# Chair of openEHR Clinical Review Board (CRB) announced **Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153) **Created:** 2008-08-24 21:04 UTC **Views:** 4 **Replies:** 31 **URL:** https://discourse.openehr.org/t/chair-of-openehr-clinical-review-board-crb-announced/14884 --- ## Post #1 by @thomas.beale \[this is a repost of an announcement made a week ago, for those on the clinical list but not on the announce list\] from Prof David Ingram, CHIME department, University College London: I am delighted to announce that Dr Tony Shannon has accepted an invitation, on behalf of the openEHR Foundation Board, to take over the chair of the Clinical Review Board\. Tony has long experience and interest in clinical information management, as Clinical Lead for the Clinical Content Service of NHS Connecting for Health and as Consultant in Emergency Medicine at Leeds Teaching Hospitals\. My UCL colleague, Dr Dipak Kalra, has been the founding chair of the CRB but felt it the right time to step down and make way for a new appointment, recognising, as we all do, that openEHR governance needs to spread beyond the founding members at UCL and Ocean Informatics\. Dipak, Sam Heard and I remain as the active directors of the Foundation, but this, too, may well change quickly, in the period ahead, as we work to broaden the governance of the Foundation\. Ideally, we feel that the Foundation needs to remain agile and inclusive in its work, while consolidating its relationships and accountability to users and international stakeholder organisations, keen to capitalise on its work\. In this transition, we must try to avoid exchanging a crucible of innovation for a tanker full of treacle\. Tony Shannon has an honorary appointment as senior research fellow at UCL and has been active clinically in building wider awareness of and engagement with the mission of openEHR, for several years\. Along with Tim Cook, a member of the ARB, he has joined Sam, Dipak, Tom Beale and me in crucial new discussions about how to take the Foundation into its next stage of development and governance, as its work grows rapidly in international focus and importance\. We have received a number of approaches for new partnerships and we will be taking these very seriously and opening discussions more widely within the international community, including at a session of the WoHIT conference in November, under the auspices of our collaborating partners in EuroRec\. openEHR exists to champion the clinical ownership of the fundamental requirements for effective and useful electronic health records and to support the discipline, engagement and trust required to help them succeed\. Central to its approach is shared and collaborative research, development and iterative evaluation, though real world implementations\. --- ## Post #2 by @tonyshannon Dear All, I am very honoured to be invited to take up this important role as Chair of the Clinical Review Board within the openEHR Foundation\. Please allow me to introduce myself and my interest in openEHRs mission\. I would welcome your feedback and views as I explain below\. --- ## Post #3 by @Mary_Sharp Congratulations Tony, Like you I am a silent member of the mailing list must be an "Irish" thing\. Good luck with the post\. Mary Sharp --- ## Post #4 by @Stefan_Sauermann Hello Tony\! Congratulations to you for your new role as chair, and we wish you lots of success\! Hope to meet you in person somtime soon\! Right on into it, you wrote: "Can I ask you \(wherever you are and whatever your clinical challenges are\) what are the \*top 5\* things you would like to see the openEHR foundation tackle to move us all in the right direction over the next year/18months and better support your own challenges as a clinician? That might be better communication, better means to get involved, better tools etc etc\.\.\.whatever you happen to think\.\." Now, here comes: Myself, I am an academic person, electronics engineer, with 15 years of research experience in a university hospital, doing biosignal analysis, and software development for experimental research in medicine\. I moved into teaching and standards, and I am now the head of the national mirror to CEN and ISO TCs for medical informatics, and a founding member of IHE Austria\. We had a lot of contact to 13606, hoping that it would evolve into something that would solve the problem of reuseability of medical information models\. Over the last year and a half I have been responsible for coordinating work on medical documents in Austria, together with others\. This is still going on, as a part of the Austrian national EHR project ELGA\. We have put together groups of high ranking medical experts, most of them clinicians, all in all about 80\-100 of them, and started the discussion about the contents of medical documents: discharge summaries, laboratory reports, radiology reports, and medication status\. The national austrian eHealth strategy recommends to use CDA as an electronic format for this exercise\. This has been confirmed by politics, and we therefore were obliged to follow that route\. We did some reviews