Archetypes: Types of use

Gerard Freriks gfrer at luna.nl
Mon Jul 9 05:42:20 EDT 2012


Dear Stephan,

We agree.

By all means, the situation as is today and that was in the past, are necessary steps to get to the state of Nirvana some day, wirth full semantic interoperability some time in the future.
Until then we see diverging ways to model archetypes, bind to coding systems and ontologies.

Gerard Freriks
+31 620347088
gfrer at luna.nl




On 9 Jul 2012, at 10:09, Stefan Sauermann wrote:

> Hello!
> I agree that we are now in the middle of the "local arrangements" mode. Let us record that "local" means >=10 million patients, 300 Hospitals, 15000 resident doctors in some "local" projects on this planet.
> In my opinion arrangements for ANY type of interoperability project in medicine "have to be strict, well defined, well managed, well maintained, well owned, well quality assured". Otherwise they will fail. "loose, flexible, unstable, and ad-hoc" solutions will not survive and scale in any setting. Nobody today will happily accept an unsafe solution.
> 
> George Mac Ginnis of NHS has provided a very beautiful slide on when it makes sense to use standards in an interoperability project, see http://sph.continuaalliance.org/docs/SPHBFSMacGinnis.pdf,
> slide number 9.
> He uses the scales of lifetime, size of patient base and number of services. Maybe that can help to better describe the scenarios we are seeing.
> What Gerard calls "local" seems to map to what George calls "Requires operational workarounds". Gerards second type might fit to "Flexible and scalable service" in George's slide and definitely is where we are going for.
> 
> I agree that we still have some work ahead until we reach the "very stable and used in a large worldwide community" phase supporting "multiple cultures and languages". In that space the timeframe of a few generations as Gerard suggest seems reasonable.
> 
> Greetings from Vienna,
> 
> Stefan Sauermann
> 
> 
> Am 08.07.2012 13:28, schrieb Gerard Freriks:
>> Hi,
>> 
>> There are two types of use for archetypes:
>> -local, ad-hoc in geographical sense and time
>> -general in geography and time
>> 
>> The first type will serve local arrangements when, for instance, one needs to integrate systems in one specific hospital with those of a specific other one.
>> The latter type when we need to express data using archetypes in systems that so to speak have to be designed, yet and used by healthcare providers that have to be born, yet and used in an other healthcare domain, an other languages an other culture.
>> 
>> In the present day reality we are content when we can achieve the first type of use in a situation with partial semantic interoperability.
>> But we have to prepare for the latter type used in a situation with full semantic interoperability.
>> 
>> It is clear that Stefan points ate the first type of use and that Koray  refers more to the latter.
>> In both cases we need human agreements.
>> In the first type they can be rather loose, flexible, relatively unstable, and ad-hoc. This is typically the situation with archetypes defined in the 'old-days', the days of learning, in many regional or national projects.
>> In the latter type they have to be strict, well defined, well managed, well maintained, well owned, well quality assured and very stable and used in a large worldwide community
>> We must start to prepare for this next phase of the use of archetypes as carriers of many human agreements on the topic of full, safe,  semantic interoperability.
>> 
>> 
>> Gerard Freriks
>> +31 620347088
>> gfrer at luna.nl
>> 
>> 
>> 
>> 
>> On 8 Jul 2012, at 11:47, Koray Atalag wrote:
>> 
>>> Hi,
>>> 
>>> I agree with Ian et al. that Archetypes, as a methodology, is not enough to enable interoperability by themselves. It is mostly dependent on the content of those Archetypes that will matter most - and the two(or multi)-level modelling approach just facilitates this by providing clinician-friendly but computable representation of health information. Since we don't use a holistic RIM from which all artefacts are derived from there's a huge degree of freedom for creating archetypes (including which data structures to choose from). Therefore we need firm control of content - which requires human agreement.
>>> 
>>> Cheers,
>>> 
>>> -koray
>>> 
>>> 
>>> 
>>> -----Original Message-----
>>> From: openehr-clinical-bounces at lists.openehr.org [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of Ian McNicoll
>>> Sent: Monday, 25 June 2012 8:25 p.m.
