Does anyone want to respond to this?
http://aushealthit.blogspot.com/2007/01/archetypically-stupid.html
David More seems to be going on a bit of a crusade at the moment,
firing shots at all current work in Australian e-health (NEHTA etc).
Some of it is deserved no doubt, but I think he is a bit confused
about exactly what the archetype approach is about.
Andrew
Andrew Patterson wrote:
Does anyone want to respond to this?
http://aushealthit.blogspot.com/2007/01/archetypically-stupid.html
David More seems to be going on a bit of a crusade at the moment,
firing shots at all current work in Australian e-health (NEHTA etc).
Some of it is deserved no doubt, but I think he is a bit confused
about exactly what the archetype approach is about.
I agree that David does not have some of the technical details about
openEHR archetypes quite right (note that the qualifier "openEHR" is
necessary as there are many other uses of the term "archetypes" out
there in information management land, some of which predate openEHR/GEHR
work and many which are more widely known), although the fact that a
smart person like David with plenty of time on his hands hasn't grasped
everything about archetypes underlines the fact that they are presented
in a rather complex and mystifying manner to someone encountering them
for the first time. Not sure how to make it less complex (a really good
professional technical writer might be able to help, but they cost a lot
to hire) - nevertheless, perceived complexity is the enemy of
widespread acceptance, I suspect.
However, I basically agree with David's main tenets that it is premature
to be pushing for finalised openEHR standards when there are so few
deployed examples of true openEHR systems in production (not research)
use out there, and when formal (or even informal) documented evaluations
of such systems (even of research systems) are so thin on the ground.
Pilot openEHR implementations funded by the Australian government may or
may not have been formally evaluated, but if they have, the reports have
not been published to my knowledge. A Medline/PubMed search for
independent peer-reviewed (i.e. not written by Ocean Informatics or UCL
staff) evaluations, even anecdotal mentions, of any aspect of openEHR
informations systems yields, well, exactly zero papers, when I last
looked a few months ago. Have I overlooked something?
I suppose what I am saying is that elsewhere in medicine and health
care, standards tend to be evidence-based i.e. before a new treatment
method or protocol is promulgated as a standard approach, there needs to
be a reasonable (not necessarily extensive) set of formal evaluations of
that method or technique using scientific methods (typically statistical
or epidemiological methods in clinical trials or observational studies
for clinical medicine, but that may not be appropriate for evaluation of
all aspects of information management systems or methods). That evidence
base seems to be lacking for openEHR archetypes. One could say that it
is also lacking for other health information management approaches and
techniques, and where these are the subject of final standards, I would
level exactly the same criticism at them.
I know that the openEHR/Ocean Informatics/UCL people, and perhaps some
other research groups, believe fervently in the adequacy and
practicality of the openEHR approach, but modern health care has just
about dispensed with fervent belief. Formal studies in peer-reviewed
journals are needed - and yes, those takes time - perhaps a large part
of a decade. But the openEHR project has been going form a decade or so
now, and the GEHR project for nearly a decade prior to that. What's a
few more years?
I also agree with David that openEHR archetypes will only be a solution
(as opposed to yet another complicated headache, like HL7 already is) if
an adequate national or global "intellectual ecosystem" can be
established for the definition, sharing and evolution of openEHR
archetype and template definitions. David comes from the "centralist
control freak" era - I'm an open source person and so am not quite so
worried about the ability to impose openEHR Stalinism. However, some
form of co-ordination and sharing mechanisms are needed, and these do
not happen by accident - they need to be carefully grown and nurtured
and even then they may not be sustainable. Certainly, the business model
for openEHR repositories is unclear, as it is not in the interest of the
large health system providers (including the likes of Microsoft and IBM)
to promote such things as true openEHR-mediated interoperability will
mean than vendor lock-in will be undermined. Governments should fund
such repositories, but will they? Also there are, to my mind, unresolved
and rather critical issue with teh way in which openEHR archetypes are
licensed. I have raised these concerns repeatedly with the openEHR
developers but am happy to share them on this list if anyone is
interested. perhaps I am needlessly concerned but I think not. Or have I
posted these concerns to this list already?
