# aus health it

**URL:** <https://discourse.openehr.org/t/aus-health-it/14607>\
**Category:** Clinical (archive)\
**Created:** [21 January 2007 23:42 UTC](https://discourse.openehr.org/t/aus-health-it/14607 "2007-01-21T23:42:36Z")\
**Posts on this page:** 20\
**Page:** 1

<div class="post-metadata">

**Author:** ![Andrew\_Patterson](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/a/76d3ee/32.png) [@Andrew\_Patterson](https://discourse.openehr.org/u/Andrew_Patterson)\
**Post date:** [21 January 2007 23:42 UTC](https://discourse.openehr.org/t/aus-health-it/14607/1 "2007-01-21T23:42:36Z")

</div>

Does anyone want to respond to this?

[http://aushealthit.blogspot.com/2007/01/archetypically-stupid.html](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

---

<div class="post-metadata">

**Author:** ![Tim\_Churches](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/t/839c29/32.png) [@Tim\_Churches](https://discourse.openehr.org/u/Tim_Churches)\
**Post date:** [22 January 2007 01:31 UTC](https://discourse.openehr.org/t/aus-health-it/14607/2 "2007-01-22T01:31:04Z")

</div>

Andrew Patterson wrote:

> Does anyone want to respond to this?
> 
> [http://aushealthit.blogspot.com/2007/01/archetypically-stupid.html](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

---

<div class="post-metadata">

**Author:** ![ognian.pishev](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/o/898d66/32.png) [@ognian.pishev](https://discourse.openehr.org/u/ognian.pishev)\
**Post date:** [22 January 2007 02:30 UTC](https://discourse.openehr.org/t/aus-health-it/14607/3 "2007-01-22T02:30:28Z")

</div>

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\>:

---

<div class="post-metadata">

**Author:** ![ognian.pishev](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/o/898d66/32.png) [@ognian.pishev](https://discourse.openehr.org/u/ognian.pishev)\
**Post date:** [22 January 2007 03:14 UTC](https://discourse.openehr.org/t/aus-health-it/14607/4 "2007-01-22T03:14:29Z")

</div>

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\>:

---

<div class="post-metadata">

**Author:** ![thomas.beale](https://discourse.openehr.org/user_avatar/discourse.openehr.org/thomas.beale/32/35_2.png) [@thomas.beale](https://discourse.openehr.org/u/thomas.beale)\
**Post date:** [22 January 2007 11:35 UTC](https://discourse.openehr.org/t/aus-health-it/14607/5 "2007-01-22T11:35:54Z")

</div>

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?  
> &nbsp;&nbsp;

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](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. ...  
> &nbsp;&nbsp;

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](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

---

<div class="post-metadata">

**Author:** ![Dipak\_Kalra](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/d/e8c25b/32.png) [@Dipak\_Kalra](https://discourse.openehr.org/u/Dipak_Kalra)\
**Post date:** [22 January 2007 12:07 UTC](https://discourse.openehr.org/t/aus-health-it/14607/6 "2007-01-22T12:07:15Z")

</div>

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](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

---

<div class="post-metadata">

**Author:** ![Tim\_Churches](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/t/839c29/32.png) [@Tim\_Churches](https://discourse.openehr.org/u/Tim_Churches)\
**Post date:** [22 January 2007 21:03 UTC](https://discourse.openehr.org/t/aus-health-it/14607/7 "2007-01-22T21:03:55Z")

</div>

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?  
> > &nbsp;&nbsp;
> 
> 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

---

<div class="post-metadata">

**Author:** ![thomas.beale](https://discourse.openehr.org/user_avatar/discourse.openehr.org/thomas.beale/32/35_2.png) [@thomas.beale](https://discourse.openehr.org/u/thomas.beale)\
**Post date:** [22 January 2007 22:18 UTC](https://discourse.openehr.org/t/aus-health-it/14607/8 "2007-01-22T22:18:03Z")

</div>

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  
> &nbsp;&nbsp;

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

---

<div class="post-metadata">

**Author:** ![Tim\_Churches](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/t/839c29/32.png) [@Tim\_Churches](https://discourse.openehr.org/u/Tim_Churches)\
**Post date:** [22 January 2007 22:46 UTC](https://discourse.openehr.org/t/aus-health-it/14607/9 "2007-01-22T22:46:18Z")

</div>

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  
> > &nbsp;&nbsp;
> 
> 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

---

<div class="post-metadata">

**Author:** ![pablo](https://discourse.openehr.org/user_avatar/discourse.openehr.org/pablo/32/3505_2.png) [@pablo](https://discourse.openehr.org/u/pablo)\
**Post date:** [22 January 2007 22:48 UTC](https://discourse.openehr.org/t/aus-health-it/14607/10 "2007-01-22T22:48:33Z")

</div>

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

---

<div class="post-metadata">

**Author:** ![Koray\_Atalag](https://discourse.openehr.org/user_avatar/discourse.openehr.org/koray_atalag/32/70_2.png) [@Koray\_Atalag](https://discourse.openehr.org/u/Koray_Atalag)\
**Post date:** [22 January 2007 23:00 UTC](https://discourse.openehr.org/t/aus-health-it/14607/11 "2007-01-22T23:00:40Z")

</div>

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.  
> &nbsp;&nbsp;  
> 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.