before we started, and it was decided to use the results of the German CDA work within VHITG as a basis\. In the middle of the work, we discovered the IHE laboratory technical framework, which contains a very useful laboratory report, see http://www.ihe.net/Technical_Framework/upload/ihe_lab_TF_rel2_1-Vol-3_FT_200 8\-08\-08\.pdf This is also used in national projects in the USA, the Netherlands, and France\. We are now in the middle of the discussion, and, \(provided we can continue, we do have national elections in September\), hope to reach some stability by end of 2008\. We are going to keep very close to the mentioned IHE lab report\. International standards are among the major goals of the Austrian EHR project\. And this is where real trouble begins\. People do approach us "experts", asking: Which standard is the right one for capturing medical content\. At the moment many in Austria believe that this is HL7 CDA\. However, 13606 is a formal international and Austrian standard, and everybody asks us how the situation is going to look like in 5 years\. Will it still be CDA, or archetypes, or full 13606, or a combination? What is the direction? What path shall we follow? Where shall we invest our money? Even if it is not finished right now: Is there at least a clear development path which will produce useful results soon? Is the cooperation between CEN, ISO, HL7, openEHR etc\. really producing a change, and will it root out the conflicting standards jungle? Even being the formally topmost medical informatics standards person in Austria, and having attended international meetings for years now I must tell them that I do not know\. This is a very unpleasant experience, and I would very much like to see some movement here\. In order to get something on the way here, I think we need to combine some major forces, and finally show that we can successfully tackle some real world problems on a multi\-national scale\. \- The IHE lab report group does collect clinical input from different countries, and it has carried the document through many iterations, and produced a final release in August 2008\. After that much effort, it can well be expected to be of clinical use, and is definitely worth consideration\. We do see a lot of vendor interest here, and things are being implemented, tested, and put to practical use\. \- openEHR is the home of archetypes, a very relevant technology, and also has a lot of international clinical input and expertise, and the tailwind of 13606 being a formal international standard\. \(\- HL7 is the home of CDA, and therefore connected deeply\) Would it be possible to connect these two \(or all three?\) groups, generate archetypes from the IHE lab report, and show how this agreed clinical content can usefully be documented and reused with the archetype technology? About people: I put Francois Macary in cc here, he is coordinating the IHE lab report work, and also responsible from a national view in France\. Francois, we did talk about these things recently on the phone\. I also cc to Andries Hamster, who is coordinting the lab report work from the Netherlands side, and Harry Rhodes, who is active in HITSP in the USA\. Alexander Mense and Stafan Sabutsch are part of the CDA work in Austria, representing HL7 Austria\. Frank Oemig is very active in HL7, in Germany and internationally\. Wolfgang Dorda and his group at Medical University of Vienna are deep into 13606 for many years, and seem to me one of the few who really understand\. Bernd Blobel keeps telling me that above 13606, CDA and the rest we do need a lot more specifications on how to build and connect and check things formally and mathematically\. Over the years I slowly tend to believe him there\. We might realise exactly what he means once we realise that a few things really do not fit together\. I can see him jumping in happily then, saying: "I kept telling you that since 1981, and here is the solution"\. May we be able to gracefully realise, learn, adapt and use it when the time comes\. Sure a lot are missing here\. Going through this will not be a smooth ride, and we will have to prove many novel ideas in practice\. The hope is that in the end we will be able to show clinicians and vendors exactly what CDA is for, and where it obviously is more efficient to use archetypes\. We do have the Istanbul ISO / CEN meeting in October, and it would make me very happy to see at least some starategic / formal light on the horizon by then\. Comments are very welcome, should you find the time, and I would be very happy to discuss this further with whoever is interested\. Well, this is it from Vienna for the moment\. Again, all the best for your chairmanship, I am sure this is an interesting experience, and I am happy to be at least a small part of it\. Greetings from Austria, and see you soon, Stefan Sauermann Acting Program Director Biomedical Engineering Sciences \(Master\) University of Applied Sciences Technikum Wien Hoechstaedtplatz 5, 1200 Vienna, Austria Tel: \+\+43\-\(0\)1\- 333 40 77 \- 988 sauermann@technikum\-wien\.at http://www.technikum-wien.at --- ## Post #5 