Re: [Hardhats] Re: [openhealth] Announcing Liberty Medical Software Foundation and a petition in support of the current VistA as Utility act

[David Forslund]

I agree.  It is better and should keep the lawyers at bay.

Dave
fred trotter wrote:
>
>
> Ok... I will call that a consensus and we will change the name!!
>
> -FT
>
> On Mon, May 11, 2009 at 8:23 AM, Elwell, Tim  <mailto:Tim.Elwell%40misys.com>> wrote:
>
> >
> > I believe 'health' is more appropriate as well.
> >
> > Tim Elwell
> >
> > -Original Message-
> > From: open-ehealth-collaborat...@googlegroups.com 
> <mailto:open-ehealth-collaborative%40googlegroups.com> [mailto:
> > open-ehealth-collaborat...@googlegroups.com 
> <mailto:open-ehealth-collaborative%40googlegroups.com>] On Behalf Of 
> fred trotter
> > Sent: Sunday, May 10, 2009 9:30 PM
> > To: open-ehealth-collaborat...@googlegroups.com 
> <mailto:open-ehealth-collaborative%40googlegroups.com>
> > Cc: hardh...@googlegroups.com <mailto:hardhats%40googlegroups.com>; 
> openhealth@yahoogroups.com <mailto:openhealth%40yahoogroups.com>
> > Subject: Re: [Hardhats] Re: [openhealth] Announcing Liberty Medical
> > Software Foundation and a petition in support of the current VistA as
> > Utility act
> >
> >
> > If there is a broad consensus that 'Health' is a more appropriate
> > name, then I will change the name. I have registered LibertyHSF.org
> > for that purpose.
> >
> > Anyone care to add an opinion?
> >
> > -FT
> >
> > On Sun, May 10, 2009 at 7:05 PM, Edmund Billings
> >  <mailto:edmund.billings%40medsphere.com>> wrote:
> > > Health is broader and may be more appropriate than Medical...
> > >
> > > Medical connotes physician centered care which is just part of the
> > solutions.
> > >
> > > Edmund
> > > ___
> > > Edmund Billings MD
> > > Chief Medical Officer
> > > Medsphere
> > > 1917 Palomar Oaks Way
> > > Suite 200
> > > Carlsbad, CA 92008
> > > 760.692.3700 office
> > > 415.505.8953 cell
> > > www.medsphere.com
> > >
> > > "Transforming Healthcare through Open Source"
> > > 
> > > From: hardh...@googlegroups.com 
> <mailto:Hardhats%40googlegroups.com> [hardh...@googlegroups.com 
> <mailto:Hardhats%40googlegroups.com>] On Behalf Of
> > fred trotter [fred.trot...@gmail.com <mailto:fred.trotter%40gmail.com>]
> > > Sent: Sunday, May 10, 2009 12:59 PM
> > > To: openhealth@yahoogroups.com <mailto:openhealth%40yahoogroups.com>
> > > Cc: open-ehealth-collaborat...@googlegroups.com 
> <mailto:open-ehealth-collaborative%40googlegroups.com>;
> > hardh...@googlegroups.com <mailto:hardhats%40googlegroups.com>
> > > Subject: [Hardhats] Re: [openhealth] Announcing Liberty Medical 
> Software
> > Foundation and a petition in support of the current VistA as Utility act
> > >
> > > This is unlikely to be a problem if we simply consistently refer to
> > > the organization as either
> > >
> > > 'LibertyMSF' and/or
> > > 'Liberty Medical Software Foundation'
> > >
> > > please help me be referring to it that way. Once we have do that for a
> > > while, the distinction should become clear.
> > >
> > > -FT
> > >
> > > On Sat, May 9, 2009 at 9:42 AM, David Forslund  <mailto:forslund%40mail.com>>
> > wrote:
> > >> My only concern about this proposal is that there is a company 
> with the
> > >> name Liberty Medical out there (http://www.libertymedical.com 
> <http://www.libertymedical.com>). That
> > >> might create some confusion as well as some legal issues, but 
> then I'm
> > >> no lawyer. (in fact, when I saw the title of the email, I initially
> > >> thought it was something connected with that company, which does 
> a lot
> > >> of advertising on TV).
> > >>
> > >> Dave Forslund
> > >>
> > >>
> > >> fred trotter wrote:
> > >>>
> > >>>
> > >>> Hi,
> > >>> At the behest of many of the vendors and individuals within
> > >>> the community, we are now announcing the creation of the Liberty
> > >>> Medical Software Foundation.
> > >>>
> > >>> http://libertymsf.org <http://libertymsf.org> 
> <http://libertymsf.org <http://libertymsf.org>>
> > >>>
> > >>> This organization will exist to 

Re: [openhealth] Announcing Liberty Medical Software Foundation and a petition in support of the current VistA as Utility act

[David Forslund]

My only concern about this proposal is that there is a company with the 
name Liberty Medical out there (http://www.libertymedical.com).  That 
might create some confusion as well as some legal issues, but then I'm 
no lawyer. (in fact, when I saw the title of the email, I initially 
thought it was something connected with that company, which does a lot 
of advertising on TV).

Dave Forslund


fred trotter wrote:
>
>
> Hi,
>  At the behest of many of the vendors and individuals within
> the community, we are now announcing the creation of the Liberty
> Medical Software Foundation.
>
> http://libertymsf.org 
>
>  This organization will exist to be our HIMSS, our EHR vendor
> association and, if needed, our CCHIT. It is intended to serve both
> the needs of the FOSS vendor community, and the community of
> individual developers and clinical users of FOSS EHR software. It is
> intended to be a place where FOSS companies like Medsphere or
> ClearHealth can sit at the same table with FOSS friendly proprietary
> companies like Misys and DSS! This is intended to be a place where a
> single developer from OpenEMR will be shown the same deference and
> respect as the CEO of IBM.
>
> We cannot afford an Open Source vs. Free Software divide in
> our community. That is the reason we chose the term 'Liberty' for our
> name. Openness is good, but it is not enough, we need freedom. But we
> cannot go around having the conversation:
> "When I say Free, I do not mean what you hope it means. You hope it
> means costless. In fact I plan to charge quite allot of money for this
> free stuff, but you will have freedom when I am done. Of course it is
> -often- true that when I say free I mean that you can just download it
> off sourceforge for no cost. So I mean 'Free-as-in-freedom' and
> 'free-as-in-beer' at different points in this conversation and you
> are expected to keep up based on context clues."
>
> The vendors are going to have trouble trying to sell 'free' stuff no
> matter how you cut it. Also, even if we wanted to use Open, everyone
> and their dog has an organization that begins with 'Open' I can rattle
> off seven without thinking hard. When we previously discussed starting
> something like this using the term 'Free' people got pretty huffy.
>
> Liberty is the compromise. You might be paying millions for the
> deployment of software that you can download from sourceforge for no
> cost, and that is OK but what you need to have is 'Liberty'. I hope
> everyone is as please with this compromise as I am. We will be
> announcing membership and leadership shortly, but you can be assured
> the usual suspects will be involved or at least invited.
>
> Our first project, and the reason that we are unveiling this now, is
> to activate the community in support of the Health IT Public Utility
> Act of 2009.
>
> We have created a petition that we will be submitting to generously to
> congressional representatives. (Just go to our homepage) Note that we
> specifically choose a petition engine that allows you to sign with
> comments, and those comments will be passed along as slightly modified
> petitions. Essentially this is a way for you to both sign a letter to
> Congress, and also send an individual note, with LibertyMSF doing most
> of the grunt work. (Note: Dr. Billings did much of the content of the
> petition in his letter published here earlier)
>
> Most importantly, you can forward the petition to your email contacts,
> or your favorite social network. If you are reading this, and you
> agree with the basic principles outlined in the legislation, please
> take it upon yourself to get ten people you know who are not in this
> community to sign the petition.
>
> I want to be clear: The only thing this community has going for it
> politically is being right. The profit margins of the average large
> proprietary EHR vendor will always dwarf the resources of even our
> largest vendors. They can always leverage their vendor lock-in to
> force more and more money out of their customers. We simply cannot
> compete with their lobbying dollars. We have to organize and mobilize.
> We need to reach out to the larger FOSS movement. We need to get out
> local Linux Users Groups or Python users group or PHP or whatever,
> aware of the basic tenants of our argument. We need to reach many,
> many more doctors. We need to get nurses involved.
>
> VistA has proven that the only way to solve the problem of healthcare
> automation is through the use of collaborative development that is
> only possible inside the VA with a single shared employer who owns
> everything or the use of FOSS licenses outside the VA.
>
> Please also signup for an account on LibertyMSF.org so that we can get
> ahold of you. We do not have direct access to the details of petition
> signers. Please email me personally if you are interested in fomenting
> a local chapter of LibertyMSF in your area or something like...
>
> R

Re: [openhealth] Experimental OSHCA catalogue of FOSS application for health and healthcare

[David Forslund]

Tim Cook wrote:
> David Forslund wrote:
>
>   
>> OpenEMed should certainly show up in the list of healthcare software
>> applications.
>> I have no idea of how to do this with JSON, particularly, since I see no
>> mention of any JSON
>> links on the referenced web pages.
>>
>> Thanks,
>>
>> Dave
>> 
>
>   
This is a big help.   I'll check it out.  I saw the link for trial 
SIMILE Exhibit, but had no idea what that was or what the Data file was 
about.  What is SIMILE?  Isn't the FOSS Health Applications link showing 
some of the same data? 

Thanks,

Dave
> Dave,
>
> It's the one that says:
>
>  Data file for trial SIMILE Exhibit listing
>  In JSON format
>
> and points to here:
> http://www.oshca.org/healthdir/foss_health.js
>
>
>
> Regards,
> Tim
>
>
>
>
>   

Re: [openhealth] Experimental OSHCA catalogue of FOSS application for health and healthcare

[David Forslund]

The link for OpenEMed would better point to OpenEMed.org rather than 
OpenEMed.net. 
Also, I don't see any link to JSON data.  OpenEMed should be listed as a 
application framework,
not as a standard.  It implements a set of standards, but isn't a 
standard in its own right.  Also
CORBAmed should be listed as the OMG Healthcare DTF and simply to 
http://healthcare.omg.org.
The link you have is way outdated.  I would also link to the 
hssp.wikispaces.com link for current
healthcare standard efforts. 

OpenEMed should certainly show up in the list of healthcare software 
applications.
I have no idea of how to do this with JSON, particularly, since I see no 
mention of any JSON
links on the referenced web pages. 

Thanks,

Dave


Tim Churches wrote:
> I have quickly put together an experimental OSHCA catalogue of FOSS
> application for health and healthcare, using The MIT SIMILE Semantic Web
> research lab's fabulous Exhibit and Timeline products (open source of
> course).
>
> See http://www.oshca.org/healthdir/
>
> If you would like to add other free, open-source health applications or
> projects, or edit any of the existing data, please see the JSON data
> file also listed on that page. Edit the relevant section or copy a
> section and edit it to reflect your application, and email me just that
> section - just pasted intot he body of an email message will do, doesn't
> have to be an attachment. Eventually an online catalogue maintenance
> facility can be built (volunteers welcome), but for now hand editing of
> the JSON file (by me or volunteers) will have to do. Feel free to add
> new data fields if you edit the data file.
>
> Tim C
>
>
>   

Re: [openhealth] Suppressing Sensitive Info From Free Text

[David Forslund]

If one uses a structured report along the lines of the ASTM CCR, then
I think it would be "relatively" easy to remove the sensitive information,
since all of the data would be tagged.  

Dave
Nandalal Gunaratne wrote:
> Will,
>
> It is not a good idea to have sensitive information in
> free text. If you do, it should not go to  "general
> circulation", right?
>
> How can one extract such info from free text? One way
> is to remove such words from free text files using a
> macro of some sort. "FInd and replace" can be used to
> remove words like HIV with a blank?
>
> There cannot be an automated solution to this, unless
> it is cutting edge! ( ..or so we like to think to
> cover our ignorance!)
>
> I wonder if we have adequate knowledge as to what
> constitutes "sensitive information" to patients. A
> good study is needed
>
>
> Nandalal
>
>
>
>
> --- Fred Trotter <[EMAIL PROTECTED]> wrote:
>
>   
>> Will,
>>  I am confused too. Wouldnt such a
>> technology have to be turning
>> test capable? Are you looking for something that can
>> search Free Text make a
>> determination if it is related to HIV, and then
>> catagorize the whole text as
>> "related to HIV"? Or are you looking for something
>> that is capable of
>> allowing the rest of the note to pass through, and
>> only eliminate the
>> portions relating to HIV. (which seems much harder).
>>
>> Could you give an example of how your application
>> might work?
>>
>> -FT
>>
>> On 3/2/07, Will Ross <[EMAIL PROTECTED]> wrote:
>> 
>>> I'm looking for a tool to suppress sensitive
>>>   
>> information (e.g., HIV
>> 
>>> status, etc.) from free text clinical notes prior
>>>   
>> to allowing the
>> 
>>> notes to be published from a protected,
>>>   
>> physician-only area into
>> 
>>> general circulation patient records for the
>>>   
>> clinic.   What existing
>> 
>>> FOSS solutions are available?
>>>
>>> With best regards,
>>>
>>> [wr]
>>>
>>> - - - - - - - -
>>>
>>> will ross
>>> chief information officer
>>> mendocino health records exchange
>>> 216 west perkins street, suite 206
>>> ukiah, california  95482  usa
>>> 707.462.6369 [office]
>>> 707.462.5015 [fax]
>>> www.mendocinohre.org
>>>
>>> - - - - - - - -
>>>
>>> "Getting people to adopt common standards is
>>>   
>> impeded by patents."
>> 
>>>  Sir Tim Berners-Lee,  BCS,  2006
>>>
>>> - - - - - - - -
>>>
>>>
>>>
>>>
>>>
>>>
>>> Yahoo! Groups Links
>>>
>>>
>>>
>>>
>>>   
>> -- 
>> Fred Trotter
>> http://www.fredtrotter.com
>>
>>
>> 
>   

Re: [openhealth] Suppressing Sensitive Info From Free Text

[David Forslund]

That is the reason for the patient consent in the HIPAA regulations.  In 
my opinion, the
patient would need to review the data to approve its release.  The usual 
escape clause
is for the data to be used in the normal care of the patient  But if it 
is for some
other purpose, then it needs specific patient consent.   But a local 
HIPAA board
should be able to provide more precise guidance.   The general accurate 
suppression
of sensitive information would seem to me to be impossible.

Dave
80n wrote:
> Will
> The only acceptable answer would be Maury's option 3.  The patient decides.
> Anything else would be be inappropriate.
>
> And not just HIV status.  The patient, and only the patient, should have the
> right to determine who has access to anything that the patient might
> consider sensitive.   And only the patient can determine what is or is not
> sensitive.
>
> 80n
>
>
>
> On 3/2/07, Will Ross <[EMAIL PROTECTED]> wrote:
>   
>>   I'm looking for a tool to suppress sensitive information (e.g., HIV
>> status, etc.) from free text clinical notes prior to allowing the
>> notes to be published from a protected, physician-only area into
>> general circulation patient records for the clinic. What existing
>> FOSS solutions are available?
>>
>> With best regards,
>>
>> [wr]
>>
>> - - - - - - - -
>>
>> will ross
>> chief information officer
>> mendocino health records exchange
>> 216 west perkins street, suite 206
>> ukiah, california 95482 usa
>> 707.462.6369 [office]
>> 707.462.5015 [fax]
>> www.mendocinohre.org
>>
>> - - - - - - - -
>>
>> "Getting people to adopt common standards is impeded by patents."
>> Sir Tim Berners-Lee, BCS, 2006
>>
>> - - - - - - - -
>>
>>  
>>
>> 
>
>   

Re: [openhealth] Suppressing Sensitive Info From Free Text

[David Forslund]

Agreed.  Such an action would at least have to have approval of a local 
HIPAA board.
How would one "prove" it is reliable at removing protected information? 
If it is
an algorithm, the algorithm would need local approval.

Dave
Maury Pepper wrote:
> 
> 1. How good does it have to be?  Is 5% leakage of "sensitive information" OK?
> 2. Another view: ALL of the information is "sensitive".
> 3. Another view: The patient MUST have input as to who can see what.
> 
>
>
>
>   - Original Message - 
>   From: Will Ross 
>   To: openhealth@yahoogroups.com 
>   Sent: Friday, March 02, 2007 10:58 AM
>   Subject: [openhealth] Suppressing Sensitive Info From Free Text
>
>
>   I'm looking for a tool to suppress sensitive information (e.g., HIV 
>   status, etc.) from free text clinical notes prior to allowing the 
>   notes to be published from a protected, physician-only area into 
>   general circulation patient records for the clinic. What existing 
>   FOSS solutions are available?
>
>   With best regards,
>
>   [wr]
>
>   - - - - - - - -
>
>   will ross
>   chief information officer
>   mendocino health records exchange
>   216 west perkins street, suite 206
>   ukiah, california 95482 usa
>   707.462.6369 [office]
>   707.462.5015 [fax]
>   www.mendocinohre.org
>
>   - - - - - - - -
>
>   "Getting people to adopt common standards is impeded by patents."
>   Sir Tim Berners-Lee, BCS, 2006
>
>   - - - - - - - -
>
>   

Re: Holding the Vision While Achieving Practical Integration/Interoperability Today (was) Re: [openhealth] Re: Hi folks..

[David Forslund]

Tim Churches wrote:
> David Forslund wrote:
>   
>> Joseph Dal Molin wrote:
>> 
>>> Open source efforts/software like OpenMRS, WorldVistA (VistA Office 
>>> etc.), OSCAR etc. that are focused on diffusion/uptake and continuous 
>>> improvement. All need to have practical tools methods etc. to work 
>>> effectively in the heterogeneous health IT ecosystem. Building on Tim's 
>>> view:
>>>
>>>  >> I believe that with a modest upfront investment one can go a long way
>>>  >> toward interoperability.  The
>>>  >> open source community should be leading in this area, because of the
>>>  >> increased cooperation.
>>>
>>> What would that modest investment be? Who would be willing to 
>>> collaborate to make it happen? How does a practical approach dance 
>>> effectively with and benefit from the vision/work of the 
>>> "interoperability" expert community?  How can we leverage the OSHCA 
>>> meeting in May to help the open source health community take the 
>>> leadership role?
>>>
>>>
>>> Joseph
>>>   
>>>   
>> The above quote was from me, not Tim.  I don't know if he has the same 
>> view or not.
>> 
>
> I am not in any way antithetical to investing effort in
> interoperability. However, I do not regard it as an end in itself. The
> goal of open source health informatics must always be to improve the
> health and health care of people. If widespread and ongoing
> interoperability is important, in a given setting or sub-domain, to
> achieving those goals, then lots of effort should be put into
> implementing highly generalised, standards-based interoperability. If
> only limited intraoperability between, say, a few clinics all running
> the same software is required, then I believe it is perfectly
> permissible to take shortcuts and go for easier-to-implement
> non-standard interoperability mechanisms, particularly when software
> development resources are tight, as they almost always are in open
> source projects. And if interoperability is just not needed, then there
> is no point building it in. All these views are modified by the level of
> resources and the expected longevity of the software. If millions of
> dollars and tens or hundreds of person-years are being ploughed into a
> project, then it would be silly not to consider standards-based
> interoperability right from the start. But if, like most open source
> projects, the budget ranges from zero to a few hundred thousand dollars,
> and a few person-years of effort or less is involved, then a more zen
> approach can be taken - regard the software as ephemeral, to be evolved
> or recreated on a regular basis, perhaps even every year or so. In that
> case, the failure to build in complex, standards=based interoperability
> at the early stages is not such a disaster, even if it is needed later.
> Better to get the project up on its feet first.
>
>   
I don't think that interoperability is that costly to consider up 
front.  The design process that
even the smallest project can easily consider it.  It may well reject 
it, but the principles
of interoperability are important so that the cost of including it in 
the future can be anticipated. 
How one separates modules or components which can facilitate 
interoperability can also lower
the cost of development even for small open source projects.  I submit 
that exchanging and integrating
medical records is an important consideration even if not fully 
implemented at the moment.  The
cost later may require completely rewriting/replacing/converting the old 
system to a new one.
Interoperability certainly isn't the major driver, but should be at 
least considered up front. 
>   
>> The "modest
>> investment" is in the design of a system up front.  It always saves time 
>> to go through a design process
>> rather than just start coding.  The design process involves 
>> understanding and documenting the underlying
>> abstractions of the process.  This can lead to well-designed interfaces 
>> which properly divide up the labor involved
>> more efficient development.  It is at this point that one reviews the 
>> literature to see how well the interfaces
>> match to existing standards or systems.
>> 
>
> I agree with this to a degree, although I am utterly convinced that the
> traditional "waterfall" methods of designing everything on paper or as
> thought-experiments, encoding that in written specs, and then slavishly
> implementing those specs, is completely broken (yet I still see it used
> all the time for software projects

Re: Holding the Vision While Achieving Practical Integration/Interoperability Today (was) Re: [openhealth] Re: Hi folks..

[David Forslund]

Joseph Dal Molin wrote:
> Open source efforts/software like OpenMRS, WorldVistA (VistA Office 
> etc.), OSCAR etc. that are focused on diffusion/uptake and continuous 
> improvement. All need to have practical tools methods etc. to work 
> effectively in the heterogeneous health IT ecosystem. Building on Tim's 
> view:
>
>  >> I believe that with a modest upfront investment one can go a long way
>  >> toward interoperability.  The
>  >> open source community should be leading in this area, because of the
>  >> increased cooperation.
>
> What would that modest investment be? Who would be willing to 
> collaborate to make it happen? How does a practical approach dance 
> effectively with and benefit from the vision/work of the 
> "interoperability" expert community?  How can we leverage the OSHCA 
> meeting in May to help the open source health community take the 
> leadership role?
>
>
> Joseph
>   
The above quote was from me, not Tim.  I don't know if he has the same 
view or not.  The "modest
investment" is in the design of a system up front.  It always saves time 
to go through a design process
rather than just start coding.  The design process involves 
understanding and documenting the underlying
abstractions of the process.  This can lead to well-designed interfaces 
which properly divide up the labor involved
more efficient development.  It is at this point that one reviews the 
literature to see how well the interfaces
match to existing standards or systems.   The collaboration could be in 
the sharing of the design processes
involved in the software development.   Get someone from the HSSP 
community to discuss the interoperability
vision and its impact.   I don't know how this can take advantage of the 
upcoming OSHCA meeting, since it is far beyond
my means or time to attend the meeting that far away. 

Dave
>
> Will Ross wrote:
>   
>> What a wonderful discussion.   I am so glad to have Regenstrief's  
>> OpenMRS at the table!   I also know there are other lurkers out there  
>> (you know who you are!) who can add to the robust discussion.  But my  
>> purpose here is to highlight one point.   Paul, Dave and Tim have all  
>> mentioned not allowing the pursuit of "perfect" semantic  
>> interoperability to interfere with simple incremental improvements  
>> that can be realized immediately.   This is in fact one of the  
>> hallmarks of the decades of dramatic real-world demonstrations that  
>> Regenstrief has brought to central Indiana.   And it is the central  
>> tenet of the Connecting For Health (USA version) effort to make  
>> records portable and electronic without requiring a rip and replace  
>> changeout of all legacy health record systems.   And it was one of  
>> the key points in Andy Grove's "Shift Left" address at Stanford this  
>> past november.
>>
>>http://news-service.stanford.edu/news/2006/november8/med- 
>> grove-110806.html
>>
>> But we all know this is a marathon, not a sprint.   This year's TEPR  
>> conference is the 23rd annual meeting devoted to the immanent  
>> transition from paper to digital charting.
>>
>>http://www.medrecinst.com/conference/tepr/index.asp
>>
>> Meanwhile, in my rural region of California, 2007 may be the year we  
>> see adoption of EHR rise above 10% among small practices.   The  
>> arrival of new FOSS projects like OpenMRS can only help improve our  
>> rate of adoption.
>>
>> With best regards,
>>
>> [wr]
>>
>> - - - - - - - -
>>
>> On Feb 17, 2007, at 9:24 PM, David Forslund wrote:
>>
>> 
>>> Tim Churches wrote:
>>>   
>>>> David Forslund wrote:
>>>>
>>>> 
>>>>> I've seen no real
>>>>> effort in the open source community to embrace interoperability.
>>>>> Certainly interoperability has
>>>>> been opposed by much of industry until recently, but there is no  
>>>>> good
>>>>> reason for the open source community to not embrace it.
>>>>>
>>>>>   
>>>> Dave, interoperability, although good in theory, is not an end in
>>>> itself. Thus you have to ask the question: in the settings in  
>>>> which open
>>>> source health information systems are or are likely to be  
>>>> deployed, what
>>>> are the "business drivers" or the "business case" for  
>>>> interoperability,
>>>> and what sort of interoperability?
>>>>
>>&

Re: [openhealth] Re: Hi folks..

[David Forslund]

Paul wrote:
> Dave,
>
> Thanks for your thoughts.  These discussions can get religious fairly
> quickly, so I'll just say that the bottom line for us is a simple one:
>  we're supporting an open-source collaboration less to meet/support
> longstanding specifications that have fairly low uptake to this point,
> and more to create economies of scale in our work.  We don't have the
> luxury of time when it comes to HIV care in Africa/developing world. 
> If there were tangible reasons to work within these frameworks (ie, we
> could insert functionalities into OpenMRS, bring on a team of new
> developers, etc), then we'd certainly consider any possibility. 
> However, it seems like a trap to spend time building on top of specs
> for the sake of doing the "right thing".
>   
>   
>> People may not agree with the COAS effort of the OMG, but this was
>> exactly its goal and I believe it achieved it.  It provides an 
>> underlying basic support for interoperability of medical records.  It
>> doesn't provide all the business logic for healthcare which isn't
>> required for interoperability.
>> 
>
> I personally love efforts like the COAS.  Intellectually sound, gives
> me ideas, etc.  I think it starts to falter as a starting point of
> work though, b/c of the lack of critical code mass around it.  That
> combined with the extra inertia involved in following the spec place
> it in the position it's in now.  We are focused on giving people
> something to touch and feel first and foremost, which compels them to
> understand the underbelly of how we got there, as they inevitably want
> to extend the functionality to meet their specific needs.  Another
> heart and mind won over in the process. :) 
>   
>   
>> Messaging is fine, although using HL7 for interoperability has its
>> issues.   I think a service oriented approach is much more powerful and 
>> provides a stronger layer of interoperability.  It is this approach that
>> is being used in the HSSP effort: http://hssp.wikispaces.org as a joint
>> effort of HL7 and the OMG. To vastly oversimplify it, the HSSP
>> 
> effort is 
>   
>> taking the PIDS/COAS specifications and updating them to the current 
>> popular technologies.  There are RFP's out there that people could join 
>> in to help set these standards.
>> 
>
> I follow the HSSP work.  In particular, the DSS initiative.
>   
>   
>> I should mention that federation with COAS/PIDS was designed in from the
>> beginning and has been
>> demonstrated for quite some time now. The implementation of COAS that
>> OpenEMed has includes
>> the capability of having dynamic data collection without changing the
>> underlying database schema.
>> The key issue in federation is to be able to federate across
>> heterogeneous systems that all utilize
>> an interoperable set of interfaces.  PIDS/COAS can be significantly
>> improved on (and will be shortly), but
>> they provide an excellent example of how to go about this and shouldn't
>> be ignored.
>> 
>
> I'll take a look at OpenEMed.  I assume this is your work? :)  I work
> during my day job, amongst a very large federated repository called
> the Indiana Network for Patient Care (INPC), which stores well over
> 1.2 billion observations for over 2 million patients.  We actually
> have aggregated a majority of all inpatient data for the metropolitan
> Indianapolis area through a federated, centralized approach which
> shadows hospital EMRs into their own standardized database located at
> Regenstrief.  These shadow repositories are aggregated through a
> master provider and master patient index.  It's been our experience
> thus far, that what's really necessary is less code interoperability
> and a greater focus on data interoperability.  Differing sites have
> differing functionalities and clinical workflows.  Therefore we're not
> too sure that inertia needs to be spent upon making sure that higher
> level system functions are synchronized.  Who knows though, we might
> be making a big mistake. :)
>
> Best,
> -Paul
>
>   
I understand and appreciate your viewpoint.   Good specifications can 
enable the differing functionalities
and workflow and still support interoperability.  I think more than data 
interoperability is important.
A common Service Oriented Architecture adds significant value and can 
reduce the cost of data interchange.
Some common functionality required by most is an MPI or an Entity 
Identification Service.  This is critical
when moving between providers.   A record locator service follows right 
after this.  Much has been done
in this area.   It would be good to see this community contribute to the 
larger community in this area.  OpenEMed
has been around quite awhile.  It is probably too late for OpenMRS to 
look at it.  It might have been useful
to look at OpenEMed when OpenMRS was started up.

Dave

Re: [openhealth] Re: Hi folks..

[David Forslund]

Tim Churches wrote:
> David Forslund wrote:
>   
>> I've seen no real
>> effort in the open source community to embrace interoperability.   
>> Certainly interoperability has
>> been opposed by much of industry until recently, but there is no good 
>> reason for the open source community to not embrace it. 
>> 
>
> Dave, interoperability, although good in theory, is not an end in
> itself. Thus you have to ask the question: in the settings in which open
> source health information systems are or are likely to be deployed, what
> are the "business drivers" or the "business case" for interoperability,
> and what sort of interoperability?
>
> Thus, although there is indeed no good reason not to embrace
> interoperability, there may be, in many open source deployment settings,
> no good reason to embrace it, either, given that supporting
> interoperability is not without some cost.
>   
I agree with you, with a caveat.  If you plan for interoperability, the 
cost isn't very high. Adding it
later is much more expensive.  For the patient, the value of 
interoperability is very high.  Clearly
for implementers, the demand for interoperability is not high since it 
might take away from the
local business model. 
> For example, the COAS specs document is 260 pages long, but if you go to
> the "Interoperation" chapter in it, it refers you to four other CORBA
> specifications, each also several hundred pages long, which need to be
> assimilated first. So that's a thousand pages. And that's even before
> one works out how to implement all this. That's the cost. So unless
> there are strong reasons to do this, in the always-resource-constrained
> world of open source development, it is no wonder it is hardly ever
> implemented.
>   
Have you tried to read WS-Services documentation?  It is far more 
complex than the CORBA specs.
Clearly the OMG specs requires an implementer to understand something 
about CORBA and IDL,
but these have been available in book stores for years and there are 
numerous free implementations
around with voluminous tutorials. The discipline of having well-defined 
interfaces between services
is well worth the time invested to understand them.  You don't have to 
read all of CORBA to understand
the value of COAS.  The UML models contained should go a long way to 
helping you see the value
of the approach and adopting some of the interface principles which 
would make the implementation
of interoperability much easier in the future.  And there are 
implementations that can be studied.
>   
>> Sending HL7 messages over SMTP encrypted email is  a wonderful idea for
>> someone who is trying to get the most amount of money for support from a 
>> customer, but has little to do with building truly distributed systems.
>> 
>
> Tell that to the people using encrypted SMTP mail. I suppose it means
> what one means by "truly distributed systems".
>   
Of course.  I'm speaking of a system that supports the ability to be 
viewed as a "single" system distributed
over a network of machines.  P2P is far from a "single" system image.
>   
>> I think that one should avoid asynchronous, time-delayed coordination of 
>> updates to the same record in multiple locations.  What we have done 
>> in COAS is to basically  provide versioning of a record so
>> that all versions are available.
>> 
>
> That skirts the issue of coming up with the currently definitive version
> of a record for analysis purposes, but doesn't solve it. Which version
> should be used when analysing the data?
>   
There obviously is no way of telling this.  This depends on how it is 
used and the type of analysis.
One might want to analyze what changes have occurred in the record for 
audit purposes.  Typically
one is only interested in the latest version of a record.   If you want 
an algorithm to create a "new"
version of a record based on previous versions, this could be done, but 
I don't believe there is
one good solution to this problem.
>   
>> The B-Safer web application in  OpenEMed was used in a
>> distributed environment.  We had very heterogeneous feeds (available in 
>> the clients/translate directory) from  a variety of data sources 
>> (no two alike).   Users of  the data had views that
>> were potentially different for each site. 
>> 
>
> Differing views are what need to be avoided (at least eventually, when
> all nodes in a network have caught up with each other).
>   
Not necessarily.  The different views in our case were driven by the 
security requirements of not
being able to see other participants data except in the aggregate.  In 
the GCPR project the vi

Re: [openhealth] Re: Hi folks..

