fund HL7 
marketing efforts. Such an operation does not come for free.

If we are to have regional communities, an affiliate model of some kind makes 
sense. However there is no getting away from some prerequisites:

 *   someone has to pay for the human resource at both local and central 
levels; 100% volunteer work is just too unreliable
 *   there has to be a way to get all the affiliates established in the first 
place, which really means creating an association in each country that 
subscribes to the same common cause - i.e. getting a lot of countries to agree 
on a common thing. History tells us this is VERY HARD.
 *   the 'common cause' almost certainly has to have some official standards 
status, or regional affiliates might get lots of interested individuals, but 
will fail to get MoH/DoH involvement, and hence fail to influence national 
programmes, and and probably also vendors

In sum: the organisation needs a distributed organisational governance 
structure, and it needs sufficient legitimacy for funding to be provided.

Now, the world currently already includes ISO, CEN, HL7, IHE, IHTSDO, OMG, and 
dozens of other standards bodies, which have a) some governance structure and 
b) sufficient perceived legitimacy to get some funding. However, there is great 
fatigue on the user side: most of these organisations compete, don't cooperate 
properly, don't formally or empirically validate their deliverables, and are 
not strongly driven by their main stakeholders. For this reason, openEHR has 
stayed away from creating yet another organisation, overlaid on this crowded 
scene.

In e-health, the exception to the above is IHTSDO, a relative newcomer to the 
scene, and while not perfect, it is significantly better in all of these areas. 
It has:

 *   a pretty good governance model, including an explicit member country and 
affiliate model
 *   direct board membership by key stakeholders of its deliverable, i.e. 
national e-health programmes
 *   formally defined and relatively well managed specification, software, and 
terminology deliverables (none of which are anything like perfect today, but 
the point is that a reasonable process is in place)

For this reason, the openEHR Foundation and IHTSDO have been in talks to 
determine what kind of cooperation could occur in the future, which would a) 
allow openEHR to work within or alongside the IHTSDO global organisational 
structure and b) enable IHTSDO to take better advantage of the openEHR 
knowledge engineering technology, in particular terminology integration.

These discussions have not yet completed, but some kind of announcement could 
be expected in the near future. If some better organisational and funding 
structure can be created, aligned with an accepted standards body, then I think 
the whole thing will accelerate very fast.

- thomas beale


On 02/11/2010 16:29, pablo pazos wrote:
Hi Seref and Shinji,

I share your opinions. Once in a while, we need discussions like this, since we 
have to lead ourselves somewhere and combine efforts if we want to support the 
difussion and adopton of the standard.

The domain is complex, the problem is complex, the solution must be complex, 
but if we add the complexity of the standard to the complexity of understanding 
another language (the specs are english only), we have a serious problems for a 
worldwide adoption. I share Shinji's vision, we must support and encourage 
regional OpenEHR communities, specs translation, and "open source multilingual 
up-to-date tools" (most tools available are:

Why is OpenEHR adoption so slow?

[pablo pazos]

Hi All, yesterday I've written some random ideas to create an OpenEHR 
governance program, to help the creation and development of regional OpenEHR 
communities, and coordination with those communities.

It would be nice if you can take a look at the ideas and make comments about 
them, or add your own ideas if you note something is missing.

http://www.openehr.org/wiki/display/oecom/Community+Governance

-- 
Kind regards,
A/C Pablo Pazos Guti?rrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
Twitter: http://twitter.com/ppazos



From: pazospa...@hotmail.com
To: openehr-technical at openehr.org
Subject: RE: Why is OpenEHR adoption so slow?
Date: Sun, 7 Nov 2010 22:22:32 -0300








Great Thomas, I'll put there some ideas to discuss with the community.

-- 
Atte.
A/C Pablo Pazos Guti?rrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
S?gueme en twitter: http://twitter.com/ppazos



Date: Mon, 8 Nov 2010 00:30:16 +
From: thomas.be...@oceaninformatics.com
To: openehr-technical at openehr.org
Subject: Re: Why is OpenEHR adoption so slow?



  



  
  


Here is a wiki page for governance discussion -
http://www.openehr.org/wiki/display/oecom/Community+Governance



Bob Mayes is a great guy by the way, he worked for many years in
Zimbabwe.