So, my view is: all power and godspeed to the openEHR project, but too
soon to be cementing openEHR stuff into final standards. Not too soon
for openEHR standards proposals, that will go through dozens of
revisions over the next decade, but definitely too soon to be pushing
through final standards for something which for the majority of health
professionals and health informatics people is largely unproven in a
documented fashion and/or through first-hand experience.
Tim C
The two-level modelling approach addresses a fundamental concern of information
system building: the separation of concerns between knowledge representation
(ontologies) and information processing. Archetypes are used to formally
represent knowledge structures in machine processable form as applied to
electronic health records.
CEN is not an openEHR standard and thus it is not "cementing" it into a
standard. What it does however is quite important: it defines an achievable
target that can be implemented on local, regional, international scale, etc.
with the support of the infrastructure and governance needed in all those
cases.
CEN standardisation, while taking into account company offerings is not
constrained to existing technology and can transcend proprietary limitations.
If industry-based efforts could produce a similar standard, they would have
done it a long time ago. But as it turns out, industry is not particularly good
at defining semantic interoperability.
openEHR is an evolving target that conforms to the well-known open/closed
principle of object-oriented programming: an architecture should be
sufficiently complete (closed) in order to produce working systems today but it
should also be open to future development. I am not sure CEN standards achieve
this level of flexibility but it is built into the fabric of openEHR which
produced the first complete set of implementable specifications about a year
ago. Then it received feedback from multiple projects that implement it in the
applications space. Thus at the end of this cycle, the openEHR specifications
will be a lot better. This iterative mechanism will continue working beyond
release 1.0.1 but with the added benefit of stability.
The beauty of archetypes is that they transfer the control over clinical
modelling to the clinician. No standard can decree in advance what real
practice needs. The distributed nature of clinical knowledge in society is
supported by an archetype infrastructure that will evolve over time and for
this to happen we don't need to know all the answers in advance.
In any business information system one needs to have the ability to write
business rules and constraints on the business objects that system is dealing
with. The archetype definition language is a formalism specifically design to
produce models of concepts that pertain to the clinical domain. How this
formalism will be used depends on the clinical practitioners.
Ogi Pishev
Ocean Informatics
P.S. I am puzzled as to when the author of the blog has discovered that the work
that has been going on for 7-8 years is "archetypically stupid!"
As usual in the case of such categorical statements one wants to find out what
the alternatives are and what that authors proposes as a working solution to
the issue of semantically interoperable shared record.
Quoting Tim Churches <tchur@optushome.com.au>:
Thanks, David,
It is funny but the title of your blog piece reminded me of Lenin. He loved
using arch, archi as a prefix.
I believe that archetypes and the two-level method are universally applicable
across industries. Their first implementation was actually at AMP back in 1999.
They work quite well but the larger the system, the harder the coordination
issues. I agree in general that it might be better to focus on simpler task.
However you can't solve problems at the level where they have been created.
Turning ontology business modelling into a primary concern is a major
accomplishment. We've got to get knowledge representation right, otherwise
we'll end up where Artificial Intelligence ended 20 years ago with the hyped
idea of "knowledge engineering without the engineer."
