lessons from Intermountain Health, and starting work on openEHR 2.x

Gerard Freriks gfrer at luna.nl
Thu Oct 4 02:21:29 EDT 2012

Dear Koray,

We both agree that the scopes of CEN/ISO 13606 and openEHR differ, as I wrote.
The scope of 13606 is about EHR communication.
That of openEHR is about the implementation in an EHR system.

At present a standard is missing about defining clinical content.
It would be nice, certainly, when both 13606 and openEHR can share that standard for clinical content.
In several places the EN13606 Association, whose scope is wider than the European context, is actively working towards that goal.
This single approach for a standard for clinical content is very important when we want generic semantic interoperability.
This is the reason why components for a potential standard on archetype production are developed inside the Association.
A standard that defines the intersections with: coding systems, ontologies, other CEN/ISO standards like System of Concepts for Continuity of Care and the Health Information Services Architecture.
All resulting in one basic generic pattern, for all artefacts, that by specialisation is able to be used for all kinds of archetypes.
A basis pattern that in more detail allows the definition of more nuances than the archetypes we know, so far.
A basic pattern that brings features closer to actual use such as negation, semantic ordinals (with inclusion and exclusion criteria), better integration with clinical workflow, ontological reasoning over structure and codes, etc.

The EN13606 Association of implementors of the 13606 standard has considerable experience in the production of applications based on this standard.
When I look into future needs and developments around the use of coding systems and ontologies, I see state of the art developments among the members of the Association.

W3C is a good example. indeed.
As far as I know W3C does not prescribes how to implement their standards in systems.
This is the responsibility of the industry in all circumstances.

Gerard Freriks
+31 620347088
gfrer at luna.nl

On 4 Oct 2012, at 02:02, Koray Atalag wrote:

> Hi Gerard,
> I think getting the content model is absolutely right – no one can argue
> But with due respect I disagree with you about the difference. I seriously think standards defining clinical content should converge (not even harmonise).
> I had the privilege of spending some time with Ed Hammond in NZ and was convinced that this is what is needed. Mappings are different and certainly a blackhole.
> That said EN13606 Association’s mission and role is paramount in terms of contextualising “exchange” within the European context.
> We chose to use openEHR for defining the Interoperability standards in New Zealand as we are very mindful of the fact that this formalism has been defined and carried on for many years by this group; and it IS naturally the leading edge with proven track in implementation (one of which is my own work). I think W3C is a good example of how important it is to have a single approach in contrast to the situation in health IT. These might sound a bit strong but it is what I believe. I acknowledge lack of organisational capacity and skills in past though.
> Cheers,
> -koray

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