- thomas



On 05/11/2010 01:21, pablo pazos wrote:

  
  Hi Thomas,

  

  I see we agreed in much of the points, I hope to see other's
  visions.

  

  Governance is a good issue to discuss with the community, but I
  can't see any governance if the OpenEHR boards are distant from
  the community, and do not understand their real needs. What I was
  really talking from the begining of this discussion is that
  people, institutions, and goverments have needs that OpenEHR can
  satisfy, but at the same time, OpenEHR as a whole is not aware of
  their needs, or is not taking actions to do something.

  

  There are a lots of ways of funding, just yesterday, we had an
  event here in Uruguay of ICT developments in healthcare (we showed
  our Open EHR-Gen Framework and people was amazed about the
  concept), there was a man called Bob Mayes from AMIA, and their
  are launching a subarea called GHiP to build and support
  communities that solve problems in healthcare informatics (with
  funding from Rockefeller and Bill Gates foundations, tehy have a
  buck or two :D). GHiP may be a good place to find some cash to
  build a governance program to the regional OpenEHR communities,
  and to support development and objective acomplishment in those
  communities.

  

  The governance program must have an item on how to spend the
  funding, and this item must be agreed by the community.

  

  It'd be a good idea if we create some section on the web or the
wiki, where we can write some thoughs on the governance subject,
also we can put some governance ideas from other communities,
discuss them, and see if the community agree them. Again,
without the involvement of the boards, this will be a
dead-before-born subject.

  




   Again, I think we can build some money to improve
the tools, like making courses, events (like the IHE
Connectathon), selling books, t-shirts, coffe cups, etc
(donations are always welcome). I'm against a paid
membership, it closes a community that claims to be open,
this is not a gym :D

  
  

  well, its why we never did
that. I think your ideas are good, the only concern I have
is that I think there still has to be a sufficiently strong
central part of the organisation to help organise materials,
resources, and run the governance structure; at the moment
there is not enough funding to do what would be needed to
support local orgs. 

   But I would very
much like to see openehr.cl, .br, .uy, etc. 

  

  

Just an idea: I think the Service Model is very green yet,
but when it go a little more mature, we can make automated
tests to test the implementations, and they can have an
OpenEHR certificate that the software meets the
specification (a paid certificate).

  
  

  we can already test with XML
schemas. You are right, the service models will be a key
basis for conformance testing, but it will take some more
time to get the required maturity.

  

- thomas


  
  

  -- 

  Atte.

  A/C Pablo Pazos Guti?rrez

  Li

Why is OpenEHR adoption so slow?

[Thomas Beale]

Here is a wiki page for governance discussion - 
http://www.openehr.org/wiki/display/oecom/Community+Governance

Bob Mayes is a great guy by the way, he worked for many years in Zimbabwe.

