openEHR-clinical Digest, Vol 35, Issue 4 pazospablo at
Thu Mar 12 00:32:47 EDT 2015


    I would agree with Thomas comments, and add that "Not having a complete picture" is a different way to say "openehr has a scope". No one can solve all the problems, and different groups are focusing in different problems, no one has a complete picture or a solution to all the problems on healthcare informatics and interoperability.
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------ Original message------From: Thomas BealeDate: Wed, Mar 11, 2015 11:51 AMTo: openehr-clinical at;Subject:Re: openEHR-clinical Digest, Vol 35, Issue 4    
      Hi William,
      there are quite a number of widely known facts and resources      ignored by the paper. See below.
      On 11/03/2015 13:16, WILLIAM R4C wrote:
                    Hi all,      
            As one of the author's of the criticized paper by Blobel et        al, I feel some need to react and give you some thoughts:      
            - OpenEHR after 20 or more years is still largely under        construction.        
    you're the only person I've ever heard say such a thing. As you can    see from this      page, available online for a decade, the Release 1.0.2 has    been stable since 2008. Hardly 'under construction' (although    specific things are of course always being worked on). The opposite    criticism (not enough recent releases) would make more sense.
           I have asked many times to get names and locations of        reference sites where I can see a real world archetypes based        system in action. No response.        
    Quite the contrary: see this      page, easily findable from the home page, also visible for a    decade in different forms. Also the well-known locations of various    national CKMs, containing archetypes used in these systems. (Australia, Slovenia, UK, Norway, Moscow CKM offline due    to trade war with Russia..., Brazil being moved as we speak.)
            - the approach with the archetypes is technology driven:        implementation specific, not clinically driven. It lacks the        basic conceptual, logical, implementation perspective of ISO        11179. In particular the logical modeling is what Blobel et all        discuss.        
    Quite the contrary - the archetype approach is completely clinically    driven, as everyone knows. Unlike every other effort I know of,    including HL7v3 and FHIR, openEHR archetypes are only built    by clinical people, in a separated space (CKM). Technical people    don't even come into it, unless they are also docs or health    informatics experts who have clinical / lab / other relevant    expertise. I'm not trying to criticise HL7 or FHIR here, merely    pointing out that openEHR clinical modelling is literally in a    dedicated clinical / health informatics space. 
    Getting more clinician input into FHIR's clinical models    and more technical input into openEHR's was one of the motivations    for the recent HL7+openEHR Adverse Reaction joint review (admittedly    well after the paper publication). 
    Why an academic paper would report the opposite is a mystery. As I    said to Jan Talmon, statements demonstrably contrary to reality    don't help the reputation of the journal at all.
    ISO 11179 is a meta-data and registry standard, it has no clinical    content. Whether it has value for standardising meta-data in    registries is another (implementation) matter, unrelated to the    design concepts of clinical modelling.
            - use and grounding the Modelling in formal ontologies is        lacking in any of the Modelling approaches: HL7 templates, HL7        FHIR, OpenEHR archetypes, 13606 archetypes, CEMLS, CIMI, DCM in        UML. The articles discussed that with respect to 3 examples. All        modelers have a job to do. For justification have a look at        semantic health net work.        
    That is more or less true. Semantic Health Net and also years of    IHTSDO activity shows just how difficult it is to get even the most    basic agreements on how to do this. Even BFO, which is a much needed    as an up upper level underpinning ontology has not yet been released    as BFO 2.0, which is sorely needed.
    I would say it is widely recognised that the ontology / model    relationship needs major attention.
            - the GCM model allows a much deeper analysis of domain,        modeling and implementation eg through domains on z axis,        business bottom up and top down on y axis, and Reference Model – Open            Distributed Processing (RM-ODP) system        development standard on x axis.        
    Well, speaking as an engineer and software engineer, I would beg to    differ. RM/ODP isn't a formal approach to domain analysis, it's a    system engineering meta-model - a way of formalising different    aspects (viewpoints) of systems. I have actually talked with people    involved in RM/ODP development at ISO (Kerry      Raymond being one such person, but also others) and they    agreed that RM/ODP is specifically weak in representing any domain     / semantic viewpoint (it weakly represents it via the 'enterprise'    viewpoint). I actually produced a health informatics-specific    version RM/ODP years ago that was presented at HL7. It was met with    mild interest, and subsequently never used again. Including by me.
    The GCM cube is one of those things that looks nice on paper, and    noone can say it's wrong, but it doesn't provide any useful    analytical output. It's not dissimilar from Zachman, FEAF and other    similar enterprise modelling grids. These are designed to help    systems engineers not forget specific aspects of system design. I    have been aware of the GCM cube since about 2003, and have never    found a use for it other than a general explanatory one in academic    papers. 
    If you are going to claim that GCM should be used to help clinical    domain modelling, you have to say how it is going to do this. The    paper doesn't do that.
          OpenEHR, like many others have not a complete picture.        
    well, that's true at least. We need to have some work to do    tomorrow...
            Of course you may critique a paper exposing this lack. But it        feels like shooting the messenger(s) instead of listening to the        message.      
            Guys, you've got work to do.
    We always have work to do. But apart from the ontology question it's    probably not where you think it is.
    Publishing academic papers that ignore well-known available evidence    and projects, and make numerous assertions unsupported by relevant    evidence doesn't help the common cause I'm afraid.
    - thomas
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