by @thomas.beale Hi Stefan, I would suggest that in this eternal quest to 'merge standards' (I have been hearing about it for 10 years now), we need understand that standards are not all the same. To understand the differences we need a small standards typology. The following is a rough classification. - A - standards for **concrete purpose-specific schemas, messages** etc, such as for particular kinds of re-imbursement, order, lab result etc; These schemas only have one use (although it might be quite wide) and are almost always hand-crafted - Characteristics: - Modelling - every message schema has to be hand built;- generally limited re-use of elements between messages;- no reuse at all across implementation technologies, there is no way to use a message definition to generate GUI elements, service interface or other expressions;- Interoperability - functional interoperability is achieved (within the limits of local variations of message implementations)- semantic interoperability is possible depending on how tightly controlled the definitions and use of coding are - systems suffer from semantic incoherence from GUI to persistence layers, because their messages are developed and implemented separately from their GUI capture and display, persistence, and service interfaces - very limited support for querying - Clinician engagement: - usually difficult for clinicians to engage with in order to define content for each new message => messages only approximate requirements- Economics - inflexible; changed requirements => new message definitions- relatively low cost of use for a given message, since message structure fully mapped out - implemeters only have to generate prescribed content; no theoretical understanding required - scalable to some point but with a linear increasing cost and often NxN complexity characteristics - costs of system building borne separately - Examples - EDIFACT - HL7v2 messages - HL7v3 messages (slightly more generic message production approach, but vastly higher development cost per message compared to HL7v2) - ASTM CCR message (one size fits all approach) - B - standards for **concrete generic schemas**, which can carry a wide variety of content: - Characteristics: - Modelling: - only a single schema required; much cheaper to implement at a basic level - however no controls on what how content is expressed in the structures defined by the schemas; two implementers are most likely to develop two different configurations to express 'vital signs observations'- Interoperability: - functional interoperability guaranteed (single shared data schema)- semantic interoperability likely to be poor / chaotic / unmanaged - basic querying supported but only useful if content structures standardised - Clinician engagement - no direct way for clinicians to engage; clinical modelling usually done (badly) by software developers- Economics: - relatively cheap in limited local contexts - not scalable - some software re-use within systems - Examples - EN13606-1 XSD on its own - HL7 CDAr2 XSD on its own (more or less, although it is only partly generic at the Entry level) - openEHR Reference Model expressed as an XSD or other similar format on its own - C - standards that define **concrete generic schemas**, plus a **formal way of defining content** that can be used with these schemas that has the effect of controlling instances of these schemas (i.e. actual documents, XML): - Characteristics - as above: - Interoperability - + semantic querying supported - Clinician engagement: - + clinicians can directly engage and build content models for use with schemas - + modelling governance framework required - + separate modelling still required for many aspects of systems, particularly GUI and service interfaces - Economics - higher costs of centralised / regional planning & governance - lower incremental costs (i.e. cost of deal with each new requirement) - higher implementation cost per site; some level of theoretical understanding required - reduced cost of systems due to some software re-use - highly scalable with a cost characteristic probably of a NlogN shape - possibility of concrete gains in preventative and personalised health due to ability to do true semantic querying through and across EHRs - Examples: - EN13606-1 + EN13606-2; caveat: EN13606-1 doesn't provide a direct basis for many useful clinical archetypes; no templates - HL7 CDAr2 + HL7 templates (schema specialisations of CDA main schema; limited reuse)- openEHR RM XSD + archetypes + templates - D - standards that define a framework for defining **reusable formal clinical content models**, that can be used with **abstract** generic schemas to be able to *generate* various concrete generic schemas (message defs, XSDs, Xforms, java code, DB schemas), and to *generate* concrete purpose-specific concrete schemas. - Characteristics as above: - Clinician engagement: - + getting towards single-source modelling - clinicians can model once and have their semantics appear everywhere. - Economics - + lower implementation cost per site - same as for using hand-built messages - + significantly