- thomas

On 05/11/2010 01:21, pablo pazos wrote:
> Hi Thomas,
>
> I see we agreed in much of the points, I hope to see other's visions.
>
> Governance is a good issue to discuss with the community, but I can't 
> see any governance if the OpenEHR boards are distant from the 
> community, and do not understand their real needs. What I was really 
> talking from the begining of this discussion is that people, 
> institutions, and goverments have needs that OpenEHR can satisfy, but 
> at the same time, OpenEHR as a whole is not aware of their needs, or 
> is not taking actions to do something.
>
> There are a lots of ways of funding, just yesterday, we had an event 
> here in Uruguay of ICT developments in healthcare (we showed our Open 
> EHR-Gen Framework and people was amazed about the concept), there was 
> a man called Bob Mayes from AMIA, and their are launching a subarea 
> called GHiP to build and support communities that solve problems in 
> healthcare informatics (with funding from Rockefeller and Bill Gates 
> foundations, tehy have a buck or two :D). GHiP may be a good place to 
> find some cash to build a governance program to the regional OpenEHR 
> communities, and to support development and objective acomplishment in 
> those communities.
>
> The governance program must have an item on how to spend the funding, 
> and this item must be agreed by the community.
>
> *It'd be a good idea if we create some section on the web or the wiki, 
> where we can write some thoughs on the governance subject, also we can 
> put some governance ideas from other communities, discuss them, and 
> see if the community agree them. Again, without the involvement of the 
> boards, this will be a dead-before-born subject.*
>
>
>
> Again, I think we can build some money to improve the
> tools, like making courses, events (like the IHE
> Connectathon), selling books, t-shirts, coffe cups, etc
> (donations are always welcome). I'm against a paid
> membership, it closes a community that claims to be open,
> this is not a gym :D
>
>
> well, its why we never did that. I think your ideas are good,
> the only concern I have is that I think there still has to be
> a sufficiently strong central part of the organisation to help
> organise materials, resources, and run the governance
> structure; at the moment there is not enough funding to do
> what would be needed to support local orgs.
> But I would very much like to see openehr.cl, .br, .uy, etc.
>
>
> Just an idea: I think the Service Model is very green yet,
> but when it go a little more mature, we can make automated
> tests to test the implementations, and they can have an
> OpenEHR certificate that the software meets the
> specification (a paid certificate).
>
>
> we can already test with XML schemas. You are right, the
> service models will be a key basis for conformance testing,
> but it will take some more time to get the required maturity.
>
> ** - thomas
>
>
> -- 
> Atte.
> A/C Pablo Pazos Guti?rrez
> LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
> Blog: http://informatica-medica.blogspot.com/
> S?gueme en twitter: http://twitter.com/ppazos
>
>
> ___
> 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 
*

Chair Architectural Review Board, /open/EHR Foundation 

Honorary Research Fellow, University College London 

Chartered IT Professional Fellow, BCS, British Computer Society 

Health IT blog 


*
*
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Why is OpenEHR adoption so slow?

[pablo pazos]

Great Thomas, I'll put there some ideas to discuss with the community.

-- 
Atte.
A/C Pablo Pazos Guti?rrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
S?gueme en twitter: http://twitter.com/ppazos



Date: Mon, 8 Nov 2010 00:30:16 +
From: thomas.be...@oceaninformatics.com
To: openehr-technical at openehr.org
Subject: Re: Why is OpenEHR adoption so slow?



  



  
  


Here is a wiki page for governance discussion -
http://www.openehr.org/wiki/display/oecom/Community+Governance



Bob Mayes is a great guy by the way, he worked for many years in
Zimbabwe.



- thomas



On 05/11/2010 01:21, pablo pazos wrote:

  
  Hi Thomas,

  

  I see we agreed in much of the points, I hope to see other's
  visions.

  

  Governance is a good issue to discuss with the community, but I
  can't see any governance if the OpenEHR boards are distant from
  the community, and do not understand their real needs. What I was
  really talking from the begining of this discussion is that
  people, institutions, and goverments have needs that OpenEHR can
  satisfy, but at the same time, OpenEHR as a whole is not aware of
  their needs, or is not taking actions to do something.

  

  There are a lots of ways of funding, just yesterday, we had an
  event here in Uruguay of ICT developments in healthcare (we showed
  our Open EHR-Gen Framework and people was amazed about the
  concept), there was a man called Bob Mayes from AMIA, and their
  are launching a subarea called GHiP to build and support
  communities that solve problems in healthcare informatics (with
  funding from Rockefeller and Bill Gates foundations, tehy have a
  buck or two :D). GHiP may be a good place to find some cash to
  build a governance program to the regional OpenEHR communities,
  and to support development and objective acomplishment in those
  communities.

  

  The governance program must have an item on how to spend the
  funding, and this item must be agreed by the community.

  

  It'd be a good idea if we create some section on the web or the
wiki, where we can write some thoughs on the governance subject,
also we can put some governance ideas from other communities,
discuss them, and see if the community agree them. Again,
without the involvement of the boards, this will be a
dead-before-born subject.

  




   Again, I think we can build some money to improve
the tools, like making courses, events (like the IHE
Connectathon), selling books, t-shirts, coffe cups, etc
(donations are always welcome). I'm against a paid
membership, it closes a community that claims to be open,
this is not a gym :D

  
  

  well, its why we never did
that. I think your ideas are good, the only concern I have
is that I think there still has to be a sufficiently strong
central part of the organisation to help organise materials,
resources, and run the governance structure; at the moment
there is not enough funding to do what would be needed to
support local orgs. 

