Link between goals and other clinical concepts

Ian McNicoll ian at
Wed Jun 25 05:05:59 EDT 2014

Hi Bert,

As ever these are interesting discussions and the 'no semantics' in
the reference model approach has some attractions. I happen to agree
with Hugh that  it seems that one way or other, there are a set of
generic semantic constructs which need to be broadly and tightly
adhered to, and controlled at 'reference level' and whether this is
done by using reference archetypes or hard-wired in to the ref. model
is somewhat arbitrary. One of the advantages, for instance, of using a
'reference-level' observation date is that vendors can optimise their
systems, knowing that this will be universally available. Whether this
is an RM attribute or an element of a reference archetype does not
much differ in terms of commitment to stability of that data point.

There is actually very good alignment between Contsys and the openEHR
RM. There are a few places where there is some degree of mismatch and
where having a top-level extension to e.g COMPOSITION or INSTRUCTION
would allow for Contsys-specific attributes to be handled more easily,
but I think this can be simply achieved by adding a top-level CLUSTER
slot to COMPOSITION and ENTRY classes. That way we can bridge the gaps
between different source information models without compromising the
overall approach.

Having said all thta, I think the openEHR implementation and
real-world use has reached a level of practical use where these kind
of discussions are moot. It is going to be up to Industry and other
real-world users to tell us if they want the kind of root-and-branch'
reform that you are advocating. I think we all recognise that there
are gaps in the current RM and things that we can do better but I am
not hearing a major push from the implementer community for the kind
of radical change in approach that you are advocating. For most
people, my impression is that the existing RM is working pretty well.
Certainly not perfect, but I am not sure that the use of reference
archetypes necessarily solves these problem, it just moves them

I agree re messaging, but again I am not sure that this is a
significant issue for implementers (at least in your terms). openEHR
systems are talking to a variety of messaging formats. If someone
wanted to build a set of archetypes that mimiced CDISC or HISA or
whatever, that could be done using the generic archetype but no-one
has taken that approach so far to my knowledge because openEHR is not
trying to build CDISC or HISA EHR systems internally. It is
deliberately optimised for EHR use.

I am also concious that we have hi-jacked Pablo's original discussion.
Perhaps we should split this into two threads but I will leave that
for Pabl / Bert to resolve!


On 24 June 2014 22:22, Hugh Leslie <hugh.leslie at> wrote:
> 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
> Bert
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Dr Ian McNicoll
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Clinical modelling consultant freshEHR
Director openEHR Foundation
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care

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