There are many things that can be improved in openEHR, no doubt about it. Some comments. First of all, HL7 charges membership fees, meeting attendance fees and purchase fees for the standards; a small company can easily spend $10,000 - $20,000 per annum just on the cash outlay. Larger companies routinely spend $100k per annum when you take into account meeting attendance expenses and opportunity costs. These fees, plus donations by some large companies, fund HL7 marketing efforts. Such an operation does not come for free.
If we are to have regional communities, an affiliate model of some kind makes sense. However there is no getting away from some prerequisites:
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someone has to pay for the human resource at both local and central levels; 100% volunteer work is just too unreliable
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there has to be a way to get all the affiliates established in the first place, which really means creating an association in each country that subscribes to the same common cause - i.e. getting a lot of countries to agree on a common thing. History tells us this is VERY HARD.
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the ‘common cause’ almost certainly has to have some official standards status, or regional affiliates might get lots of interested individuals, but will fail to get MoH/DoH involvement, and hence fail to influence national programmes, and and probably also vendors
In sum: the organisation needs a distributed organisational governance structure, and it needs sufficient legitimacy for funding to be provided.
Now, the world currently already includes ISO, CEN, HL7, IHE, IHTSDO, OMG, and dozens of other standards bodies, which have a) some governance structure and b) sufficient perceived legitimacy to get some funding. However, there is great fatigue on the user side: most of these organisations compete, don’t cooperate properly, don’t formally or empirically validate their deliverables, and are not strongly driven by their main stakeholders. For this reason, openEHR has stayed away from creating yet another organisation, overlaid on this crowded scene.
In e-health, the exception to the above is IHTSDO, a relative newcomer to the scene, and while not perfect, it is significantly better in all of these areas. It has:
- a pretty good governance model, including an explicit member country and affiliate model
- direct board membership by key stakeholders of its deliverable, i.e. national e-health programmes
- formally defined and relatively well managed specification, software, and terminology deliverables (none of which are anything like perfect today, but the point is that a reasonable process is in place)
For this reason, the openEHR Foundation and IHTSDO have been in talks to determine what kind of cooperation could occur in the future, which would a) allow openEHR to work within or alongside the IHTSDO global organisational structure and b) enable IHTSDO to take better advantage of the openEHR knowledge engineering technology, in particular terminology integration.
These discussions have not yet completed, but some kind of announcement could be expected in the near future. If some better organisational and funding structure can be created, aligned with an accepted standards body, then I think the whole thing will accelerate very fast.
- thomas beale
This is interesting and very conquering I think and may have some implications for openEHR in future. I personally don’t think the current clinical information representation using v3 RIM methodology will survive for long and this space looks like to be filled pretty good with SNOMED+Archetypes. Perhaps because of this I am clearly witnessing more and more ignorance and even non-promotion of SNOMED / IHTSDO in HL7 rounds 