Clinical Modeling - A critical analysis

Ian McNicoll ian at
Fri Feb 20 09:50:57 EST 2015

Hi Birger,

I did read this paper some months ago and to be honest but as a
non-computer scientist found it quite difficult to understand. It
seems to be based on a comparison of a theoretical architectural
approach based on high-level ontologies but also contains some
puzzling assertions

e.g. "An archetype is a user-defined table in relational database
models, so intentionally or not-intentionally notifying the ICT-focus
of the Archetype approach." - which is almost universally incorrect
and may have misled the entire assessment.


"However, the archetype schemas used, refer to existing ontologies
like SNOMED CT [32] just as terminology. We should remember that
SNOMED CT itself has developed from a terminology and is still in
process of growing into a logically and ontologically coherent
ontology. The problem still is a strong conceptualist legacy. So, it
might be better to derive schemas from realism-based ontologies, e.g.,
from members or candidates of the OBO Foundry [13], most of which are
based on BFO."

when openEHR is completely terminology/ontology neutral and its own
'minimal ontology' Compostions, sections, Entries etc has no
relationship to SNOMED CT whatsoever.

The comparison with Hl7v3 seems to be to be completely spurious. HL7v3
constructs are directly analagous to those in openEHR and 13606

e.g "In contrast to the archetypes that are derived from a top down
approach, the clinical statement structure in HL7 v3 allows a top down
decomposition through the headers, sections, and core content. "

how does this clinical statement structure with headers, sections and
core content fundamentally differ from the openEHR/13606 approach?

Finally .. "Therefore, they are facing the problem that the
architectural representation and composition/decomposition of
real-world classes and instances cannot be provided appropriately.
Instead, the models are quite different from reality and themselves

This statement makes the assumption that clinical modelling is trying
to represent 'real-world' classes and instances, when we are actually
trying to represent the content found within clinical records, not
their 'real world' equivalents i.e the record of diagnosis of diabetes
, not diabetes itself. The reason that the models are inconsistent is
that we are reflecting the inconsistency found in clinical content
capture and understanding. If every clinican in the world agreed on
the content of an allergy record, or if the content could be derived
from a scientific/logical examination of the concept , then perhaps
ontology would have its place but ... in the real, messy inconsistent
world such differences have to be resolved by negotiation and messy.
emergent consensus not by the application of logics.

or perhaps I have just missed the authors' point altogether!


Dr Ian McNicoll
mobile +44 (0)775 209 7859
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Director, freshEHR Clinical Informatics
Director, openEHR Foundation
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL

On 20 February 2015 at 13:29, Birger Haarbrandt
<birger.haarbrandt at> wrote:
> Hi folks,
> recently found this article by Blobel and Goossen:
> Here are some quotes that I found interesting:
> "[openEHR Archteypes]  they are facing the problem that the architectural
> representation and composition/decomposition of real-world classes and
> instances cannot be provided appropriately"
> "Nonetheless, their [(openEHR and CIMI)] architectural basis is
> insufficient"
> "What is driving the development seems to be more competition and the
> defense of market shares than a sophisticated methodology"
> "The demonstrated substantial weaknesses caused by ignoring the rediscovered
> systems approach to the domains of discourse and the resulting needs for
> architecturally sound and ontology-driven modeling approaches are inherent
> in most of the health informatics standardization efforts intended to go
> beyond the traditional health information systems’ perspective toward a
> comprehensive reflection of the business domain"
> I would love to hear some thoughts about the statements and the paper.
> Best,
> --
> Birger Haarbrandt, M.Sc.
> Peter L. Reichertz Institut für Medizinische Informatik
> Technische Universität Braunschweig und
> Medizinische Hochschule Hannover
> Mühlenpfordtstraße 23
> D-38106 Braunschweig
> T +49 (0)531 391-2129
> F +49 (0)531 391-9502
> birger.haarbrandt at
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