   But I would very
much like to see openehr.cl, .br, .uy, etc. 

  

  

Just an idea: I think the Service Model is very green yet,
but when it go a little more mature, we can make automated
tests to test the implementations, and they can have an
OpenEHR certificate that the software meets the
specification (a paid certificate).

  
  

  we can already test with XML
schemas. You are right, the service models will be a key
basis for conformance testing, but it will take some more
time to get the required maturity.

  

- thomas


  
  

  -- 

  Atte.

  A/C Pablo Pazos Guti?rrez

  LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez

  Blog: http://informatica-medica.blogspot.com/

  S?gueme en twitter: http://twitter.com/ppazos
  
___
openEHR-technical mailing list
openEHR-technical at openehr.org
http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical






-- 

  

  
 

  Thomas Beale

  Chief Technology Officer, Ocean
Informatics



Chair Architectural Review Board, openEHR
  Foundation 

Honorary Research Fellow, University College
  London 

Charter

Why is OpenEHR adoption so slow?

[pablo pazos]

Hi Thomas,

I see we agreed in much of the points, I hope to see other's visions.

Governance is a good issue to discuss with the community, but I can't see any 
governance if the OpenEHR boards are distant from the community, and do not 
understand their real needs. What I was really talking from the begining of 
this discussion is that people, institutions, and goverments have needs that 
OpenEHR can satisfy, but at the same time, OpenEHR as a whole is not aware of 
their needs, or is not taking actions to do something.

There are a lots of ways of funding, just yesterday, we had an event here in 
Uruguay of ICT developments in healthcare (we showed our Open EHR-Gen Framework 
and people was amazed about the concept), there was a man called Bob Mayes from 
AMIA, and their are launching a subarea called GHiP to build and support 
communities that solve problems in healthcare informatics (with funding from 
Rockefeller and Bill Gates foundations, tehy have a buck or two :D). GHiP may 
be a good place to find some cash to build a governance program to the regional 
OpenEHR communities, and to support development and objective acomplishment in 
those communities.

The governance program must have an item on how to spend the funding, and this 
item must be agreed by the community.

It'd be a good idea if we create some section on the web or the wiki, where we 
can write some thoughs on the governance subject, also we can put some 
governance ideas from other communities, discuss them, and see if the community 
agree them. Again, without the involvement of the boards, this will be a 
dead-before-born subject.



  

  Again, I think we can build some money to improve the tools, like
  making courses, events (like the IHE Connectathon), selling books,
  t-shirts, coffe cups, etc (donations are always welcome). I'm
  against a paid membership, it closes a community that claims to be
  open, this is not a gym :D


well, its why we never did that. I think your ideas are good, the
only concern I have is that I think there still has to be a
sufficiently strong central part of the organisation to help
organise materials, resources, and run the governance structure; at
the moment there is not enough funding to do what would be needed to
support local orgs. 

But I would very much like to see openehr.cl, .br, .uy, etc. 



  Just an idea: I think the Service Model is very green yet, but
  when it go a little more mature, we can make automated tests to
  test the implementations, and they can have an OpenEHR certificate
  that the software meets the specification (a paid certificate).



we can already test with XML schemas. You are right, the service
models will be a key basis for conformance testing, but it will take
some more time to get the required maturity.


  
- thomas








-- 
Atte.
A/C Pablo Pazos Guti?rrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
S?gueme en twitter: http://twitter.com/ppazos   
  
-- next part --
An HTML attachment was scrubbed...
URL: 

Why is OpenEHR adoption so slow?

[Thomas Beale]

There are many things that can be improved in openEHR, no doubt about 
it. Some comments. First of all, HL7 charges membership fees, meeting 
attendance fees and purchase fees for the standards; a small company can 
easily spend $10,000 - $20,000 per annum just on the cash outlay. Larger 
companies routinely spend $100k per annum when you take into account 
meeting attendance expenses and opportunity costs. These fees, plus 
donations by some large companies, fund HL7 marketing efforts. Such an 
operation does not come for free.