[David Forslund]

is being used in the HSSP effort: http://hssp.wikispaces.org as a joint
effort of HL7 and the OMG. To vastly oversimplify it, the HSSP effort is 
taking the PIDS/COAS specifications and updating them to the current 
popular technologies.  There are RFP's out there that people could join 
in to help set these standards.
>   
>> Those who want to
>> extend our code functionality will be able to do so through "modules"
>> which are code extensions ala Firefox.
>>
>> Federation is rising higher on our lists as an important feature of
>> the platform.  People are needing this functionality within
>> implementations.   From our perspective, the secret sauce to make that
>> happen is robust person matching algorithms between systems, as we
>> already have the capability to link OpenMRS medical concepts to
>> standardized vocabularies.  That being said, we are in the planning
>> stages (as of literally the past 3-4 weeks) to add statistical
>> matching algorithm functionality to our framework.  Some of my
>> colleagues @ Regenstrief have a lot of experience in that space, and
>> are interested in adding that to our code base.  So stay tuned, but as
>> it stands right now, federation could be achieved if MPI functionality
>> was in place.
>> 
>
>   
I should mention that federation with COAS/PIDS was designed in from the
beginning and has been
demonstrated for quite some time now. The implementation of COAS that
OpenEMed has includes
the capability of having dynamic data collection without changing the
underlying database schema.
The key issue in federation is to be able to federate across
heterogeneous systems that all utilize
an interoperable set of interfaces.  PIDS/COAS can be significantly
improved on (and will be shortly), but
they provide an excellent example of how to go about this and shouldn't
be ignored.
> Yes, we also see federation as a key issue. Basically, we think that
> NetEpi needs to be able to operate as a multi-master federated database
> (i.e. any record can be created, edited or deleted on any node of the
> federation), but over potentially low-band and very low reliability
> network links (i.e. subject to frequent and prolonged network
> partition). Furthermore, all this needs to be tightly integrated into
> the application so that update conflicts can be handled nicely. The
> ability to dynamically evolve (on-the-fly) data collection forms and
> other aspects of the database schemas is also a large added
> complication. We have some ideas, proven in practice in other,
> non-health settings, about how to tackle these challenges, but think
> there is perhaps 6-12 person-months work in it to get it to
> production-ready stage - it is very complex. Would be happen to exchange
> ideas with members of the OpenMRS team on this.
>
> Finally, can someone from OpenMRS give a presentation atteh OSCHCA
> conference in Kuala Lumpur in may 2007? I suggested OpenMRS as a
> potential conference topic to the organising committee, and I am sure
> they would be delighted if someone could talk about it.
>
> Tim C
>   

Dave
>   
>> --- In openhealth@yahoogroups.com, David Forslund <[EMAIL PROTECTED]> wrote:
>> 
>>> Paul,
>>> I have a question as to the interoperability of OpenMRS.  At what
>>> level can or could it interoperate with other systems?  It seems to have
>>> its own API rather than some of the "standard" APIs out there.   This
>>> information says that OpenMRS isn't another "stovepipe", but only talks
>>> of how others can use it as a building block for their system.  It is 
>>> clearly
>>> open, but this alone doesn't mean that it is interoperable with other 
>>> existing
>>> systems.  In addition, can it be used in a "federated" environment where
>>> information is linked together from a variety of locations? 
>>>
>>> Thanks,
>>>
>>> Dave Forslund
>>>
>>> Paul wrote:
>>>   
>>>> I stumbled across this mailing list in my Google travels, and I
>>>> thought I'd drop a quick note to you all, as you seem like likely
>>>> allies in the type of work our group is fostering. I'm one of the
>>>> co-founders of the OpenMRS (http://www.openmrs.org 
>>>> <http://www.openmrs.org>) collaborative, and
>>>> we're always looking for folks interested in creating HIT
>>>> infrastructures for developing countries. Here's a quick overview of
>>>> our project:
>>>>
>>>> --
>>>>
>>>> I. What is OpenMRS?
>>>>

Re: [openhealth] Hi folks..

[David Forslund]

Paul,
I have a question as to the interoperability of OpenMRS.  At what
level can or could it interoperate with other systems?  It seems to have
its own API rather than some of the "standard" APIs out there.   This
information says that OpenMRS isn't another "stovepipe", but only talks
of how others can use it as a building block for their system.  It is 
clearly
open, but this alone doesn't mean that it is interoperable with other 
existing
systems.  In addition, can it be used in a "federated" environment where
information is linked together from a variety of locations? 

Thanks,

Dave Forslund

Paul wrote:
>
> I stumbled across this mailing list in my Google travels, and I
> thought I'd drop a quick note to you all, as you seem like likely
> allies in the type of work our group is fostering. I'm one of the
> co-founders of the OpenMRS (http://www.openmrs.org 
> ) collaborative, and
> we're always looking for folks interested in creating HIT
> infrastructures for developing countries. Here's a quick overview of
> our project:
>
> --
>
> I. What is OpenMRS?
> Our world continues to be ravaged by a pandemic of epic proportions,
> as over 40 million people are infected with or dying from HIV. The
> vast majority of these people (up to 95%) are in developing countries.
> The severity of this pandemic necessitates rapid, coordinated efforts
> toward HIV prevention and treatment which rely upon efficient
> information management. In 2004, researchers at the Regenstrief
> Institute (http://www.regenstrief.org ) 
> served as consultants to scale
> up a pre-existing MS Access®-based HIV management system within
> western Kenya. Their response was to begin the design and development
> of the AMPATH Medical Record System (AMRS).
>
> When work on this project began in earnest, the team investigated
> other "best of breed" solutions. It became clear that the
> overwhelming need for basic clinical data management (often to provide
> outcome data to funding agencies) along with the needs for rapid
> solutions in the face of limited technical resources typically led to
> disparate, "stovepipe" efforts which often stored computer
> uninterpretable clinical data that rarely scaled well in both size and
> functionality. To combat these common shortcomings, the AMRS team
> evolved their early work into a collaboration with Harvard's Partners
> In Health (PIH) initiative (http://www.pih.org ). 
> The product of this
> collaboration, OpenMRS (http://www.openmrs.org 
> ) represents an earnest
> attempt to create the foundation for collaborative medical record
> system development within developing countries, by serving as a common
> foundation and set of open-source "building blocks" from which
> fledgling implementations can begin constructing health information
> systems.
>
> II. Who is OpenMRS for?
> OpenMRS is for people that need to implement medical record systems.
> It is a scalable health-centric database design, a Java-based library
> of API calls to this schema, and a default implementation of those API
> calls in the form of a web application. It has also evolved a modular
> architecture which provides third party developers with a framework to
> customize extended functionality of this base architecture.
>
> III. How much does OpenMRS cost?
> OpenMRS is a free program, and the source is released under a close
> equivalent of the Mozilla Public License.
>
> IV. Where is OpenMRS being used?
> OpenMRS is currently implemented in Kenya, Rwanda, South Africa,
> Uganda, amd Tanzania. Further implementations are underway in multiple
> other locations throughout Africa through the work of such groups as
> the Millenium Village Project and FACES. Over nine million discrete
> observations have been collected for over 42,000 HIV patients with
> over 450,000 encounters within the AMPATH implementation in Kenya.
> The MRC team in South Africa is leading the effort to form an
> implementers group to aid in further implementations.
>
> V. Why should I use OpenMRS?
> At this stage, OpenMRS requires fairly sophisticated awareness of how
> to install and develop medical record systems. It is not a
> shrink-wrapped project, by design. However, teams in several
> developing countries are in various stages of implementing OpenMRS at
> this time. To serve less technically inclined future implementations,
> the collaborative is working toward a pre-built implementation that
> would allow more clinic sites to take advantage of a sophisticated,
> scalable system without needing the expertise to maintain and support
> and this work at low levels. OpenMRS is driven by a concept
> dictionary, allowing for the collection of coded, reusable data
> without requiring changes to the data model. Furthermore, OpenMRS has
> not been developed with exclusive notions of providing only HIV care,
> so it can be adapted for use in tuberculosis, malaria

Re: [openhealth] SCALE talk

[David Forslund]

The PIDS specification deals with this fairly well, in my opinion.
It is similar to naming issues in DNS.  It specifies that an identifier
must be unique in a domain, but this could be hospital lab, a hospital,
a regional care provider, a state or a nation.  It enables mapping
between identifiers for multiple identifiers for the same person.  This
is all spelled out in the spec originally published in 1998.   This is
likely to be expanded with the EIS specification now being
considered by the OMG (and HL7).

Dave
Nandalal Gunaratne wrote:
>
>
> --- David Forslund <[EMAIL PROTECTED] <mailto:forslund%40mail.com>> wrote:
> Thanks David. Please clarify the following for me:
>
> The MPI has to be global to be of any use, each human
> being being uniquely identified. To what layer/level
> the identification entities can be extended, maybe of
> concern to individuals and countries. WIll this affect
> the lobal application of unique identifiers?
>
> Nandalal
>
> > OpenEMed continues to be in modest development but
> > perhaps not visible at a higher level. The MPI work
> > is based on the OMG PIDS standard. It is open
> > source and has been so since 2000. The next
> > generation of PIDS will result from the current
> > EIS RFP from the OMG which is currently
> > soliciting responses. The EIS is a joint effort
> > of the OMG and HL7. We would like to provide
> > an implementation of EIS as part of OpenEMed and
> > are soliciting help in anyone interested in doing
> > so.
> >
> > Dave
> > Nandalal Gunaratne wrote:
> > >
> > > Hello Will,
> > >
> > > I do not see any MPI projects in the OpenHRE
> > except
> > > the description of four Patient-Data Matching
> > > Software.
> > >
> > > The OpenEMed project is somewhat dormant and did
> > not
> > > have a fully developed MPI software based on it's
> > > Person identification service. I am not sure if
> > during
> > > the aborted Phoenix project anything was done
> > regards
> > > the development of an MPI using OpenEMed, except
> > the
> > > Patient identification terminology service itself.
> > >
> > > Therfore your peoject maybe the first open-source
> > one,
> > > if it is used for this purpose in the future.
> > >
> > > Please correct me if I am wrong.
> > >
> > > Nandalal
> > > --- Will Ross <[EMAIL PROTECTED] <mailto:wross%40openhre.org>
> > <mailto:wross%40openhre.org>> wrote:
> > >
> > > > Hello World,
> > > >
> > > > Like Fred I'm also speaking at SCALE. During the
> > > > afternoon at SCALE
> > > > my presentation will discuss FOSS options for
> > MPI
> > > > solutions.
> > > > Here's my short list of open source MPI
> > projects:
> > > >
> > > > [1] OpenEMed
> > > > [2] OpenHRE
> > > >
> > > > If you know of any further FOSS options for MPI,
> > > > please send me links
> > > > to the MPI project(s). Also, Dr. Stuart Turner
> > and
> > > > I have launched
> > > > a small portal to persistently track FOSS
> > options
> > > > for MPI solutions.
> > > >
> > > > http://www.openempi.org/ <http://www.openempi.org/>
> > <http://www.openempi.org/ <http://www.openempi.org/>>
> > > >
> > > > All comments and suggestions are welcome.
> > > >
> > > > With best regards,
> > > >
> > > > [wr]
> > > >
> > > > - - - - - - - -
> > > > On Jan 11, 2007, at 7:31 AM, Fred Trotter wrote:
> > > >
> > > > > Hello OpenHealth,
> > > > > I hope you are all aware of the SCALE
> > > > healthcare day...
> > > > >
> > > > > http://www.socallinuxexpo.com/healthcare07/ 
> <http://www.socallinuxexpo.com/healthcare07/>
> > > <http://www.socallinuxexpo.com/healthcare07/ 
> <http://www.socallinuxexpo.com/healthcare07/>>
> > > > >
> > > > > If you can make it you should, the
> > > > speakers line up is
> > > > > full of
> > > > > real players in our industry.
> > > > >
> > > > > I am scheduled to talk on "Whats
> > > > going on in
> > > > > healthcare" the
> > > > > intent of my talk is to give a summary about
> > what
> > > > 

Re: [openhealth] SCALE talk

[David Forslund]

OpenEMed continues to be in modest development but
perhaps not visible at a higher level.  The MPI work
is based on the OMG PIDS standard.  It is open
source and has been so since 2000.  The next
generation of PIDS will result from the current
EIS RFP from the OMG which is currently
soliciting responses.  The EIS is a joint effort
of the OMG and HL7.   We would like to provide
an implementation of EIS as part of OpenEMed and
are soliciting help in anyone interested in doing so.

Dave
Nandalal Gunaratne wrote:
>
> Hello Will,
>
> I do not see any MPI projects in the OpenHRE except
> the description of four Patient-Data Matching
> Software.
>
> The OpenEMed project is somewhat dormant and did not
> have a fully developed MPI software based on it's
> Person identification service. I am not sure if during
> the aborted Phoenix project anything was done regards
> the development of an MPI using OpenEMed, except the
> Patient identification terminology service itself.
>
> Therfore your peoject maybe the first open-source one,
> if it is used for this purpose in the future.
>
> Please correct me if I am wrong.
>
> Nandalal
> --- Will Ross <[EMAIL PROTECTED] > wrote:
>
> > Hello World,
> >
> > Like Fred I'm also speaking at SCALE. During the
> > afternoon at SCALE
> > my presentation will discuss FOSS options for MPI
> > solutions.
> > Here's my short list of open source MPI projects:
> >
> > [1] OpenEMed
> > [2] OpenHRE
> >
> > If you know of any further FOSS options for MPI,
> > please send me links
> > to the MPI project(s). Also, Dr. Stuart Turner and
> > I have launched
> > a small portal to persistently track FOSS options
> > for MPI solutions.
> >
> > http://www.openempi.org/ 
> >
> > All comments and suggestions are welcome.
> >
> > With best regards,
> >
> > [wr]
> >
> > - - - - - - - -
> > On Jan 11, 2007, at 7:31 AM, Fred Trotter wrote:
> >
> > > Hello OpenHealth,
> > > I hope you are all aware of the SCALE
> > healthcare day...
> > >
> > > http://www.socallinuxexpo.com/healthcare07/ 
> 
> > >
> > > If you can make it you should, the
> > speakers line up is
> > > full of
> > > real players in our industry.
> > >
> > > I am scheduled to talk on "Whats
> > going on in
> > > healthcare" the
> > > intent of my talk is to give a summary about what
> > is REALLY going
> > > on in Free
> > > and Open Source Healthcare. I want to talk about
> > what projects are
> > > moving
> > > and which projects are dead. I want to talk about
> > what we as a larger
> > > community are doing well with and what we as a
> > community are doing
> > > poorly
> > > with. In short I want to present my audience with
> > useful bias as
> > > opposed to
> > > mere information.
> > >
> > > I fully intend to make some bold
> > statements about the
> > > state of
> > > our industry. But I do not want to do that without
> > having more
> > > information
> > > about what is really happening. So I am turning
> > this question on the
> > > community? What IS going on in Free and Open
> > Source Healthcare?
> > > Here are the
> > > areas that I would like commentary on. Please feel
> > free to comment
> > > on areas
> > > that I am overlooking.
> > >
> > > First whats going on in medical imaging? ie Osiris
> > >
> > > Second what is happening in
> > Genomics/Protenomics/Cell Modeling? i.e.
> > > http://www.bioconductor.org/ 
> > >
> > > What is happening in decision support/diagnostics?
> > OpenPsyc etc etc
> > >
> > > Clinical Trial/ Research Software ie OIO
> > >
> > > Drug Database - i.e. Uversa effort
> > >
> > > EHR clinical i.e. MirrorMed/ClearHealth -- VOE
> > >
> > > EHR hospital ie. VistA/Care2x
> > >
> > > PHR ie Indivo
> > >
> > > Interoperability/MPI Mirth/OHF etc etc.
> > >
> > > There are lots of fine project lists out there. I
> > do not want
> > > information
> > > that I could find on Google. I want the inside
> > scoop! Who are the
> > > loosers
> > > who are the winners. In some of these areas I
> > already know the
> > > answers, and
> > > I simply need a gut-check. In other areas I am
> > truly ignorant. Feel
> > > free to
> > > email me privately if you want something to be
> > off-the-record.
> > >
> > > Regards,
> > >
> > > --
> > > Fred Trotter
> > > http://www.fredtrotter.com 
> > >
> >
> > - - - - - - - -
> >
> > [wr]
> >
> > - - - - - - - -
> >
> > will ross
> > project manager
> > mendocino informatics
> > 216 west perkins street, suite 206
> > ukiah, california 95482 usa
> > 707.462.6369 [office]
> > 707.462.5015 [fax]
> > www.minformatics.com
> >
> > - - - - - - - -
> >
> > "Getting people to adopt common standards is impeded
> > by patents."
> > Sir Tim Berners-Lee, BCS, 2006
> >
> > - - - - - - - -
> >
> >
> >
> >
>
> __
> Need a quick answer? Get one in minutes from people who know.
> Ask your ques

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

I think the issue is bigger than that.  The AMA has a legal agreement
with CMS/HCFA for reimbursement of CPT codes.  If the code isn't an
"official" CPT code, then reimbursement would be denied by CMS,
even if you weren't sued by the AMA.   If the descriptions didn't
match the AMA's then they would easily claim it wasn't "official".

Dave
mspohr wrote:
>
> This decision addresses the question of whether the AMA's copyright
> becomes invalid when the government mandates it for reimbursement. It
> uses some tortured logic to say that the CPT is NOT a "system" (that
> therefore would not be eligible for copyright) but rather an specific
> expression that can be copyrighted.
> Following this, it would seem that you could use the "system" (of
> numbers) but with a different expression (descriptions) and not tread
> on the AMA's copyright. Other cases (such as with telephone
> directories) have reaffirmed that you cannot copyright the numbers
> themselves.
> However, the AMA would probably sue you anyway.
>
> /Mark
>
> --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>, "Fred Trotter" <[EMAIL PROTECTED]>
> wrote:
> >
> > I dont think so. From what I understood the codes themselves are
> copyright.
> > Further, thier use is mandated by the government for use in medical
> billing.
> > This issue has already been the subject of litigation.
> >
> > http://www.usdoj.gov/atr/cases/f2000/2076.htm 
> <http://www.usdoj.gov/atr/cases/f2000/2076.htm>
> >
> > -FT
> >
> > On 12/11/06, mspohr <[EMAIL PROTECTED]> wrote:
> > >
> > > The codes would be the same as those that they currently accept (i.e.
> > > the AMA CPT codes) so there is no issue with the codes.
> > > The problem with the AMA is that they copyright the descriptions and
> > > prevent distribution of their copyrighted descriptions.
> > > The project would be to create new descriptions that were functionally
> > > the same and could be freely distributed under an open license such as
> > > the Creative Commons license (http://creativecommons.org/ 
> <http://creativecommons.org/>).
> > >
> > > /Mark
> > >
> > >
> > >
> > > --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>, David Forslund  wrote:
> > > >
> > > > This effort would require commitment from the payor that they
> > > > would accept those codes for reimbursement. Otherwise this
> > > > effort will be relatively useless.
> > > >
> > > > Dave
> > > > mspohr wrote:
> > > > >
> > > > > The goal of the CPT code project would be to create a version of
> > > > > procedure codes for use in billing in the US that could be freely
> > > > > distributed.
> > > > > While it would be nice to fit this into an overarching
> ontology, this
> > > > > would introduce overhead which is not warranted. The CPT codes
> > > > > themselves are a dead end (except for billing in the US) from both
> > > > > intellectual property and information design standpoints and
> the task
> > > > > of an ontology of procedures is better left to something more
> suitable
> > > > > such as Snomed or ICD or even the HCPCS.
> > > > >
> > > > > I think KISS applies here.
> > > > >
> > > > > /Mark
> > > > >
> > > > > --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>
> > > > > <mailto:openhealth%40yahoogroups.com>, Adrian Midgley 
> > > > > wrote:
> > > > > >
> > > > > > Rod Roark wrote:
> > > > > > >
> > > > > > >
> > > > > > > Perhaps I don't understand what you mean, but CPT codes are
> > > just for
> > > > > > > procedures. The project I was suggesting was limited to
> > > restating the
> > > > > > > descriptions for them, with about the same standards for
> > > preciseness
> > > > > > > currently found in CPT. A broader scope would be very
> daunting.
> > > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > > But if we are going to do (an) ontology, let us not handicap
> > > ourselves
> > > > > > by building it for just one lot of data. It could be written one
> > > > > > chapter at a time, certainly.
> > > > > >
> > > > >
> > > >
> > >
> > >
> > >
> > >
> > >
> > > Yahoo! Groups Links
> > >
> > >
> > >
> > >
> >
> >
> > --
> > Fred Trotter
> > http://www.fredtrotter.com <http://www.fredtrotter.com>
> >
> >
> > [Non-text portions of this message have been removed]
> >
>

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

I agree. I don't think you would have to declare them something
other than CPT codes even if they had the same number.  With
a different description, they couldn't be certified as the same and
wouldn't come under the legal agreement of CMS (HCFA). 
I think it would be nice to have alternative to CPT, but this would
require more than coming up with code descriptions.  It would require
calling it something else and entering into agreements with CMS and
other organizations including states.  This is not a free exercise.

Dave
Fred Trotter wrote:
>
> I dont think so. From what I understood the codes themselves are 
> copyright.
> Further, thier use is mandated by the government for use in medical 
> billing.
> This issue has already been the subject of litigation.
>
> http://www.usdoj.gov/atr/cases/f2000/2076.htm 
> <http://www.usdoj.gov/atr/cases/f2000/2076.htm>
>
> -FT
>
> On 12/11/06, mspohr <[EMAIL PROTECTED] <mailto:mspohr%40yahoo.com>> wrote:
> >
> > The codes would be the same as those that they currently accept (i.e.
> > the AMA CPT codes) so there is no issue with the codes.
> > The problem with the AMA is that they copyright the descriptions and
> > prevent distribution of their copyrighted descriptions.
> > The project would be to create new descriptions that were functionally
> > the same and could be freely distributed under an open license such as
> > the Creative Commons license (http://creativecommons.org/ 
> <http://creativecommons.org/>).
> >
> > /Mark
> >
> >
> >
> > --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>, David Forslund <[EMAIL PROTECTED]> 
> wrote:
> > >
> > > This effort would require commitment from the payor that they
> > > would accept those codes for reimbursement. Otherwise this
> > > effort will be relatively useless.
> > >
> > > Dave
> > > mspohr wrote:
> > > >
> > > > The goal of the CPT code project would be to create a version of
> > > > procedure codes for use in billing in the US that could be freely
> > > > distributed.
> > > > While it would be nice to fit this into an overarching ontology, 
> this
> > > > would introduce overhead which is not warranted. The CPT codes
> > > > themselves are a dead end (except for billing in the US) from both
> > > > intellectual property and information design standpoints and the 
> task
> > > > of an ontology of procedures is better left to something more 
> suitable
> > > > such as Snomed or ICD or even the HCPCS.
> > > >
> > > > I think KISS applies here.
> > > >
> > > > /Mark
> > > >
> > > > --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>
> > > > <mailto:openhealth%40yahoogroups.com>, Adrian Midgley 
> > > > wrote:
> > > > >
> > > > > Rod Roark wrote:
> > > > > >
> > > > > >
> > > > > > Perhaps I don't understand what you mean, but CPT codes are
> > just for
> > > > > > procedures. The project I was suggesting was limited to
> > restating the
> > > > > > descriptions for them, with about the same standards for
> > preciseness
> > > > > > currently found in CPT. A broader scope would be very daunting.
> > > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > > But if we are going to do (an) ontology, let us not handicap
> > ourselves
> > > > > by building it for just one lot of data. It could be written one
> > > > > chapter at a time, certainly.
> > > > >
> > > >
> > >
> >
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
>
> -- 
> Fred Trotter
> http://www.fredtrotter.com <http://www.fredtrotter.com>
>
> [Non-text portions of this message have been removed]
>
> _

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

So could one use the CPT number for reimbursement without some
certification that they are the same as the "real" CPT codes?

Dave
mspohr wrote:
>
> The codes would be the same as those that they currently accept (i.e.
> the AMA CPT codes) so there is no issue with the codes.
> The problem with the AMA is that they copyright the descriptions and
> prevent distribution of their copyrighted descriptions.
> The project would be to create new descriptions that were functionally
> the same and could be freely distributed under an open license such as
> the Creative Commons license (http://creativecommons.org/ 
> <http://creativecommons.org/>).
>
> /Mark
>
> --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>, David Forslund <[EMAIL PROTECTED]> 
> wrote:
> >
> > This effort would require commitment from the payor that they
> > would accept those codes for reimbursement. Otherwise this
> > effort will be relatively useless.
> >
> > Dave
> > mspohr wrote:
> > >
> > > The goal of the CPT code project would be to create a version of
> > > procedure codes for use in billing in the US that could be freely
> > > distributed.
> > > While it would be nice to fit this into an overarching ontology, this
> > > would introduce overhead which is not warranted. The CPT codes
> > > themselves are a dead end (except for billing in the US) from both
> > > intellectual property and information design standpoints and the task
> > > of an ontology of procedures is better left to something more suitable
> > > such as Snomed or ICD or even the HCPCS.
> > >
> > > I think KISS applies here.
> > >
> > > /Mark
> > >
> > > --- In openhealth@yahoogroups.com 
> <mailto:openhealth%40yahoogroups.com>
> > > <mailto:openhealth%40yahoogroups.com>, Adrian Midgley 
> > > wrote:
> > > >
> > > > Rod Roark wrote:
> > > > >
> > > > >
> > > > > Perhaps I don't understand what you mean, but CPT codes are
> just for
> > > > > procedures. The project I was suggesting was limited to
> restating the
> > > > > descriptions for them, with about the same standards for
> preciseness
> > > > > currently found in CPT. A broader scope would be very daunting.
> > > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > But if we are going to do (an) ontology, let us not handicap
> ourselves
> > > > by building it for just one lot of data. It could be written one
> > > > chapter at a time, certainly.
> > > >
> > >
> >
>
> _

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

This effort would require commitment from the payor that they
would accept those codes for reimbursement.  Otherwise this
effort will be relatively useless.

Dave
mspohr wrote:
>
> The goal of the CPT code project would be to create a version of
> procedure codes for use in billing in the US that could be freely
> distributed.
> While it would be nice to fit this into an overarching ontology, this
> would introduce overhead which is not warranted. The CPT codes
> themselves are a dead end (except for billing in the US) from both
> intellectual property and information design standpoints and the task
> of an ontology of procedures is better left to something more suitable
> such as Snomed or ICD or even the HCPCS.
>
> I think KISS applies here.
>
> /Mark
>
> --- In openhealth@yahoogroups.com 
> , Adrian Midgley <[EMAIL PROTECTED]> 
> wrote:
> >
> > Rod Roark wrote:
> > >
> > >
> > > Perhaps I don't understand what you mean, but CPT codes are just for
> > > procedures. The project I was suggesting was limited to restating the
> > > descriptions for them, with about the same standards for preciseness
> > > currently found in CPT. A broader scope would be very daunting.
> > >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > But if we are going to do (an) ontology, let us not handicap ourselves
> > by building it for just one lot of data. It could be written one
> > chapter at a time, certainly.
> >
>

Re: [openhealth] [Fwd: HSSP Passes Major Milestone Today!]

[David Forslund]

Thanks, Will!

These are good links, too.  The links I sent got an extra '_' added at 
the end which messed up
the links.  If you remove that underscore, you can get to the documents 
on the OMG site.

Dave
Will Ross wrote:
>
> The OMG link to the RFP documents is not working for me.
>
> Here's an alternate link to the RFP for the EIS.
>
> http://hssp-eis.wikispaces.com/ <http://hssp-eis.wikispaces.com/>
>
> The corresponding wikispaces site for the RLUS has not been updated
> with their RFP, but here it is anyway.
>
> http://hssp-rlus.wikispaces.com/ <http://hssp-rlus.wikispaces.com/>
>
> As a frame of reference, here's the FAQ from HSSP.
>
> http://hssp.wikispaces.com/hssp-faq <http://hssp.wikispaces.com/hssp-faq>
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Dec 8, 2006, at 8:58 PM, David Forslund wrote:
>
> > (I forgot that you can't forward an email as an attachment. Here
> > is the
> > announcement I was referring to:)
> >
> >
> > All:
> >
> > I would like to take a moment to pause and acknowledge a significant
> > event that occurred this morning. At about 11:30am EST, the OMG
> > Domain
> > Task Force voted to issue Requests for Proposals for both the Entity
> > Identification Service (EIS) and Retrieve, Locate, Update Service
> > (RLUS)
> > specifications. Until today, the notion of developing Service
> > Functional Models in HL7 and transforming them into technical RFP's to
> > be issued to industry was just a destination to which we have been
> > diligently working towards for a year (with prework having begun far
> > before then).
> >
> > On March 31st, 2007, "Letters of Intent" are due to the OMG indicating
> > companies and product vendors that will develop both technical
> > specifications and ultimately implementations of software (either open
> > source, reference implementations, or products). [We're planning to
> > have one quarter dedicated to each RFP and how you may participate
> > in a
> > submission at HL7 in San Diego in January]. I'm already aware of
> > companies that are exploring joining forces to collaborate as part
> > of a
> > joint submission team.
> >
> > I'd like to take a moment in particular to thank and congratulate Alan
> > Honey and John Koisch, whom have been championing these specifications
> > not only within HL7, but within the OMG community as well. Additional
> > thanks to Barbara Eckman, Scott Robertson, Craig Bennett, Virinder
> > Batra, and all of the other individuals that have contributed their
> > time
> > and efforts in making these quality specifications. Also, our
> > thanks to
> > the countless folks who took time to provide ballot feedback on the
> > Service Functional Models, and those who contributed on
> > teleconferences
> > and the list on these specifications.
> >
> > The OMG RFP documents are publicly available on the OMG website at:
> >
> > EIS: _http://www.omg.org/cgi-bin/doc?health/2006-12-01_ 
> <http://www.omg.org/cgi-bin/doc?health/2006-12-01_>
> >
> > RLUS: _http://www.omg.org/cgi-bin/doc?health/2006-12-02_ 
> <http://www.omg.org/cgi-bin/doc?health/2006-12-02_>
> >
> > In addition, we'll be getting those documents available from our Wiki.
> > Things are shaping up to be a very engaging and busy meeting in San
> > Diego in January. I look forward to seeing you there.
> >
> > - Ken
> >
> >
> >
> > Ken Rubin
> > Chief Healthcare Architect
> > EDS Civilian Government & DoD Healthcare Portfolio
> > 5109 Leesburg Pike, Suite 414
> > Falls Church, VA 22041
> > Tel: +1-703-845-3277
> > Mobile: +1-301-335-0534
> > + _mailto:[EMAIL PROTECTED] <mailto:ken.rubin%40eds.com>_
> >
> >
> > David Forslund wrote:
> >>
> >> Here is an opportunity for the open source community to contribute
> >> to a
> >> significant new standard for healthcare.
> >> Anyone willing to participate in a response to these RFPs?
> >>
> >> Dave Forslund
> >>
> >> [Non-text portions of this message have been removed]
> >>
> >>
> >
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california 95482 usa
> 707.462.6369 [office]
> 707.462.5015 [fax]
> www.minformatics.com
>
> - - - - - - - -
>
> "Getting people to adopt common standards is impeded by patents."
> Sir Tim Berners-Lee, BCS, 2006
>
> - - - - - - - -
>
> __._

Re: [openhealth] [Fwd: HSSP Passes Major Milestone Today!]

