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

Thomas Beale thomas.beale at oceaninformatics.com
Thu Oct 4 12:07:01 EDT 2012

On 03/10/2012 23:26, Gerard Freriks wrote:
>> I just care about getting one model.... 
> In the case of 13606 _one good model _that describes a generic 
> interface for EHR communication, also, for communication with other 
> proprietary EHR solutions.
> In the case of openEHR _one good model_ that describes one particular 
> implementation of an EHR-system.
> This difference is something the EN1366 Association cares about.
> *
> *

well except that the above is a misunderstanding of openEHR, so if the 
13606 association works on that basis they will miss the opportunity to 
get harmonisation. openEHR is a model for an open EHR (it's in the name 
;-), and includes three kinds of semantics:

  * core semantics that apply for any use of health information -
    messages, EHR systems, documents etc
  * semantics that describe accessing EHR information in repositories -
    any repository
  * semantics that describe EHR information in an Extract from one
    system to another - any kind of system

These are used to specify the interfaces of EHR systems, EHR gateways 
(that sit next to existing EMR systems), and EHR Extracts. The openEHR 
architecture describes the externally shareable information semantics, 
not the internal implementation. The implementations are the business of 
vendors, and are all different. In other words, openEHR is an 
interoperability description of the system - how the information and 
services look from the outside.

Insofar as 13606 has been used (uptake by industry vendors appears very 
low as far as we can tell), it has been used to build either EHR systems 
or gateways, rarely messages, which is what it designed for. This seems 
a fair indication that what the sector wants is a specification for the 
interoperability interface of the systems and gateways required to even 
connect a healthcare enterprise to the outside world - and additionally, 
a specification for making EHR Extracts in these systems.

A specification only for EHR Extracts is not that useful, what the 
sector clearly wants are specifications of the interoperability 
interface of systems, as well as messages they might create. That's the 
opportunity here for us working on these standards.

13606 needs to be updated a priori, and has lessons from use waiting to 
be implemented; openEHR has lessons from the last 5 years of use which 
will lead to changes, so there is scope for change and harmonisation. I 
think the community here, and also the stakeholders are interested in 
practical proposals for a new set of standards that actually address needs.

- thomas
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