If we are to have regional communities, an affiliate model of some kind 
makes sense. However there is no getting away from some prerequisites:

* someone has to pay for the human resource at both local and
  central levels; 100% volunteer work is just too unreliable
* there has to be a way to get all the affiliates established in the
  first place, which really means creating an association in each
  country that subscribes to the same common cause - i.e. getting a
  lot of countries to agree on a common thing. History tells us this
  is VERY HARD.
* the 'common cause' almost certainly has to have some official
  standards status, or regional affiliates might get lots of
  interested individuals, but will fail to get MoH/DoH involvement,
  and hence fail to influence national programmes, and and probably
  also vendors

In sum: the organisation needs a distributed organisational governance 
structure, and it needs sufficient legitimacy for funding to be provided.

Now, the world currently already includes ISO, CEN, HL7, IHE, IHTSDO, 
OMG, and dozens of other standards bodies, which have a) some governance 
structure and b) sufficient perceived legitimacy to get some funding. 
However, there is great fatigue on the user side: most of these 
organisations compete, don't cooperate properly, don't formally or 
empirically validate their deliverables, and are not strongly driven by 
their main stakeholders. For this reason, openEHR has stayed away from 
creating yet another organisation, overlaid on this crowded scene.

In e-health, the exception to the above is IHTSDO, a relative newcomer 
to the scene, and while not perfect, it is significantly better in all 
of these areas. It has:

* a pretty good governance model, including an explicit member
  country and affiliate model
* direct board membership by key stakeholders of its deliverable,
  i.e. national e-health programmes
* formally defined and relatively well managed specification,
  software, and terminology deliverables (none of which are anything
  like perfect today, but the point is that a reasonable process is
  in place)

For this reason, the openEHR Foundation and IHTSDO have been in talks to 
determine what kind of cooperation could occur in the future, which 
would a) allow openEHR to work within or alongside the IHTSDO global 
organisational structure and b) enable IHTSDO to take better advantage 
of the openEHR knowledge engineering technology, in particular 
terminology integration.

These discussions have not yet completed, but some kind of announcement 
could be expected in the near future. If some better organisational and 
funding structure can be created, aligned with an accepted standards 
body, then I think the whole thing will accelerate very fast.

- thomas beale


On 02/11/2010 16:29, pablo pazos wrote:
> Hi Seref and Shinji,
>
> I share your opinions. Once in a while, we need discussions like this, 
> since we have to lead ourselves somewhere and combine efforts if we 
> want to support the difussion and adopton of the standard.
>
> The domain is complex, the problem is complex, the solution must be 
> complex, but if we add the complexity of the standard to the 
> complexity of understanding another language (the specs are english 
> only), we have a serious problems for a worldwide adoption. I share 
> Shinji's vision, we must support and encourage regional OpenEHR 
> communities, specs translation, and "open source multilingual 
> up-to-date tools" (most tools available are: or not multiligual or the 
> translations are horrible, or not open source, or not updated recently).
>
> I think regional communities can create courses, resources, materials, 
> etc... and share them with other communities, throught OpenEHR 
> foundation. Guidelines to do this must be set from the OpenEHR 
> Foundation Boards (I think they are there to lead the community, to 
> encourage the spread and adoption of the standard, I can't remember 
> the last time I saw an email of the OpenEHR Boards in the mailling 
> lists). Within those guidelines, we can be coordinated, and maybe set 
> year-based goals. And once a year or two we can make some event to 
> share our experiences and progress from our local communities (can be 
> local or regional events, since for most of ours it's hard to travel 
> so far).
>
> These ideas are not new, just look at t

Why is OpenEHR adoption so slow?

[pablo pazos]

Hi Thomas,

I didn't mean that we have to follow the HL7 structure and ways of funding. 
They have good and bad things, as you point. One of the good things is that a 
set of small regional communities are stronger than a huge central community, 
because they have common interests, common language, common culture, etc. For 
example I spend more than 15 mins on writing emails to the lists because of the 
language, when I spend 3 mins writing to lists in spanish. Reading the english 
only specs is another thing that discourages people with no formation in the 
language.

But a central community is needed to build guidelines and coordinates the 
global view, plans and concrete objectives for OpenEHR as a whole. This is a 
work for the boards, but now I can't see any interest from them (of course, 
individuals like you are always here, but the boards had no presence here, and 
we need leadership and vision).