[David Forslund]

(I forgot that you can't forward an email as an attachment.  Here is the 
announcement I was referring to:)


All:

I would like to take a moment to pause and acknowledge a significant 
event that occurred this morning.  At about 11:30am EST, the OMG Domain 
Task Force voted to issue Requests for Proposals for both the Entity 
Identification Service (EIS) and Retrieve, Locate, Update Service (RLUS) 
specifications.  Until today, the notion of developing Service 
Functional Models in HL7 and transforming them into technical RFP's to 
be issued to industry was just a destination to which we have been 
diligently working towards for a year (with prework having begun far 
before then).

On March 31st, 2007, "Letters of Intent" are due to the OMG indicating 
companies and product vendors that will develop both technical 
specifications and ultimately implementations of software (either open 
source, reference implementations, or products).  [We're planning to 
have one quarter dedicated to each RFP and how you may participate in a 
submission at HL7 in San Diego in January].  I'm already aware of 
companies that are exploring joining forces to collaborate as part of a 
joint submission team.

I'd like to take a moment in particular to thank and congratulate Alan 
Honey and John Koisch, whom have been championing these specifications 
not only within HL7, but within the OMG community as well.  Additional 
thanks to Barbara Eckman, Scott Robertson, Craig Bennett, Virinder 
Batra, and all of the other individuals that have contributed their time 
and efforts in making these quality specifications.  Also, our thanks to 
the countless folks who took time to provide ballot feedback on the 
Service Functional Models, and those who contributed on teleconferences 
and the list on these specifications.

The OMG RFP documents are publicly available on the OMG website at:

EIS:  _http://www.omg.org/cgi-bin/doc?health/2006-12-01_

RLUS:  _http://www.omg.org/cgi-bin/doc?health/2006-12-02_

In addition, we'll be getting those documents available from our Wiki.  
Things are shaping up to be a very engaging and busy meeting in San 
Diego in January.  I look forward to seeing you there. 

- Ken



Ken Rubin
Chief Healthcare Architect
EDS Civilian Government & DoD Healthcare Portfolio
5109 Leesburg Pike, Suite 414
Falls Church, VA 22041
Tel:  +1-703-845-3277 
Mobile:  +1-301-335-0534
+ _mailto:[EMAIL PROTECTED]


David Forslund wrote:
>
> Here is an opportunity for the open source community to contribute to a
> significant new standard for healthcare.
> Anyone willing to participate in a response to these RFPs?
>
> Dave Forslund
>
> [Non-text portions of this message have been removed]
>
> 

[openhealth] [Fwd: HSSP Passes Major Milestone Today!]

[David Forslund]

Here is an opportunity for the open source community to contribute to a 
significant new standard for healthcare.
Anyone willing to participate in a response to these RFPs?

Dave Forslund


[Non-text portions of this message have been removed]

Re: [openhealth] Open standards are meaningless.

[David Forslund]

It certainly should be, but I've not had a chance to test this.
The standards OpenEMed are based on include support for the old
GEHR project which is now OpenEHR.I would like
to see this happen, but probably don't have the time to do
it myself.  We have a CTS implementation called OpenCTS
as part of OpenEMed that could be used in this context.  All
open source, of course.

Thanks,

Dave
Nandalal Gunaratne wrote:
>
>
> --- David Forslund <[EMAIL PROTECTED] <mailto:forslund%40mail.com>> wrote:
> I think
> > EHR applications should be interoperable without
> > having to use the same
> > underlying code. Given some time and effort I
> > would like to show that
> > OpenEMed
> > can accommodate the OpenEHR specifications.
>
> Since the archetypes are central to the OpenEHR and
> these are in turn dependent on terminologies,
> ontologies and vocabualries, how does OpenEMed support
> this? Is the Terminology Query Service sufficient to
> support these?
>
> _
>

Re: [openhealth] Open standards are meaningless.

[David Forslund]

Just a comment:
  I like OpenEHR, but it is erroneous to refer to it as an "open standard".
The term "standard" is usually reserved for something certified as a 
standard
by an organization or that is a de facto standard by its widespread 
use.  Neither
of these apply to OpenEHR at this time.  It apparently has a published API
but this doesn't make it a standard. 

An example of what I'm saying is that the API for OpenEMed is an "open
standard" developed by the OMG (and its member organizations).  OpenEMed
is an open source implementation of those open standards.   So the two
issues are orthogonal.   As an aside, I would like to see OpenEHR use
and open standard API (Perhaps something such as COAS or PIDS, or
an equivalent such as the upcoming EIS and RLUS specifications).  I think
EHR applications should be interoperable without having to use the same
underlying code.   Given some time and effort I would like to show that 
OpenEMed
can accommodate the OpenEHR specifications. 

Dave
ivhalpc wrote:
>
> Open standards alone are an artificial separation of code and data
> that is un-tenable. Source code without data and data without source
> code are not very useful. To be circular: a .odt (Open Document Text)
> file without OpenOffice.org is a .odt file without Openoffice.org.
> Major thinkers going back to Alan Turing have noted that the
> artificial separation of code and data is just that: artificial. It is
> like space-time. Time without space and space without time are
> meaningless. You can argue with me on this, but I don't think I can be
> convinced otherwise. Everytime I hear someone advocating open
> standards without or against open source I remember this.
>
> -- IV
>
> _

Re: [openhealth] Re: GPs Revolt

[David Forslund]

Because that will result in massive loss of
clinical information and lack of availability
when needed and failure to get it updated
in a timely manner. If everyone in the
world was a responsible person, this might
have a chance, but people make mistakes
and forget things. I'm all for a person
to have their copy with them but it shouldn't
be the only copy nor should it be expected
to be comprehensive. Even this requires
organizations to adopt standards of interoperability
which they have been loathe to do.

Dave
Nandalal Gunaratne wrote:
>
> Why not hand over the keeping of the patient records
> to patients ( like PING), where clinicians just upload
> to this, and they also carry it with them in a storage
> format that is secure and easily accessible?
>
> The National Health Card Taiwan
> http://www.gi-de.com/portal/page?_pageid=42,55000&_dad=portal&_schema=PORTAL 
> 
>
> --- Will Ross <[EMAIL PROTECTED] > wrote:
>
> > thomas,
> >
> > i appreciate your concern for what you allege is dr.
> > grove's naivete,
> > but i share dr. grove's concern that when it comes
> > to intelligent
> > health information systems, the perfect is the enemy
> > of the good.
> > in the age of wikis, soa, voip, wifi and rfid there
> > is no reason we
> > cannot leverage existing secure internet transport
> > and composing
> > capabilities to substantially improve the
> > interoperability of
> > existing clinical text and image files. when i
> > look at where dr.
> > grove's fire is directed -- at overpriced
> > enterprise packages that
> > deliberately build new proprietary silos -- i find
> > an ally who is
> > saying the right disruptive things to people who
> > would never listen
> > to me.
> >
> > with best regards,
> >
> > [wr]
> >
> > - - - - - - - -
> >
> > On Nov 26, 2006, at 11:52 PM, Thomas Beale wrote:
> >
> > > Will Ross wrote:
> > >> With regard to the underestimated complexity of
> > Healthcare IT, the
> > >> recent comments by Andrew Grove are relevant.
> > >>
> > >> "But a key problem with this plan is the lack of
> > a good medical
> > >> records system, Grove said. His solution? Not the
> > complicated,
> > >> expensive medical record-keeping system that many
> > companies and
> > >> health-care providers are trying to develop, but
> > something much
> > >> simpler—the use of existing mass-produced
> > technologies."
> > >>
> > >>
> >
> http://news-service.stanford.edu/news/2006/november8/med- 
> 
> > >> grove-110806.html
> > >>
> > >>
> > > classic complete naivete:
> > >
> > >> Although there's debate about how to create a
> > record that would be
> > >> accessible to a range of providers and still
> > protect files, Grove
> > >> presented a simple answer: Keep medical records
> > on a Web-accessible
> > >> word-processing file.
> > >>
> > >> "It costs nothing because it's already in place,"
> > Grove said. "The
> > >> technology already exists."
> > >>
> > > there's nothing more to say.
> > >
> > > - thomas beale
> > >
> > >
> > >
> > >
> > >
> > > Yahoo! Groups Links
> > >
> > >
> > >
> > >
> >
> >
> > [wr]
> >
> > - - - - - - - -
> >
> > will ross
> > project manager
> > mendocino informatics
> > 216 west perkins street, suite 206
> > ukiah, california 95482 usa
> > 707.462.6369 [office]
> > 707.462.5015 [fax]
> > www.minformatics.com
> >
> > - - - - - - - -
> >
> > "Getting people to adopt common standards is impeded
> > by patents."
> > Sir Tim Berners-Lee, BCS, 2006
> >
> > - - - - - - - -
> >
> >
> >
> >
>




 
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Re: [openhealth] Re: GPs Revolt

[David Forslund]

My views haven't changed.  Obviously
the patient can't do it him/herself.  This
typically requires an agent involved, but
the patient is a key ingredient of the process.
The patient doesn't have the record in
his/her possession although they are likely
to have a copy updated to a certain point
in time.  The idea we proposed would
work across international boundaries. 
It basically has a mechanism to identify
a patient and then link multiple records
together dynamically to create a view
of the medical record that could be used
in multiple locations for different purposes.
The patient would have the ability
to control access to the information.
The author of the data (presumably the
GP) would have control over the
viewing of the data they generated until
they sign off on it.

Dave
Nandalal Gunaratne wrote:
>
> 10 years ago! Do you think that is still valid, now?
> Have you changed your views since then?
>
> If the patients record is held in different places,
> how does the patient keep up with the changes? Is it
> his responsibility to keep it completed and upto date?
>
> Maybe he should carry the version wth him in a e-card
> of some sort, especially in this era, when people are
> moving from country to country and suddenly need their
> records in a strange land!
>
> --- David Forslund <[EMAIL PROTECTED] <mailto:forslund%40mail.com>> wrote:
>
> > Absolutely not! I do want the patient to be in
> > control
> > of his/her data, with GPs assisting. I believe in a
> > distributed
> > EMR with control by the patient. Sometimes we
> > called
> > this a Virtual Medical/Patient Record (about 10
> > years ago in a
> > journaled publication).
> >
> > Dave
> > Nandalal Gunaratne wrote:
> > >
> > > IT would seem to me that, what you favour is a
> > system
> > > where, all patients will have their EMR with their
> > GPs
> > > and nobody else and nowhere else. What is done in
> > a
> > > hospital encounter, for example a Urological
> > Surgery,
> > > Cardioloical tests, CT scan reports, will be sent
> > to
> > > the GP for inclusion in the EMR. For this these
> > must
> > > be interoperable with each other.
> > >
> > > Making the GP the crux of EMR development,
> > recording
> > > and storing, makes sense as it is patient based.
> > He
> > > will decide as to whom he will provide access? HE
> > has
> > > also to ensure access without fail to the patient
> > in
> > > an emergency, which may happen in another country
> > at
> > > an ungodly hour.
> > >
> > > Unfortunately not every country has such a well
> > > developed, GP based system, as in the UK.
> > >
> > > Nandalal
> > >
> > > --- Adrian Midgley <[EMAIL PROTECTED] 
> <mailto:amidgley2%40defoam.net>
> > > <mailto:amidgley2%40defoam.net>> wrote:
> > >
> > > > David Forslund wrote:
> > > >
> > > > I tend to think that my notes, made by me, and
> > > > sitting where they
> > > > currently sit, upstairs in my Practice building,
> > > > mean something.
> > > >
> > > > It is clear to me that anyone else who gets to
> > read
> > > > them, now or later,
> > > > makes their own judgement about what they mean
> > and
> > > > to what degree of
> > > > relevance and reliability, and so do I for
> > others'
> > > > notes.
> > > >
> > > > So providing the means for other people to
> > negotiate
> > > > access to my stored
> > > > notes seems sensible, they will interpret them
> > in
> > > > the light of whatever
> > > > is going on, and the next person will do _their_
> > own
> > > > thing.
> > > >
> > > > Pushing them all into one heap, or passing them
> > > > around into everyone's
> > > > heap until none of us know which are ours and
> > which
> > > > are some
> > > > school-leaver's is a different and semantically
> > > > inferior process.
> > > >
> > > > --
> > > > A
> > > >
> > >
> > >
> >
>

Re: [openhealth] Re: GPs Revolt

[David Forslund]

Absolutely not!  I do want the patient to be in control
of his/her data, with GPs assisting.  I believe in a distributed
EMR with control by the patient.  Sometimes we called
this a Virtual Medical/Patient Record (about 10 years ago in a
journaled publication).

Dave
Nandalal Gunaratne wrote:
>
> IT would seem to me that, what you favour is a system
> where, all patients will have their EMR with their GPs
> and nobody else and nowhere else. What is done in a
> hospital encounter, for example a Urological Surgery,
> Cardioloical tests, CT scan reports, will be sent to
> the GP for inclusion in the EMR. For this these must
> be interoperable with each other.
>
> Making the GP the crux of EMR development, recording
> and storing, makes sense as it is patient based. He
> will decide as to whom he will provide access? HE has
> also to ensure access without fail to the patient in
> an emergency, which may happen in another country at
> an ungodly hour.
>
> Unfortunately not every country has such a well
> developed, GP based system, as in the UK.
>
> Nandalal
>
> --- Adrian Midgley <[EMAIL PROTECTED] 
> <mailto:amidgley2%40defoam.net>> wrote:
>
> > David Forslund wrote:
> >
> > I tend to think that my notes, made by me, and
> > sitting where they
> > currently sit, upstairs in my Practice building,
> > mean something.
> >
> > It is clear to me that anyone else who gets to read
> > them, now or later,
> > makes their own judgement about what they mean and
> > to what degree of
> > relevance and reliability, and so do I for others'
> > notes.
> >
> > So providing the means for other people to negotiate
> > access to my stored
> > notes seems sensible, they will interpret them in
> > the light of whatever
> > is going on, and the next person will do _their_ own
> > thing.
> >
> > Pushing them all into one heap, or passing them
> > around into everyone's
> > heap until none of us know which are ours and which
> > are some
> > school-leaver's is a different and semantically
> > inferior process.
> >
> > --
> > A
> >
>
> __
> Cheap talk?
> Check out Yahoo! Messenger's low PC-to-Phone call rates.
> http://voice.yahoo.com <http://voice.yahoo.com>
>
>  

Re: [openhealth] Re: GPs Revolt

[David Forslund]

I'm not sure what Thomas' view is, but here are my $.02.
Thinking of messaging tends to distract one from trying to solve the
real problem.   The idea seems to be that sending messages around is
good and people will eventually be able to figure out what they mean.
One needs to worry more about semantic integration and leave the
technology underlying this aside.   Messaging is a particular
technological approach rather than a semantic integration approach.
This, IMHO, has been the weakness of HL7 in that it has blurred
the boundary of technology and semantics too much. 

Dave

Will Ross wrote:
>
> Thomas,
>
> Can you elaborate on the design flaw you see in a message based
> National e-Health Grid? Is a message based grid inherently
> flawed? Or is the design flaw contained in the CFH implementation
> of a message based e-Health Grid? That is, can a message based grid
> be implemented correctly?
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Nov 23, 2006, at 9:46 AM, Thomas Beale wrote:
>
> > Adrian Midgley wrote:
> >>
> >> The driving force for the programme was, so far as I can tell, a
> >> pitch
> >> by Sir William Gates 3 over lunch at number 10 to the outgoing prime
> >> minister, and therefore, in the nature of these things, as The Rt
> >> Hon Mr
> >> Anthony Blair MP steps back to being a back bench MP, the plan is
> >> likely
> >> to fall apart.
> >>
> >>
> > just based on what we read in the Guardian, it appears to be on a
> > knife-edge anyway. But there has been substantive spending - CFH has
> > already spent many millions (I would think many times £100m) on
> > message
> > development and other work that blithely assumes the central message
> > bank idea, without taking any account of how health record systems
> > work,
> > where they might be and how they should be integrated with each other.
> > Some extremely competent people working in CFH today are living
> > with the
> > terrible choices of a few years ago (a message-based design conception
> > of a national e-Health grid), and are trying to do their best in those
> > circumstances.
> >
> > - thomas beale
> >
> >
> > --
> > __
> > _
> > CTO Ocean Informatics (http://www.OceanInformatics.biz 
> )
> > Research Fellow, University College London (http://
> > www.chime.ucl.ac.uk)
> > Chair Architectural Review Board, openEHR (http://www.openEHR.org 
> )
> >
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> >
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california 95482 usa
> 707.462.6369 [office]
> 707.462.5015 [fax]
> www.minformatics.com
>
> - - - - - - - -
>
> "Getting people to adopt common standards is impeded by patents."
> Sir Tim Berners-Lee, BCS, 2006
>
> - - - - - - - -
>
>  

Re: [openhealth] [Fwd: Draft Healthcare Domain Task Force RFP's Available]

[David Forslund]

Sorry about the earlier email.  I forgot that the mailer strips off 
attachments
so I'm sending it as inline text.

-Dave
David Forslund wrote:
>
> For those looking for interoperability, here is the chance to
> participate in the next generation
> of interface specifications. This is a joint effort of the OMG and HL7
> and interested parties.
>
> -Dave
>








 From Ken Rubin
All:

We have pre-release versions of the two RFP's we hope to issue in 
December posted to the OMG Server.  We expect to continue to make 
refinements on these over the coming weeks, but the substantive content 
is included in these already.  These documents reflect the revisions to 
the working draft RFPs that were discussed in Anaheim.

They are:

the EIS RFP is now available as health/2006-10-01 at URL
  http://www.omg.org/cgi-bin/doc?health/2006-10-01
RLUS RFP is available as health/2006-10-02 at URL
  http://www.omg.org/cgi-bin/doc?health/2006-10-02

- Ken

Ken Rubin
Chief Healthcare Architect
EDS Civilian Government & DoD Healthcare Portfolio
5109 Leesburg Pike, Suite 414
Falls Church, VA 22041
Tel:  +1-703-845-3277
Mobile:  +1-301-335-0534
+ mailto:[EMAIL PROTECTED]




 
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[openhealth] [Fwd: Draft Healthcare Domain Task Force RFP's Available]

[David Forslund]

For those looking for interoperability, here is the chance to 
participate in the next generation
of interface specifications.  This is a joint effort of the OMG and HL7 
and interested parties.

-Dave


[Non-text portions of this message have been removed]



 
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Re: [openhealth] Needed: (mammographic) recall with some tracking

[David Forslund]

In fact, I believe the PIDS used by OpenHRE is from OpenEMed (although their
report doesn't mention this).  I know it started that way but haven't 
heard from
them for quite awhile. 

As for Adrian's points 1) and 2), the PIDS specification and implementation
are designed to fulfill both of those requirements.  "Plays nicely
with arbitary other systems" is a little difficult without some constraints.
The constraints of the PIDS specification is an example of a useful
constraint.

The evolution of PIDS is the EIS of the HSSP effort 
(http://hssp.wikispaces.org). 
If you are interested, you should follow this work.

Dave
Will Ross wrote:
>
> Both OpenEMed (BSD license) and OpenHRE (GPL) are PIDS based.
>
> http://openemed.org/ 
>
> http://openhre.org/ 
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Oct 14, 2006, at 2:15 PM, Adrian Midgley wrote:
>
> > Rod Roark wrote:
> >> Surely this would best be done within the context of a PM/EMR system?
> >> OpenEMR is popular for smaller practices and is easily extensible.
> >>
> >
> > It is a DGH for say 150 000 population. Scalability is something
> > for us
> > to think about.
> >
> >
> > Will Ross wrote:
> >> Adrian,
> >>
> >> Is this something as simple as a contact manager that knows how to
> >> track [a] logistical details on the order itself, and [b] additional
> >> clinical details required by NHS? If so, maybe one of the small
> >> footprint forks of the SugarCRM project would suffice.
> >
> > The question of whether there is anything about this task which is
> > special to medicine or healthcare is a very valid one.
> >
> >
> > I think that a regional or district or hospital or Practice personal
> > identity server is a solved problem. PICNIC produced one, and Los
> > Alamos have produced one.
> >
> > I don't think that we can try to solve single requirements by bringing
> > in a system that does everything, unless it also plays nicely with
> > arbitrary other systems. This is in principle a FLOSS attribute, but
> > I'm not sure that each potential system is ready to meet two
> > requirements:-
> >
> > 1. Can work as a PIDS for other systems
> > 2. Can use as a PIDS another system.
> >
> > I submit that we should design our systems with such a pair of aims
> > in mind.
> >
> > --
> > A
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> >
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california 95482 usa
> 707.462.6369 [office]
> 707.462.5015 [fax]
> www.minformatics.com
>
> - - - - - - - -
>
> "Getting people to adopt common standards is impeded by patents."
> Sir Tim Berners-Lee, BCS, 2006
>
> - - - - - - - -
>
>  




 
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Re: [openhealth] Bhaskar will be out of pocket July 9 through July 16

[David Forslund]

I would hope that your campsite would be out of range of a blackberry.   
This
would help in the overall isolation that should be the goal of the 
camping experience.

Dave
K.S. Bhaskar wrote:
>
> They don't call them Crackberries for nothing!!!
>
> Seriously, I have to take it with me because it is also my cell phone
> and I will want to have it handy while driving there and back. But I
> leave it turned off and at the camp site when we are in camp.
>
> I did want to let people know that I would be away next week, because I
> am an administrator for the openhealth list, and folks from time to time
> expect responses from me on hardhats.
>
> Regards
> -- Bhaskar
>
> Tim Churches wrote:
> > Tim Cook <[EMAIL PROTECTED] > wrote:
> > >
> > > -BEGIN PGP SIGNED MESSAGE-
> > > Hash: SHA1
> > >
> > > K.S. Bhaskar wrote:
> > > > As a scoutmaster of the troop my younger sons are in, I will be 
> doing
> > > my
> > > > part to keep the local insects well fed (sorry, I meant to say
> > > camping)
> > > > next week and will be out of pocket July 9 through July 16. Although
> > > my
> > > > Blackberry does pick up a signal if I go to the upper elevations and
> > > on
> > > > the other side of a ridge, in the area where our troop camps, there
> > > has
> > > > not been a signal in previous years.
> > > >
> > >
> > > IMHO ... you should leave that Blackberry at home and enjoy those kids
> > > and the Scouting experience. 
> >
> > Yes, I thought that the Scouts frowned on drugs-of-addiction. Every
> > Blackberry user I have ever seen has become hooked and utterly 
> dependent
> > on fixes from their little devices within a week. As Tim suggests: go
> > cold turkey.
> >
> > Tim C
>
>  




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Re: [openhealth] Re: OSHCA

[David Forslund]

I apologize for bringing this up, but it does affect my relationship 
with OSHCA
since it is being incorporated in Malaysia.  I will be unable to support 
OSHCA
in Malaysia because of the politics/human rights issues I see happening 
in that country.

Sorry,

Dave Forslund
K.S. Bhaskar wrote:
> Please, let's keep the discussion on this mailing list focused on
> Free/Libré and Open Source Software (with a broad interpretation of
> software, so discussion of ICD codes and OSHCA incorporation are within
> the scope of the group) as it pertains to healthcare.  There are plenty
> of other forums for other topics.
>
> Thank you very much.
>
> Regards
> -- Bhaskar
>







  
  
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Re: [openhealth] Re: OSHCA

[David Forslund]

Tim.Churches wrote:
> David Forslund wrote:
> > What is happening with the setting up of OSHCA in Malaysia?  It has been
> > quiet for some time now.
>
> My understanding is that the papers have been filed with the relevant
> authority and presumably they are being or will soon be assessed and
> processed. Meanwhile arrangements are being made to establish a new
> OSHCA web site - hopefully we'll have something working in a week or
> three. Is there anyone familar with Plone who could assist?
>
> > It is disturbing to see the Prime Minister of Malaysia shaking hands
> > with the Hamas terrorist Mahmoud Zahar.   What
> > possible good can come from that?  How are we supposed to interpret this
> > action?
>
> That question is rather off-topic, but anyway: Mahmoud Zahar is the
> Foreign Minister of a democratically and popularly elected government,
> visiting Malaysia. Thus it would be rather surprising for the Malaysian
> Prime Minister not to shake his hand. As to whether Zahar is a
> terrorist, well, one person's terrorist is another person's freedom
> fighter. I am not defending the actions of Hamas or its supporters, but
> it is worth remembering that it is well documented and undisputed that
> numerous Zionist groups engaged in terrorist campaigns before and
> shortly after the declaration of the state of Israel in 1948. Violence,
> both unofficial and state-sanctioned, breeds more violence.
>
> Tim C
>
I respectfully disagree with your assessment, when the "official" 
position of a government
is to seek the destruction of their "neighbor" and to disavow any 
participation in an
internationally agreed to peace process.  They should be treated no 
better than
South Africa was during apartheid.

Dave







  
  
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[openhealth] Re: OSHCA

[David Forslund]

What is happening with the setting up of OSHCA in Malaysia?  It has been 
quiet for some time now.

It is disturbing to see the Prime Minister of Malaysia shaking hands 
with the Hamas terrorist Mahmoud Zahar.   What
possible good can come from that?  How are we supposed to interpret this 
action?

Dave Forslund







  
  
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Re: [openhealth] Beyond standards.

[David Forslund]

I hope no politicians have anything to do with the OMG HDTF.  This would 
be a severe
mistake since it would then contain nothing technically useful.   A 
requirement that "industry"
come up with rigorous interoperability requirements would be useful.

The issue of "humanely motivated reason" is clearly off topic and such 
subjects are of no value
to this list.

Dave
Karsten Hilbert wrote:
> On Sun, May 21, 2006 at 09:01:11AM -0700, Nandalal Gunaratne wrote:
>
> > Thus the necessity to inculcate the need for
> > interoperability as the most important part of healthcare IT
> > to politicians. If they insist on it from the top and revise
> > OMG HDTF with the same enthusiasm Mr Bush promotes VistA,
> > things may go in the right direction.
> > 
> >  Anyone here on a mailing list with Mr Bush?
> People might wonder whether he's accessible to humanely
> motivated reason.
>
> Karsten
>
> 
>




  




  
  
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[David Forslund]

Tim Churches wrote:
> David Forslund wrote:
> > Tim Cook wrote:
> >  > -BEGIN PGP SIGNED MESSAGE-
> >  > Hash: SHA1
> >  >
> >  > ivhalpc wrote:
> >  >
> >  > >
> >  > > I wonder how this is all going to end and I fear it will end 
> badly as
> >  > > in Nationalized medicine in the US
> >  >
> >  > Would that truly be a bad thing?  I'm not sure how a transition would
> >  > work but answer these questions:
> > The transition is already underway with Medicare and Medicaid, both 
> of which
> > are about to go bankrupt in the US.
>
> Sorry for my ignorance, but how can govt-funded health insurance/payment
> schemes "go bankrupt"?
So I guess this speaks of the curious way that the US works.  Medicare 
and Medicaid
are not paid for out of the general revenues, but out of a specific 
tax.  Since this
involves "entitlements", i.e., obligations into the future, the 
projected income
won't meet the projected outgo in the years ahead.  This is a "classic" 
definition
of bankrupt.   Much of the problem comes from unfunded mandates, where any
hospital ER can't turn anyone away based on their ability to pay even if 
they
aren't covered by Medicare or Medicaid.  This is one of the reasons that we
have an immigration problem here as people can come from Mexico, for 
example,
illegally and get healthcare coverage.
>
> >  > 1) What western country spends the largest portion (by a wide 
> margin) of
> >  > GDP on healthcare?
> > This, by itself, doesn't mean that healthcare in the US is bad.  It
> > might mean the opposite.
>
> Despite having one of the highest per-capita spends on healthcare in the
> world, the US ranks in the bottom half (and often right at the bottom)
> of all OECD countries on just about every health and health outcome
> measure, on a population basis. Sure, for wealthier people in the US who
> can afford good health insurance, health outcomes are excellent, but
> those people represent about 50% of the total population. The rest of
> the population have really very bad outcomes, so the overall results are
> remarkably poor given the overall expenditure. And even amongst the
> insured, the quality and nature of the care is very patchy, due to the
> incredibly fragmented nature of the US healthcare system.
Where do you get your numbers?   The percentage that isn't covered is
much smaller, I believe, particularly since people who haven't applied
and thus don't show up on a list are, in fact, covered.  The quality
of healthcare is patchy, but not necessarily based on income, but on 
locality.
I've heard horror stories from other countries, too, but I largely 
discount such
reports.
>
> >  > 2) What western country has the largest percentage of citizens 
> without
> >  > healthcare?
> > Do you have any idea what the percentage of citizens in the US is
> > without healthcare
> > coverage?   The main stream media  and some politicos grossly
> > misrepresent this
> > number.  The fact is that healthcare for those that need it in the US
> > can't be denied.
> > The type of coverage isn't the same for everyone, but essentially
> > everyone has coverage
> > of some sort.  People may not have signed up for it, but, in fact, may
> > have coverage.
> > Take a look at the sign in every ER room in America, e.g.
>
> It may be that acute, emergency care is mostly available to everyone in
> the US (but I constantly hear horror stories of denied or badly
> truncated emergency care in the US due to lack of insurance or cash,
> stories which you never hear here in Australia or in the UK - they are
> just inconceivable).
The problem here is that ER care is the most expensive and is the one
that can't be legally denied. In northern New Mexico, ER is the primary
care for a number of people.  There is a continuous effort to provide
care in a different way which will reduce costs.
>
> However, it is lack of access to ongoing, routine medical care for
> poorer people in the US which is the problem. It may be that even the
> struggling single parent unskilled casual worker in the US can have
> their myocardial infarct treated at an ER, but it would have been better
> if they had had free or subsidised access to regular care by a family
> physician or community clinic for the decade before that, as well as
> access to subsidised antihypertensive and cholesterol lowering drugs
> instead of paying the full, ridiculous inflated US market prices for
> such medications.
The problem also is how healthcare insurance is paid for as part of
one's employment.  One doesn't hav

Re: [openhealth] Beyond standards.

[David Forslund]

Well, since you asked. :-)  The OMG website is its usual confusing self, 
since you have to wade
through all the domain specs to see the relevant ones for healthcare.  

The current specs are available at: 

COAS: 
http://www.omg.org/technology/documents/formal/clinical_observation_access_service.htm
PIDS: 
http://www.omg.org/technology/documents/formal/person_identification_service.htm
LQS: 
http://www.omg.org/technology/documents/formal/lexicon_query_service.htm
RAD: 
http://www.omg.org/technology/documents/formal/resource_access_decision.htm

The HSSP group is working on updating and extending and harmonizing 
these specs with HL7:
http://hssp.wikispaces.org

We have open source implementations of the above specifications in 
OpenEMed: http://OpenEMed.org.  These
implementations have been around for more than 5 years and continue to 
be worked on and enhanced
for various projects.