reduced costs of system due to pervasive re-use of generated artefacts- Examples: - openEHR abstract RM + archetypes + templates; openEHR abstract RM ==> generate ==> multiple concrete expressions, including various XSD, database schema, Java code, C# code, and many more; openEHR operational template (incorporating archetypes & reference model elements) ==> generate ==> Template Data Schema (TDS) e.g. for messaging, display. The last kind is what we have been working on in openEHR - it is getting toward the goal of fully semantically informed systems and interoperability engineered within the one framework. Clearly in the above you cannot just compare openEHR with CDA with HL7v2, with whatever else. The overall framework in each case brings significantly different advantages and cost characteristics. Until recently, openEHR was not the cheapest to engage with if you are a single implementer site or company; this has changed due to the TDS; previously message-oriented standards were cheaper to engage with from a single site point of view. However if you are a region or a country, then the cost advantages of a better framework may make a qualitative difference on national health budgets. I think that if health authorities and governments don't realise the qualitative differences, they will not succeed in creating a sustainable e-health framework (i..e they will simply succeed in creating the only kind that we know of to date, which is one that has to be recreated every few years). I did not include IHE above, because it is really a 'standard' for a transport system for other content developed by whatever means. But: consider how useful it would have been to have the IHE lab report definition generated from trly reusable content models of lab reports, that could also be used for other purposes. I am not saying that the various kinds of standards can't be made to work together - they possibly can (some are easy - e.g. openEHR / 13606); the above typology helps show how they could be integrate and what the costs are likely to be (and therefore what integrations make sense). - thomas beale Stefan Sauermann wrote: --- ## Post #6 by @Stef_Verlinden1 Hi Thomas, Thanks for this excellent overview, it's very helpfull. One short question? How could I explain 'semantic querying' to a non-technical person Cheers, Stef --- ## Post #7 by @thomas.beale Stef Verlinden wrote: > Hi Thomas, > > Thanks for this excellent overview, it's very helpfull. > > One short question? How could I explain 'semantic querying' to a non-technical person > > Cheers, > > Stef Hi Stef, I missed out 'semantic interoperability' in the last categories, which is of course what underpins semantic querying. Semantic querying is not a completely simple concept in my mind. I would explain it as being able to query the data such that the answer of any query: - is independent of the data capture form or grouping of data - may include data from different sources and provider enterprises (i.e. can be based on merged data, or even done as a distributed query) - correctly takes account of real-world context (particularly time) - correctly takes account of data status (actual=N v target=N v mean=N etc; or actual X v risk of X v no risk of X etc) - correctly matches concepts (i.e. identified categories of things, e.g. serum sodium, hypertension, viral infection, ....) - can therefore be safely used as a basis for inferencing, i.e. queries on data about an individual or group can be processed against an ontology like Snomed (when the latter is safe to use;-) As a side-effect of all these, semantic queries should be completely independent of the concrete database schemata which may be used to persist health information; they should therefore be 'portable'. This concept of 'semantic query' can't really exist without the data either being represented using semantically strong models and formalisms, or existing data having been re-processed into such a form. The latter is achievable in most cases, and we use openEHR templates to perform the conversion. To try and summarise in a sound-bite, maybe we could define a semantic query as one that works correctly regardless of the origin, capture method, or persistence details of the data. - thomas --- ## Post #8 by @Stef_Verlinden1 Dear Tony, Congratulations and thanks for taking up this role\. You asked "what are the \*top 5\* things you would like to see the openEHR foundation tackle to move us all in the right direction over the next year/18months and better support your own challenges as a clinician?"\. Here's my list: \- an 'top level' archetype repository hosted and mainained by an independent organisation which can assure the quality and 'beschikbaarheid' \- per country a local organisation to review, adapt if necessary and maintain the local archetypes \- a good course specifically for clinicians how to create archetypes and templates en user groups where experiences can be shared\. \- a clear\(er\) structure how and where requests functional requirements for archetypes can be addressed and by whom\. Please don't take this personally but from a distance it seems that all the request come from the NHS right now and there's not much room for 'others'\. In itself it is great that the NHS puts so much effort and trust in openEHR, but one should try to avoid the picture that openEHR=NHS\. On my personal 'wish list' are still: 1\) a manner to establish if an measurement if performed according a certain protocol and if yes, which and did the measurement comly to this protocol/ standard\. 