Ogi
Quoting David More <davidgm@optusnet.com.au>:
Tim Churches wrote:
I know that the openEHR/Ocean Informatics/UCL people, and perhaps some
other research groups, believe fervently in the adequacy and
practicality of the openEHR approach, but modern health care has just
about dispensed with fervent belief. Formal studies in peer-reviewed
journals are needed - and yes, those takes time - perhaps a large part
of a decade. But the openEHR project has been going form a decade or so
now, and the GEHR project for nearly a decade prior to that. What's a
few more years?
well, actually, openEHR was only created in 1999, so that's 8 years. As
for archetypes - while Sam and I conceived of the solution which is the
core of today's archetypes in 1997, it was not until about 2001 that we
managed to turn it into anything explainable or formal (this is the year
of my original web paper explaining it). So that's...5 years. And it is
as far as I know a new idea. I found afterwards Michael Kifer's F-logic
paper (due to being pointed in the right direction by Alberto Maldondo
and his team in Valencia polytechnic - far better researchers than I
will ever be). In this there is the barest outline of F-logic queries,
but if you know how to read it, it is the formal idea of the definition
part of an archetype. But no connection to terminologies....or multiple
natural languages. We built the current formalism based on our ideas
from 1997 and with all kinds of other people's thinking along the way
(see the revision history of the documents; CEN meeting minutes, work
done at UCL, DSTC etc), and particularly from a post Peter Elkin once
made on an HL7 list about what was needed: flexible integration with
languages and terminologies.
Today it does these things, as shown by the tools. So that is about 6
years' work. Papers and PhDs have been appearing so fast in the last 3
years that I have lost count, and I admit we must make a better effort
to get more references posted on openEHR's website. [paper authors
please help....]
But your really shouldn't accuse people of using 'fervant belief' when
they are using scientific methods. All of the progress made so far is
based on evidence and testing. That's why we have tools that work and
archetypes that actually do model what clinicians want. That's why
templates were easy to define and implement (specifications are close to
being publishable, but we are still looking at the evidence;-). And why
it was possible to actually build EHR repositories using them, e.g.
http://demo.oceanehr.com/EhrViewDemo (this is an online demonstration of
archetyped openEHR EHRs).
I also agree with David that openEHR archetypes will only be a solution
(as opposed to yet another complicated headache, like HL7 already is) if
an adequate national or global "intellectual ecosystem" can be
established for the definition, sharing and evolution of openEHR
archetype and template definitions. David comes from the "centralist
control freak" era - I'm an open source person and so am not quite so
worried about the ability to impose openEHR Stalinism. ...
there is no doubt that this is true. And it is also happening. But you
have to realise that not everything happens in public. Various e-health
authorities are working on this issue. The requirements in this area are
still being researched, with some initial technical solutions, such as
this ontology-driven repository:
http://www.archetypes.com.au/archetypefinder/archetypefinder .
But the main issue here is this: if agreeing on anything at all were
predicated not only on formalisms, tools, etc but also on having
government buy-in and requirements for large-scale governance of
archetypes, terminology and so on, we really will be waiting 10 years
before we can build the first blood pressure archetype. That's just not
practical. Electronics engineers did not wait for the Pentium or VLSI
technology before standardising resistor and capacitor values or
building the first transistor radio.
I don't believe the approach to governance will be greatly dependent on
the details of archetypes or other alternatives, so allowing it to be
dealt with independently seems reasonable.
With respect to David More's points, I am fine with sceptical commentary
and critique - it is necessary for progress. But, please, make sure the
criticism is based on facts, and offer some alternatives if you don't
like what you see. What is here is the best analysis of a growing group
of people who know the challenges of this area very well. I also don't
think that titles like "archetypically stupid" help your case to be
taken seriously.
- thomas beale
Dear All,
Rather than respond to this list, I felt it better to reply directly
to David's blog site, since this is where his readers will go to
follow the discussion. He has kindly now authorised it to be posted,
so you can go and read it if you wish!
http://aushealthit.blogspot.com/2007/01/archetypically-stupid.html
It may be helpful for us to nominate one location to continue this
thread of discussion, rather than this list and his blog site.
I should like also to point out that the breadth of work that
underpins where we are today on archetypes and what can can consider
as its evidence base is broader even than those items listed in Tom's
mail (and would be longer than any sensible e-mail to contain!).