These specifications are early examples of what is now popularly known 
as SOA (Service Oriented Architecture).

Dave

Greg Woodhouse wrote:
>
>
> --- David Forslund <[EMAIL PROTECTED]> wrote:
>
>
> -
> HL7 is only a partial "solution" to interoperability as you indicate
> and
> less than
> most might have thought.  Which is why there is the HSSP
> effort underway which is picking up from the OMG HDTF effort
> almost a decade ago.    The OMG HDTF made enormous
> progress toward interoperability but it is little recognized today.
>
> Where can I go to learn more about it? I looked at healtchare.omg.org,
> but most of what I can find (at least in public areas) doesn't seem to
> be healthcare related at all.
>
> At any rate, I'm intrigued.
>
> ===
> Gregory Woodhouse  <[EMAIL PROTECTED]>
>
> Metaphors be with you.
>
>







  
  
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[David Forslund]

Tim Cook wrote:
> -BEGIN PGP SIGNED MESSAGE-
> Hash: SHA1
>
> ivhalpc wrote:
>
> >
> > I wonder how this is all going to end and I fear it will end badly as
> > in Nationalized medicine in the US
>
> Would that truly be a bad thing?  I'm not sure how a transition would
> work but answer these questions:
The transition is already underway with Medicare and Medicaid, both of which
are about to go bankrupt in the US.
>
> 1) What western country spends the largest portion (by a wide margin) of
> GDP on healthcare?
This, by itself, doesn't mean that healthcare in the US is bad.  It 
might mean the opposite.
>
> 2) What western country has the largest percentage of citizens without
> healthcare?
Do you have any idea what the percentage of citizens in the US is 
without healthcare
coverage?   The main stream media  and some politicos grossly 
misrepresent this
number.  The fact is that healthcare for those that need it in the US 
can't be denied. 
The type of coverage isn't the same for everyone, but essentially 
everyone has coverage
of some sort.  People may not have signed up for it, but, in fact, may 
have coverage. 
Take a look at the sign in every ER room in America, e.g.

Dave
>
>
> TWC
>






  
  
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Re: [openhealth] Beyond standards.

[David Forslund]

HL7 is only a partial "solution" to interoperability as you indicate and 
less than
most might have thought.  Which is why there is the HSSP
effort underway which is picking up from the OMG HDTF effort
almost a decade ago.    The OMG HDTF made enormous
progress toward interoperability but it is little recognized today.
I think we know how to develop standards for interoperability
and have for some time.   People just haven't had the
interest/motivation/incentive to do so.

I agree that everyone running the same code is not the answer to 
interoperability.
This is precisely the message of the OMG HDTF effort done 5-10 years ago.
It is also why the push by the House of Representatives to have the DoD
and the VA use a common set of software isn't the answer, either.  It might
save money, but it doesn't do much for interoperability.  What is curious
is that they failed to recognize that there was a big effort to have 
interoperability
between the VA and DOD (GCPR project) around 2000, but people gave up
only part way through the effort due to political considerations.

Your response is an eloquent reason why FOSS by itself
does little for interoperability.

Dave

Greg Woodhouse wrote:
> But what level of interoperability do you really have in healthcare
> applications. Sure, there are standards like HL7, but they do not
> really help much when it comes to achieving interoperability of
> systems. That's not a criticism of HL7, rather an acknowledgment that
> its goals are different. It provides a framework from within which
> interoperability can be achieved (much as SOAP does for web services),
> but does very little when it comes to actually providing a mechanism
> for ensuring interoperability v3 does somewhat more in this regard by
> defining the RIM and CDA framework. But ultimately, the real issue is
> that how to develop standards for interoperability between healthcare
> systems remains an open problem -- we just don't know how to do it
> (yet).
>
> I'm less than enthusiastic about the idea that interoperability should
> be achieved by having everyone run the same (open source) applications
> beccause it just dodges the issue: If everyone is running the same
> code, well then yes, of cours, they'll be interoperable. But that is an
> empty sort of success. Similarly, it is fine to say that I am free to
> peruse the source code of an application and thus learn how it works
> and what I need to do to integrate with it, but why should it be
> necessary? Again the suggestion that I need to "use the source" (to
> borrow a chapter title from a book I read years ago, and one that still
> bothers me) is preposterous. Yes, that is one option that open source
> makes available to me, but it should be an option of last resort! If
> someone wants to learn to drive, should I had them a wrench and say:
> Well, take a look and see how the car works. It's an "open source" car,
> so you're in luck. If I sound a little passionate about this...well,
> maybe it's the result of spnding too many years reading through other
> people's code because that was my only option when it came to trying to
> figure out what they were doing, and what is going to take to enhance
> (or build interfaces with) their code.
>
> ===
> Gregory Woodhouse  <[EMAIL PROTECTED]>
>
> Metaphors be with you.
>
> 







  
  
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Re: [openhealth] Beyond standards.

[David Forslund]

I am familiar with this problem. It seems to me to stem from negotiating
the wrong kind of contract. I don't think FOSS helps that much because
the contracts seem to me to be negotiated from ignorance. If the local
organization demands interoperability BEFORE they sign a contract they
will have more power over the provider. If they don't understand the 
technology
and interoperabilty, FOSS won't help, since they will still be at the mercy
of the company providing the software and support . Many organizations 
are afraid
of FOSS because they have no local capability of managing it and are
dependent totally on the software company providing the software and
support. They are more "comfortable" with a company that "holds their
hand" and "picks their pocket" :-) Until people understand and
adopt interoperability so that they can switch out a non-performer
easily, this will continue. FOSS can impact this but only marginally.
FOSS needs to support full interoperability so that it becomes a
viable option to the user. For example, running on a "LAMP"
platform provides great platform portability and cost
but says nothing about interoperability. If FOSS would
lead in interoperability, it would be beneficial to the end user
and improve FOSS' chance of market penetration.

I'll now get down off of my "soapbox".

Dave

ivhalpc wrote:
> I know I'm preaching to the choir, but beyond standards, my point is
> that I don't see how it is going to solve the proprietary motivation
> problem. Proprietary companies are like Emperor Palpatine in that they
> can have absolute power over who can interoperate with their system by
> what is in their support contracts. They can veto, delay or demand
> money for practically anything because the contract they write says
> they can. The local system support, for fear of being cut off by the
> mother ship, can be clueless or easily intimidated or just don't want
> to do it. That's just one of many ways interoperability can be
> torpedoed in a proprietary world. It doesn't matter what standards
> real or future that reach all the way up to the GUI say. FOSS
> eliminates many of these problems or makes them tractable. Again, I'm
> probably preaching to the choir on this list.
>
> -- Ignacio H. Valdes, MD, MS
> -- Editor: Linux Medical News
> -- http://www.linuxmednews.com
>
> --- In openhealth@yahoogroups.com, David Forslund <[EMAIL PROTECTED]> wrote:
> >
> > Well there is a proliferation of "standards" in this arena and the
> > WebServices effort is adding to this proliferation. I think the
> > one positive note I see is that at least a portion of IBM is working
> > on standards at a higher level. It would be nice to see the
> > technical underpinnings of the IHII and the nature of its open source.
> >
> > Dave
> > ivhalpc wrote:
> > > Good point. Where IBM and all other efforts fail is these little
> > > feifdoms controlled by shrew proprietary companies and skittish locals
> > > who are afraid of 'voiding the support contract' with said companies
> > > to get data out of local systems. The inevitable answer becomes: $15K
> > > and minimum 90 days for data feed for one site.
> > >
> > > The whole proprietary system sucks because it crushes most
> > > interoperability efforts by creating local mini-monopolies in which
> > > local technical support, local legal, local leadership, proprietary
> > > company technical support, proprietary company legal, proprietary
> > > company sales, proprietary company leadership can either delay or
> > > cripple any and all interoperability efforts by just saying no. In
> > > effect, it takes a local Act of Congress to get these things done for
> > > just one medical setting regardless of the technical feasibility or
> > > not. I don't see how IBM or anyone else can deal with this.
> > >
> > > I wonder how this is all going to end and I fear it will end badly as
> > > in Nationalized medicine in the US when costs continue to climb out of
> > > control because of this kind of insanity.
> > >
> > > -- Ignacio H. Valdes, MD, MS
> > > -- Editor: Linux Medical News
> > > -- http://www.linuxmednews.com
> > >
> > > --- In openhealth@yahoogroups.com, David Forslund  wrote:
> > > >
> > > > IBM is part of one of the ONCHIT "winners". Also IBM is
> > > participating in
> > > > the HSSP effort. Sounds like normal operations for IBM.
> > > > I've not found a technical reference to the IHII yet, although the
> > > > ONCHIT 

Re: [openhealth] Re: article re IBM and others contributing open source epi and other

[David Forslund]

Well there is a proliferation of "standards" in this arena and the
WebServices effort is adding to this proliferation. I think the
one positive note I see is that at least a portion of IBM is working
on standards at a higher level. It would be nice to see the
technical underpinnings of the IHII and the nature of its open source.

Dave
ivhalpc wrote:
> Good point. Where IBM and all other efforts fail is these little
> feifdoms controlled by shrew proprietary companies and skittish locals
> who are afraid of 'voiding the support contract' with said companies
> to get data out of local systems. The inevitable answer becomes: $15K
> and minimum 90 days for data feed for one site.
>
> The whole proprietary system sucks because it crushes most
> interoperability efforts by creating local mini-monopolies in which
> local technical support, local legal, local leadership, proprietary
> company technical support, proprietary company legal, proprietary
> company sales, proprietary company leadership can either delay or
> cripple any and all interoperability efforts by just saying no. In
> effect, it takes a local Act of Congress to get these things done for
> just one medical setting regardless of the technical feasibility or
> not. I don't see how IBM or anyone else can deal with this.
>
> I wonder how this is all going to end and I fear it will end badly as
> in Nationalized medicine in the US when costs continue to climb out of
> control because of this kind of insanity.
>
> -- Ignacio H. Valdes, MD, MS
> -- Editor: Linux Medical News
> -- http://www.linuxmednews.com
>
> --- In openhealth@yahoogroups.com, David Forslund <[EMAIL PROTECTED]> wrote:
> >
> > IBM is part of one of the ONCHIT "winners". Also IBM is
> participating in
> > the HSSP effort. Sounds like normal operations for IBM.
> > I've not found a technical reference to the IHII yet, although the
> > ONCHIT required at least some of the response to be open source.
> >
> > Dave Forslund
> > Nandalal Gunaratne wrote:
> > > This is another interesting paragraph
> > >
> > > "A statement from IBM said the company will engage with industry
> > > leaders. But it did not mention whether it will coordinate efforts
> > > with the so-called Interoperability Consortium—a group of large IT
> > > vendors including IBM, Cisco Systems Inc., Microsoft Corp. and Oracle
> > > Corp.—who banded together to call for open standards to be used in
> any
> > > national health information network."
> > >
>
>
>
>




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Re: [openhealth] article re IBM and others contributing open source epi and other

[David Forslund]

IBM is part of one of the ONCHIT "winners". Also IBM is participating in 
the HSSP effort. Sounds like normal operations for IBM.
I've not found a technical reference to the IHII yet, although the 
ONCHIT required at least some of the response to be open source.

Dave Forslund
Nandalal Gunaratne wrote:
> This is another interesting paragraph
>
> "A statement from IBM said the company will engage with industry 
> leaders. But it did not mention whether it will coordinate efforts 
> with the so-called Interoperability Consortium—a group of large IT 
> vendors including IBM, Cisco Systems Inc., Microsoft Corp. and Oracle 
> Corp.—who banded together to call for open standards to be used in any 
> national health information network."
>
> Nanda
>
> Heitzso <[EMAIL PROTECTED]> wrote: Not sure what pieces of this 
> are relevant, but it raised a flag for me
> (was posted on LinuxToday.com). One of the interesting sentences:
> "IBM has created a software framework, IHII (Interoperable Healthcare
> Information Infrastructure), to ease sharing of health data."
>
> http://www.eweek.com/article2/0,1895,1963157,00.asp
>
>




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Re: [openhealth] Standards -- more questions

[David Forslund]

It isn't clear to me the role that OSHCA can/should play in the 
standards world.   It might be useful
for the community to agree on things that "everyone" will support, but 
that alone doesn't make it a "standard".
Standards my be dictated by national entities or other bodies outside 
the control of OSHCA. 
Alvin B. Marcelo wrote:
> First thread:
>
> I propose we standardize on ICD-10 (as a minimum). It's an 
> international standard anyway (albeit
> difficult to use). This of course does not preclude the others from 
> using SNOMED if they can
> afford to do so.
>
> That being the case, OSHCA can also 'standardize' on the preferred 
> mapping system between SNOMED
> to ICD-10. Any proposals?
UMLS has some such mappings, I believe.  If SNOMED isn't free outside 
the US and UK, it isn't clear how
one could agree on a mapping. 
>
> Molly, how do 'sweeping statements' like these get to be approved 
> officially by OSHCA?
>
> Second thread:
>
> An interesting insight I got at the last Regional Conference in Open 
> Standards sponsored by NECTEC
> and IOSN in Bangkok (May 2-4) --  an Intel smployee (Danese) 
> emphasized that open standards may
> only be considered open if they can be fully implemented by open 
> source software.
>
> Any thoughts about that statement? Can we actually call a standard 
> open if there are limitations
> to its implementation by FOSS?
The question is what types of limitations are we talking about.   ASTM's 
CCR, for example, costs money but can
easily be implemented in open source without any licensing issues.   
There is an open source implementation of
HL7 V3 in Java but it requires the HL7 RIM to properly function and this 
costs money to use (but not to deploy?).
People have argued that the OMG specs "might" be encumbered by a patent 
and thus don't want to implement them
in open source.  But many areas of software are in this category that 
they "might" be encumbered by a patent, so I
argue this is a "red herring".   We have existence proofs that OMG specs 
can be implemented in open source.

It might be possible to implement CPT codes in open source, but not to 
be able to deploy it for free.  I don't think
open source "necessarily" implies "free".   This is the old argument as 
to what one means by "free".   (as in beer vs ideas).

Dave
>
>
> alvin
>
>
>
>
>
> --- Nandalal Gunaratne <[EMAIL PROTECTED]> wrote:
>
> >
> >
> > "Alvin B. Marcelo" <[EMAIL PROTECTED]> wrote:
> >  You are quite right. Interoperability depends in turn on the 
> agreement on standards. Coding
> > systems included.
> >   
> >  Unfortunately the best nomenclature coding system is SNOMED-CT 
> which is a proprietary product.
> > But I am sure the new versions of the ICD system will improve if 
> they are widely used.
> >   
> >  Can our group agree on such standards?
> >   
> >  Nanda Gunaratne
> >   
> >  However, my question to the group is: can there actually be 
> interoperability
> >  without agreement on coding systems? And if we accept the fact that 
> yes we need to share coding
> >  systems, what coding systems should these be and why. I believe 
> this is an area where
> > openhealth
> >  can greatly contribute by laying down these 'open' standards upon 
> which future interoperabilty
> > can
> >  be made more possible.
> > 
> >  alvin
> >    




  




  
  
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Re: [openhealth] Standards

[David Forslund]

In the US  (and UK) SNOMED-CT is freely available.    Do folks use the 
ICPC-2 spec?  If so what do you all think of it?

Dave
Nandalal Gunaratne wrote:
>
>
> "Alvin B. Marcelo" <[EMAIL PROTECTED]> wrote:
> You are quite right. Interoperability depends in turn on the agreement 
> on standards. Coding systems included.
>   
> Unfortunately the best nomenclature coding system is SNOMED-CT which 
> is a proprietary product. But I am sure the new versions of the ICD 
> system will improve if they are widely used.
>   
> Can our group agree on such standards?
>   
> Nanda Gunaratne
>   
> However, my question to the group is: can there actually be 
> interoperability
> without agreement on coding systems? And if we accept the fact that 
> yes we need to share coding
> systems, what coding systems should these be and why. I believe this 
> is an area where openhealth
> can greatly contribute by laying down these 'open' standards upon 
> which future interoperabilty can
> be made more possible.
>
> alvin
>    







  
  
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Re: [openhealth] Standards

[David Forslund]

I like OpenEHR a lot, but it is not a standards body.   ASTM is (in the 
US anyway).  OpenEHR needs to be able to support the
various standards out there.    CCR is rather simple and I'm sure rather 
trivial for OpenEHR to support.  It is trivial for OpenEMed
to support it, for example, with no changes in the server code. The 
OpenEHR folks need to lend their expertise to the design
of the CCR to ensure it properly represents what is needed in the 
healthcare community.  Many companies, both open source
and proprietary have contributed to its design and specification.

Nandalal Gunaratne wrote:
>
>
> David Forslund <[EMAIL PROTECTED]> wrote:
> The coding system standards in the US have been specified by CHI.   We
> should share coding systems, but
> even more important is to provide mappings between coding systems, since
> not everyone will ever use the
> same coding system.   OSS could lead by example.  Proprietary systems
> are moving rapidly in this direction.
> The ASTM CCR enables one to describe an event in multiple coding
> systems.   The ASTM CCR isn't free,
> but the cost is nominal and isn't per site.
>   
> The OpenEHR project is also setting these standards, but not using a 
> coding system. It uses archetypes to describe every clinical item in a 
> standard and explicit manner. It could be able to map to different 
> coding systems as well. OpenEHR is free and FOSS.
You could view the CCR is a form of archetype.  It uses coding systems.
>   
> The ASTM CCR has some inconsistencies in exported reports. Take the 
> chronological order for example. Encounters are from the oldest to the 
> latest from top to bottom and Results are the other way.
I'm puzzled by your statement as there is nothing in the schema or the 
implementation guide that makes what you say as a requirement.  The 
schema clearly doesn't so you must be referring to something in the 
implementation guide, but I've not seen it.
>   
>   There is also a large amount of text fields in use which means 
> coding becomes useless or difficult.
It has strong support for coded results and also supports text fields.  
Coded results, of course, are required if one is to have 
interoperability.  I don't think the CCR is perfect but I don't think it 
suffers from the "defects" you state.

Thanks,

Dave
>   
>
> Dave
> >
> > alvin
> >
>
>
>    







  
  
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Re: [openhealth] Standards

[David Forslund]

Alvin B. Marcelo wrote:
> > Tell me where I can find something of the Phillipine RUV system for 
> procedures?
>
> http://www.philhealth.gov.ph/download/RVS2003.pdf
What is the meaning of the RVU column in this document?

Someone needs to do a mapping of this to one of the other UMLS data models.
>
> > If you are using ICD-10 for disease codes you could have used the 
> ICD-10-PCS (Procedure Coding
> System).
>
> I agree, but you see, I do not make the call regarding these things at 
> home [politicians do :( ].
> But which is better, CPT4 or ICD-10-PCS?
Isn't CPT proprietary and expensive?
>
> > Interoperability is not something to do with just using the same 
> coding systems though...
>
> I agree. Interoperability is more than just codes.
>
> However, my question to the group is: can there actually be 
> interoperability
> without agreement on coding systems? And if we accept the fact that 
> yes we need to share coding
> systems, what coding systems should these be and why. I believe this 
> is an area where openhealth
> can greatly contribute by laying down these 'open' standards upon 
> which future interoperabilty can
> be made more possible.
The coding system standards in the US have been specified by CHI.   We 
should share coding systems, but
even more important is to provide mappings between coding systems, since 
not everyone will ever use the
same coding system.   OSS could lead by example.  Proprietary systems 
are moving rapidly in this direction.
The ASTM CCR enables one to describe an event in multiple coding 
systems.   The ASTM CCR isn't free,
but the cost is nominal and isn't per site.

Dave
>
> alvin
>







  
  
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Re: [openhealth] Standards for health information systems

[David Forslund]

As most of you know by now, OpenEMed uses a service oriented architecture
based on the OMG  PIDS/COAS/RAD/LQS standards, with PIDS using
by default the HL7 2.3 PID segment of patient identification.   COAS uses
various HL7 codes for observations (or any other coding system that is 
available).
LQS sits on top of a kernel based on Mayo's LexGrid and also implements
HL7 CTS service (OpenCTS).   RAD is the logical equivalent and predecessor
to XACML.   All of these services support federation so that multiple 
servers
could provide the functionality in a distributed manner.

Is there an effort to map RUV to something in UMLS so that translations 
could be done
for CHITS?

Dave Forslund
[EMAIL PROTECTED] wrote:
> Hi all,
>
> I'm collating standards (open or otherwise) that are being used in open
> source health applications.
>
> I'd appreciate if the developers on the list would explicitly publish what
> standards they base their applications on and perhaps we can establish
> interoperability from thereon.
>
> For CHITS, we use ICD-10 (for disease codes), the Philippine medicare's
> RUV (relative unit values)  system for procedures, and are currently
> developing an XML schema for our local claims processing system (most
> probably a subset of HL7). Although HL7 is an international standard, this
> Philippine subset still has to go through the process of approval by local
> authorities.
>
> Thanks in advance.
>
>
>







  
  
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[openhealth] Re: voting results

[David Forslund]

Will we hear the voting results or are they posted somewhere?
What is the point of the election unless the votes are reported?
Have I missed something?

Dave Forslund






  
  
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[openhealth] OSHCA voting

[David Forslund]

When will we hear how the voting went?

Thanks,

Dave Forslund



  




  
  
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Re: [openhealth] OSHCA Inaugural Meeting - Closing remarks

[David Forslund]

I commend Molly and the Protem committee for all of the hard work.
I assume the digestion of this event will include reporting how the 
voting went.
( I've been curious why "protem" was used for the committee name instead 
of "protemp"?)
I supposed I should have followed all the openhealth discussions on 
registering, etc., but I've not
had much time to do that.   I've been more interested in the technical 
exchanges
on the list rather than organizational discussions.

Dave
Molly Cheah wrote:
> Hi,
>
> It's time that the Inaugural Meeting has come to a close, the longest
> inaugural meeting that allows interested and supportive people across
> the globe to move for the registration of OSHCA. The protem committee
> will take note of all comments and submission and will deliberate and
> then proceed to get OSHCA registered. I believe we have the right
> conditions to do it.
>
> Thank you all for participating.
>
> Rgds,
> Molly
>
> 







  
  
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Re: [openhealth] Re: oshca inaugural meeting - constitution

[David Forslund]

I don't understand the complaint about Will's concerns.  The voting 
wasn't done when he indicated his comments.
So why do you say that "everything was done and over with"?  What is the 
voting about then?  Perhaps
I'm missing something important?  I thought voting was a "democratic" 
process. :-)

Dave
Nandalal Gunaratne wrote:
>
>
> Fred Trotter <[EMAIL PROTECTED]> wrote:
>
> Fred,
>
> There was enough time given for dissent/discussion. Molly asked 
> everyone repeatedly to comment on the issues. We can't wait for ever, 
> therefore a time limit was set, and the FINAL draft was set down. 
> Therfore there was really nothing to disagree about!
>
> Perhaps, Molly should have removed the disagree part and just left 
> everyone to approve.
>
> Will sent his comments once everything was done and over with. Where 
> was he all that time? His late comments would only disrupt a process 
> set in motion in a very democratic manner.
>
> If you cannot understand this situation, by all means wait in the 
> sidelines and join when you are happy to do so. Nobody will stop you. 
> See the democracy at work ?
> :-)
>
> Hope to see you back soon, dissenting and arguing!
>
> Nandalal
>  OSCHA committee,
>   It is a little troublesome that Will's membership is being
> discarded along with his comments. Essentially the arguments of the
> committee is "lets get it working and then worry about getting it right".
> This is fine but I, at least, will have to wait to see it working right
> before I can toss my hat in the ring. This is not so much a criticism,
> perhaps the committee has the right idea! But until there is an entity 
> that
> merits trust (which means having a forum for dissenting supporters) then I
> will have to stay on the sidelines with (apparently) Will.
>
> --
> Fred Trotter
> SynSeer, Consultant
> http://www.fredtrotter.com
> http://www.synseer.com
>
>
> [Non-text portions of this message have been removed]
>
>   




  




  
  
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Re: [openhealth] Re: oshca inaugural meeting - constitution

[David Forslund]

Will Ross wrote:
> dave,
>
> it's not necessarily flawed if the majority vote moves the process 
> forward and all the resolutions pass.   i think the organization has 
> enough "yea" votes to pass all the resolutions, and i anticipate they 
> will pass.   i find it curious that the "yea" votes want to kick me 
> out for voting "nay", that's an interesting self-discovery issue for 
> the open source health care community, as if i am an osi partisan in 
> a fsf meeting, or something like that.
I agree.  I was just giving my opinion of the process.  If you weren't
allowed to vote no on a single item, then I believe the process is
not what is represented.  Others may/can/will disagree.
>
> it's also not necessarily flawed if the resolutions do not pass, 
> because in the process we will acquire targeted information that will 
> allow us to improve the portions that the community identifies as 
> flawed.
I agree.
>
> in my case, i AGREED with six resolutions as proposed, i ABSTAINED 
> from three resolutions (because i lack sufficient information for a 
> decision), and i DISAGREED with only one resolution.   given the 
> process we have created, i will be surprised if they don't all pass.
I did about the same.

Dave
>
> [wr]
>
> - - - - - - - -
>
> On Apr 25, 2006, at 7:10 AM, David Forslund wrote:
>
> > If the process requires all of the items to be approved to move 
> > forward,
> > I submit it is fatally flawed.  If all are required to be approved 
> > then
> > there should simply be one vote up or down.  If not then the 
> > results of
> > the process should be able to go forward based on the various possible
> > outcomes. I haven't decided how to vote yet, but will do so 
> > sometime today.
> >
> > Dave
> > Will Ross wrote:
> >> molly,
> >>
> >> with all due respect, what is the point of offering opportunities to
> >> vote for or against a position if a nay vote is disallowed or
> >> prevents the possibility of membership?   please explain to me how
> >> the loyal opposition can voice their opinion without harassment,
> >> retribution, exclusion and expulsion.
> >>
> >> please review the motions.   i approved the creation of the entity,
> >> the naming of the entity, and the members of the protem committee,
> >> but i opposed submission of the proposed constitution because i
> >> consider it to be unnecessarily flawed, and the process to be
> >> unnecessarily rushed.   i fail to see to see the connection between
> >> my nay vote on the constitution and your assertion that i am
> >> disallowed to be a founding member.   if anything, it is flawed
> >> instructions for a meeting process that is interfering with my good
> >> faith attempt to openly join oshca.
> >>
> >> with best regards,
> >>
> >> [wr]
> >>
> >> - - - - - - - -
> >>
> >> On Apr 24, 2006, at 9:00 PM, Molly Cheah wrote:
> >>
> >>> Hi Will,
> >>> What you have done is incorrect. As you disagree with the
> >>> constitution, we will not be able to include your name in the list
> >>> of founding members to the ROS simply because the ROS will not
> >>> register OSHCA. Therefore there will be no OSHCA for you to be a
> >>> member of.
> >>>
> >>> I am posting this to the openhealth list for the information of
> >>> others.
> >>>
> >>> Molly
> >>> Will Ross wrote:
> >>>
> >>>> joseph,
> >>>>
> >>>> not sure if this is correct.
> >>>>
> >>>> [wr]
> >>>>
> >>>> - - - - - - - -
> >>>>
> >>>> will ross
> >>>> project manager
> >>>> mendocino informatics
> >>>> 216 west perkins street, suite 206
> >>>> ukiah, california  95482  usa
> >>>> 707.462.6369 [office]
> >>>> 707.462.5015 [fax]
> >>>> www.minformatics.com
> >>>>
> >>>> - - - - - - - -
> >>>>
> >>>> "Getting people to adopt common standards is impeded by patents."
> >>>> Sir Tim Berners-Lee,  BCS, 2006
> >>>>
> >>>> - - - - - - - -
> >>>>
> >>>>
> >>>>
> >>>> - - - - - - - -
> >>>>
> >>>>
> >>>> ---

Re: [openhealth] Re: oshca inaugural meeting - constitution

[David Forslund]

If the process requires all of the items to be approved to move forward,
I submit it is fatally flawed.  If all are required to be approved then
there should simply be one vote up or down.  If not then the results of
the process should be able to go forward based on the various possible
outcomes. I haven't decided how to vote yet, but will do so sometime today.

Dave
Will Ross wrote:
> molly,
>
> with all due respect, what is the point of offering opportunities to 
> vote for or against a position if a nay vote is disallowed or 
> prevents the possibility of membership?   please explain to me how 
> the loyal opposition can voice their opinion without harassment, 
> retribution, exclusion and expulsion.
>
> please review the motions.   i approved the creation of the entity, 
> the naming of the entity, and the members of the protem committee, 
> but i opposed submission of the proposed constitution because i 
> consider it to be unnecessarily flawed, and the process to be 
> unnecessarily rushed.   i fail to see to see the connection between 
> my nay vote on the constitution and your assertion that i am 
> disallowed to be a founding member.   if anything, it is flawed 
> instructions for a meeting process that is interfering with my good 
> faith attempt to openly join oshca.
>
> with best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Apr 24, 2006, at 9:00 PM, Molly Cheah wrote:
>
> > Hi Will,
> > What you have done is incorrect. As you disagree with the 
> > constitution, we will not be able to include your name in the list 
> > of founding members to the ROS simply because the ROS will not 
> > register OSHCA. Therefore there will be no OSHCA for you to be a 
> > member of.
> >
> > I am posting this to the openhealth list for the information of 
> > others.
> >
> > Molly
> > Will Ross wrote:
> >
> >> joseph,
> >>
> >> not sure if this is correct.
> >>
> >> [wr]
> >>
> >> - - - - - - - -
> >>
> >> will ross
> >> project manager
> >> mendocino informatics
> >> 216 west perkins street, suite 206
> >> ukiah, california  95482  usa
> >> 707.462.6369 [office]
> >> 707.462.5015 [fax]
> >> www.minformatics.com
> >>
> >> - - - - - - - -
> >>
> >> "Getting people to adopt common standards is impeded by patents."
> >> Sir Tim Berners-Lee,  BCS, 2006
> >>
> >> - - - - - - - -
> >>
> >>
> >>
> >> - - - - - - - -
> >>
> >>
> >> -
> >> ---
> >>
> >> No virus found in this incoming message.
> >> Checked by AVG Free Edition.
> >> Version: 7.1.385 / Virus Database: 268.4.6/323 - Release Date: 
> >> 4/24/2006
> >>
> >
> >
>
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california  95482  usa
> 707.462.6369 [office]
> 707.462.5015 [fax]
> www.minformatics.com
>
> - - - - - - - -
>
> "Getting people to adopt common standards is impeded by patents."
>  Sir Tim Berners-Lee,  BCS, 2006
>
> - - - - - - - -
>
>




  




  
  
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Re: [openhealth] Re: OSHCA Membership question

[David Forslund]

Interoperability certainly isn't the "only" issue.  However, you will 
find that it
is an integrating issue.  That is it brings a number of important issues 
together and
actually reduces cost.  There is never a question of whether one needs
to interoperate, only when.  Typically people want to defer this issue,
but in doing so they only increase the long term cost and reduce
the benefit to the patient.   We wrote a paper on this in 2000, which I 
referred
to in an earlier email, but I've not heard a critique of that paper.
Planning for interoperability (not necessarily fully implementing it) I 
submit
reduces even short term costs.   One reason is that it leads to more
reusable software and allows new projects to be started at a lower cost
by using earlier developed capabilities. 