---

<div class="post-metadata">

**Author:** ![thomas.beale](https://discourse.openehr.org/user_avatar/discourse.openehr.org/thomas.beale/32/35_2.png) [@thomas.beale](https://discourse.openehr.org/u/thomas.beale)\
**Post date:** [23 January 2007 00:11 UTC](https://discourse.openehr.org/t/aus-health-it/14607/12 "2007-01-23T00:11:14Z")

</div>

Tim Churches wrote:

> ```auto
> Thomas Beale wrote:
> 
> ```
> 
> > ```auto
> > formance and volume in actual deployment this calendar year.
> > 
> > ```
> 
> ```auto
> 
> 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.

> ```auto
> 
> ```
> 
> > ```auto
> > (actually, I would like to see similar papers about similar / competing
> > systems ...)
> > 
> > ```
> 
> ```auto
> 
> 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.

> ```auto
> 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…

- thomas beale

---

<div class="post-metadata">

**Author:** ![ognian.pishev](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/o/898d66/32.png) [@ognian.pishev](https://discourse.openehr.org/u/ognian.pishev)\
**Post date:** [23 January 2007 01:03 UTC](https://discourse.openehr.org/t/aus-health-it/14607/13 "2007-01-23T01:03:54Z")

</div>

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\>:

---

<div class="post-metadata">

**Author:** ![Hugh\_Grady](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/h/6a8cbe/32.png) [@Hugh\_Grady](https://discourse.openehr.org/u/Hugh_Grady)\
**Post date:** [23 January 2007 01:34 UTC](https://discourse.openehr.org/t/aus-health-it/14607/14 "2007-01-23T01:34:54Z")

</div>

Or, as Google translator puts it, "With day and pots we will win"

Que?

Hugh Grady

---

<div class="post-metadata">

**Author:** ![ognian.pishev](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/o/898d66/32.png) [@ognian.pishev](https://discourse.openehr.org/u/ognian.pishev)\
**Post date:** [23 January 2007 01:54 UTC](https://discourse.openehr.org/t/aus-health-it/14607/15 "2007-01-23T01:54:13Z")

</div>

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\>:

---

<div class="post-metadata">

**Author:** ![David\_More](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/d/d07c76/32.png) [@David\_More](https://discourse.openehr.org/u/David_More)\
**Post date:** [23 January 2007 01:59 UTC](https://discourse.openehr.org/t/aus-health-it/14607/16 "2007-01-23T01:59:30Z")

</div>

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.

---

<div class="post-metadata">

**Author:** ![Tim\_Churches1](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/t/838e76/32.png) [@Tim\_Churches1](https://discourse.openehr.org/u/Tim_Churches1)\
**Post date:** [23 January 2007 03:44 UTC](https://discourse.openehr.org/t/aus-health-it/14607/17 "2007-01-23T03:44:49Z")

</div>

> 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

---

<div class="post-metadata">

**Author:** ![Tim\_Churches1](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/t/838e76/32.png) [@Tim\_Churches1](https://discourse.openehr.org/u/Tim_Churches1)\
**Post date:** [23 January 2007 04:02 UTC](https://discourse.openehr.org/t/aus-health-it/14607/18 "2007-01-23T04:02:06Z")

</div>

> 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

---

<div class="post-metadata">

**Author:** ![David\_More](https://discourse.openehr.org/letter_avatar_proxy/v4/letter/d/d07c76/32.png) [@David\_More](https://discourse.openehr.org/u/David_More)\
**Post date:** [23 January 2007 04:13 UTC](https://discourse.openehr.org/t/aus-health-it/14607/19 "2007-01-23T04:13:25Z")

</div>

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

---

<div class="post-metadata">

**Author:** ![system](https://discourse.openehr.org/uploads/default/original/2X/f/f0a1dedb20c42747bddcafd6c7df9db5f34f003c.svg) [@system](https://discourse.openehr.org/u/system)\
**Post date:** [23 January 2007 06:04 UTC](https://discourse.openehr.org/t/aus-health-it/14607/20 "2007-01-23T06:04:14Z")

</div>

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](mailto:gfrer@luna.nl)

Those who would give up essential Liberty, to purchase a little temporary  
Safety, deserve neither Liberty nor Safety. Benjamin Franklin 11 Nov 1755

[Next page](https://discourse.openehr.org/t/aus-health-it/14607.md?page=2)