With best wishes,
Dipak
Thomas Beale wrote:
Tim Churches wrote:
I know that the openEHR/Ocean Informatics/UCL people, and perhaps some
other research groups, believe fervently in the adequacy and
practicality of the openEHR approach, but modern health care has just
about dispensed with fervent belief. Formal studies in peer-reviewed
journals are needed - and yes, those takes time - perhaps a large part
of a decade. But the openEHR project has been going form a decade or so
now, and the GEHR project for nearly a decade prior to that. What's a
few more years?
well, actually, openEHR was only created in 1999, so that's 8 years.
OK, I stand corrected.
But your really shouldn't accuse people of using 'fervant belief' when
they are using scientific methods. All of the progress made so far is
based on evidence and testing.
Where can I read about that evidence and the results of that testing,
Thomas? That was my point. Perhaps I am looking in the wrong places? I
can find some papers, and lots of technical reports published by Ocean
Informatics and openEHR and a few others describing the underlying ideas
and implementation details of openEHR, but no documents which describe
how well it actually works in practice - any aspect of "how well it
works", from speed and capacity with large data volumes and many users,
to the adequacy of concept representation when using currently published
archetype definitions in the field, to the ability to seemlessly
exchange openEHR data between heterogenous openEHR clinical information
systems without information loss or degradation or misinterpretation.
I'd be very grateful if you could point out these papers and reports.
But only if they are publicly available. No-one is interested in
unpublished, unavailable reports. Yet-to-be published manuscripts, yes.
Research degree dissertations, if available in electronic form, yes.
Of course, I should do a fresh PubMed and Google Scholar search on
openEHR. I last did one about 10 or 11 months ago and could not find any
evaluations of how well openEHR works in practice, only descriptions of it.
Tim C
Tim Churches wrote:
Where can I read about that evidence and the results of that testing,
Thomas? That was my point. Perhaps I am looking in the wrong places? I
Tim,
you are asking for papers about systems that have been fully engineered,
deployed, and run long enough to gather statistics on. Given that the
effort started (in earnest) about 5 years ago, these clearly won't be
available just yet, although I expect to see independent validations of
performance and volume in actual deployment this calendar year.
(actually, I would like to see similar papers about similar / competing
systems ...)
- thomas
Thomas Beale wrote:
Tim Churches wrote:
Where can I read about that evidence and the results of that testing,
Thomas? That was my point. Perhaps I am looking in the wrong places? I
Tim,
you are asking for papers about systems that have been fully engineered,
deployed, and run long enough to gather statistics on. Given that the
effort started (in earnest) about 5 years ago, these clearly won't be
available just yet, although I expect to see independent validations of
performance and volume in actual deployment this calendar year.
OK, that's fair enough, and I wasn't intending any criticism of the pace
- these things do indeed take time. I was merely pointing out (or
rather agreeing with David More's point) that a push for finalised ISO
and other standards for openEHR implementations does seem a bit
premature in the absence of such documented real-world experience of
successful use.
Or am I just being overly pernickety?
(actually, I would like to see similar papers about similar / competing
systems ...)
Yes indeed. But two (or more) wrongs (or absences of evidence) don't
make a right. My view is that the practice of health informatics needs,
desperately, to become evidence-based, otherwise we will continue to see
hundreds of millions or billions of dollars being poured into the
deployment of health information systems based on what is in the sales
brochure, or based on tender responses, which tend to be just more
elaborate versions of the sales brochures.
No government would ever dream of subsidising the cost of a new
pharmaceutical unless there was good evidence that the drug offered
real-world benefits over existing drugs of the same type. (Actually they
would, but I am sure you get my point).
Tim C
Hi,
I think the results of testing openEHR for developing systems may come out
when those systems where finished or prototyped.