Dave

Tim Churches wrote:
> Thomas Beale wrote:
> > I have to agree with Dave here - I see it as problematic if OSHCA
> > doesn't see interoperability as a key issue. FOSS just gets you
> > applications and components. Interoperable FOSS gets you integrated,
> > componentised systems and environments. This is where the cost advantage
> > of FOSS will be shown in the future. It is worth considering the
> > ObjectWeb approach (http://www.objectweb.org). 
> 
>
> No-one has suggested that interoperability is not an important issue for
> FOSS, although personally I don't regard it as the *only* issue. As with
> nearly everything, there are costs as well a benefits associated with
> building interoperability into software, and these have to be weighed
> and judgements made about what to do and when, given the inevitably
> finite resources and time available to any particular project.
>
> Tim C
>
>
>
> 
>




  




  
  
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Re: [openhealth] Re: OSHCA Membership question

[David Forslund]

This would be worthwhile.  Interoperability is far broader than open 
source, but FOSS could set the kind of example that is required.
This may (must?) involve working with those not involved in open source 
but who may be committed to interoperability.

Thanks,

Dave

Nandalal Gunaratne wrote:
>
>
> David Forslund <[EMAIL PROTECTED]> wrote:
>
> David,
>
> If the OSHCA takes on the task of making the "glue"
>
> * to get FOSS for Health groups to understand the true value of FOSS 
> which is sharing/contributing and collaborating with ideas and code
> *to demonstrate the value of interoperability and common set of 
> standards as the crux, the way forward and the power of FOSS for health
>
> does that make OSHCA worthwhile?
>
> Nandalal
>  I don't see that your answer has much to do with my question.  It 
> isn't
> about
> where we have been but where we are going and why.  I don't doubt the
> need for an international forum but what will be the constraints on
> participation?
> I currently don't see any difference in most open source systems as to
> the vendor
> "lock-in" other than that one can look at the code.   I don't see that
> the proposed fees for OSHCA will do anything other than allow it to
> organize (but not fund) meetings.   I'm not sure that that will accomplish
> much without some purpose or goal to the meetings.   I need to see the
> value of the organization.  People can participate in our project, for
> example, for nothing
> and this includes contributing code, etc.   This typically would be a lot
> more participation than might occur in OSHCA itself.  Without a strong
> set of goals which might include interoperability, the value of OSHCA is
> unclear to me.
>
> If OSHCA is non-profit, will it be recognized as such in the US so that
> gifts
> to it would be tax-deductible, or is the membership fee not a charitable
> "gift" but
> something that you "purchase" and receive value in return? 
>
> Thanks,
>
> Dave
>
>
> Joseph Dal Molin wrote:
> > OSHCA meetings have always been open to anyone. While there has been
> > much progress without OSHCA and there are other open source "working
> > groups" imbedded in organizations like AMIA etc. there is a need for an
> > open international forum whose focus is solely open source in health and
> > provides a place both in the form of meetings and online venues for what
> > I perceive to be "islands" of activity to interact and cross pollenate.
> > This will evolve into concrete initiatives where there is sufficient
> > "itch to scratch" and motivation to actI would definitely vote for
> > promoting open source interoperability as a good starting pointit
> > would be truly ironic if open source projects reinvented "lock-in".
> >
> > Where OSHCA goes from here will be up to its membership and the goal
> > creating a "formal" organization will allow the scope of what OSHCA can
> > accomplisy, through funding etc. to expand significantly.
> >
> > Joseph
> >
> > David Forslund wrote:
> > > Is OSHCA membership intended to simply be an issue of who can vote on
> > > decisions by the organization or does it entail other matters?  Most
> > > organizations allow for observers and external contributors, but those
> > > can't vote on organizational decisions.   For example, can anyone
> > > participate/attend an OSHCA meeting (subject to possible meeting fees
> > > which are distinct from membership) or only paying members?   Will 
> this
> > > list only be for paying OSHCA members?  So far the benefits of 
> this list
> > > on discussion of technical issues is valuable, but I don't yet see the
> > > benefits of joining OSHCA.  There are other open source organizations
> > > that are at least as valuable being a member of.  I don't  know what
> > > OSHCA will be "doing".   I would think that promoting interoperability
> > > amongst open source systems would be a good task to do, but I 
> don't see
> > > that on the list.  We have been fairly successful championing and
> > > promoting open source in healthcare without OSHCA.   I need to
> > > understand the benefit of joining the organization.  The cost 
> isn't the
> > > issue; the time and effort is.
> > >
> > > Thanks,
> > >
> > > Dave Forslund
> > >
> > >




  




  
  
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Re: [openhealth] Re: Community Health Information Tracking System www.chits.info

[David Forslund]

I agree precisely with Thomas' succinct statement.   Healthcare
is still dealing with and producing silos that can't easily be penetrated.
We have found it easier to tackle this in locations that have no
existing infrastructure to overcome, such as underdeveloped regions
(of which we have many in the US, including one area within 20 miles
of Los Alamos).   It is easier to do it "right" in those areas than in
big hospital systems because one doesn't have to discard existing
systems.  This is something that OSHCA should really
embrace as it would make an enormous difference in underdeveloped
countries and regions. 

Dave
Thomas Beale wrote:
>
> The areas where we need to commit to standards to achieve proper
> interoperability include:
> - information (what is stored and shared)
> - service interfaces and APIs (how do components talk to each other; how
> do apps talk to business logic, to back-ends etc)
> - terminology & other knowledge resources (computable guidelines, drug
> databases etc)
> - clinical and other content models (archetypes & templates).
>
> Not being interested in this is equivalent to working on yet another 
> silo...
>
> - thomas
>
>
>
> 
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Re: [openhealth] Re: OSHCA Membership question

[David Forslund]

I don't see that your answer has much to do with my question.  It isn't 
about
where we have been but where we are going and why.  I don't doubt the
need for an international forum but what will be the constraints on 
participation?
I currently don't see any difference in most open source systems as to 
the vendor
"lock-in" other than that one can look at the code.   I don't see that
the proposed fees for OSHCA will do anything other than allow it to
organize (but not fund) meetings.   I'm not sure that that will accomplish
much without some purpose or goal to the meetings.   I need to see the
value of the organization.  People can participate in our project, for 
example, for nothing
and this includes contributing code, etc.   This typically would be a lot
more participation than might occur in OSHCA itself.  Without a strong
set of goals which might include interoperability, the value of OSHCA is 
unclear to me.

If OSHCA is non-profit, will it be recognized as such in the US so that 
gifts
to it would be tax-deductible, or is the membership fee not a charitable 
"gift" but
something that you "purchase" and receive value in return?  

Thanks,

Dave


Joseph Dal Molin wrote:
> OSHCA meetings have always been open to anyone. While there has been
> much progress without OSHCA and there are other open source "working
> groups" imbedded in organizations like AMIA etc. there is a need for an
> open international forum whose focus is solely open source in health and
> provides a place both in the form of meetings and online venues for what
> I perceive to be "islands" of activity to interact and cross pollenate.
> This will evolve into concrete initiatives where there is sufficient
> "itch to scratch" and motivation to actI would definitely vote for
> promoting open source interoperability as a good starting pointit
> would be truly ironic if open source projects reinvented "lock-in".
>
> Where OSHCA goes from here will be up to its membership and the goal
> creating a "formal" organization will allow the scope of what OSHCA can
> accomplisy, through funding etc. to expand significantly.
>
> Joseph
>
> David Forslund wrote:
> > Is OSHCA membership intended to simply be an issue of who can vote on
> > decisions by the organization or does it entail other matters?  Most
> > organizations allow for observers and external contributors, but those
> > can't vote on organizational decisions.   For example, can anyone
> > participate/attend an OSHCA meeting (subject to possible meeting fees
> > which are distinct from membership) or only paying members?   Will this
> > list only be for paying OSHCA members?  So far the benefits of this list
> > on discussion of technical issues is valuable, but I don't yet see the
> > benefits of joining OSHCA.  There are other open source organizations
> > that are at least as valuable being a member of.  I don't  know what
> > OSHCA will be "doing".   I would think that promoting interoperability
> > amongst open source systems would be a good task to do, but I don't see
> > that on the list.  We have been fairly successful championing and
> > promoting open source in healthcare without OSHCA.   I need to
> > understand the benefit of joining the organization.  The cost isn't the
> > issue; the time and effort is.
> >
> > Thanks,
> >
> > Dave Forslund
> >
> >







  
  
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[openhealth] Re: OSHCA Membership question

[David Forslund]

Is OSHCA membership intended to simply be an issue of who can vote on 
decisions by the organization or does it entail other matters?  Most 
organizations allow for observers and external contributors, but those 
can't vote on organizational decisions.   For example, can anyone 
participate/attend an OSHCA meeting (subject to possible meeting fees 
which are distinct from membership) or only paying members?   Will this 
list only be for paying OSHCA members?  So far the benefits of this list 
on discussion of technical issues is valuable, but I don't yet see the 
benefits of joining OSHCA.  There are other open source organizations 
that are at least as valuable being a member of.  I don't  know what 
OSHCA will be "doing".   I would think that promoting interoperability 
amongst open source systems would be a good task to do, but I don't see 
that on the list.  We have been fairly successful championing and 
promoting open source in healthcare without OSHCA.   I need to 
understand the benefit of joining the organization.  The cost isn't the 
issue; the time and effort is.

Thanks,

Dave Forslund



  




  
  
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Re: [openhealth] OSHCA inaugural meeting - important announcement

[David Forslund]

Yes, it would be nice if this info was put on the oscha.org web site (or 
at least told
there where to find the information).    I don't understand 
"representation by region".
I assumed that people from anywhere can join and that region doesn't 
matter. I
also don't understand the use of HDI.    It seems to me that the 
organization should
look for non-profit foundation support rather than dues.  If the goals 
of OSHCA
are worthwhile, it shouldn't be hard to find grant support of some kind.

Dave
Fred Trotter wrote:
> Sorry, I do not find a link... should we be looking at www.oscha.org?? 
> That
> says the next meeting is in 2002 :)
>
> -FT
>
> On 4/21/06, Molly Cheah <[EMAIL PROTECTED]> wrote:
> >
> > Hi everyone,
> >
> > I would like to announce the following:
> > 1) 25th April 2006 will be the OSHCA Inaugural Meeting Day. The form for
> > participating in the inaugural meeting will be uploaded to the files
> > section of this list by 24th April. I will provide the procedures for
> > participating in this inaugural meeting by tomorrow as we need to
> > finalise the representation for Latin America & Caribbean which is still
> > outstanding.
> > 2. The proposed OSHCA constitution (latest copy includes the OSHCA logo
> > under Article 19), the OSHCA regions list and the OSHCA  country list by
> > HDI (Human Development Index) are now available for you to download. The
> > regions list essentially provides information of the region your country
> > belongs to. Article 6 of the constitution provides for membership fees
> > which is based on the principles of equity and affordability and the HDI
> > list gives information on which category your country belongs to in the
> > HDI list.
> >
> > Please note that the protem committee had gone through 7 drafts of the
> > constitution which was also made available on this list for 7 days for
> > comments. However, the constitution itself is a living document.
> >
> > For the purpose of registering OSHCA all those who wish to be OSHCA
> > members need to agree to the constitution, agree to the resolutions
> > (this will be uploaded by the 24th April) and provide minimal personal
> > information all of which will be made available in the said form.
> >
> > As preparatory to the process, I suggest that you look through the
> > constitution to familiarize with the Articles to understand your
> > commitment if you chose to be a member of OSHCA.
> >
> > Rgds,
> > Molly
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> >
> >
> >
>
>
> --
> Fred Trotter
> SynSeer, Consultant
> http://www.fredtrotter.com
> http://www.synseer.com
>
>
> [Non-text portions of this message have been removed]
>
>
> 
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Re: [openhealth] Areas for cooperation and collaboration for OpenHealth

[David Forslund]

Tim.Churches wrote:
> David Forslund wrote:
> > Tim.Churches wrote:
> >  > David Forslund wrote:
> >  > > OMG HDTF:  PIDS, COAS, RAD, LQS
> >  >
> >  > In case anyone else is looking for these, this message provides 
> pointers
> >  > to them - they are nigh-on impossible to find just be navigating 
> around
> >  > the OMG Web site: 
> http://www.omg.org/archives/healthcare/msg01716.html
> > Of course they are also all on our site: http://OpenEMed.org
> >
> > SOAP and WSDL interfaces didn't exist when these specs were written. :-)
> >
> > The specs do have UML models behind them.  It is relatively
> > easy to translate the interfaces to WSDL (and can be done automatically
> > and even dynamically).  The unfortunate feature of WSDL is that it
> > is almost impossible to read by a human and has no good representation
> > of objects.   We've implemented HL7's CTS WSDL interface on a server
> > that also implements the OMG LQS (in OpenCTS on OpenEMed.org).
> >
> > It may not be obvious, but the importance of those interfaces aren't
> > that they are in CORBA (really IDL, which is not the same as CORBA).
> > It is that they are examples of important abstractions of value to
> > healthcare (and other domains)
>
> Sure, no argument there - the abstractions are potentially useful.
> However, for a project like, say, CHITS (which is where this thread
> started), considerable extra work involving considerable expertise is
> required to convert the OMG HDTF specs from IDL form into SOAP/WSDL.
> That is yet another reason why these interfaces are hardly ever
> implemented.
That is too bad, as it only takes a few seconds to do the automatic 
translation.
I'm not saying I like the translation, because the WSDL layer is pretty
opaque once finished, but there is no real effort.
The CTS approach of HL7 was to take the IDL create java code, edit
the java code in a rather trivial way (throwing away things) and then 
generating
the WSDL from that.   This isn't conventional but isn't difficult and is 
documented
in the CTS specification and gets most of the benefit.  

Are there any open source projects other than ours and LexGrid that are 
using
CTS?
>
> >  > However, the documents all refer to CORBA interfaces. Are there
> >  > equivalent SOAP and WSDL interface definitions? CORBA might be 
> superior
> >  > to SOAP and WSDL, but it nevertheless lost the marketing battle. 
> CORBA
> >  > interface libraries for popular open source languages are also 
> far less
> >  > well supported and maintained than SOAP libraries eg SOAP 
> libraries for
> >  > PHP, Python, Ruby, Java etc are all available as standard, 
> installable
> >  > packages for the popular Linux distributions. Not so with CORBA
> >  > libraries. That is a big consideration when it comes to 
> deployment and
> >  > support of systems.
> > Mature robust CORBA libraries are delivered with every version of Java.
> > I can't speak for PHP, etc.   C++ CORBA libraries are also delivered on
> > every Linux platform, to my knowledge. (Orbit?)
> >  >
> >  > And then there is the patent threat which Tim Cook points out. It is
> >  > pretty blatant: the OMG specification document says that readers are
> >  > granted perpetual, royalty-free copyright licenses to implement the
> >  > specifications described in software, but the very next paragraph 
> warns
> >  > that the companies contributing to the specifications might sue your
> >  > socks off for breach of unspecified patents if you do implement the
> >  > specifications. If I asked our legals about this, I am sure they 
> would
> >  > say that there is no way we should implement such specs due to 
> the legal
> >  > risk involved, evinced by the thinly veiled threat in the preface to
> >  > each of the documents.
> > Have you spoken to the OMG folks about this issue?  I still think this
> > is the usual legaleze that seems to be ubiquitous in products and 
> services
> > these days. The OMG doesn't want to be responsible for things that 
> it has
> > no control over.   I think this is a empty excuse for not using these
> > specifications
>
> If the companies involved in formulating the OMG HDTF specs had no
> intention of suing anyone for patent infringement over ideas in the
> specs, then frankly they should have said so in the pre-able to the
> specs, instead of inserting this kind of legal threat, standard though
> it may be (although I am not so sure - for example, the Open Geospatial
> Consortium specs 

Re: [openhealth] Areas for cooperation and collaboration for OpenHealth

[David Forslund]

Tim.Churches wrote:
> David Forslund wrote:
> > OMG HDTF:  PIDS, COAS, RAD, LQS
>
> In case anyone else is looking for these, this message provides pointers
> to them - they are nigh-on impossible to find just be navigating around
> the OMG Web site: http://www.omg.org/archives/healthcare/msg01716.html
Of course they are also all on our site: http://OpenEMed.org

SOAP and WSDL interfaces didn't exist when these specs were written. :-)

The specs do have UML models behind them.  It is relatively
easy to translate the interfaces to WSDL (and can be done automatically
and even dynamically).  The unfortunate feature of WSDL is that it
is almost impossible to read by a human and has no good representation
of objects.   We've implemented HL7's CTS WSDL interface on a server
that also implements the OMG LQS (in OpenCTS on OpenEMed.org).

It may not be obvious, but the importance of those interfaces aren't
that they are in CORBA (really IDL, which is not the same as CORBA).
It is that they are examples of important abstractions of value to
healthcare (and other domains)
>
> However, the documents all refer to CORBA interfaces. Are there
> equivalent SOAP and WSDL interface definitions? CORBA might be superior
> to SOAP and WSDL, but it nevertheless lost the marketing battle. CORBA
> interface libraries for popular open source languages are also far less
> well supported and maintained than SOAP libraries eg SOAP libraries for
> PHP, Python, Ruby, Java etc are all available as standard, installable
> packages for the popular Linux distributions. Not so with CORBA
> libraries. That is a big consideration when it comes to deployment and
> support of systems.
Mature robust CORBA libraries are delivered with every version of Java.
I can't speak for PHP, etc.   C++ CORBA libraries are also delivered on
every Linux platform, to my knowledge. (Orbit?)
>
> And then there is the patent threat which Tim Cook points out. It is
> pretty blatant: the OMG specification document says that readers are
> granted perpetual, royalty-free copyright licenses to implement the
> specifications described in software, but the very next paragraph warns
> that the companies contributing to the specifications might sue your
> socks off for breach of unspecified patents if you do implement the
> specifications. If I asked our legals about this, I am sure they would
> say that there is no way we should implement such specs due to the legal
> risk involved, evinced by the thinly veiled threat in the preface to
> each of the documents.
Have you spoken to the OMG folks about this issue?  I still think this
is the usual legaleze that seems to be ubiquitous in products and services
these days. The OMG doesn't want to be responsible for things that it has
no control over.   I think this is a empty excuse for not using these 
specifications
even as some kind of example of useful interface capabilities.  I've seen
no evidence that others in this community have even evaluated these
interfaces as to their usefulness.   I think they are very valuable
even if you don't want to implement them.

But then there are open source implementations of these interfaces 
available. :-)

Dave


>
> Back to square one.
>
> Tim C
>
> > Tim.Churches wrote:
> >  > David Forslund wrote:
> >  > > What we have done shouldn't be the issue at all.  What is 
> important is
> >  > > that there has been standards
> >  > > in this area for some time (98-00).  I've heard people complain 
> that
> >  > > they were too complex, but I've not heard
> >  > > people complain that they are incomplete (although I believe 
> they are).
> >  > > I claim the specs aren't
> >  > > too complex for the task that is required of them.  Almost all the
> >  > > things in the spec (particularly
> >  > > taking into account differing conformance criteria) have to be done
> >  > anyway.
> >  >
> >  > Which specs are you referring to, Dave?
> >  >
> >  > Tim C
> >  >
> >
> > 




  




  
  
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Re: [openhealth] Areas for cooperation and collaboration for OpenHealth

[David Forslund]

If you were involved more with the process, I don't think this would 
bother you too much.
If I worried about such things, I wouldn't buy anything or any
services these days.   The lawyers put caveats into everything these days.
A car manual reads like a legal document, for example.
You may notice that we've implemented all of these specifications and
there is no problem.  If you require all lawyers to be out of the loop
to deal with anything, then you won't be able to get anything done.
It also doesn't mean you can do something quite similar even
if you were worried about licensing issues.

Dave

Tim Cook wrote:
> -BEGIN PGP SIGNED MESSAGE-
> Hash: SHA1
>
> David Forslund wrote:
> > OMG HDTF:  PIDS, COAS, RAD, LQS
> >
>
> This little snippet from the OMG specs I have seen really makes
> me want to spend my time implementing them
>
> "The attention of adopters is directed to the possibility that
> compliance with or adoption of OMG specifications may
> require use of an invention covered by patent rights. OMG shall not be
> responsible for identifying patents for which a
> license may be required by any OMG specification, or for conducting
> legal inquiries into the legal validity or scope of
> those patents that are brought to its attention. OMG specifications are
> prospective and advisory only. Prospective users are
> responsible for protecting themselves against liability for infringement
> of patents."
>
> Their process needs to be modified so that this disclaimer is no longer
> needed.  But then maybe large corporations wouldn't participate 
> anymore? ;-)
>
> Just a thought or two...
>
> Tim




  




  
  
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Re: [openhealth] Re: Community Health Information Tracking System www.chits.info

[David Forslund]

Tim.Churches wrote:
> David Forslund wrote:
> > My general comment is that it is never to early to consider
> > interoperability.  The cost in the design
> > up front is very small compared to later.   Designing systems with a
> > "SOA" approach is actually
> > easier than some other ad hoc process because it keeps one focused on
> > requirements and
> > a proper level of abstraction.
>
> Hmmm, I have always found abstraction quite difficult - particularly in
> the first instance. Thought experiments about how to abstract things are
> valuable, but I find they then have to be tested in real-life systems in
> order to refine them further.
I absolutely agree.   That is what we did as part of the process.  We 
implement the abstraction
to see if it meets expectations.  From the learning process, we improve 
the abstraction.  This is
all part of the standardization process.  It should be part of any 
system which is trying to follow
a "design by contract" approach.  It doesn't mean one doesn't change the 
contract, but rather
refine it to ensure it does what everyone expects.
>
> > Interoperability is not the process of
> > coming up with a mechanism
> > of exchanging .csv files.  It is quite different.  What you describe is
> > a mechanism to exchange data,
> > but has essentially nothing to do with interoperability and doesn't
> > necessarily get you any closer
> > to interoperability with other systems.
>
> Um, it works for me in a large number of instances. Seriously, if the
> meaning of the data is clear to both systems, then exchanging data via
> CSV is definitely interoperability as far as I am concerned, because it
> very often gets the job done. These systems are not an end in themselves
> - they have no meaning or purpose other than to manage data. If a
> somewhat primitive mechanism involving human intervention to check the
> semantic congruence and to specify the syntactic details is used to get
> system to exchange information, then it is still interoperability.
This is a point-to-point interoperability which doesn't scale well with 
a lot of systems, as each
one might need a different representation of the data, including 
different terms for almost the same
thing.  Interoperability should meant that systems can work together 
almost out of the box.  HL7
hasn't provided good interoperability because it allows for to much 
custom use of and definition
of terms.   When we completed the PIDS spec in Feb 1998 (after a lot of 
hard work), we demonstrated
out of the box interoperability between about 5 vendors without any 
prior arrangements other than
implementation of the specification.  This is probably an unusual case, 
but should be a goal of
interoperability.   The CCR of the ASTM is approaching this but only 
after a lot of hard work.
>
> >  Ad hoc xml-rpc connections
> > doesn't provide interoperability
> > either.   Connectivity and communications are required for
> > interoperability, but not at all sufficient.
>
> Sure, but with CSV files and XML-RPC, it is humans which provide the
> per-instance smarts needed to get the interoperation working. It is
> messy, but it works.
I prefer to have a system in which the interfaces are publishable and 
discoverable, so it requires
little human intervention to allow systems to work together.  We know 
this is possible and reduces
human labor costs enormously.
>
> > The big problem with Web Services these days is that they are not really
> > addressing interoperability,
> > since they make the same "mistake" of allowing each implementor to have
> > their own web service.
> > Thus one has the n-body problem where one needs a different
> > communication channel for each pair
> > of systems that want to communicate.   I understand that one doesn't
> > need a lot of machinery
> > to communicate locally, but there is nothing wrong with having well
> > defined interfaces within a system
> > built of components.
>
> That assumes that the components have been built to a common set of
> interfaces. They hardly ever are because the interfaces don't exist.
But examples do exist.   You might not like them, or choose to ignore 
them, but the interfaces for
some relevant functionality do exist.  I'm sure you agree they exist 
outside of the healthcare domain.
People use http, html, xml, sql, dns, ldap, etc, which fall into this 
category.  It is more difficult
to have standard interfaces in healthcare, but such interfaces have been 
defined and implemented.
>
> > The type of interfaces needed has been documented
> > for a long time and should
> > be done in a language-independent way so that one properly understands
> &g

Re: [openhealth] Areas for cooperation and collaboration for OpenHealth

[David Forslund]

OMG HDTF:  PIDS, COAS, RAD, LQS

Dave
Tim.Churches wrote:
> David Forslund wrote:
> > What we have done shouldn't be the issue at all.  What is important is
> > that there has been standards
> > in this area for some time (98-00).  I've heard people complain that
> > they were too complex, but I've not heard
> > people complain that they are incomplete (although I believe they are).
> > I claim the specs aren't
> > too complex for the task that is required of them.  Almost all the
> > things in the spec (particularly
> > taking into account differing conformance criteria) have to be done 
> anyway.
>
> Which specs are you referring to, Dave?
>
> Tim C
>




  




  
  
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Re: [openhealth] Areas for cooperation and collaboration for OpenHealth

[David Forslund]

alvinbmarcelo wrote:
> Hi Dave,
>
> Good to see you're still here.
>
> Way back in 2001, I unsubscribed from openhealth (still in Minoru back
> then) because I felt much of the discussions were very theoretical and
> I had not much code/experience to contribute. Well now, we have source
> code (but still not enough experience, I regret).
>
> I'm beginning to see that OSHCA will not really arrive at a point when
> our apps will 'interoperate' (in the ideal sense of the word) *not*
> because it is technically impossible (you have demostrated that it can
> be done already) but rather because of 1) simple 'stubborness' [aka
> 'not invented here syndrome'] or 2) a lack of initiative to study
> what's already out there [aka laziness. Or hiding behind the 'we want
> to get a feel for it ourselves first'].
>
> To a degree, maybe we thought: "Gee, there is no standard. Maybe we
> can publish our own! And we better make it fast because Dave's might
> gain ground before ours does." [thought did not occur, believe me].
What we have done shouldn't be the issue at all.  What is important is 
that there has been standards
in this area for some time (98-00).  I've heard people complain that 
they were too complex, but I've not heard
people complain that they are incomplete (although I believe they are).  
I claim the specs aren't
too complex for the task that is required of them.  Almost all the 
things in the spec (particularly
taking into account differing conformance criteria) have to be done anyway.
>
> Personally, I could not understand the interoperability techniques you
> were proposing back then, and to be honest, did not give it enough
> time to be comprehended properly.
One simple one was that the specs were written in UML and they use 
component architecture
both of which help the development process rather than hinder it.
>
> I believe in much the same way, this same stubborness will prevent
> many (but not all) to study CHITS in depth. In our local case, it
> doesn't really matter much because our target for the CHITS
> is not OSHCA but rather the Philipine healthcare system or any other
> resource-constrained facility which would like to 'grow' into their
> HIS. CHITS in the end is a methodology with a built-in framework, and
> not a standard. It's made up of the set of capability building
> activities for local personnel to interact with CHITS in various ways.
The target of interoperability isn't and shouldn't be OHSCA.  It is much 
bigger than this.  Systems
can be built on a framework which itself isn't a standard and still have 
full interoperability.  
I don't expect others to implement persistent store the way we do, but 
still expect (hope for?) them to be interoperable
with us. 
>
> Maybe the CHITS design/glue is 'proprietary', but since it's open
> source, then it becomes non-proprietary. Will that make for
> inclusion into the OSHCA list of open source health apps ?
It can still be "proprietary" even if it is open source.  I don't think 
that OSHCA is restrictive
in this sense.   Where do I find the specifications for your "glue"?  I 
would like to do
that without having to download or read your code.   Interoperability 
specifications
should require one to read implementation code to figure out what it 
does and how it works.
That is why interoperability can actually be orthogonal to open source.
>
> If we cannot settle the interoperability question then [been at it
> ever since or maybe like the holy grail, it does not exist?], what
> might be a common concern of all OSHCA members where we can
> demonstrate cooperation and collaboration?
Join the various groups involved with interoperability and standards.  
Work in cooperation
with non-open source systems.  Contributions to these efforts can be 
done with no cost or
minimal cost in some cases.   For example, ASTM is involved with 
demonstrating CCR
interoperability at TEPR next month.  The cost of being involved is 
somewhere around $100.  
We have an open source implementation of the CCR based on OpenEMed and 
hope to
show interoperability with a number of open and closed systems.

My comments are that open source systems should demonstrate themselves 
as capable
or more capable than proprietary closed source systems and need to work 
side by side
with them.   The requirement of interoperability in the US, at least, 
has reached a critical
mass, in my opinion.   The NHIN is forcing vendors to deal with 
interoperability and not
ignore it and hope it will go away.   There is no reason why the open 
source community
shouldn't be leading in this area.

Dave





  




  
  
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Re: [openhealth] Re: Community Health Information Tracking System www.chits.info

[David Forslund]

My general comment is that it is never to early to consider 
interoperability.  The cost in the design
up front is very small compared to later.   Designing systems with a 
"SOA" approach is actually
easier than some other ad hoc process because it keeps one focused on 
requirements and
a proper level of abstraction.  Interoperability is not the process of 
coming up with a mechanism
of exchanging .csv files.  It is quite different.  What you describe is 
a mechanism to exchange data,
but has essentially nothing to do with interoperability and doesn't 
necessarily get you any closer
to interoperability with other systems.   Ad hoc xml-rpc connections 
doesn't provide interoperability
either.   Connectivity and communications are required for 
interoperability, but not at all sufficient.
The big problem with Web Services these days is that they are not really 
addressing interoperability,
since they make the same "mistake" of allowing each implementor to have 
their own web service.
Thus one has the n-body problem where one needs a different 
communication channel for each pair
of systems that want to communicate.   I understand that one doesn't 
need a lot of machinery
to communicate locally, but there is nothing wrong with having well 
defined interfaces within a system
built of components.   The type of interfaces needed has been documented 
for a long time and should
be done in a language-independent way so that one properly understands 
the abstractions.   That doesn't
mean that one has to or should use CORBA or IDL, but the processes 
should be properly abstracted
so that when one wants to turn on communication, it doesn't break things 
elsewhere in the code. This failure
to take into account interoperability seems universal in healthcare and 
other domains.

If there is a mechanism in CHITS to "glue" things together, I would like 
to see the documentation so I could
see what is involved.   Unfortunately, if it is only in PHP, it makes it 
more difficult because it has PHP artifacts.