2\) a manner to 're\-use' devices information, so that I don't have to fill out all the device details every time one performes a measurement \(also see my mails sended to the clinical list regarding this topic a while ago\) \- administrative archetypes: how can I bill hours on a certain action? \- tools to create templates including GUI's \- tools to create/add bussines rules Cheers, Stef --- ## Post #9 by @system Hi Stefan It is a big step forward having someone like Tony Shannon with his wealth of experience leading the clinical developments in openEHR. I am delighted that he has agreed to this role. In answering Stefan, as a clinician, I see the world very differently. I see the first need for standardisation being the **clinical content** that we want to share - this can be laboratory results, orders, blood gases, differential diagnoses, problem lists, medication lists, weight etc etc. If we are to have interoperability we have to be able to do this in a straight forward manner where clinicians can really agree to the outputs and technicians can work with these. It also ensures that data specifications are relevant at the point of care and can meet the reporting requirements and support distributed work flow. It is a form of collaborative configuration of eHealth - and as such can save massive amounts of money. The next thing to standardise are the **terminologies** to support each content specification - not a terminology for everything, rather one that actually supports what we want to share. This task is orders of magnitude more simple if you start with the content specifications. This ensures we assist the capture of key data (not everything) in a way that supports complex inferencing and improves the prospect of reuse of decision support. After this, it is essential to be able to **query clinical data** based on the specifications - this requires a standard expression of what is data is requested in terms of the clinical content and the terminology. This means, regardless of implementation, the data can be accessed for reporting, decision support and distributed health care. Finally, it would be good to standardise the **integration** and **outputs** from the clinical data environment. Again millions are spent around the world working with different messages and formats and standardisation of content, terminology and query allows One step on from this is a standard EHR specification, such as openEHR, which provides all of the above. It does encroach on current approaches and bring capabilities that are not presently available. But if we are proposing a way forward, it must provide a superset of capability and ideally add substantial new prospects. If you take this view then the actual technology that transmits things down the wire becomes rather more flexible. Within the *open*EHR environment we can now populate health records in a variety of ways - using IHE, direct web services, HL7 v2 messages, CDA etc - as long as we know what is being sent and that it conforms to the clinical models specified using archetypes. I believe that Austria, like all the other countries trying to make this a success, will find that such an approach is quite complementary to the technical approaches. It also ensures that the outputs are suitable for future use in an increasingly aligned environment. Cheers, Sam Stefan Sauermann wrote: [details="(attachments)"] ![OceanInformaticsl.JPG|183x82](upload://2lcnRHcC3QqDv6AeaDZuo8M9Qlv.jpeg) [/details] --- ## Post #10 by @Stefan_Sauermann I am not asking to merge standards. I am asking for cooperation to show on a large scale and in real world examples where each standard shall be put to use for which purpose. Cooperation with the IHE lab report group may be a useful starting point. There may be better ones. Greetings from Austria. Stefan Sauermann --- ## Post #11 by @thomas.beale Stefan Sauermann wrote: > I am not asking to merge standards\. I am asking for cooperation to > show on a large scale and in real world examples where each standard > shall be put to use for which purpose\. Cooperation with the IHE lab > report group may be a useful starting point\. There may be better ones\. > \*I think it is quite a good one\. \- thomas --- ## Post #12 by @Stefan_Sauermann Ha\! I do sense an air of agreement here\! Makes me very happy\! Are there others who might agree? See you, greetings to the other side of the planet, Stefan \[mailto:openehr-clinical-bounces@openehr.org] Im Auftrag von Thomas Beale --- ## Post #13 by @thomas.beale Stefan Sauermann wrote: > Ha\! > I do sense an air of agreement here\! > Makes me very happy\! > Are there others who might agree? > > See you, greetings