Link between goals and other clinical concepts

Hugh Leslie hugh.leslie at
Tue Jun 24 17:22:45 EDT 2014

Hi Bert,

I assume you are talking about those types of semantics that are currently in the openEHR reference model like observation and instruction.

This argument has been around for a while.  My issue with this is that if you start to control some way of modelling generic archetypes for these types  of semantic structures, then you are in exactly the same space as doing it in the reference model but without the same level of governance or control.  CIMI have also suggested this approach.  This is likely to be more difficult for developers as there is a much higher likelihood of multiple types of instructions/actions/observations that will need to be dealt with rather than one reference model based way of doing it.

I actually would contend that these structures are not domain specific, although they may have domain specific names.  We want the reference model to tell us how to construct compositions and entries as well as a consistent way of defining tables or tree structures so that software can be written once to handle all possibilities.  These openEHR constructs that seem to cause such controversy, just make explicit things that are going to be modelled over and over in the same way as these other things.  If we don't put these things in the reference model, then we will have to accept that there will be an increased variability in the way that they are modelled which is likely to make software more complex.

Its an argument/discussion that we will continue to have I suspect.

Regards Hugh

. -----Original Message-----
From: openEHR-clinical [mailto:openehr-clinical-bounces at] On Behalf Of Bert Verhees
Sent: Tuesday, 24 June 2014 6:25 PM
To: openehr-clinical at
Subject: Re: Link between goals and other clinical concepts

On 24-06-14 02:28, pablo pazos wrote:
> creating CLUSTERs for all the stuff than .....

I missed a part of the discussion, but maybe I get the point, or I see my hobbyhorse everywhere.  ;-)

I have been thinking about this some time, and I started a few times a discussion about this subject. But I must say, there is not much enthusiasm for this idea on this list.
Let me explain compactly.

Take a look at the EN13606 RM which is already much more generic then OpenEHR. You can model archetypes for it with the LinkEHR archetype-editor.

For a developer, it is nice to have a generic reference model, it can help you create generic code in the application/kernel.
For a domain-modeler (a medical-information-specialist, f.e.) it is nice to have semantics in the reference model. It helps thinking about how to model an archetype for a specific purpose.

There is a way in between, which can serve both groups:
You need to bring order in the chaos of generic CLUSTER_archetypes. You can do a lot with archetype-slots with defined reg-expressions, so in this way, the generic archetypebase canconsolidate in an information-model which can be used by the domain-modeler.
This information-model needs to be defined, controlled and documented.

Then you reach the area of proprietary.
Domain-modelers need besides adapting the reference model, conforming to your defined proprietary information model.

And, on second thought, anyway, you need to adapt a good message-model, because not the whole world will run OpenEHR.

The nice thing about two level modeling is that, this is all possible.

good luck

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