Anyway, that is my $.02

Dave
Tim.Churches wrote:
> David Forslund wrote:
> > Alvin,
> >
> > We had exactly this approach with the OMG HDTF (aka corbamed) in the
> > late 90's.   There are standards there which do exactly this (long
> > before people thought about doing web services).  In addition, this is
> > now being revisited with the HSSP joint effort of HL7 and the OMG
> > (hssp.wikispaces.org).   Since there are specifications for this type of
> > integration, I would hope people would pay attention to at least learn
> > from them in later versions of such standards.   The HSSP effort is and
> > all are invited to participate.   The only open source system I'm aware
> > of that has tried to follow this pattern is the OpenEMed software :-) 
> > What is the "glue" that is used in CHITS?
> >
> > If all open source systems "glue" stuff together differently, it isn't
> > all that much better than proprietary systems although it might be more
> > "discoverable".   Our entire philosophy with OpenEMed is to have well
> > defined interfaces that define component behavior so that systems can
> > interoperate easily.  This was proven to work very well at HIMSS in
> > 1998, where a number of commercial products worked out of the box
> > without any prior configuration.
>
> Alvin and Herman can give far more informed answers on CHITS, but lack
> of information has never stopped me from venturing an opinion...
>
> Looking at the documentation for CHITS, it seems that the "glue" in
> CHITS is a set of specifications for writing plug-in modules in PHP.
> Although that gets one only so far, I think it is a very appropriate
> place to start given the immediate goals of CHITS - it is intended for
> deployment in community health clinics in developing countries. Note the
> list of pre-requisites for a CHITS installation in a clinic:
>
> "...a telephone connection is desirable but optional..."
>
> (that's a telephone for voice communications, not computer 
> communications).
>
> That doesn't mean that attention should not be paid to interoperability,
> but worrying about which standard to use for a network-based
> service-oriented architecture (SOA) comes a fair way down the list when
> writing software intended for such settings.
>
> Of more relevance is interoperability between applications on the same
> server (which is likely to be the only server in the clinic, without any
> persistent network connections to any other server anywhere else - at
> best an intermittent dial-up connection). Thus starting with a plug-in
> framework for the software implementation language, as the CHITS people
> have do

Re: [openhealth] Re: Community Health Information Tracking System www.chits.info

[David Forslund]

Nandalal Gunaratne wrote:
>
>
> alvinbmarcelo <[EMAIL PROTECTED]> wrote:
>
> I think everyone in openhealth will agree to what you say Alvin. But 
> we need to set these standards first, and from what i can see this is 
> not going anywhere.
The HSSP folks are doing this now.  Service Oriented Architectures (SOA) 
is a new "fad" even though the concept has been around for a long time.  
The HSSP is seeking to help provide SOA solutions in healthcare through 
the HL7 (for functional specs) and the OMG (for technical specs).  We 
are participating in this and any one can participate and should if they 
are interested in promoting interoperability.
>
> What standards do we need to allow the FOSS community to build little 
> products that work together and share information ? Have we got any we 
> can use and what are they?
We have several (from the OMG HDTF) but people aren't using them. 
They've been around for almost a decade.   Probably people think they
are too complex, but they are simple compared to the Web Service stuff 
that is going on now.
>
> OpenEHR archetypes is one of the most sensible that I see.
>
> I agree that MirrorMed is doing something useful by getting and 
> sharing code, but this is only one way of collaboration.
What are the interface supported by MirrorMed?  Interoperability 
requires more than sharing code.   Interoperability shouldn't require 
everyone to use the same database backend, for example.
>
> What happens if MirrorMed works with Chits and Hospital OS based in 
> Phillipines (using Linux and postgresql)? Can we use the functions of 
> OIO/Zope which has undeniable advantages in some areas of medicine? 
> Can we share information between them? Then there is the Java based 
> OSCAR McMaster.
>
> Maybe something can come out soon on these matters.
There has been lots of discussion on these subjects on the openhealth 
list over a long period of time.  It is having people commit to 
standards that seems to be missing.

Dave
>
> Nandalal
>
>
>  Thanks Nandalal.
>
> I was wondering: whatever happened to the old discussions about making
> interchangeable health software objects (rather than large bulky
> applications). That was at a time when XML was just revving up and web
> services was in its infancy. Tom Beale had a lot to share about GEHR,
> artifacts and the like. I thought that was interesting. To some
> extent, we implemented the same concept in CHITS but we would hardly
> call it standard. (It takes a global community to create a standard?)
>
> Does OSHCA have a framework of some sort for this kind of health
> software object interchange? That's where gap is most felt in the
> industry and where openness would be of most value.
>
> I admire MirrorMed's 'gluing' stuff together. That was the kind of
> cooperation I had expected from OSHCA 'products' before. And that's
> where FOSS is strong and gains an edge over proprietary products.
>
>
> --- In openhealth@yahoogroups.com, Nandalal Gunaratne <[EMAIL PROTECTED]>
> wrote:
> >
> >
> >
> > alvinbmarcelo <[EMAIL PROTECTED]> wrote:
> > 
> >  This looks like a very good system. Congratulations!
> > 
> >  I will try this and introduce it to my colleagues in community
> health. Maybe some of them are already aware of it.
> > 
> >  Nandalal
> >  Hello all. This is Alvin Marcelo (formerly of NLM) re-subscribing.
> > 
> >  Happy to be back and to see that everyone is well.
> > 
> >  I return because now we have source code to share :)
> > 
> >  Our system is called Community Health Information Tracking System
> >  (www.chits.info) and it runs on LAMP.
> > 
> >  It was designed to be modular so you can add on modules as you see
> >  fit. This way the system 'grows' with you. Although the primary
> >  targets are village health centers in developing countries, the same
> >  modules can be used for practice management anywhere around the world.
> > 
> >  Developers and testers are welcome.
> > 
> >  System architect is Dr. Herman Tolentino (who is now a public health
> >  informatics fellow in CDC).
> > 
> >  alvin
> > 
> >  PS. CHITS shirts are also on sale in Stockholm if you are interested :)
> > 
> >  Alvin B. Marcelo, MD
> >  Director-OIC
> >  National Telehealth Center, University of the Philippines Manila
> >  547 Pedro Gil Street
> >  Ermita, Manila
> >  Philippines 1000
> > 
> > 
> > 
> > 
> > 
> > 




 
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Re: [openhealth] Re: Community Health Information Tracking System www.chits.info

[David Forslund]

I don't know what motivates others.  There are several factors that I 
gather are involved.   One is that people aren't that interested
in interoperability.  This certainly has been the case in commercial 
products.  A number have used these standards internally but don't
even tell their customers.   Another is that people regard them as too 
complex mostly because they are different than what they have done.
I've found that people don't want to create interfaces (contracts) and 
program to those contracts.   OpenEHR folks understand this but
the interfaces need to be standardized for general use by both open 
source and proprietary formats.  There are many such standards
in use but not many that are specific to healthcare.   The OMG specs 
were the first in this area.  Although they are not complete, they
are a good start and quite easy to extend.

Dave
Nandalal Gunaratne wrote:
>
>
> David Forslund <[EMAIL PROTECTED]> wrote:
>
> David,
>
> The only open source system I'm aware
> of that has tried to follow this pattern is the OpenEMed software :-) 
>   
> Why is this so? Why is it that others hae not used this way of 
> development? Were they unaware or is it difficult to use? Too little 
> to build upon?
>   
> Nandalal
>   
>   
>   
>   
>What is the "glue" that is used in CHITS?
>
> If all open source systems "glue" stuff together differently, it isn't
> all that much better than proprietary systems although it might be more
> "discoverable".   Our entire philosophy with OpenEMed is to have well
> defined interfaces that define component behavior so that systems can
> interoperate easily.  This was proven to work very well at HIMSS in
> 1998, where a number of commercial products worked out of the box
> without any prior configuration.
>
> Dave
> alvinbmarcelo wrote:
> > Thanks Nandalal.
> >
> > I was wondering: whatever happened to the old discussions about making
> > interchangeable health software objects (rather than large bulky
> > applications). That was at a time when XML was just revving up and web
> > services was in its infancy. Tom Beale had a lot to share about GEHR,
> > artifacts and the like. I thought that was interesting. To some
> > extent, we implemented the same concept in CHITS but we would hardly
> > call it standard. (It takes a global community to create a standard?)
> >
> > Does OSHCA have a framework of some sort for this kind of health
> > software object interchange? That's where gap is most felt in the
> > industry and where openness would be of most value.
> >
> > I admire MirrorMed's 'gluing' stuff together. That was the kind of
> > cooperation I had expected from OSHCA 'products' before. And that's
> > where FOSS is strong and gains an edge over proprietary products.
> >
> >
> > --- In openhealth@yahoogroups.com, Nandalal Gunaratne <[EMAIL PROTECTED]>
> > wrote:
> > >
> > >
> > >
> > > alvinbmarcelo <[EMAIL PROTECTED]> wrote:
> > >
> > >  This looks like a very good system. Congratulations!
> > >
> > >  I will try this and introduce it to my colleagues in community
> > health. Maybe some of them are already aware of it.
> > >
> > >  Nandalal
> > >  Hello all. This is Alvin Marcelo (formerly of NLM) 
> re-subscribing.
> > >
> > >  Happy to be back and to see that everyone is well.
> > >
> > >  I return because now we have source code to share :)
> > >
> > >  Our system is called Community Health Information Tracking System
> > >  (www.chits.info) and it runs on LAMP.
> > >
> > >  It was designed to be modular so you can add on modules as you see
> > >  fit. This way the system 'grows' with you. Although the primary
> > >  targets are village health centers in developing countries, the same
> > >  modules can be used for practice management anywhere around the 
> world.
> > >
> > >  Developers and testers are welcome.
> > >
> > >  System architect is Dr. Herman Tolentino (who is now a public health
> > >  informatics fellow in CDC).
> > >
> > >  alvin
> > >
> > >  PS. CHITS shirts are also on sale in Stockholm if you are 
> interested :)
> > >
> > >  Alvin B. Marcelo, MD
> > >  Director-OIC
> > >  National Telehealth Center, University of the Philippines Manila
> > >  547 Pedro Gil Street
> > >  Ermita, Manila
> > >  Philippines 1000
> > >
> > >

Re: [openhealth] Re: Community Health Information Tracking System www.chits.info

[David Forslund]

Alvin,

We had exactly this approach with the OMG HDTF (aka corbamed) in the 
late 90's.   There are standards there which do exactly this (long 
before people thought about doing web services).  In addition, this is 
now being revisited with the HSSP joint effort of HL7 and the OMG 
(hssp.wikispaces.org).   Since there are specifications for this type of 
integration, I would hope people would pay attention to at least learn 
from them in later versions of such standards.   The HSSP effort is and 
all are invited to participate.   The only open source system I'm aware 
of that has tried to follow this pattern is the OpenEMed software :-)   
What is the "glue" that is used in CHITS?

If all open source systems "glue" stuff together differently, it isn't 
all that much better than proprietary systems although it might be more 
"discoverable".   Our entire philosophy with OpenEMed is to have well 
defined interfaces that define component behavior so that systems can 
interoperate easily.  This was proven to work very well at HIMSS in 
1998, where a number of commercial products worked out of the box 
without any prior configuration.

Dave
alvinbmarcelo wrote:
> Thanks Nandalal.
>
> I was wondering: whatever happened to the old discussions about making
> interchangeable health software objects (rather than large bulky
> applications). That was at a time when XML was just revving up and web
> services was in its infancy. Tom Beale had a lot to share about GEHR,
> artifacts and the like. I thought that was interesting. To some
> extent, we implemented the same concept in CHITS but we would hardly
> call it standard. (It takes a global community to create a standard?)
>
> Does OSHCA have a framework of some sort for this kind of health
> software object interchange? That's where gap is most felt in the
> industry and where openness would be of most value.
>
> I admire MirrorMed's 'gluing' stuff together. That was the kind of
> cooperation I had expected from OSHCA 'products' before. And that's
> where FOSS is strong and gains an edge over proprietary products.
>
>
> --- In openhealth@yahoogroups.com, Nandalal Gunaratne <[EMAIL PROTECTED]>
> wrote:
> >
> >
> >
> > alvinbmarcelo <[EMAIL PROTECTED]> wrote:
> > 
> >  This looks like a very good system. Congratulations!
> > 
> >  I will try this and introduce it to my colleagues in community
> health. Maybe some of them are already aware of it.
> > 
> >  Nandalal
> >  Hello all. This is Alvin Marcelo (formerly of NLM) re-subscribing.
> > 
> >  Happy to be back and to see that everyone is well.
> > 
> >  I return because now we have source code to share :)
> > 
> >  Our system is called Community Health Information Tracking System
> >  (www.chits.info) and it runs on LAMP.
> > 
> >  It was designed to be modular so you can add on modules as you see
> >  fit. This way the system 'grows' with you. Although the primary
> >  targets are village health centers in developing countries, the same
> >  modules can be used for practice management anywhere around the world.
> > 
> >  Developers and testers are welcome.
> > 
> >  System architect is Dr. Herman Tolentino (who is now a public health
> >  informatics fellow in CDC).
> > 
> >  alvin
> > 
> >  PS. CHITS shirts are also on sale in Stockholm if you are interested :)
> > 
> >  Alvin B. Marcelo, MD
> >  Director-OIC
> >  National Telehealth Center, University of the Philippines Manila
> >  547 Pedro Gil Street
> >  Ermita, Manila
> >  Philippines 1000
> > 
> > 
> > 
> > 
> > 
> >  
> > -
> >YAHOO! GROUPS LINKS
> > 
> >
> > Visit your group "openhealth" on the web.
> >
> > To unsubscribe from this group, send an email to:
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> >
> > -
> > 
> > 
> > 
> >
> > __
> > Do You Yahoo!?
> > Tired of spam?  Yahoo! Mail has the best spam protection around
> > http://mail.yahoo.com
> >
> > [Non-text portions of this message have been removed]
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Re: [openhealth] EHR Review makes progress, needs help!

[David Forslund]

Is someone going to review OpenEMed?  I'm not sure who is using it, but 
it has been the basis for several EMR efforts and has been downloaded 
some 15,000+ times from Sourceforge (?!).   It will have full support 
for the ASTM CCR shortly.

Thanks,

Dave
Nandalal Gunaratne wrote:
> It seems to me that Fred is going to review just these, and others are 
> supposed to chiop in with some reviews or part of reviews of any other 
> EMRs worth talking about.
>
> Open VistA remains to be reviewed and OSCAR.
>
> Zope based SPIRIT? and OIO are two others that come to mind. While the 
> ones reviewed are in dire need of HTML forms for data collection, OIO 
> makes web forms with ease and is a clinicians dream for research and 
> audit.
>
> Nandalal
>
> James Busser <[EMAIL PROTECTED]> wrote:On Apr 4, 2006, at 12:00 
> PM, Fred Trotter wrote:
>
> > EHR review on LinuxMedNews...
> > http://www.linuxmednews.com/1144128464/index_html
> >
> > At this point, I have finished about 80% of the reviews...
>
> Hi Fred
>
> The site lists only 3 EMRs, so I wonder what is meant by 80%. Do you 
> mean you have completed 80% of the 3, or do you mean there are many 
> others which you have not yet posted? Maybe in the "Review 
> process" (or ahead of it) it would be worth inserting "Selection 
> process".
>
> PS While a few misspellings could be casually tuned, Ignacio Valdez 
> might like something fixed earlier ("Ignacio is posses both an M.D. 
> and a M.S." on the page Who_are_the_Reviewers)
>




 
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Re: [openhealth] Important announcement and oshca update

[David Forslund]

I also think this has gone too far off topic but the responses you have 
given don't correspond to the statements
made earlier and assume rationality on the parts of various governments, 
which has been shown not to be
a good assumption worldwide.  I have no problem with incorporation in 
Malaysia.  But it won't help much, if and when we
have a meeting in the US and need to collect fees for the meeting.   If 
business is to be conducted
in a country, I believe that incorporation in that country will be 
required particularly if it is to be a non-profit
company.   Incorporation in Malaysia won't help much in this respect.   
I assume that OSHCA has engaged
a lawyer to deal with this business process and to make recommendations. 

Dave
Tim.Churches wrote:
> David Forslund wrote:
> > Tim.Churches wrote:
> >  > David Forslund wrote:
> >  > > Molly,
> >  > >
> >  > > Incorporating OSHCA in the US doesn't necessarily imply US 
> domination.
> >  >
> >  > No, but US citizens need to be sensitive to the negative feelings
> >  > towards the US which are present and growing in many countries around
> >  > the world. Whether this antipathy towards the US is justified 
> depends a
> >  > great deal on one's standpoint - and I don't think we should 
> debate it
> >  > here - but it definitely exists and is remarkably pervasive - in some
> >  > countries it is the dominant attitude, in others, it is present in a
> >  > sizeable minority of the population.
> > This certainly is too bad as the characterization of things in the US by
> > the press outside the US is certainly not very factual or unbiased.
>
> This is a bit off-topic, but anyway... I don't think attitudes to the US
> are informed primarily by press reports of the internal situation in the
> US. I think that attitudes to the US are informed more by reports or
> direct experience of the actions and policies of the US govt and of US
> businesses outside the US.
>
> >  > Given these attitudes to the US, incorporation of an international
> >  > organisation in the US may be perceived negatively by some would-be
> >  > participants in OSHCA, and certainly by many potential funding or
> >  > collaborating bodies, such as the WSIS. Thus it *is* a practical
> >  > consideration.
> > What about unwarranted bias against the US that some organizations might
> > have?
>
> Whether the biases are warranted or unwarranted depends a great deal on
> one's point of view - but either way, it is not OSHCA's role to fight
> against anti-US sentiment. It does need to be mindful of it when dealing
> with other agencies and individuals, but should certainly not pander or
> play up to it. OSHCA needs to be seen to be non-aligned. Incorporation
> in Malaysia is a good basis for such a stance, I feel.
>
> >  > > I did not hear an
> >  > > answer to my question about the possible necessity of incorporating
> >  > > OSHCA in multiple countries.
> >  >
> >  > Yes, that may be necessary, but OSHCA should cross that bridge if and
> >  > when it comes to it. There is no need for immediate, simultaneous
> >  > incorporation in many countries in the first instance. If the 
> need for
> >  > incorporation elsewhere becomes apparent, then the necessary 
> steps can
> >  > be taken. But let OSHCA walk before forcing it to run a cross-country
> >  > race.
> > It wasn't clear why it needs to be incorporated anywhere.  I thought
> > Molly talked about "registration".
>
> Incorporation is needed in order to handle funds in an accountable
> manner from just about any source.
>
> >  > > I didn't understand Tim C.'s comment about there not being 
> freedom of
> >  > > political expression in Malaysia.
> >  >
> >  > I was alluding to the case of Anwar Ibrahim - see
> >  > http://en.wikipedia.org/wiki/Anwar_Ibrahim - amongst others. But that
> >  > was a while ago now, and Mahathir has retired. This happens in many
> >  > democracies from time to time - see for example
> >  > http://en.wikipedia.org/wiki/Mccarthyism
> >  >
> >  > > How does that fit with a form of democracy?  I just read this 
> week in a
> >  > > Australian paper about a government
> >  > > official threatening to jail non-Muslims if they were 
> "perceived" as
> >  > > insulting Islam.  These types of things concern
> >  > > me if an international body is to be organized in such a country.
> >  > > Perhaps this 

Re: [openhealth] Important announcement and oshca update

[David Forslund]

Tim.Churches wrote:
> David Forslund wrote:
> > Molly,
> >
> > Incorporating OSHCA in the US doesn't necessarily imply US domination. 
>
> No, but US citizens need to be sensitive to the negative feelings
> towards the US which are present and growing in many countries around
> the world. Whether this antipathy towards the US is justified depends a
> great deal on one's standpoint - and I don't think we should debate it
> here - but it definitely exists and is remarkably pervasive - in some
> countries it is the dominant attitude, in others, it is present in a
> sizeable minority of the population.
This certainly is too bad as the characterization of things in the US by 
the press outside
the US is certainly not very factual or unbiased. 
>
> Given these attitudes to the US, incorporation of an international
> organisation in the US may be perceived negatively by some would-be
> participants in OSHCA, and certainly by many potential funding or
> collaborating bodies, such as the WSIS. Thus it *is* a practical
> consideration.
What about unwarranted bias against the US that some organizations might 
have?
>
> > I did not hear an
> > answer to my question about the possible necessity of incorporating
> > OSHCA in multiple countries.
>
> Yes, that may be necessary, but OSHCA should cross that bridge if and
> when it comes to it. There is no need for immediate, simultaneous
> incorporation in many countries in the first instance. If the need for
> incorporation elsewhere becomes apparent, then the necessary steps can
> be taken. But let OSHCA walk before forcing it to run a cross-country 
> race.
It wasn't clear why it needs to be incorporated anywhere.  I thought 
Molly talked about "registration".
>
> > I didn't understand Tim C.'s comment about there not being freedom of
> > political expression in Malaysia.
>
> I was alluding to the case of Anwar Ibrahim - see
> http://en.wikipedia.org/wiki/Anwar_Ibrahim - amongst others. But that
> was a while ago now, and Mahathir has retired. This happens in many
> democracies from time to time - see for example
> http://en.wikipedia.org/wiki/Mccarthyism
>
> > How does that fit with a form of democracy?  I just read this week in a
> > Australian paper about a government
> > official threatening to jail non-Muslims if they were "perceived" as
> > insulting Islam.  These types of things concern
> > me if an international body is to be organized in such a country.
> > Perhaps this information is totally erroneous?
>
> Such things are often misreported. However, OSHCA is unlikely to ever
> make insulting comments about Islam or any other religion for that
> matter. In fact, the only religious topics which might be discussed are
> emacs vs vi or Java vs Python or Ruby. Thus I can't see why such things
> are of concern with respect to where OSHCA is incorporated. Note that
> incorporation of OSHCA in Malaysia or anywhere else has no impact on
> your freedom of speech as an individual, even if you are also a member
> of OSHCA.
>
> Tim C
>
>
It isn't that OSHCA would deliberately do such things, but when the 
interpretation is by a government official
and an action is perceived to be offensive, it could run into trouble 
and have no recourse.  This would be
counterproductive to the advancement of OSHCA's principles.  I actually 
think that multiple organizations
that work together might be better, if people would have the energy to 
do so.  This is the same as the
organization mentioned as an example.   Open Source issues in the US may 
well be different than in other countries,
but we should all work together to promote the general cause, which 
OSHCA as presented could do.

Dave




 
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Re: [openhealth] Important announcement and oshca update

[David Forslund]

t fine and be stabilized by the U.S.
> >based parent.
> > 
> >
> I don't agree that US incorporation offers more legal protection than
> Malaysia which are also signatories to International Conventions and
> legal frameworks and taking them seriously. Under the law OSHCA will be
> a legal entity with rights to all provisions under the relevent acts.
> Incidently Malaysia is not a new regime and we got our independence from
> the British in 1957. Before that we were colonized by the Portugese,
> then the Dutch and then the British.
> Stabilized by US based parent? How so?
>
> >2. Repatriation of capital: As OSCHA earns fees, receives donations,
> >pays taxes, etc... it's much more straightforward in the U.S. I believe.
> >  The tax burden on a non-profit like OSHCA would be minimal or
> >non-existent.
> > 
> >
> I plan to apply for tax-exempt status, in addition to the non-profit
> status which will automatically be given. That means that donors to
> OSHCA do not pay taxation on their donations to OSHCA and OSHCA does not
> have to pay tax on the donations received. There is no control on the
> repatriation of monies earned in Malaysia.
>
> >3. Political stability: In politically less-stable countries (e.g.
> >Malaysia, Taiwan, Mexico, South Africa, Haiti, etc..) when regimes
> >change so does the law - you can find your corporation and all its
> >assets suddenly owned by someone else.
> > 
> >
> I didn't know that Malaysia is politically unstable and I don't know of
> any assets that had been suddenly owned by someone else. But I'm amazed
> by your perceptions of Malaysia. I would be happy to play host and
> invite you to come and see Malaysia.
>
> >4. Government funding: incorporating in a country because "it looks like
> >there's government funding" is a bad idea. You need a much harder offer
> >than that.  What are the incentive programs, specifically that the other
> >government offers?  Who, specifically in the government, is offering 
> them?
> > 
> >
> I've not mentioned about Govt funding. I did say that it would be easier
> to get funding for OSHCA activities from the likes of organisations like
> UNDP, IDRC, CIDA, SIDA etc. Maybe I failed to "market" or "hard sell"
> Malaysia for our purpose. As for incentive programmes and other Govt
> offers, it is obvious that you are not aware of the Malaysian Govt's
> Policy on Open Source, incentives related to ICT companies and projects.
> There are too many to enumerate here. I did a google search on
> Malaysia's incentives for ICT and they're all there. However, after all
> these efforts I wonder if the members of OSHCA are capable to make a
> difference to push the open source agenda in health care especially in
> the developing world. I must quality that this is my main interest - the
> developing world that needs help.
>
> Molly
>
> >
> >Richard
> >
> >
> >
> >
> >Molly Cheah wrote:
> > 
> >
> >>I was born in Malaysia and lived through the period where we obtained
> >>independance from the British and from whom our legal framework was
> >>adopted. Just wondering what are the concerns of Richard and David on
> >>the legal protection for OSHCA. Can you elaborate rather than make a
> >>comment that imply there isn't legal protection. Incidently we don't
> >>have the equivalence of Guantanano Bay in Malaysia.
> >>Molly
> >>Joseph Dal Molin wrote:
> >>
> >>
> >>   
> >>
> >>>Legal protection in the context of an organization like OSHCA is IMHO
> >>>not a major concern. What is more important is how the countries laws
> >>>influence governance.
> >>>
> >>>David Forslund wrote:
> >>>
> >>>
> >>>
> >>> 
> >>>
> >>>>I don't understand why this is good or even relevant.  What should
> >>>>matter is the legal protection
> >>>>provided by the incorporation in the various countries participating,
> >>>>which I think was Richard's point.
> >>>>
> >>>>Dave Forslund
> >>>> 
> >>>>
> >>>>   
> >>>>
> >>>
> >>>Yahoo! Groups Links
> >>>
> >>>




 
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Re: [openhealth] Important announcement and oshca update

[David Forslund]

This is good.   As I read about Malaysian law, it is also appears 
necessary that if OHSCA exists in Malaysia that it
must be incorporated in Malaysia.   This may be true in other countries, 
so I would guess then that
OHSCA would need to be incorporated in multiple countries.  Am I 
understanding correctly?
I'm not suspicious about other countries' law; rather trying to 
understand the issues, requirements,  reasons, and advantages.
Sometimes people make decisions without understanding the reality of the 
choices.

-Dave
Tim.Churches wrote:
> David Forslund wrote:
> > There may be legal protection, etc in Malaysia.
>
> Not may be, there definitely is. As Molly said, Malaysian law was
> originally based on British law - it is now distinct from it, but rest
> assured that there is rule of civil law in Malaysia. There is also
> corruption and political influence over the courts, but I would not like
> to have to say whether there is more or less such corruption in Malaysia
> than in the US or other countries. However, for a tiny, nascent
> organisation like OSHCA, none of this is relevant. Suffice to say that
> Malaysian corporate law should be more than adequate for OSHCA's
> purposes. That's correct, isn't it Molly?
>
> >  We are more familiar
> > with the situation in the US.
>
> Well, yes. I am more familiar with Australian law. But that doesn't mean
> that I regard the legal regimes in every other country with suspicion.
>
> > It is more of a question of comparing what is required and what you can
> > do with a corporation
> > in Malaysia than in the US.  The decision shouldn't be made on political
> > grounds but on technical grounds,
> > in my opinion.
>
> Given what OSHCA hopes to achieve - things like engaging with
> UN-sponsored initiatives such as WSIS and perhaps with national and
> international development agencies -  I think that incorporation in
> Malaysia (or some other "non-aligned" developing or transitional
> country) is a *much* more sound choice, from a political perspective,
> than incorporation in the US (or other G8 or other rich nations, but
> particularly the US, particularly at the moment).
>
> Tim C
>
> > Molly Cheah wrote:
> >  > I was born in Malaysia and lived through the period where we obtained
> >  > independance from the British and from whom our legal framework was
> >  > adopted. Just wondering what are the concerns of Richard and David on
> >  > the legal protection for OSHCA. Can you elaborate rather than make a
> >  > comment that imply there isn't legal protection. Incidently we don't
> >  > have the equivalence of Guantanano Bay in Malaysia.
> >  > Molly
> >  > Joseph Dal Molin wrote:
> >  >
> >  > >Legal protection in the context of an organization like OSHCA is 
> IMHO
> >  > >not a major concern. What is more important is how the countries 
> laws
> >  > >influence governance.
> >  > >
> >  > >David Forslund wrote:
> >  > >
> >  > >
> >  > >>I don't understand why this is good or even relevant.  What should
> >  > >>matter is the legal protection
> >  > >>provided by the incorporation in the various countries 
> participating,
> >  > >>which I think was Richard's point.
> >  > >>
> >  > >>Dave Forslund
> >  > >> 
> >  > >>
> >  > >
> >  > >
> >  > >
> >  > >Yahoo! Groups Links
> >  > >
> >  > >
> >  > >
> >  > >
> >  > >
> >  > >
> >  > >
> >  > >
> >  > >
> >  > >
> >  >
> >  >
> > 




 
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Re: [openhealth] Important announcement and oshca update

[David Forslund]

There may be legal protection, etc in Malaysia.  We are more familiar 
with the situation in the US.
It is more of a question of comparing what is required and what you can 
do with a corporation
in Malaysia than in the US.  The decision shouldn't be made on political 
grounds but on technical grounds,
in my opinion.

Dave
Molly Cheah wrote:
> I was born in Malaysia and lived through the period where we obtained
> independance from the British and from whom our legal framework was
> adopted. Just wondering what are the concerns of Richard and David on
> the legal protection for OSHCA. Can you elaborate rather than make a
> comment that imply there isn't legal protection. Incidently we don't
> have the equivalence of Guantanano Bay in Malaysia.
> Molly
> Joseph Dal Molin wrote:
>
> >Legal protection in the context of an organization like OSHCA is IMHO
> >not a major concern. What is more important is how the countries laws
> >influence governance.
> >
> >David Forslund wrote:
> > 
> >
> >>I don't understand why this is good or even relevant.  What should
> >>matter is the legal protection
> >>provided by the incorporation in the various countries participating,
> >>which I think was Richard's point.
> >>
> >>Dave Forslund
> >>   
> >>
> >
> >
> >
> >Yahoo! Groups Links
> >
> >
> >
> >
> >
> >
> >
> >
> > 
> >
>
>




 
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Re: [openhealth] Important announcement and oshca update

[David Forslund]

The last time I checked the political issues were intertwined with 
governance and legal issues
in every country I'm aware of.   I might even suggest that for political 
reasons Malaysia
might not be the best choice, but I was thinking more of what would 
allow the organization
to do what it wants to do internationally.