>>> To: For openEHR clinical discussions
>>> Subject: Re: Regarding the role of ITEM_STRUCTURE
>>> 
>>> Hi Sam,
>>> 
>>> I actually did think Stefan was making an important point about clinical modelling. If I have understood Stefan's comments correctly , he is stating that in his experience interoperability is rarely possible without local negotiation, compromise and detailed understanding of the use case and shared requirements. That would also be my view, which is why I believe that while good definition and ontological analysis is helpful, it will never be possible to 'clean room' interoperability without directly involving the end-use
>>> stakeholders: Interoperability is ultimately negotiated not designed.
>>> 
>>> The value of the archetype approach is in making this negotiation progressively possible without asking end-users to become embroiled in complex technical discussions. Complex and detailed clinical discussions will still be required but that is only to be expected.
>>> 
>>> Ian
>>> 
>>> 
>>> 
>>> 
>>> 
>>> On 24 June 2012 22:43, Sam Heard<sam.heard at oceaninformatics.com>  wrote:
>>>> Thanks Stefan
>>>> This is a highly technical discussion and should not be on this list.
>>>> Cheers, Sam
>>>> 
>>>> 
>>>> On 22/06/2012 5:28 PM, Stefan Sauermann wrote:
>>>> 
>>>> Hello eveybody!
>>>> Looking at this discussion, the volume it is taking weighted against
>>>> the visible progress I ask myself if this is an efficient way to reach
>>>> harmonised conclusions.
>>>> 
>>>> In our experience doing the national EHR standards and the lab report
>>>> for Austria we noticed:
>>>> - Once you reach a sufficient level of detail it is not possible to
>>>> reach generic (one fits all) solutions within available timeframes.
>>>> - Data models and their descriptions only started to work after all
>>>> involved had agreed on a specific, crisp and clear definition of the usecase.
>>>> - No information model / description did work for all thinkable usecases.
>>>> - We had to tailor information models to specific usecases.
>>>> - Then bridging from one use case into the other becomes a challenge,
>>>> as subtle differences in the information will become an issue.
>>>> - In order to bridge information from one specific use case into the
>>>> other we typically need to define another specific usecase.
>>>> 
>>>> I do not see the specific usecases you are referring to. I therefore
>>>> can not contribute to or understand this discussion. Maybe I missed something.
>>>> Sorry!
>>>> 
>>>> Greetings from Vienna,
>>>> 
>>>> Stefan Sauermann
>>>> 
>>>> Program Director
>>>> Biomedical Engineering Sciences (Master)
>>>> 
>>>> University of Applied Sciences Technikum Wien Hoechstaedtplatz 5, 1200
>>>> Vienna, Austria
>>>> P: +43 1 333 40 77 - 988
>>>> M: +43 664 6192555
>>>> E: stefan.sauermann at technikum-wien.at
>>>> 
>>>> I: www.technikum-wien.at/mbe
>>>> I: www.technikum-wien.at/ibmt
>>>> I: www.healthy-interoperability.at
>>>> 
>>>> 
>>>> Am 22.06.2012 09:29, schrieb Gerard Freriks:
>>>> 
>>>> Yes.
>>>> 
>>>> It all is about classifying.
>>>> It is all about proper definitions we all share and use.
>>>> 
>>>> I believe that when we all interpret the definitions in our own way in
>>>> our own data bases all is working nicely.
>>>> 
>>>> The moment we start to exchange this data we will discover that we are
>>>> not interoperable, The moment we start to re-use data in clinical
>>>> decision support service we will discover that all systems that worked
>>>> so nicely, have become problems to connect.
>>>> 
>>>> As EN13606 we work at full semantic interoperability as much as possible.
>>>> So we have to define many things, we use to produce archetypes, properly.
>>>> Don't we all have an obligation to make semantic interoperability possible?
>>>> 
>>>> 
>>>> Gerard Freriks
>>>> +31 620347088
>>>> gfrer at luna.nl
>>>> 
>>>> 
>>>> 
>>>> 
>>>> On 22 Jun 2012, at 02:45, Jussara wrote:
>>>> 
>>>> Think the background of our discussions is about CLASSfying.
>>>> 
>>>> Sent from my iPad
>>>> 
>>>> 
>>>> 
>>>> 
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>>> 
>>> 
>>> --
>>> Dr Ian McNicoll
>>> office +44 (0)1536 414 994
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>>> ian.mcnicoll at oceaninformatics.com
>>> 
>>> Clinical Modelling Consultant, Ocean Informatics, UK Director openEHR Foundation  www.openehr.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care  www.phcsg.org
>>> 
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