Clinical Modeling - A critical analysis

Diego Boscá yampeku at gmail.com
Sun Mar 1 15:38:50 EST 2015


I agree, a response paper seems the most logical approach.

2015-03-01 21:31 GMT+01:00 Koray Atalag <k.atalag at auckland.ac.nz>:
> I’m completely disappointed, but not surprised, that this paper was accepted
> as a scientific paper in the first place with such bold arguments.
>
> We have all seen him advocating on openEHR during quite a few EU FP6 project
> proposals – I certainly attended a few workshops together. At some point he
> must have been alienated or something?? At any rate I think it is our
> responsibility to publish a formal rebuttal and challenge this paper. That’s
> what science is about, isn’t it?
>
>
>
> Cheers,
>
>
>
> -koray
>
>
>
> From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org]
> On Behalf Of "Gerard Freriks (privé)"
> Sent: Sunday, 22 February 2015 3:15 a.m.
> To: For openEHR clinical discussions
> Subject: Re: Clinical Modeling - A critical analysis
>
>
>
>
>
> On 20 feb. 2015, at 15:50, Ian McNicoll <ian at freshehr.com> wrote:
>
>
>
> 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
>
>
>
> Ian, I noticed before, in other publications by Bernt Blobel, serious
> misconceptions about his understanding of Archetypes.
>
>
>
>
> 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.
>
>
>
> An archetype is much more than a view on a data base.
>
> - an expression of data needs of a system
>
> - the Information Viewpoint in an Interface between EHR-system Services (of
> which the database is one)
>
> - a set of constraints on a Reference Model
>
>
>
> I agree that without the proper definition of the concept Archetypes the
> assessment is void.
>
>
>
>
> and
>
> "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.”
>
>
>
> What the hell are Archetype Schema’s. Schema’s of Archetypes? I fear they
> are not.
>
>
>
> What the authors write is questionable.
>
> EHR’s, Patient records are NEVER about the reality in the Patient System.
>
> They are about what one author wishes to document.
>
> It is what the author is thinking and documents.
>
>
>
> Archetypes and the RM they constrain are about documenting and archiving
> statements.
>
>
>
> I reserve reality for Ontologies to take care of.
>
> Ontologies with an Open World Assumption, using expressions that define
> logical relationships.
>
> Ontological systems because they are based on logical expressions can make
> inferences and generate new rules.
>
>
>
> Archetypes and the Reference Model take care of what gets documented.
>
> This world is based on the Closed World Assumption.
>
> In Closed World Systems what is not defined, never will exist.
>
> It will never exist despite what really is going on in reality.
>
>
>
> Stating that it is better to derive schema’s from Ontologies is perhaps
> wrong and impossible when using first order logics and Ontological Methods
> like Owl.
>
>
>
>
> when openEHR is com defined never can exist.pletely 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
>
>
>
> Both allow the definition of clinical and non-clinical statements as part of
> an organising documentation structure
>
>
>
>
> 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?
>
>
>
> I agree.
>
>
>
> What do they consider top-down?
>
> And what bottom up?
>
>
>
>
>
>
> 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
> inconsistent."
>
> 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.
>
>
>
> Wrong, unproven, assumptions by the authors about what Archetypes are, make
> any discussion void.
>
> If the conclusion by Ian is true, it worries me that one or more reviewers
> have not noticed this essential issue.
>
>
>
> I’m convinced that terms from a terminology (that is built using ontological
> methods) is -together with complete EHR standards like EN13606) can create
> Statements that are semantically interoperable.
>
> When it is enough for human understanding to resort to syntax, to standard
> phrases, and worlds from a dictionary plus an encyclopedia, I think that
> these same is enough for semantical interoperability in and between
> EHR-systems.
>
>
>
> HL7 v3 and EN13606 are about documenting statements by authors ABOUT what
> they see and think reality could be.
>
>
>
>
> or perhaps I have just missed the authors' point altogether!
>
> Ian
>
>
>
>
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical at lists.openehr.org
> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org




More information about the openEHR-clinical mailing list