Dave
Tim.Churches wrote:
> David Forslund wrote:
> > I don't understand why this is good or even relevant.  What should
> > matter is the legal protection
> > provided by the incorporation in the various countries participating,
> > which I think was Richard's point.
>
> Joseph and I (and Molly) were thinking of the political dimensions of
> the choice of country for incorporation, rather than the engineering
> excellence of each country's corporation API.
>
> I remain unconvinced that US corporate law offers any advantages with
> respect to an organisation like OSHCA over Malaysian corporate law. If
> the discussion were about the incorporation of an Enron, then that's a
> different matter...
>
> Tim C
>
> > Dave Forslund
> > Tim.Churches wrote:
> >  > Richard Schilling wrote:
> >  > > If I were involved in the incorporation (which I can do, by the 
> way in a
> >  > > day) I would object to doing it in Malaysia.  I would do it in 
> the U.S.
> >  > > first.  The protections offered a U.S. corporation might be 
> much greater
> >  > > than in Malaysia.
> >  >
> >  > Glad that you have compared US and Malaysian corporate law. 
> Personally I
> >  > think it is great that OSHCA will finally be incorporated, and 
> given the
> >  > current Zeitgeist in many rich countries, that it will be 
> incorporated
> >  > under a flag bearing the crescent and star.
> >  >
> >  > Tim C
> >  >
> >  > > Molly Cheah wrote:
> >  > >  > Dear all,
> >  > >  >
> >  > >  > I am happy to annouce that the transfer of the domain name 
> oshca.org
> >  > >  > from Brian had been completed. Brian is in the process of
> >  > creating and
> >  > >  > signing a document disclaiming rights to the OSHCA trademark.
> >  > Thank you
> >  > >  > Brian for these initiatives.
> >  > >  >
> >  > >  > I understand that Brian will also make a decision with 
> regards to the
> >  > >  > fate of the openhealth lists on Minoru and Yahoo by this 
> weekend.
> >  > I'll
> >  > >  > leave that to Brian to make that annoucement.
> >  > >  >
> >  > >  > As for the status of OSHCA, the protem committee members 
> (volunteers
> >  > >  > expressed on the list as well as those agreed to serve when
> >  > requested)
> >  > >  > are as follows:
> >  > >  > Joseph dal Molin (Canada/US)
> >  > >  > Adrian Midgley (UK/Europe)
> >  > >  > Thomas Beale (Australia/Pacific islands)
> >  > >  > Nandalal Gunaratne (Sri Lanka/Asia)
> >  > >  > Molly Cheah (Malaysia/Asia)
> >  > >  >
> >  > >  > I hope to keep the protem committee small for quick decision
> >  > making but
> >  > >  > hope to add 2 more names, preferably from South America and
> >  > >  > Africa/Middle East by the time we submit the incorporation
> >  > documents for
> >  > >  > registration. Please volunteer. These numbers and representation
> >  > >  > structure can change after incorporation if members wish so. 
> I don't
> >  > >  > know how much discussion should go into the incorporation 
> process
> >  > or how
> >  > >  > much time should be alotted. My proposed timeline for 
> completion of
> >  > >  > incorporation is 3 months from 15th April 2006 - tentative 
> date for
> >  > >  > submission of papers. We should have OSHCA ressurrected by 
> 15th July
> >  > >  > 2006, barring unforseen circumstances. Here are my 
> assumptions in
> >  > order
> >  > >  > to realise this initiative:
> >  > >  > 1. Provisions in the constitution/M&A of OSHCA is a living
> >  > document and
> >  > >  > can be changed by members' majority wishes. For purpose of
> >  > >  > incorporation, we will take into consideration past discussions
> >  > >  > (2002-2004) and make the provisions as general and flexible as
> >  > possible
> >  > >  > to meet incorporation requir

Re: [openhealth] Important announcement and oshca update

[David Forslund]

I don't understand why this is good or even relevant.  What should 
matter is the legal protection
provided by the incorporation in the various countries participating, 
which I think was Richard's point.

Dave Forslund
Tim.Churches wrote:
> Richard Schilling wrote:
> > If I were involved in the incorporation (which I can do, by the way in a
> > day) I would object to doing it in Malaysia.  I would do it in the U.S.
> > first.  The protections offered a U.S. corporation might be much greater
> > than in Malaysia.
>
> Glad that you have compared US and Malaysian corporate law. Personally I
> think it is great that OSHCA will finally be incorporated, and given the
> current Zeitgeist in many rich countries, that it will be incorporated
> under a flag bearing the crescent and star.
>
> Tim C
>
> > Molly Cheah wrote:
> >  > Dear all,
> >  >
> >  > I am happy to annouce that the transfer of the domain name oshca.org
> >  > from Brian had been completed. Brian is in the process of 
> creating and
> >  > signing a document disclaiming rights to the OSHCA trademark. 
> Thank you
> >  > Brian for these initiatives.
> >  >
> >  > I understand that Brian will also make a decision with regards to the
> >  > fate of the openhealth lists on Minoru and Yahoo by this weekend. 
> I'll
> >  > leave that to Brian to make that annoucement.
> >  >
> >  > As for the status of OSHCA, the protem committee members (volunteers
> >  > expressed on the list as well as those agreed to serve when 
> requested)
> >  > are as follows:
> >  > Joseph dal Molin (Canada/US)
> >  > Adrian Midgley (UK/Europe)
> >  > Thomas Beale (Australia/Pacific islands)
> >  > Nandalal Gunaratne (Sri Lanka/Asia)
> >  > Molly Cheah (Malaysia/Asia)
> >  >
> >  > I hope to keep the protem committee small for quick decision 
> making but
> >  > hope to add 2 more names, preferably from South America and
> >  > Africa/Middle East by the time we submit the incorporation 
> documents for
> >  > registration. Please volunteer. These numbers and representation
> >  > structure can change after incorporation if members wish so. I don't
> >  > know how much discussion should go into the incorporation process 
> or how
> >  > much time should be alotted. My proposed timeline for completion of
> >  > incorporation is 3 months from 15th April 2006 - tentative date for
> >  > submission of papers. We should have OSHCA ressurrected by 15th July
> >  > 2006, barring unforseen circumstances. Here are my assumptions in 
> order
> >  > to realise this initiative:
> >  > 1. Provisions in the constitution/M&A of OSHCA is a living 
> document and
> >  > can be changed by members' majority wishes. For purpose of
> >  > incorporation, we will take into consideration past discussions
> >  > (2002-2004) and make the provisions as general and flexible as 
> possible
> >  > to meet incorporation requirements.
> >  > 2. There is no objection to incorporate ina developing country like
> >  > Malaysia. There will be provisions for setting up geographical
> >  > sections/branches etc with as much de-centralization as possible.
> >  > 3.The Vision, Mission Statements, Principles and Activities as 
> discussed
> >  > earlier this year will be included in the incorporation papers. Any
> >  > suggestion of changes posted on the Yahoo list by 15th April will be
> >  > taken into consideration by the protem committee for incorporation.
> >  > Procedures will be provided for amendments to be made after 
> incorporation.
> >  > 4. Elections for new committee members can take place immediately 
> after
> >  > incorporation. Provision will be made for the protem committee to 
> stay
> >  > on for a defined number of months to attend to "teething" issues that
> >  > may arise.
> >  > 5. The yahoo list will continue to discuss organising the 1st
> >  > post-incorporation OSHCA meeting scheduled for later part of 2006 to
> >  > kick-start/launch OSHCA. This may not be in the form of a full
> >  > conference. I would like to see presentations of current status 
> of open
> >  > source healthcare solutions/applicaions. It should also provide the
> >  > opportunity to include indepth discussions on planning for the 
> future of
> >  > OSHCA so that its resurrection becomes meaningful - reflecting 
> more than
> >  > just a community of open source enthusiasts in health care. If 
> there are
> >  > no other bidders, I plan to get funding to do this in Malaysia.
> >  > Naturally it may be on a modest scale.
> >  >
> >  > Please feel free to propose ideas.The protem committee will work 
> on an
> >  > action plan and invite volunteers to help.
> >  >
> >  > Molly
> >  >
> >  >
> >  >
> >  >
> >  >
> >  > Yahoo! Groups Links
> >  >
> >  >
> >  >
> >  >
> >  >
> >  




 
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Re: [openhealth] Demonstrations & Standards.

[David Forslund]

I think there is an intermediate position here.   In my experience these 
standards, far from perfect, are
good enough to gain experience and see them work in practice.   The 
resulting models and infrastructure
are actually rather easy to change into new paradigms, I believe.   I 
can't wait until the standards are
the best they can be, which probably will never happen.   By using some 
of these standards, one still
opens up transition to the future, as the need to migrate to something 
better will be ubiquitous and paths will
become available for the transition.   The fact that code may need to be 
re-written is no big deal. 

Dave
Thomas Beale wrote:
> David Forslund wrote:
> > Will,
> > I agree with you, which is why I also argue for using standards for
> > the communication and
> > interfaces in a system.  That way one can replace the system with others
> > that implement
> > those same standards.   This allows even for a replacement of an open
> > source solution
> > with a proprietary one as long as the standards are conformed to.   So
> > to reduce the
> > risk you describe for open source, I recommend using open standards.  In
> > fact,
> > I believe that open standards are normally a better protection against
> > vendor lock-in
> > than open source.   The combination of open source and open standards is
> > very powerful.
> > The Shark workflow engine I've mentioned before falls into this 
> category.
> problem is, they need to be good standards; and the current paradigm for
> creating standards in most SDOs is almost guaranteed to produce
> something mediocre at the very best...and with no vehicle for ongoing
> evolution or support until the next 5 year round...
>
> - thomas beale
>




 
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Re: [openhealth] Demonstrations & Standards.

[David Forslund]

There is an intermediate value to the workflows if they can be used in 
software. One
can model the behavior of the system without having to have the entire 
system under
workflow management.   This can help assess the accuracy of the workflow 
diagrams
to be sure that side effects are what you think they are.  Think of this 
a s a visual use
case model.   Adding a little formality to the process without going all 
the way to
the running system can add substantially to the quality of the process.

Dave
Will Ross wrote:
> These workflows are intentionally not computable.   They are simple  
> visual aids to sketch the overall operational processes where a user  
> interacts with software, without descending into the complexities of  
> computable steps.   The diagrams are deliberately chunked into single  
> page views with a limited number of high level process steps and  
> decision gates.   The purpose of the diagrams is to excel at  
> describing the general use of the software within the daily workflow  
> of a specific user (in this case, a clerk at the registration desk)  
> while at the same time communicating to the programmers the general  
> flow of interactive tasks between a line worker and the enterprise  
> software package.   I think of the diagrams as a "visual use case."
> Collectively, the entire suite of drawings is an inventory of every  
> user process in the facility with an interactive dependency on the  
> specific software package (in this case "HealthPro").
>
> [wr]
>
> - - - - - - - -
>
> On Mar 23, 2006, at 9:39 PM, David Forslund wrote:
>
>   
>> Is this workflow put into a "computable" form or is it just to help
>> understand the various processes?
>> If it is "computable", what are you using to describe the workflow.  
>> This
>> type of workflow
>> is rather easily described in XPDL, for example, and can drive the
>> various tasks and user inputs.
>>
>> Most of this workflow as described would be internal to a healthcare
>> system and thus
>> doesn't need to use a standard. However, if one wants to switch  
>> software
>> suites or
>> connect in a partner for part of the process, using an implemented
>> standard would help a lot.
>>
>> Dave
>> Will Ross wrote:
>> 
>>> Dave,
>>>
>>> Attached is a diagram which is part of a practice management software
>>> replacement project I am managing for a group of rural ambulatory
>>> clinics.   This particular diagram maps the initial steps at one
>>> clinic as Reception interacts with the current software ("HP") when a
>>> patient arrives for an appointment.   These high level procedural
>>> diagrams  completely map user interaction with the HealthPro software
>>> at this facility.   The user centered workflows are grouped into
>>> procedural chunks to enable analysis and planning for migration to
>>> the replacement practice management software, which is ClearHealth
>>> from Uversa.   Using these maps allows lead users in the key
>>> operations areas (Scheduling, Billing, Medical Records, etc) to step
>>> through the ClearHealth demo, creating a gap analysis to identify
>>> software features that must be added to ClearHealth.   I anticipate
>>> implementation of ClearHealth at our first clinic site this summer.
>>> I started this open source project in February 2004 and have been
>>> fortunate to raise enough funds to aggressively and comprehensively
>>> add the necessary features to the base ClearHealth product.   All the
>>> new code being paid with grant funds will be released under the
>>> GPL.   The project portal is located here:
>>>
>>>http://www.phoenixpm.org/
>>>
>>> With best regards,
>>>
>>> [wr]
>>>
>>> - - - - - - - -
>>>
>>> On Mar 23, 2006, at 6:44 AM, David Forslund wrote:
>>>
>>>
>>>   
>>>> I wholeheartedly agree with you, Will!Do you have some example
>>>> workflow diagrams that you have found useful?
>>>>
>>>> Dave
>>>> Will Ross wrote:
>>>>
>>>> 
>>>>> Philippe,
>>>>>
>>>>> Actually, I am still talking about Wayne's focus on the user.
>>>>> As a
>>>>> project manager I spend much of my time in a balancing act by
>>>>> advocating for someone else's perspective.   When I work with  
>>>>> with IT
>>>>> developers and vendors, the most 

Re: [openhealth] [Fwd: Re: [n-gaa] Is Open Source Good for Innovation?]

[David Forslund]

http://www.economist.com/business/displaystory.cfm?story_id=5624944

is the link to the article I intended to post.
David Forslund wrote:
> I thought folks might like to see this article.   Any comments?
>
> -Dave
>




 
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Re: [openhealth] [Fwd: Re: [n-gaa] Is Open Source Good for Innovation?]

[David Forslund]

Sorry about the mailer stripping the message. 

Dave
David Forslund wrote:
> I thought folks might like to see this article.   Any comments?
>
> -Dave
>
>
> [Non-text portions of this message have been removed]
>
>
> 
> YAHOO! GROUPS LINKS
>
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>   <http://groups.yahoo.com/group/openhealth>" on the web.
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>   Service <http://docs.yahoo.com/info/terms/>.
>
>
> 
>




 
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[openhealth] [Fwd: Re: [n-gaa] Is Open Source Good for Innovation?]

[David Forslund]

I thought folks might like to see this article.   Any comments?

-Dave


[Non-text portions of this message have been removed]



 
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Re: [openhealth] Demonstrations & Standards.

[David Forslund]

Will,
I agree with you, which is why I also argue for using standards for 
the communication and
interfaces in a system.  That way one can replace the system with others 
that implement
those same standards.   This allows even for a replacement of an open 
source solution
with a proprietary one as long as the standards are conformed to.   So 
to reduce the
risk you describe for open source, I recommend using open standards.  In 
fact,
I believe that open standards are normally a better protection against 
vendor lock-in
than open source.   The combination of open source and open standards is 
very powerful.
The Shark workflow engine I've mentioned before falls into this category. 

Dave


Will Ross wrote:
> Joseph,
>
> I disagree on your community challenge.   I think the "community" 
> aspect of open source is not only over rated, it is in fact a 
> negative, a risk factor to be considered.   I think what we need is 
> software that works better than what we have, and so by progressive 
> iterative cycles we can constantly improve our operating 
> environments.   I use open source software to accomplish this gradual 
> improvement not because I want to join a community, but because I 
> want to eliminate vendor lock-in as a local risk factor in my 
> projects.   Proprietary lock-in is therefore replaced by the risk 
> that an open source "community" may get bogged down in ego and power 
> issues that dissipate productivity rather than focus on great 
> software that precisely targets user needs.   I try to keep user 
> needs at the center of the risk calculus.   And in that equation, an 
> open source community is not a net positive, it is at best neutral.
>
> [wr]
>
> - - - - - - - -
>
> On Mar 23, 2006, at 7:05 AM, Joseph Dal Molin wrote:
>
> > IMHO this may be setting the bar too highsorry for singing to the
> > choir: what we need are a few "good enough" solutions (and there are a
> > couple) that meet user needs and more importantly, critical mass
> > communities of users and developers that collaboratively, continuously
> > improve them. The most compelling solutions will emerge from those
> > communities. The real challenge is building the communities, not the
> > software.
> >
> > Joseph
> >
> > Will Ross wrote:
> >
> >> Until we have compelling informatics solutions that meet actual
> >> clinical user needs, adoption of new IT proposals will be minimal at
> >> best, which describes the current state of EHR deployment in this
> >> country (i.e., minimal).
> >>
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> >
> >
> >
> >
>
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california  95482  usa
> 707.272.7255 [voice]
> 707.462.5015 [fax]
> www.minformatics.com
>
> - - - - - - - -
>
>




 
Yahoo! Groups Links

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Re: [openhealth] Demonstrations & Standards.

[David Forslund]

Is this workflow put into a "computable" form or is it just to help 
understand the various processes?
If it is "computable", what are you using to describe the workflow. This 
type of workflow
is rather easily described in XPDL, for example, and can drive the 
various tasks and user inputs.

Most of this workflow as described would be internal to a healthcare 
system and thus
doesn't need to use a standard. However, if one wants to switch software 
suites or
connect in a partner for part of the process, using an implemented 
standard would help a lot.

Dave
Will Ross wrote:
> Dave,
>
> Attached is a diagram which is part of a practice management software  
> replacement project I am managing for a group of rural ambulatory  
> clinics.   This particular diagram maps the initial steps at one  
> clinic as Reception interacts with the current software ("HP") when a  
> patient arrives for an appointment.   These high level procedural  
> diagrams  completely map user interaction with the HealthPro software  
> at this facility.   The user centered workflows are grouped into  
> procedural chunks to enable analysis and planning for migration to  
> the replacement practice management software, which is ClearHealth  
> from Uversa.   Using these maps allows lead users in the key  
> operations areas (Scheduling, Billing, Medical Records, etc) to step  
> through the ClearHealth demo, creating a gap analysis to identify  
> software features that must be added to ClearHealth.   I anticipate  
> implementation of ClearHealth at our first clinic site this summer.
> I started this open source project in February 2004 and have been  
> fortunate to raise enough funds to aggressively and comprehensively  
> add the necessary features to the base ClearHealth product.   All the  
> new code being paid with grant funds will be released under the  
> GPL.   The project portal is located here:
>
>http://www.phoenixpm.org/
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Mar 23, 2006, at 6:44 AM, David Forslund wrote:
>
>   
>> I wholeheartedly agree with you, Will!Do you have some example
>> workflow diagrams that you have found useful?
>>
>> Dave
>> Will Ross wrote:
>> 
>>> Philippe,
>>>
>>> Actually, I am still talking about Wayne's focus on the user.   As a
>>> project manager I spend much of my time in a balancing act by
>>> advocating for someone else's perspective.   When I work with with IT
>>> developers and vendors, the most important missing voice is generally
>>> the perspective of the user.   Workflow diagrams and use case
>>> narratives are excellent tools to bring the user back into the center
>>> of the technology planning process, and they also provide users with
>>> a convenient way to redirect well intentioned but inappropriate
>>> technology proposals.
>>>
>>> Until we have compelling informatics solutions that meet actual
>>> clinical user needs, adoption of new IT proposals will be minimal at
>>> best, which describes the current state of EHR deployment in this
>>> country (i.e., minimal).
>>>
>>> With best regards,
>>>
>>> [wr]
>>>
>>> - - - - - - - -
>>>
>>> On Mar 23, 2006, at 3:43 AM, Philippe AMELINE wrote:
>>>
>>>
>>>   
>>>>> Any opinion on YAWL ( http://www.yawl.fit.qut.edu.au/ )?
>>>>>
>>>>> Tim C
>>>>>
>>>>>
>>>>>
>>>>>   
>>>> Hi guys,
>>>>
>>>> I very much like the way Wayne Wilson explicated the Big problem :
>>>>
>>>> "The very first thing to do is to build a believable (to doctors and
>>>> patients) scenario for needing to get information from one system
>>>> to the next, preferably in real time. IF you don't lead with that  
>>>> from a
>>>> demonstrably practical point of view and just assume a generic need
>>>> justifies all (interchange is good and will save the world, etc.),
>>>> then I suggest that this interoperability demo is no different  
>>>> than a
>>>> vendor plug fest designed to show managers why they should keep  
>>>> buying the
>>>> same stuff they have already bought."
>>>>
>>>> And how funny it was to see that 6 posts after, all this vanished
>>>> into a workflow engines comparison (very interesting, by the way).
>>>>
>>>>  From my point of view, Wayne is ver

Re: [openhealth] Demonstrations & Standards.

[David Forslund]

As you probably noticed, images (and attachments) are stripped off by 
the mailer, so the diagram isn't visible. :-(
What is the communication between components of ClearHealth or with 
other systems?

Thanks,

Dave
Will Ross wrote:
> Dave,
>
> Attached is a diagram which is part of a practice management software  
> replacement project I am managing for a group of rural ambulatory  
> clinics.   This particular diagram maps the initial steps at one  
> clinic as Reception interacts with the current software ("HP") when a  
> patient arrives for an appointment.   These high level procedural  
> diagrams  completely map user interaction with the HealthPro software  
> at this facility.   The user centered workflows are grouped into  
> procedural chunks to enable analysis and planning for migration to  
> the replacement practice management software, which is ClearHealth  
> from Uversa.   Using these maps allows lead users in the key  
> operations areas (Scheduling, Billing, Medical Records, etc) to step  
> through the ClearHealth demo, creating a gap analysis to identify  
> software features that must be added to ClearHealth.   I anticipate  
> implementation of ClearHealth at our first clinic site this summer.
> I started this open source project in February 2004 and have been  
> fortunate to raise enough funds to aggressively and comprehensively  
> add the necessary features to the base ClearHealth product.   All the  
> new code being paid with grant funds will be released under the  
> GPL.   The project portal is located here:
>
>http://www.phoenixpm.org/
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Mar 23, 2006, at 6:44 AM, David Forslund wrote:
>
>   
>> I wholeheartedly agree with you, Will!Do you have some example
>> workflow diagrams that you have found useful?
>>
>> Dave
>> Will Ross wrote:
>> 
>>> Philippe,
>>>
>>> Actually, I am still talking about Wayne's focus on the user.   As a
>>> project manager I spend much of my time in a balancing act by
>>> advocating for someone else's perspective.   When I work with with IT
>>> developers and vendors, the most important missing voice is generally
>>> the perspective of the user.   Workflow diagrams and use case
>>> narratives are excellent tools to bring the user back into the center
>>> of the technology planning process, and they also provide users with
>>> a convenient way to redirect well intentioned but inappropriate
>>> technology proposals.
>>>
>>> Until we have compelling informatics solutions that meet actual
>>> clinical user needs, adoption of new IT proposals will be minimal at
>>> best, which describes the current state of EHR deployment in this
>>> country (i.e., minimal).
>>>
>>> With best regards,
>>>
>>> [wr]
>>>
>>> - - - - - - - -
>>>
>>> On Mar 23, 2006, at 3:43 AM, Philippe AMELINE wrote:
>>>
>>>
>>>   
>>>>> Any opinion on YAWL ( http://www.yawl.fit.qut.edu.au/ )?
>>>>>
>>>>> Tim C
>>>>>
>>>>>
>>>>>
>>>>>   
>>>> Hi guys,
>>>>
>>>> I very much like the way Wayne Wilson explicated the Big problem :
>>>>
>>>> "The very first thing to do is to build a believable (to doctors and
>>>> patients) scenario for needing to get information from one system
>>>> to the next, preferably in real time. IF you don't lead with that  
>>>> from a
>>>> demonstrably practical point of view and just assume a generic need
>>>> justifies all (interchange is good and will save the world, etc.),
>>>> then I suggest that this interoperability demo is no different  
>>>> than a
>>>> vendor plug fest designed to show managers why they should keep  
>>>> buying the
>>>> same stuff they have already bought."
>>>>
>>>> And how funny it was to see that 6 posts after, all this vanished
>>>> into a workflow engines comparison (very interesting, by the way).
>>>>
>>>>  From my point of view, Wayne is very right to ask for a scenario  
>>>> "for
>>>> needing to get information from one system to the next". And I think
>>>> that such a scenario will be pretty much artificial if these
>>>> systems are HIS since the genuine main reason to communicate is  
>>>> continuity of
>>>> care, an

Re: [openhealth] Demonstrations & Standards.

[David Forslund]

Tim Cook wrote:
> -BEGIN PGP SIGNED MESSAGE-
> Hash: SHA1
>
> David Forslund wrote:
> > I'm trying to understand what these reference view points have to do
> > with getting the data between organizations.
> > In a single care place, the data for the patient may have to come from
> > multiple locations to be available to build
> > a diagnosis.   The MRI may be done at a facility 40 miles away, the Lab
> > test may be done across town, but all
> > of this needs to be available to a physician to make a diagnosis and
> > treatment plan, whether the patient is at the point
> > of care or not.   To manage a continuity of care system (which doesn't
> > exist in the US), one must be able
> > to rather freely move information around.  This doesn't happen if the
> > various systems can't or won't talk
> > to each other.  The idea of a "virtual patient record" is to avoid
> > precisely the issue of information showing up
> > at a doctor's office which you no longer visit.  In the US, it is very
> > hard to get a patient-centered view of the
> > treatment of a patient.   The only examples I know of are where a
> > patient creates their own chart and carries
> > it with them between providers.  Other than that, the patient never has
> > their medical record.  It is scattered
> > amongst the various points of care that a patient has to deal 
> with.   It
> > is the movement of data from one care provider
> > to another (or the virtual movement) that requires multiple information
> > systems to communicate with each other.
> >
> > I don't think we are in any disagreement, just different viewpoints on
> > the same situation.
> >
> > Dave
>
>
> Hi Dave,
>
> Your example is a very good.  However, the practical point of view is
> that unless you can get people in the US (or anywhere else)  to accept a
> universal health care ID number (politically and technically impossible)
> you will not be able to build a valid federated / virtual patient record.
I don't think the universal healthcare ID is the key, since this can be 
in error like any other data and
must be matched to the individual to make sure that one is talking about 
the same person (unless the ID
is a robust biometric).   One has to have a way to determine if a person 
is the same or different from
someone else regardless. A healthcare ID might make searching a little 
more efficient, but not necessarily
any more accurate. We have described ways that one can do this 
technically (AMIA, 2000), but the
virtual record is unlikely to have all of the patient record, hopefully 
enough to improve the diagnosis
and treatment process.
>
> If you cannot guarantee that you have searched everywhere that patient
> the may have been seen then how can you have confidence in the validity
> of the data in front of you as a clinician?
There is no way to guarantee this even with a healthcare ID.Today 
the clinician acts without
all the data in front of them, so providing more data than before should 
hopefully improve (and not
confuse) things.
>
> - From a pragmatic stand point the patient MUST be presented with a
> pain/pleasure relationship [ http://www.zaadz.com/quotes/view/36462 ]
> that encourages them to assign custody of their EHR to one location.
> All EMR summaries should feed into the EHR via a PUSH type transaction.
> The receiver should still be able to verify that the data is going into
> the correct patient record (EHR).
I don't believe this is realistic, in the US anyway.   Perhaps for a 
while but not on a long time scale.
Healthcare payers change all the time and much data is basically lost in 
the process.  This
will require in the US incentive from the payer side of the house that 
their costs will be reduced by
providing this and overseeing it even when the payer changes.
>
> As a patient I should be able to tell my podiatrist that my EHR is held
> at Dr. M.Q. Jones' office and my patient ID is XYZ098. My podiatrist
> could then send a summary of my visit to my GP.  If my GP (or other
> downstream users) needed more details they could track back the summary
> to my podiatrist.
I agree, and simple cases work like that today (via paper).   People 
that are chronically ill, for
example, present a much more complex situation.  You may even have a 
referral to a provider out
of state.   There is nothing today which allows the information to flow 
electronicallly, even in
summary form between the providers.  I believe the CCR of the ASTM is a 
good attempt and
trying to normalize this process, and they hope to be demonstrating 
moving data between
multivendor EHR's and PHR (Personal Health Record) at the upcoming TEPR.

If I as a 

Re: [openhealth] Demonstrations & Standards.

[David Forslund]

I'm trying to understand what these reference view points have to do 
with getting the data between organizations.
In a single care place, the data for the patient may have to come from 
multiple locations to be available to build
a diagnosis.   The MRI may be done at a facility 40 miles away, the Lab 
test may be done across town, but all
of this needs to be available to a physician to make a diagnosis and 
treatment plan, whether the patient is at the point
of care or not.   To manage a continuity of care system (which doesn't 
exist in the US), one must be able
to rather freely move information around.  This doesn't happen if the 
various systems can't or won't talk
to each other.  The idea of a "virtual patient record" is to avoid 
precisely the issue of information showing up
at a doctor's office which you no longer visit.  In the US, it is very 
hard to get a patient-centered view of the
treatment of a patient.   The only examples I know of are where a 
patient creates their own chart and carries
it with them between providers.  Other than that, the patient never has 
their medical record.  It is scattered
amongst the various points of care that a patient has to deal with.   It 
is the movement of data from one care provider
to another (or the virtual movement) that requires multiple information 
systems to communicate with each other.

I don't think we are in any disagreement, just different viewpoints on 
the same situation.

Dave


Philippe AMELINE wrote:
> David,
>
> I am not very at ease with this vision.
>
> Let's express it simply: what you try to do with a person/care workflow 
> is to make sure that will be present, at a given place and a given time, 
> the patient, the professionals and the proper material.
> If you work in the care place's referential, you can assume that the 
> material doesn't move, and that the professionals are also "fixed". This 
> referential sees the patient as a moving object passing through (from 
> inpatient to outpatient).
> If you work in the patient's referential, the patient doesn't move, but 
> materials and professionals are passing by in front of him.
>
> So, you have two moving referentials. And you have to synchronize them. 
> This is typically the topology of a continuity of care system.
>
> In the same way, from the patient point of view, health professionals 
> are changing inside his/her own care team (they enter the team, maybe 
> change their positions (for example from a GP you see sometimes to your 
> usual GP), then probably disappear someday).
> So, when some information has to be transfered from one team member to 
> another one, they have to use the continuity of care system in order to 
> know who is in charge at this moment. Elsewhere, the information may end 
> up at a doctor's you no longer visit.
>
> Continuity of care "is" the patient, not a communication between care 
> places.
>
> Regards,
>
> Philippe
>
> David Forslund a écrit :
>
>   
>> Philippe AMELINE wrote:
>>  
>>
>> 
>>> Will,
>>>
>>> Who is the "user" you want to show workflow diagrams too?
>>> Is he/she an health professional or a citizen/patient?
>>>  
>>>
>>>
>>>   
>> I can't speak for Will, but I think workflow is useful for the tasks 
>> that people need to do in
>> caring for a patient.   In the work we did with City of Hope, the 
>> workflow for a clinical
>> trial took an entire wall to illustrate.   There are a large number of 
>> tasks involved in setting
>> up and carrying out a clinical trial and there are large numbers of 
>> dependencies in the process.
>> It is a classic workflow problem.   The people caring for the patient 
>> don't need to look
>> at a diagram of the workflow, but a system which assists them needs the 
>> workflow specification
>> to ensure that all the right things are being done.   The diagram is to 
>> setup and evaluate the
>> process to ensure that the specification is correct.   The execution of 
>> the workflow is invisible
>> to the user other than that they are given tasks to do. 
>>
>> If care is done at multiple healthcare organizations, there needs to be 
>> communication between
>> those organizations.  This may or may not involve workflow.   I had a 
>> procedure done last year
>> ordered by my doctor but done at another location.  When I visited him 
>> this year, I found out that
>> the results had never been sent to him (not even simply on paper).  
>> Information from one system to another
>> almost unrelated system is common and importa

Re: [openhealth] Demonstrations & Standards.

[David Forslund]

Philippe AMELINE wrote:
> Will,
>
> Who is the "user" you want to show workflow diagrams too?
> Is he/she an health professional or a citizen/patient?
>   
I can't speak for Will, but I think workflow is useful for the tasks 
that people need to do in
caring for a patient.   In the work we did with City of Hope, the 
workflow for a clinical
trial took an entire wall to illustrate.   There are a large number of 
tasks involved in setting
up and carrying out a clinical trial and there are large numbers of 
dependencies in the process.
It is a classic workflow problem.   The people caring for the patient 
don't need to look
at a diagram of the workflow, but a system which assists them needs the 
workflow specification
to ensure that all the right things are being done.   The diagram is to 
setup and evaluate the
process to ensure that the specification is correct.   The execution of 
the workflow is invisible
to the user other than that they are given tasks to do. 

If care is done at multiple healthcare organizations, there needs to be 
communication between
those organizations.  This may or may not involve workflow.   I had a 
procedure done last year
ordered by my doctor but done at another location.  When I visited him 
this year, I found out that
the results had never been sent to him (not even simply on paper).  
Information from one system to another
almost unrelated system is common and important if one is to have 
continuity of care. 