  



  
  


There are many things that can be improved in openEHR, no doubt
about it. Some comments. First of all, HL7 charges membership fees,
meeting attendance fees and purchase fees for the standards; a small
company can easily spend $10,000 - $20,000 per annum just on the
cash outlay. Larger companies routinely spend $100k per annum when
you take into account meeting attendance expenses and opportunity
costs. These fees, plus donations by some large companies, fund HL7
marketing efforts. Such an operation does not come for free.


I don't think that a paid membership to local communities will work, as you 
point, is not the best way to build a community, it's just a way to get enought 
money to do things. I rather prefer an open model, where people just pay for a 
service, like courses. There are two types of communities, discution 
communities and action communities. The first are made of people with a common 
interest, link "cars" or "travel", you don't have to pay someone for something 
they want to talk and discuss. We have to encourage people to have interest in 
OpenEHR. The second, are communities of people that have common problems and 
try to solve them. We need this type of community to really do things, but we 
need to start with a common interest.


If we are to have regional communities, an affiliate model of some
kind makes sense. However there is no getting away from some
prerequisites:

  someone has to pay for the human resource at both local and
central levels; 100% volunteer work is just too unreliable
  there has to be a way to get all the affiliates established in
the first place, which really means creating an association in
each country that subscribes to the same common cause - i.e.
getting a lot of countries to agree on a common thing. History
tells us this is VERY HARD.

  
  the 'common cause' almost certainly has to have some official
standards status, or regional affiliates might get lots of
interested individuals, but will fail to get MoH/DoH
involvement, and hence fail to influence national programmes,
and and probably also vendors

In sum: the organisation needs a distributed organisational
governance structure, and it needs sufficient legitimacy for funding
to be provided. 




Again, I think we can build some money to improve the tools, like making 
courses, events (like the IHE Connectathon), selling books, t-shirts, coffe 
cups, etc (donations are always welcome). I'm against a paid membership, it 
closes a community that claims to be open, this is not a gym :D

Just an idea: I think the Service Model is very green yet, but when it go a 
little more mature, we can make automated tests to test the implementations, 
and they can have an OpenEHR certificate that the software meets the 
specification (a paid certificate).


Now, the world currently already includes ISO, CEN, HL7, IHE,
IHTSDO, OMG, and dozens of other standards bodies, which have a)
some governance structure and b) sufficient perceived legitimacy to
get some funding. However, there is great fatigue on the user side:
most of these organisations compete, don't cooperate properly, don't
formally or empirically validate their deliverables, and are not
strongly driven by their main stakeholders. For this reason, openEHR
has stayed away from creating yet another organisation, overlaid on
this crowded scene.




In e-health, the exception to the above is IHTSDO, a relative
newcomer to the scene, and while not perfect, it is significantly
better in all of these areas. It has:


  a pretty good governance model, including an explicit member
country and affiliate model
  direct board membership by key stakeholders of its
deliverable, i.e. national e-health programmes
  formally defined and relatively well managed specification,
software, and terminology deli

Why is OpenEHR adoption so slow?

[pablo pazos]

Hi Seref and Shinji,

I share your opinions. Once in a while, we need discussions like this, since we 
have to lead ourselves somewhere and combine efforts if we want to support the 
difussion and adopton of the standard.

The domain is complex, the problem is complex, the solution must be complex, 
but if we add the complexity of the standard to the complexity of understanding 
another language (the specs are english only), we have a serious problems for a 
worldwide adoption. I share Shinji's vision, we must support and encourage 
regional OpenEHR communities, specs translation, and "open source multilingual 
up-to-date tools" (most tools available are: or not multiligual or the 
translations are horrible, or not open source, or not updated recently).

I think regional communities can create courses, resources, materials, etc... 
and share them with other communities, throught OpenEHR foundation. Guidelines 
to do this must be set from the OpenEHR Foundation Boards (I think they are 
there to lead the community, to encourage the spread and adoption of the 
standard, I can't remember the last time I saw an email of the OpenEHR Boards 
in the mailling lists). Within those guidelines, we can be coordinated, and 
maybe set year-based goals. And once a year or two we can make some event to 
share our experiences and progress from our local communities (can be local or 
regional events, since for most of ours it's hard to travel so far).