Where are developing a system based on openEHR java core implementation
(thanks Rong!) and a "restricted" openEHR reference model, and we have
learning and testing many aspects of openEHR over six months, and all work
fine, the idea, the reference model, the archetypes, the persistence system
based on their proposal, etc, etc. Yes, it works. I know that is not a
serious evaluation of the openEHR idea, but we dont have enough time to do
so, I think that today there is not much information about openEHR and not
formal studies (your point is correct), may be in a while, when there where
more systems o prototypes of systems finished (that use openEHR) will be
more time to create "Formal Papers" testing openEHR, so I think you have to
wait a bit 
Ragards,
Pablo Pazos
SICTI Project - NIB
Hi, I want to express a few thoughts here...I am doing Ph.D. study on
modeling of a medical domain (endoscopy) with openEHR and alternative
methods (such as UML, Protege, openSDE, HL7 and so on) and evaluation of
the methodology. I asked exactly the same question to leading openEHR
people: where in heavens I can find formal papers that I can cite and
put in my references list of my papers and use in academic work. Because
I needed them badly to convince my professors that I am doing something
sensible and acceptable. I had started my research in 2000, it is only
now that things got mature for me to finalize my work. In the beginning
phase (1-2 years) I discovered that even my advisor, not to mention
other faculty, did really not give good credit for my work just because
I could not show many references in reputable journals. After that
phase, after insisting on this topic and changing my advisor(!), they
became more neutral. And now after 6-7 years, they do not ask many
questions about other studies but look at the advance and impact of my
study.
So what's the catch? There is clearly a real "paradigm-shift" here in
design, development, deployment and most important maintenance of HISs.
So it is only natural that formal papers and academic work start
evaluating these.
I'd be very grateful if you could point out these papers and reports.
But only if they are publicly available. No-one is interested in
unpublished, unavailable reports. Yet-to-be published manuscripts, yes.
Research degree dissertations, if available in electronic form, yes.
I would also love to learn about other material; I guess a page exists
at openEHR website to put the docs and links which can be used.
I always think other examples in history like Watson & Crick's discovery
of DNA double helix, or Information Theory in 1968 which was published
in Bell Laboratories Record (which is not a classical "peer-reviewed"
journal), or Three Amigo's initial writings about OO methodologies and
UML...How many references were there in their original article? I guess
quite few. As far as I know, they did not start as some academic
exercise and then jumped into market and get commercialized...They
rooted from the very problem domain and done by very committed and
ambitious (and I guess smart) people after a long time of study. I
personally put openEHR into this class of research, it is a
"paradigm-shift" and should be treated as such.
Another point is that, probably I am not in a position to say so due to
my relatively short experience in academia, but I will say it 
I have
really seen many examples of directed research (i.e. by a pharmaceutical
or medical device maker) published in high impact journals. I am sure
many of you have realized the importance of knowing editor or having a
good network with key people in a domain to get your stuff published. So
reliability is still an issue here. Also discussion lists and other
sorts of electronic collaboration tools when controlled (and sometimes
moderated) provide more useful and timely information than classical
ways of disseminating knowledge and information. So I trust openEHR
lists and personal communications more than journal papers in most
situations. Of course these are my own thoughts...
Best regards,
Koray Atalag, M.D.
Tim Churches wrote:
Thomas Beale wrote:formance and volume in actual deployment this calendar year.OK, that's fair enough, and I wasn't intending any criticism of the pace - these things do indeed take time. I was merely pointing out (or rather agreeing with David More's point) that a push for finalised ISO and other standards for openEHR implementations does seem a bit premature in the absence of such documented real-world experience of successful use. Or am I just being overly pernickety?
to be honest I don’t know when is the right point for an ISO standard. All I can say is that it is the wrong point if no software had been done, no archetypes had been built, no clinicians had been involved and no data have been built with the archetypes etc…but all this has been achieved and demonstrated. Obviously more has to be achieved, but on the other hand this is a lot better than a lot of standards that have no implementations at all. And if it isn’t useful, it won’t get used - something better will come along and replace it.