Dave
>  From my point of view, and according to the tools I already elaborated 
> and tested, the health professional should be provided with two 
> different kind of tools : front office tools and back office tools. 
> Quite in the same way market places information systems work inside banks:
> - front office tools are groupware services dedicated to continuity of 
> care, they belong to the public health information system. The citizen 
> is the owner and grants access to the members of his/her care team.
> - back office tools belong to care places, and are "record oriented".
>
> You may disagree with this model , but if you don't, then you will 
> realize that there is no use to have the back office systems communicate 
> with something else than the front office system. This is why I pointed 
> out that exchanges from one Hospital IS to another has probably no 
> genuine use case.
>
> I am ok to put a workflow engine among the front office services, but 
> are you talking about a workflow of people/acts (something like a care 
> path) or a workflow of documents?
>
> Best regards,
>
> Philippe
>
> Will Ross a écrit :
>
>   
>> Philippe,
>>
>> Actually, I am still talking about Wayne's focus on the user.   As a  
>> project manager I spend much of my time in a balancing act by  
>> advocating for someone else's perspective.   When I work with with IT  
>> developers and vendors, the most important missing voice is generally  
>> the perspective of the user.   Workflow diagrams and use case  
>> narratives are excellent tools to bring the user back into the center  
>> of the technology planning process, and they also provide users with  
>> a convenient way to redirect well intentioned but inappropriate  
>> technology proposals.
>>
>> Until we have compelling informatics solutions that meet actual  
>> clinical user needs, adoption of new IT proposals will be minimal at  
>> best, which describes the current state of EHR deployment in this  
>> country (i.e., minimal).
>>
>> With best regards,
>>
>> [wr]
>>
>> - - - - - - - -
>>
>> On Mar 23, 2006, at 3:43 AM, Philippe AMELINE wrote:
>>
>>  
>>
>> 
 Any opinion on YAWL ( http://www.yawl.fit.qut.edu.au/ )?

 Tim C


  

 
>>> Hi guys,
>>>
>>> I very much like the way Wayne Wilson explicated the Big problem :
>>>
>>> "The very first thing to do is to build a believable (to doctors and
>>> patients) scenario for needing to get information from one system  
>>> to the
>>> next, preferably in real time. IF you don't lead with that from a
>>> demonstrably practical point of view and just assume a generic need
>>> justifies all (interchange is good and will save the world, etc.),  
>>> then
>>> I suggest that this interoperability demo is no different than a  
>>> vendor
>>> plug fest designed to show managers why they should keep buying the  
>>> same
>>> stuff they have already bought."
>>>
>>> And how funny it was to see that 6 posts after, all this vanished  
>>> into a
>>> workflow engines comparison (very interesting, by the way).
>>>
>>> From my point of view, Wayne is very right to ask for a scenario "for
>>> needing to get information from one system to the next". And I think
>>> that such a scenario will be pretty much artificial if these  
>>> systems are
>>> HIS since the genuine main reason to communicate is continuity of  
>>> care,
>>> and that it is the very issue that hospitals don't address at all -  
>>> and
>>> even rarely understand.
>>>
>>> This "generic

Re: [openhealth] Demonstrations & Standards.

[David Forslund]

I wholeheartedly agree with you, Will!Do you have some example 
workflow diagrams that
you have found useful?

Dave
Will Ross wrote:
> Philippe,
>
> Actually, I am still talking about Wayne's focus on the user.   As a  
> project manager I spend much of my time in a balancing act by  
> advocating for someone else's perspective.   When I work with with IT  
> developers and vendors, the most important missing voice is generally  
> the perspective of the user.   Workflow diagrams and use case  
> narratives are excellent tools to bring the user back into the center  
> of the technology planning process, and they also provide users with  
> a convenient way to redirect well intentioned but inappropriate  
> technology proposals.
>
> Until we have compelling informatics solutions that meet actual  
> clinical user needs, adoption of new IT proposals will be minimal at  
> best, which describes the current state of EHR deployment in this  
> country (i.e., minimal).
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> On Mar 23, 2006, at 3:43 AM, Philippe AMELINE wrote:
>
>   
>>> Any opinion on YAWL ( http://www.yawl.fit.qut.edu.au/ )?
>>>
>>> Tim C
>>>
>>>
>>>   
>> Hi guys,
>>
>> I very much like the way Wayne Wilson explicated the Big problem :
>>
>> "The very first thing to do is to build a believable (to doctors and
>> patients) scenario for needing to get information from one system  
>> to the
>> next, preferably in real time. IF you don't lead with that from a
>> demonstrably practical point of view and just assume a generic need
>> justifies all (interchange is good and will save the world, etc.),  
>> then
>> I suggest that this interoperability demo is no different than a  
>> vendor
>> plug fest designed to show managers why they should keep buying the  
>> same
>> stuff they have already bought."
>>
>> And how funny it was to see that 6 posts after, all this vanished  
>> into a
>> workflow engines comparison (very interesting, by the way).
>>
>>  From my point of view, Wayne is very right to ask for a scenario "for
>> needing to get information from one system to the next". And I think
>> that such a scenario will be pretty much artificial if these  
>> systems are
>> HIS since the genuine main reason to communicate is continuity of  
>> care,
>> and that it is the very issue that hospitals don't address at all -  
>> and
>> even rarely understand.
>>
>> This "generic need" that would justify a "need for communication"
>> between HIS is a myth that became a religion when a sufficient  
>> number of
>> people started to make a living by building standards for it. This is
>> not an issue for the citizen.
>>
>> My 2 € ;-)
>>
>> Philippe
>>
>>
>>
>>
>>
>> Yahoo! Groups Links
>>
>>
>>
>>
>>
>>
>>
>> 
>
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california  95482  usa
> 707.272.7255 [voice]
> 707.462.5015 [fax]
> www.minformatics.com
>
> - - - - - - - -
>
>
>
>
>
>   




 
Yahoo! Groups Links

<*> To visit your group on the web, go to:
http://groups.yahoo.com/group/openhealth/

<*> To unsubscribe from this group, send an email to:
[EMAIL PROTECTED]

<*> Your use of Yahoo! Groups is subject to:
http://docs.yahoo.com/info/terms/
 

Re: [openhealth] Demonstrations & Standards.

[David Forslund]

Communication between HIS isn't specifically a need of a citizen, just 
the results of it.   It has been
almost impossible for a patient to be able to see or possess a record of 
their healthcare which is
being done by a variety of organizations and providers.   This need for 
a "virtual healthcare record" is
very real and something we've argued for for almost a decade in print.   
To the end user, how it is
done is irrelevant.   It's need isn't.   Continuity of care is gaining 
in its recognized importance in the US
these days as being critical for the improvement of patient health.   
The flow of data between healthcare
organizations is critical for this.  It is probably the main focus of 
the US NHIN effort.

Dave
Philippe AMELINE wrote:
>> Any opinion on YAWL ( http://www.yawl.fit.qut.edu.au/ )?
>>
>> Tim C
>>  
>>
>> 
> Hi guys,
>
> I very much like the way Wayne Wilson explicated the Big problem :
>
> "The very first thing to do is to build a believable (to doctors and 
> patients) scenario for needing to get information from one system to the 
> next, preferably in real time. IF you don't lead with that from a 
> demonstrably practical point of view and just assume a generic need 
> justifies all (interchange is good and will save the world, etc.), then 
> I suggest that this interoperability demo is no different than a vendor 
> plug fest designed to show managers why they should keep buying the same 
> stuff they have already bought."
>
> And how funny it was to see that 6 posts after, all this vanished into a 
> workflow engines comparison (very interesting, by the way).
>
>  From my point of view, Wayne is very right to ask for a scenario "for 
> needing to get information from one system to the next". And I think 
> that such a scenario will be pretty much artificial if these systems are 
> HIS since the genuine main reason to communicate is continuity of care, 
> and that it is the very issue that hospitals don't address at all - and 
> even rarely understand.
>
> This "generic need" that would justify a "need for communication" 
> between HIS is a myth that became a religion when a sufficient number of 
> people started to make a living by building standards for it. This is 
> not an issue for the citizen.
>
> My 2 € ;-)
>
> Philippe
>
>
>
>   




 
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Re: [openhealth] Demonstrations & Standards.

[David Forslund]

I've been quite impressed by the YAWL work of van der Alst at 
Eindhoven.   It is probably technically superior to
some of the other workflow systems out their, particularly in its 
richness and accuracy of expressing workflow, but I don't
believe it supports any of the standards out there.  Thus exchanging 
workflow models and interoperability would
appear to be sacrificed which was the origin of this discussion.   I 
know that XPDL isn't expressive enough
for everything, but that might not be needed to get workflow out and in 
use.  Shark currently has a longer history
of stable releases, too.

Dave
Tim.Churches wrote:
> Thomas Beale wrote:
> > David Forslund wrote:
> >  >
> >  > We have been using workflow engines for a while.  The one I happen to
> >  > prefer is Shark (http://shark.objectweb.org) 
> <http://shark.objectweb.org%29>
> >  > <http://shark.objectweb.org%29> which is quite robust and
> >  > uses standard WfMC's XPDL for the workflow representation and that it
> >  > supports both Web Services and the OMG CORBA workflow standard.  The
> >  > lack of interoperability in workflow models is a major 
> impediment.  We
> >  > worked with the City of Hope for three years to try to come up 
> with the
> >  > fundamental generic workflow for clinical trials, but didn't 
> finish the
> >  > task. My main interest in XPDL is that it separates out the workflow
> >  > definitions from the implementation of workflow.  The popular 
> BPEL seems
> >  > to confuse this issue, at least as I see it.   Getting some 
> agreement on
> >  > the basic workflow elements for healthcare that might be shared 
> would be
> >  > quite interesting and valuable, in my opinion.
> >
> > During last last year I read 3 clinical workflow PhD dissertations, and
> > spent a fair bit of time looking at BPEL, XPDL etc. My conclusions when
> > struggling to see what was "the" workflow model to use to represent
> > workflow were:
> > a) none of the models I reviewed did everything needed
> > b) I realised one day that the right way to represent such semantics is
> > in a programming language-like syntax, rather than the object model
> > form. The reason for this is that a syntax and parser approach are far
> > more amenable to understanding a problem domain; it is only when it is
> > completely sorted that you can afford to publish object models.
> > c) such a language needs to have all the temporal operators required by
> > workflow, including all the synchronous/asynchronous branching, split &
> > join operators and so on. I can imagine a modified version of current
> > programming language syntax might go close to this. The advantage is
> > that the language can be improved over time, but previous workflows will
> > still compile (if the compiler builders take care); whereas object model
> > representations are usually left out in the cold because they are the
> > equivalent of what the compiler generates (the parse tree), not the
> > input, whose syntax might not change, but whose meaning might.
> > d) the XML-based attempts really suffer from not having an abstract
> > language. XML is just a transfer syntax. When will people start getting
> > this? (do you read OWL in XML-RDF? Of course not, you read it in
> > OWL-abstract; do you read .class files or .java files? etc). Worse,
> > XML models are actually direct serialisations of structural object
> > models, they are not any kind of syntax. It is too early in the learning
> > curve of this area to be committing to object models.
> >
> > I agree with Dave that this area is interesting and important to sort
> > out. I'll put the PhD thesis links on openEHR.org  - they are all a
> > great read.
> >
> > my 5c
>
> Any opinion on YAWL ( http://www.yawl.fit.qut.edu.au/ )?
>
> Tim C
>
>
> 
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Re: [openhealth] Demonstrations & Standards.

[David Forslund]

Tim.Churches wrote:
> Wayne Wilson wrote:
> > Boy, is this discussion bringing back old memories, Dave Forslund 
> reminds me
> > exactly how old later on and I have some inline comments.
> >
> > Just below, Tom Beale suggests interoperability built on engineering
> > principles.  Some discussion follows about the difficulty of 
> connecting systems
> > with different models, etc.
>
> Um, is some of this discussion occurring on a different list, or
> privately - no problem if so, but just curious because I haven't seen
> all the messages which you quote below from the openhealth list on Yahoo.
>
> > So, I agree with Tom about what experience tells us about standards 
> and de facto
> > momentum.
>
> Also agree that de facto engineering standards, rather than ones nutted
> out by small, select technical committees, tend to be much better.
> However, de facto engineering standards only develop when one company or
> group comes up with a very good implementation way ahead of everyone
> else. I don't think that is the case in much of health informatics -
> typically engineering solutions which might become standards take so
> long to develop that competing or alternative solutions inevitably
> spring up during the development period. Unless one solution is so
> vastly superior on all counts to the others (which hardly  ever happens
> in health informatics), we end up with a plurality of engineering
> solutions and national authorities or standards committees then have to
> decide between them and anoint one or the other, or at least a few.
>
> >  > David Forslund wrote:
> >  >  The vendor lock-in was the
> >  >biggest factor that worked against
> >  >the adoption of the fairly reasonable OMG specifications we worked on
> >  >from 96-01.
> >  >
> > Gosh, was it that long ago?  I have come to believe that alongside 
> vendor
> > lock-in, high complexity played a significant role.
>
> I agree. Complexity + lack-of-Internet in the mid-1990s -> lack of CORBA
> take-up. If you look at all the SOAP, WSDL and other current WS-*
> standards, they are just as complex as CORBA (but mostly not as good) -
> but the social network effects of the Internet mean that the complexity
> can be conquered, even by a small start-up software company.
This is a good point.  I see even more complexity in the current WS-* 
standards because of poor handling of object syntax, and a reinvention 
of much of what has gone before.  Now that SOA is popular, there seems 
to be more acceptance of the concept of services instead of simply 
message passing.  But interoperability has been mostly ignored or lost 
in the shuffle.  The fact that I can readily put up my own Web Services 
contributes essentially nothing to interoperability despite the fact 
that you and I might use the same technology.
>
> > I am not as sold on multi-source components as I once was.  I 
> believe that
> > nearly all the value lies in process (workflow in it's generic 
> sense) and how
> > various 'natural' groupings of functions (Things that people do in a 
> patient
> > care setting)  need to hand off to each other.
>
> Absolutely. We have recently realised, with respect to public health
> information systems, that workflow management is just as important as
> semantic and syntactic information management, if not more so. We're
> busily reading up everything we can on various workflow engines and
> their underlying calculus and theoretical bases. I think the same
> applies to hospital-based clinical medicine, and to primary care. In
> fact, some form of workflow engine are vital to any human enterprise
> which can't be done or isn't typically done by a small group who can all
> talk to one-another face-to-face in order to co-ordinate their actions.
We have been using workflow engines for a while.  The one I happen to 
prefer is Shark (http://shark.objectweb.org) which is quite robust and 
uses standard WfMC's XPDL for the workflow representation and that it 
supports both Web Services and the OMG CORBA workflow standard.  The 
lack of interoperability in workflow models is a major impediment.  We 
worked with the City of Hope for three years to try to come up with the 
fundamental generic workflow for clinical trials, but didn't finish the 
task. My main interest in XPDL is that it separates out the workflow 
definitions from the implementation of workflow.  The popular BPEL seems 
to confuse this issue, at least as I see it.   Getting some agreement on 
the basic workflow elements for healthcare that might be shared would be 
quite interesting and valuable, in my opinion.
>
> > Clearly many people 'sense' this value and find a

Re: Open Source Interoperability (was) Re: [openhealth] Re: OS at MedInfo 2007

[David Forslund]

Thomas Beale wrote:
> David Forslund wrote:
> > I think we should have some time of interoperability testbed for open
> > source systems with each other and with other
> > non-open source systems.  Interoperability and open source can be quite
> > orthogonal.   Certainly all systems
> > need to today to indicate their level of "interoperability" and how that
> > is established and how it is verified.   I think
> > there is little understanding in the user community of interoperability
> > and what the long term risk of a particular
> > "solution" is be it open source or closed-source.   Active participation
> > by open source vendors in the standards
> > efforts is critical and documentation of the "risks" associated with
> > adopting any particular solution.
> >
> > Dave
> >
> > Joseph Dal Molin wrote:
> > > An excellent summary Thomas! The following point really strikes a 
> chord,
> > > especially as the VistA-Office EHR team is about to begin to work to
> > > meet the ONCHIT EHR certification criteria:
> > >
> > > > , it is definitely not a given that OS efforts will
> > > > do any better at exploiting it than commercial ones.
> > >
> > > What would you suggest we, the community as whole, do in practical 
> terms
> > > to ensure that we exlpoit the power of interoperability? So far 
> most if
> > > not all of the "projects" have been working in relative
> > > isolationmostly I'm sure because of time and energy 
> constraints than
> > > anything elsedo we need a sort of IHE effort/wdemonstration 
> for open
> > > source solutions?
> > >
> > > Joseph
> > >
> > >
> > >
> [hmmm...this turned out much longer than I intended. Must be the wine...]
>
> I should say: software implementers, go and look at standards and use
> them. But the available standards are a minefield and fraught with poor
> design choices, and are often not tested at all. My experience in the
> health sector is that the only workable standards I have seen are very
> specialised things like DICOM, relatively simple things like HL7v2 (once
> bashed into shape by 10 years of trial and errorbut they do actually
> work ok these days), some of the OMG standards which were far out in
> front in terms of engineering qualityI don't know if I could point
> to much else. Experience has taught me to be much more firmly in favour
> of de facto standards built by engineering processes (which may become
> de jure when shown to work well) than de jure ones created in
> smoke-filled rooms by who-was-there and who-shouts-loudest. (Just think
> of the history of TCP/IP).
>
> So here is what I would suggest instead: a community of software
> producers (not necessarily all OS) should get together and contemplate
> what is needed to actually make various applications, back-end solutions
> in that community etc talk to each other. That means thinking about
> APIs, data interchange and service interfaces. It also means drawing
> some kind of system architecture in which the products of these multiple
> groups are shown deployed together (well, not necessarily a single
> architecture); the object is to find out how to implement the connecting
> lines & interfaces. Some design thought should go into roughly what
> these connections and interfaces look like. Then standards should be
> researched for applicability to these interconnections. If there is not
> much useful around, then the community can think about designing 
> something.

Many of the "interoperability" standards weren't really designed for 
interoperability.  Thus the proliferation
of "standards" we see today allow one system to talk to another, but 
this has little to do with interoperability. 
Many of the WS-* standards (but not all) fall into this category.  In my 
experience, unless interoperability
is designed in from the beginning, a system may be hopeless isolated 
from others.  
>
> The platform we need includes the following elements:
>
> Engineering dimension:
> * information models, particularly data types, structures, identifiers
> and such
> * component-level APIs
> * service interface definitions
>
> Knowledge dimension:
> * terminology
> * domain content models
> * guidelines
> * etc
These are reasonable.   It seems to be a relatively new idea today to 
have set of services (even though
that is a very old idea).  The attempt of the OMG around a decade ago 
was to have a set of service
components out of which one could build a rather arbitrary system, but 
the service components inter

Re: Open Source Interoperability (was) Re: [openhealth] Re: OS at MedInfo 2007

[David Forslund]

I think we should have some time of interoperability testbed for open 
source systems with each other and with other
non-open source systems.  Interoperability and open source can be quite 
orthogonal.   Certainly all systems
need to today to indicate their level of "interoperability" and how that 
is established and how it is verified.   I think
there is little understanding in the user community of interoperability 
and what the long term risk of a particular
"solution" is be it open source or closed-source.   Active participation 
by open source vendors in the standards
efforts is critical and documentation of the "risks" associated with 
adopting any particular solution.

Dave

Joseph Dal Molin wrote:
> An excellent summary Thomas! The following point really strikes a chord,
> especially as the VistA-Office EHR team is about to begin to work to
> meet the ONCHIT EHR certification criteria:
>
> > , it is definitely not a given that OS efforts will
> > do any better at exploiting it than commercial ones.
>
> What would you suggest we, the community as whole, do in practical terms
> to ensure that we exlpoit the power of interoperability? So far most if
> not all of the "projects" have been working in relative
> isolationmostly I'm sure because of time and energy constraints than
> anything elsedo we need a sort of IHE effort/wdemonstration for open
> source solutions?
>
> Joseph
>
>
> Thomas Beale wrote:
> > I think (and I may be wrong) that OS as a theme in and of itself is not
> > that interesting; the point is: how does the OS approach in health
> > improve things? Positive consequences that spring to mind:
> >
> > * OS software it is potentially a better means of achieving
> >   interoperability, since open source developments are more like
> >   than closed ones to want to reuse rather than reinvent due to more
> >   limited resources (however, the evidence is that all modes of
> >   software development are trapped largely in reinvention mode)
> > * OS software is accordingly more likely to be a better vector for
> >   standards, since there is not the commercial motivation to lock in
> >   customers (but how do we know there isn't another kind of
> >   motivation in the OS area to do the same thing - based e.g. on 
> pride?)
> > * OS software is more likely to be componentised, and delivered in
> >   components, due to more limited resources and the inability to
> >   financially sustain gigantic new build efforts.
> > * It should be cheaper to own and run
> > * It might even be more innovative, due to the need to find smart
> >   solutions that work on cheap technology. I have no evidence at all
> >   for this, but it could well be true for the sectors of the market
> >   that are not pursued by big companies (e.g. small systems for
> >   developing countries).
> > * being a vector of systemic change - i..e not just serving
> >   individual customers but offering alternatives for widespread
> >   change across entire sectors of health. This is also related to
> >   not locking in users.
> >
> > All obvious? I don't think it is. I think these are all potentials, and
> > I think that OS development efforts owe it to themselves and the
> > community they aspire to serve to be more interested in
> > interoperability, (good) standards, and thinking in terms of attractive
> > long-term options for users. I think we all run the risk of being just
> > as inward-looking and non-customer focussed as any commercial
> > development effort. The record of commercial products for
> > interoperability and lock-in has been mostly poor, so the opportunity is
> > there, but in my mind, it is definitely not a given that OS efforts will
> > do any better at exploiting it than commercial ones.
> >
> > These are the kinds of themes I would find more interesting in a
> > conference or other forum; not endless debates about free/libre,
> > licenses or other details. In other words the interest in OS must be
> > about better outcomes.
> >
> > - thomas beale
> >
> >
> > Tim.Churches wrote:
> >  > Forwarded message from Peter Murray.
> >  >
> >  >  Original Message 
> >  > Subject: Re: OS at MedInfo 2007
> >  > Date: Sun, 19 Mar 2006 09:54:15 +
> >  > From: Peter Murray <[EMAIL PROTECTED]>
> >  > To: Tim.Churches <[EMAIL PROTECTED]>
> >  > CC: [EMAIL PROTECTED]
> >  >
> >  > Hi, Tim -
> >  >
> >  > good question on OS activities at medinfo2007. (Could you copy the
> >  > substance of this reply to the openhealth list, as I am not on it -
> >  > thought I was going to be added after the AMIA OSWG meeting in 
> November,
> >  > but does not seem to have happened yet - I will copy this to AMIA 
> OSWG
> >  > list).
> >  >
> >  > I think we should aim for something substantial at medinfo2007 in the
> >  > free/libre open source area - we can at least get an IMIA OSWG 
> activity
> >  > of some kind, which we can o

Re: [openhealth] Openhealth mailing list

[David Forslund]

I second Will Ross position and Bhaskar's recommendation.   The 
yahoogroups email is working fine as
far as I can see.   I think it was problems with the other list that had 
caused some trouble in the past.  Let's
put this behind us and move forward.

Dave Forslund
Will Ross wrote:
> I agree with Bhaskar's proposal.   The openhealth@yahoogroups.com 
> list is not broken, so there is no need to "fix" it.   Rather than 
> dissipate community resources in an unnecessary technology migration 
> task, let's concentrate instead on the governance and planning tasks 
> needed for a cohesive re-launch of OSHCA.
>
> [wr]
>
> - - - - - - - -
>
> On Mar 17, 2006, at 7:40 AM, Peter Holt Hoffman wrote:
>
> > I agree with Bhaskar for all the reasons he enumerated in his email 
> > below (I
> > edited it to just the relevant portion).  I would also like to take 
> > this
> > opportunity to thank him for having started this group.
> >
> > -- Peter.
> >
> >
> > -Original Message-
> > From: openhealth@yahoogroups.com 
> > [mailto:[EMAIL PROTECTED] On
> > Behalf Of Bhaskar, KS
> > Sent: Friday, March 17, 2006 10:32 AM
> > To: openhealth@yahoogroups.com
> > Subject: [openhealth] Openhealth mailing list
> > 
> >
> > In my role as moderator, I see myself as serving the wishes of the 
> > free
> > and open source software for healthcare community.  One suggestion I
> > would make, however, is simply to leave the list at Yahoogroups.  Yes,
> > we can create our own list on our own server, but then we would be
> > responsible for things like the list below for a server that will 
> > sit on
> > the Internet:
> >
> > 1. Backups.
> > 2. Indexing and searching.
> > 3. Anti-virus and spam filtering.
> > 4. Security, including keeping up to date with patches.
> > 5. Network access, bandwidth, data center operations.
> >
> > I recently had an opportunity to observe the need to respond to a 
> > server
> > that was found to have the t0rn root kit installed on it, and it was
> > very disruptive on the lives of those who managed it.
> >
> > Yahoogroups does all of this for us, and the price is some advertising
> > appended to each message (and if you opt for text messages rather than
> > HTML messages, the advertising is at the bottom and quite innocuous).
> > All the group moderators have to do is to approve requests to join the
> > group.
> >
> > We already have several moderators from the community who are 
> > members of
> > the group, and there is redundancy should I, or any of the other
> > moderators, have something untoward happen to us and be unable to 
> > serve.
> > I am also happy to accept others who would like to volunteer to serve
> > the community as moderator.
> > 
> >
> >
> > [Non-text portions of this message have been removed]
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> >
> >
> >
>
>
> [wr]
>
> - - - - - - - -
>
> will ross
> project manager
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california  95482  usa
> 707.272.7255 [voice]
> 707.462.5015 [fax]
> www.minformatics.com
>
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Re: [openhealth] Open Source Clinical Messaging Software

[David Forslund]

Have you looked at openedi on sourceforge?

Dave
Will Ross wrote:
> I'm looking for one.   At any stage of development.   Any suggestions 
> will be welcome.
>
> With best regards,
>
> [wr]
>
> - - - - - - - -
>
> will ross
> mendocino informatics
> 216 west perkins street, suite 206
> ukiah, california  95482  usa
> 707.272.7255 [voice]
> 707.462.5015 [fax]
>
> - - - - - - - -
>
>
>
>
> SPONSORED LINKS
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>   Salon software 
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>  
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Re: [openhealth] Drug Database was:OSCAR passed!

[David Forslund]

Perhaps it is obvious from my questions, but I've little interest in the 
DrugRef API and more interest in the data (if it is relevant).   The 
package seems to come with a particular set of data tuned to a 
particular database.  I might have assumed if it is database independent 
that the API would enable the loading of a data set without regard to 
the database.   In any case, my question is "is the data provided with 
the DrugRef software the Canadian specific data and then does it need 
the same permission as the CSV files for use?"

Dave
Karsten Hilbert wrote:

> On Thu, Nov 24, 2005 at 09:35:48AM -0700, David Forslund wrote:
>
> > "The Drug Product Database (DPD) system captures information on 
> Canadian human,
> > veterinary and disinfectant products approved by the Drugs Programme 
> for use in Canada."
> >
> > So its use outside of Canada may be problematic independent of the 
> copyright.  Is this the
> > same data that is in DrugRef? 
> If I properly understand the architecture of DrugRef the
> answer would be:
>
> Yes, it is -- IF you chose it to be so and loaded the
> appropriate backend driver.
>
> To my understanding the drugref API allows plugging in any
> database(s) there is a driver for and it be accessed by the
> uniform drugref API.
>
> Karsten
> -- 
> GPG key ID E4071346 @ wwwkeys.pgp.net
> E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346
>




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Re: [openhealth] Drug Database was:OSCAR passed!

[David Forslund]

I also don't see anything different about use outside or inside Canada.  
However, I do have a question about the Canadian nature of the data.  It 
mentions the use of French characters in the data and in the 
identification of products no longer marketed in Canada.  It also says

"The Drug Product Database (DPD) system captures information on Canadian human,
veterinary and disinfectant products approved by the Drugs Programme for use in 
Canada."

So its use outside of Canada may be problematic independent of the copyright.  
Is this the 
same data that is in DrugRef?  

Thanks,

Dave 

Karsten Hilbert wrote:

> On Thu, Nov 24, 2005 at 07:21:18AM -0800, Tim Cook wrote:
>
> > Please note that the copyright statement is quite clear about use
> > outside of Canada. 
> >
> > 
> > Copyright
> > Drug Product Database. © Her Majesty the Queen in Right of Canada. All
> > rights reserved. No part of the DPD may be reproduced, in whole or in
> > part, for any purpose, without prior written permission from the
> > Government of Canada's copyright administrator, Public Works and
> > Government Services Canada. To obtain permission to reproduce the DPD
> > please contact:
> ...
>
> I cannot see anything that distinguishes the applicability
> of the license outside Canada from inside Canada ?
>
> In short: Regardless of location I'll have to ask permission
> to use it. The license itself doesn't seem to specify
> whether "they" care or not where the data is going to be
> used.
>
> Karsten
> -- 
> GPG key ID E4071346 @ wwwkeys.pgp.net
> E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346
>
> 





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Re: [openhealth] OSCAR passed!

[David Forslund]

I guess it is too much to ask that these databases be made available
in a database independent format.   This way they could be
incorporated into existing systems that don't happen to have (or don't 
want) PostgresSQL
running.   It seems to me that the descriptions of the data and the data
could easily be independent of the database used to store them.  This would
greatly extend their usability, in my opinion.   I'm glad they are 
available, but
would like to see it more generally accessible (perhaps in XML?).

Thanks,

Dave
David Chan wrote:

>OSCAR Drugref 1.0 is another significant software
>piece which is part of the OSCAR McMaster Certified
>product. It is now available for download at:
>
>http://www.oscarmcmaster.org/drugref/
>
>The free web-service DRUGREF is definitely going
>OFFLINE by Dec 15, 2005!!! Instead of hosting a new
>drugref server on ServerBeach.com we will be posting
>the software (python and PostgreSQL scripts) and
>instruction for installation here shortly. We think
>most current OSCAR installations should be able to run
>drugref on their OSCAR servers without cutting into
>the performance. You can always find an old PC and
>install drufref on it :-) You may need help from your
>support vendor to do this properly. This version of
>drugref will automatically load the drug data tables
>from Health Canada each time you restart the program.
>DRUGREF version 2 will include a number of enhanced
>features. We have chosen NOT to include drugref on our
>CVS site because we don't want to appear to have
>forked the drugref code. We continue to work closely
>with the drugref team to make drugref a truly
>collaborative project.
>
>Enjoy!
>
>David
>--- Adrian Midgley <[EMAIL PROTECTED]> wrote:
>
>  
>
>>On Sat, 2005-11-19 at 11:09 -0800, David Chan wrote:
>>
>>
>>>*** It's official! *** OSCAR has been certified by
>>>OntarioMD under the Physician IT Program. 
>>>  
>>>
>>Excellent!
>>
>>If we take Vista as being the first open source
>>medical record system
>>certified and in widespread use, (and I'm not sure
>>that the difference
>>between OSS and US PD isn't significant there so
>>perhaps we shouldn't)
>>then OSCAR is the first FLOSS general
>>practice/family practice/academic
>>practice EMR to be so certified.
>>
>>Hurrah.
>>
>>
>>
>>-- 
>>Adrian Midgley
>>
>>
>>
>>
>
>
>David H Chan, MD, CCFP, MSc, FCFP
>Associate Professor
>Department of Family Medicine
>McMaster University
>
>
>   
>   
>__ 
>Yahoo! Mail - PC Magazine Editors' Choice 2005 
>http://mail.yahoo.com
>
>  
>




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