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

Heather Leslie heather.leslie at oceaninformatics.com
Mon Oct 8 02:55:29 EDT 2012

Hi everyone,

At the last two ISO meetings the revision of ISO 13606, under leadership of
Dipak Kalra, was discussed: 

.         All five parts of ISO 13606 are being revised simultaneously and
have passed NWIP ballot in the last couple of weeks.

.         At the recent Vancouver ISO meeting WG1 confirmed that the scope
of each of the five parts should not be changed for the purposes of this ISO
revision - it will remain for EHR communication only. However there are
plans to align ISO 13606 with other ISO standards and HL7 standards
including CDA, plus include learnings from other initiatives including
openEHR (especially for part 1) and CIMI (for part 2). 

.         Extension of 13606 to include data storage/repository requirements
has been discussed but if it proceeds will be managed as a separate piece of
work at some point in the future.

Next steps:

.         Confirm experts

.         Request Member bodies to launch information gathering exercise -
what national and regional eHealth programmes and vendors/vendor
associations are using 13606





From: openEHR-technical [mailto:openehr-technical-bounces at lists.openehr.org]
On Behalf Of Gerard Freriks
Sent: Friday, 5 October 2012 8:14 PM
To: For openEHR technical discussions
Cc: openehr-clinical at lists.openehr.org
Subject: Re: lessons from Intermountain Health, and starting work on openEHR


See below. 


On 4 Oct 2012, at 18:07, Thomas Beale wrote:

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

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


Whatever openEHR aspires to be, it is clear that the scope of 13606 is EHR
Communication in general.

It has been made clear that, in the renewal process of the 13606 EHR
Communication standard, EHR-system implementation specifics are out of

The scope of 13606 will not be extended to match the scope of openEHR.



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

Accessing data in repositories is definitely out of scope for 13606 in this
round of updating.

*	semantics that describe EHR information in an Extract from one
system to another - any kind of system

If openEHR is serious about its scope, to be a general receiver of health
data, then its Reference Model must become much more generic than it is now,

The 13606 Reference Model is very generic just to serve this important
requirement that it must be able to deal with all systems. 


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.


13606 based interfacing systems have proven to be capable of extracting data
from any feeder system, transform it into the 13606 format, and into any
other structured format.

And do this in matter of days.

We do not need openEHR to do that.


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.


All this is within the scope of 13606.

It is misleading to suggest that the scope of 13606 is just messaging. EHR
Extracts are about interoperability of data objects in general.


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.


I'm happy to announce that there is a wealth of implementation experience
not only in the world of openEHR.

There is a wealth of experiences in deploying the 13606 EHR communication
standard in hospitals, research, regions.

Sometimes in relation with HL7 CDA artefacts, sometimes to create
applications for data entry, sometime integrated with ontological


In the meantime I sincerely hope that harmonisation is possible without
making too many unneeded remarks about potential partners.


- thomas


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