(actually, I would like to see similar papers about similar / competing systems ...)Yes indeed. But two (or more) wrongs (or absences of evidence) don't make a right. My view is that the practice of health informatics needs, desperately, to become evidence-based, otherwise we will continue to see hundreds of millions or billions of dollars being poured into the deployment of health information systems based on what is in the sales brochure, or based on tender responses, which tend to be just more elaborate versions of the sales brochures.
well, I can’t disagree. We are working as fast as possible on such outcomes.
No government would ever dream of subsidising the cost of a new pharmaceutical unless there was good evidence that the drug offered real-world benefits over existing drugs of the same type. (Actually they would, but I am sure you get my point).
it is not so clear cut in my mind. On the road to “a new pharmaceutical” are all kinds of intermediate steps, often occurring in university labs, teaching hospitals and elsewhere. To have the level of teaching and basic research framework to allow someone to get close to making a new drug necessarily implies some level of social funding (unless we want a user-pays-for-every-little-thing kind of society); so while the drug itself should not be funded unless it is safe etc, the other 90% of the iceberg must have already been funded somehow to even have a society with organisations and people who could make such a drug…
The first question to ask ourselves is: Does openEHR have to be an ISO standard?
If yes, this entails all the procedural handicaps that we have been avoiding so
far. The current model allows us to tightly manage an evolving architecture.
Its acceptance is neither mandated nor enforced. If it doesn't work for David
More, W. Goossens, and others, they don't have to adopt openEHR (but then
they'll have to come up with a credible alternative). On the other hand, if it
offers competitive advantages to multiple vendors that are developing solutions
requiring scalability and semantic interoperability, it is up to them to define
the limits (or limitations) of its applicability.
Since openEHR is neither Microsoft nor the EU, it can only proceed through
consensus community building. Critical voices inside the community contribute
to the evolution of openEHR. Sweeping criticisms from without don't seem to
contribute much.
Every company needs to find the business model that works for it. In the case of
Ocean Informatics it seems that demand for its tools and components is rapidly
increasing and there exist a growing number of partners willing to pay for
developer licenses and also to commit sufficient in-house resources to testing
and deploying openEHR-based solutions.
Does it pay to have more articles and studies published? Probably it does. Is it
a good use of scarce resources to engage in a "my PowerPoint against your
PowerPoint" competition? I guess not. As general San Martin said "Con dias y
ollas venceremos."
Ogi Pishev
Ocean Informatics
Quoting Thomas Beale <Thomas.Beale@OceanInformatics.biz>:
Or, as Google translator puts it, "With day and pots we will win"
Que?
Hugh Grady
During the wars of independence of Latin America (1810-1817), General San Martin
laid siege on Lima, Peru. His lieutenants wanted to attack but he had a fifth
column (a nice mix of latter day metaphors with historic facts) in the city and
received information on the mood in the besieged city in pots with false
bottoms. Hence - "con dias..." - with every single day the mood was changing...
"y ollas" - more information received.
And finally after a while, the city opened its gates and capitulated without
fighting...
Ogi
Quoting Hugh Grady <hugh.grady@oceaninformatics.biz>:
Tom and All,
This is all starting to drift off my main topic.
My simple point was that deployment of archetypes had not been brought to the stage of development required to be incorporated into an ISO standard..and that is that.
I am still of the view that to do this is “stupid” - allowing a little journalistic licence to catch attention and have people read what it pretty dry stuff.
I will persist in my view you create Standards after something has established its utility, viability and applicability - not after!
I am also of the view that some of the smartest people working in the area are involved with all this and have a feeling they would make more impact attacking more tractable problems..but obviously it is their call.
If you have browsed my blog you will be aware I have been suggesting for a while that a focus on solving those problems we can get our heads around before addressing “life the universe and everything” is more likely to be a successful way forward. I am sure others will have a different view - that’s life! An example of my view is that I think semantic inter-operability is a much less important problem that getting systems which provide quality decision support into the hands of clinical users. Doing this would save more lives in the next decade in my view.
You can all disagree or agree, but given I am not able to post on the list this will be my last comment.
Cheers
David.