These ideas are not new, just look at the HL7 coutry based structure.

I know this words may sound hard to someone, I just want to support the success 
of the standard, but I think if we keep doing things the same way, we'll end 
with a high quality standard with no one to implement it.

Kind regards,

-- 
A/C Pablo Pazos Guti?rrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
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Date: Tue, 2 Nov 2010 22:25:17 +0900
Subject: Re: Why is OpenEHR adoption so slow?
From: sk...@moss.gr.jp
To: openehr-implementers at openehr.org

Hi Pablo,

I also think regional community is necessary for this project.
I launched openEHR.jp in 2007 in Japan. This is the first regional community of 
the openEHR project.
We have provided Japanese translation and promotion for multilevel clinical 
modeling technology.

We have implemented on Ruby as OSS and been trying national intractable disease 
surveillance
database by openEHR technology.
Your idea, to make a guideline is interesting. We will also try to do it.

Cheers,

Shinji KOBAYASHI

Date: Tue, 2 Nov 2010 12:32:56 +0000
Subject: Re: Why is OpenEHR adoption so slow?
From: serefari...@kurumsalteknoloji.com
To: openehr-implementers at openehr.org
CC: openehr-implementers at chime.ucl.ac.uk; openehr-clinical at openehr.org; 
openehr-clinical at chime.ucl.ac.uk; openehr-technical at chime.ucl.ac.uk

Hi Pablo, 
A very useful insight into the issues indeed. This is one topic that may end up 
being a quite long discussion, but I feel it is a topic that is worth laying 
out, not only today, but every couple of years or so, to see where we are. 


I'll provide my personal views here. openEHR is not a small specification. It 
is not a simple one either. Considering the problem it is trying to solve, I do 
not expect it to be. Therefore, the complexity of implementation is 
significant. The nature of the problem openEHR is trying to solve inevitably 
creates the blind men and the elephant situation 
http://en.wikipedia.org/wiki/Blind_men_and_an_elephant 

In explaining what openEHR is, we are faced with the problem of communicating 
the whole picture. In my experience, partial views or decriptions of openEHR 
lead to confusion, even if every bit of information provided is correct. 
Technical people and clinicians alike have a hard time seeing the big picture, 
and who can blaim them? The picture is really, really big.


Be warned: the kind of statements I've just started to make are usually 
perceived so that one gets the message "this needs to change". No. When I say 
openEHR is complex, openEHR is big, openEHR is not easy to implement, I don't 
mean openEHR is more complex than it needs to be, or openEHR is bigger than it 
needs to be, or openEHR is harder than it should be to implement. 


We are attempting to solve a huge problem, and complexity of the solution will 
enevitably rise in response. The instinct to simplify the solution usually 
cripples the solution by pruning its support for less frequently required 
features, but most of the time, this leads to an unsatisfactory outcome. 
Surprisingly, everyone seems to follow the instinct. 


In my opinion, tooling and education are the two most important fronts we need 
to make progress. The mechanics of an MRI is very complex, and yet, due to way 
it was implemented, it is a practical, useful clinical tool. The implementation 
of the ve

Why is OpenEHR adoption so slow?

[Seref Arikan]

Hi Pablo,
A very useful insight into the issues indeed. This is one topic that may end
up being a quite long discussion, but I feel it is a topic that is worth
laying out, not only today, but every couple of years or so, to see where we
are.

I'll provide my personal views here. openEHR is not a small specification.
It is not a simple one either. Considering the problem it is trying to
solve, I do not expect it to be. Therefore, the complexity of implementation
is significant. The nature of the problem openEHR is trying to solve
inevitably creates the blind men and the elephant situation
http://en.wikipedia.org/wiki/Blind_men_and_an_elephant
In explaining what openEHR is, we are faced with the problem of
communicating the whole picture. In my experience, partial views or
decriptions of openEHR lead to confusion, even if every bit of information
provided is correct. Technical people and clinicians alike have a hard time
seeing the big picture, and who can blaim them? The picture is really,
really big.

Be warned: the kind of statements I've just started to make are usually
perceived so that one gets the message "this needs to change". No. When I
say openEHR is complex, openEHR is big, openEHR is not easy to implement, I
don't mean openEHR is more complex than it needs to be, or openEHR is bigger
than it needs to be, or openEHR is harder than it should be to implement.

We are attempting to solve a huge problem, and complexity of the solution
will enevitably rise in response. The instinct to simplify the solution
usually cripples the solution by pruning its support for less frequently
required features, but most of the time, this leads to an unsatisfactory
outcome. Surprisingly, everyone seems to follow the instinct.

In my opinion, tooling and education are the two most important fronts we
need to make progress. The mechanics of an MRI is very complex, and yet, due
to way it was implemented, it is a practical, useful clinical tool. The
implementation of the very complex solution is designed so that without
knowing anything about the underlying mechanics, it can be used.

Clinicians and developers need tooling to take control of complex concepts,
and not having enough tooling is leading to lots and lots of angels and
pinheads type of discussions. The chain of problems go like this: not enough
tooling -> not enough implementation -> not enough understanding & feedback
-> lots and lots of hypothetical discussions.

So if (at least according to me) the biggest problem is tooling, why not
build the tools and solve the problem? Because no one is paying for it.
Whatever we have out there in terms of actual tools and implemenation is
mostly out there thanks to good intentions and hard work of people. I've
opened up the code I'm writing for my PhD, Ocean, Zilics, and people Rong
Chen and Tim Cook are doing the same, but with limited resources it is hard
to trigger a mass adoption.

We are moving forward, no doubt, but people staying up in the middle of the
night are usually paying the steepest price, and the most interesting thing
in all this is that the expectations are huge. Please do not get me wrong,
I'm not saying this in response to your analysis, but most of the time, when
people encounter openEHR, they are amazingly expecting a piece of software
to install, which will deliver everything openEHR can deliver, out of the
box. And of course they want it to be open source. When they can't find
this, they say it is not there yet. I think this is also related to
education; personally I think that we need to stop people from having
unrealistic expectations, and clearly explain what the offer is, and what it
takes to turn that offer into value added.

Anyway, this is a big topic, and I can't put everything I have in my mind
into one e-mail. Still wanted to say these bits. BTW, I've written about
openEHR almost two years ago, trying to explain it to novice, though my own
understanding at the time was not very clear.
http://www.serefarikan.com/?p=97 may be of help, next time you're trying to
describe what it is, at least some of it.

Best Regards
Seref


2010/11/2 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 improvemen

Why is OpenEHR adoption so slow?

[Dr Lavanian]

Dear All,
I think Pablo has a very pertinent point. Theory and armchair discussions are 
good, but applicability in real life situations, and painlessly, is the need of 
the hour. 
If I were an implementor I would need a (no nonsense) 'openEHR for dummies', an 
SDK, sample code, a ready out-of-the-box installation with all the components 
in place (probably in ISO format) and a HUGE FAQ.

End of the day, what a guy need for his requirement - is what he actually need 
- nothing more, nothing less.

I am sure, somewhere in the www, many of these components do exist. Now it 
would be nice if we could get it all together on a single page.

With warm regards,

Dr D Lavanian
MBBS,MD
CEO and MD
HCIT Consultant
www.hcitconsultant.com

Certified HL7 Specialist
Member- American Medical Informatics Association
Member HIMSS
Senior Consultant and Domain Expert - Healthcare Informatics and TeleHealth

Former Vice President - Healthcare Products, Bilcare Ltd
Former Vice President - Software Division, AxSys Healthtech Ltd
Former Co-convener Sub committee on Standards , Governmental Task force for 
Telemedicine
Former Vice President - Telemedicine (Technical), Apollo Hospitals Group
Former Deputy Director Medical Services, Indian Air Force
Office: +91 20 32345045
Mobile: +91-9970921266
  - Original Message - 
  From: pablo pazos 
  To: openehr implementers2 ; openehr implementers ; openehr clinical ; openehr 
clinical ; openehr technical chime 
  Sent: Tuesday, November 02, 2010 9:36 AM
  Subject: Why is OpenEHR adoption so slow?


  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 the 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 d

Why is OpenEHR adoption so slow?

[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 the 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 o