During the wars of independence of Latin America (1810-1817), General
San Martin
laid siege on Lima, Peru. His lieutenants wanted to attack but he had a
fifth
column (a nice mix of latter day metaphors with historic facts) in the
city and
received information on the mood in the besieged city in pots with false
bottoms. Hence - "con dias..." - with every single day the mood was
changing...
"y ollas" - more information received.
And finally after a while, the city opened its gates and capitulated
without fighting...
I think that pots of money might help openEHR succeed.
Tim C
I will persist in my view you create Standards after something has
established its utility, viability and applicability - not after!
I presume you meant "not before", in which case I agree completely, particularly for something like an ISO standard. Thomas and others on this list probably also agree with this position. The difference is over whether the utility, viability and applicability of openEHR has already been established. For Thomas and others, it seems that it has. For me, it hasn't adequately been established. Perhaps it is just a matter of time.
If you have browsed my blog you will be aware I have been suggesting for
a while that a
focus on solving those problems we can get our heads around before
addressing "life the
universe and everything" is more likely to be a successful way forward.
I am sure others
will have a different view - that's life! An example of my view is that
I think semantic
inter-operability is a much less important problem that getting systems
which provide
quality decision support into the hands of clinical users. Doing this
would save more
lives in the next decade in my view.
I'll have to disagree with this. I think it is good that Thomas and others are working on solving "life, the
universe and everything" (Douglas Adams, you are much missed), although as I have said, claims of success in such a large endeavour do, I feel, need to be backed by reasonably good levels of published evidence which can be verified and reproduced by others.
I also think that semantic precision and, related to that, semanic interoperabilty is a sine qua non for a generalised clinical decision support system infrastructure or ecosystem - otherwise we are doomed to forever creating one-off, specific decision support systems which only work with specific health information system installations. But whether openEHR is the answer, or a sufficient answer, to the problem of semantic interoperability remains to be demonstrated, from my perspective. It looks promising, but more experience with it in real-life and pilot situations on a wider range of clinical problems is needed, and that experience needs to be formally assessed and evaluated and reported if at all possible. Again, perhaps it is just a matter of time.
Tim C
Hi Tim,
Yes I meant before - not “not after” .
On the second point - I agree its good for people to be working on this stuff (but worry when it seems to become akin to religion and possibly as potentially divisive) - but I think more lives will be saved by e-health applications in my life time if the focus was more practical and clinical outcome focussed. (Its part of my walk before running view - but I do see your ecosystem point) That is why I got into this long ago - hoping it would be a point of leverage to make a difference. There is a idea I have yet to show to be valid! (Oh well)
Anyway I said I would shut up - so I better do so.
Cheers
David
The question raised is: can we trust it.
Some are of the opinion that when it is not published in a peer reviewed journal it can not be trusted.
Application of the rule that only published academic articles contain truths that can be trusted, is false.
It is the review process by a few selected people before publishing that provides some trust.
With EU R&D projects it must be clear that these consortia consists many times of nice collections of the best and the brightest that are in continuous interaction for three years.
With the standardisation process of CEN and ISO it is clear (in Europe) that many times people that are active in R&D as well take part in an very interactive process in the technical committees.
Results of which are discussed in the many member states is local committees.
OpenEHR is based on European and Australian R&D
CEN/tc251 EN13606 (and other standards) are based on sometimes 20 years of European R&D (plus demonstrators) and standardisation.
OpenEHR is an open source community that produced implementable specs and working software.
It is on the basis of these observations that I think that work by OpenEHR, CEN/tc251 and ISO/tc215 is much more peer reviewed than any article in a journal.
Therefor I have much more trust in the knowledge contained in documents from OpenEHR, CEN and ISO than articles in good (academic) journals.
Gerard Freriks
former convenor of CEN/tc251 wg1
– –
Gerard Freriks, MD
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands
T: +31 252544896
M: +31 620347088
E: gfrer@luna.nl
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