to the other side of the planet, > Stefan > \*let's hope London isn't quite that far from Vienna just yet \(although they do say there may be some continental drift in 2012;\-\) \- thomas --- ## Post #14 by @Seref Don't worry Thomas, if something goes a little bit wrong in the next few days at CERN, we can all unite in an unprecented level of harmony in a nice little black hole. Of course, the issue about being close to or far away from each other in a black hole is an important one, but I have the feeling that it would not matter to us then. Sorry, had to say it. --- ## Post #15 by @system Stefan, Even I agree. Gerard -- -- 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 --- ## Post #16 by @ameye_sanyaolu It not really an Irish thing\. I have been been silent too and from Nigeria\. Good luck with the post\. hope to contribute more actively Sanyaolu Ameye --- ## Post #17 by @system Ooooh\! So Nigeria isn't the capital of Ireland? :\-\) Although IANAC \(I Am Not A Clinician\), I would like to add another point that might be worth discussing: the interoperability between openEHR based systems and those of the Really Big Companies \(Microsoft's HealthVault & RelayHealth, Google's Health\)\. They're gaining momentum, and maybe we can ride on the wave along with them\. Probably it's time for openEHR to gear up some PR\-machinery\. The propaganda should be backed up by tutorials, screencasts, lectures, workshops, flyers, working demos, etc\. And finally, on the risk of being pedantic, but following these tips would really make reading the mailing lists on PDA's \(as many clinicians do own\) much more comfortable: http://www.netmeister.org/news/learn2quote.html Good luck on your new position\! Roger --- ## Post #18 by @system > I would like to add another point > that might be worth discussing: the interoperability between openEHR > based systems and those of the Really Big Companies \(Microsoft's > HealthVault & RelayHealth, Google's Health\)\. They're gaining momentum, > and maybe we can ride on the wave along with them\. Probably it's time > http://www.ictzorg.com/home/id101-49805/nictiz_persoonlijk_zorgdossier_nuttige_aanvulling_op_epd.html The Dutch ICT in health care organization \(NICTIZ\) is saying that the mentioned systems from Microsoft and Google are useful add\-ons to the system Nictiz is defining \(for more than 7 years by now, about gaining momentum\)\. Nictiz is saying that those systems can be part of national EPD \(electronic patient dossier\), but they should never replace the national EPD\. http://www.ictzorg.com/home/id101-46903/kedzierski_van_mca_vws_kan_wel_stoppen_met_landelijk_epd.html http://www.ictzorg.com/home/id101-42405/mca_onderzoekt_mogelijkheden_google_health.html Kedzierski, member of the board of a big hospital \(Alkmaar\) is saying that the personal health dossiers from Google and Microsoft can replace the national EPD system from Nictiz\. He is saying that in the USA Kaiser Permanente, with 9 million patients has chosen for both the MS and the Google system, and Cleveland Clinic chooses for the Google system only\. The Alkmaar hospital will make its choice after the summer, he says\. --- ## Post #19 by @Stefan_Sauermann This was clearly meant geographically\. I thought you are in Australia most of the time\. The standard deviation of your spatial distribution of probability of presence is definiely wider than mine\. Anyway, happy to hear from you, wherever you are\. Stefan \[mailto:openehr-clinical-bounces@openehr.org] Im Auftrag von Thomas Beale --- ## Post #20 by @system >> I would like to add another point >> that might be worth discussing: the interoperability between openEHR >> based systems and those of the Really Big Companies \(Microsoft's >> HealthVault & RelayHealth, Google's Health\)\. They're gaining momentum, >> and maybe we can ride on the wave along with them\. Probably it's time >> > http://www.ictzorg.com/home/id101-49805/nictiz_persoonlijk_zorgdossier_nuttige_aanvulling_op_epd.html > The Dutch ICT in health care organization \(NICTIZ\) is saying that the > mentioned systems from Microsoft and Google are useful add\-ons to the > system Nictiz is defining \.\.\. Sounds reasonable\. > Nictiz is saying that those systems can be part of national EPD > \(electronic patient dossier\), but they should never replace the national > EPD\. >   Never say never\! If they have enough momentum \(being funded by large companies\), their functional coverage can become more and more extensive, making such a national EPD obsolete indeed in the long run\. > http://www.ictzorg.com/home/id101-46903/kedzierski_van_mca_vws_kan_wel_stoppen_met_landelijk_epd.html > http://www.ictzorg.com/home/id101-42405/mca_onderzoekt_mogelijkheden_google_health.html > Kedzierski, member of the board of a big hospital \(Alkmaar\) is saying that > the personal health dossiers from Google and Microsoft can replace the > national EPD system from Nictiz\. He is saying that in the USA Kaiser > Permanente, with 9 million patients has chosen for both the MS and the > Google system, and Cleveland Clinic chooses for the Google system only\. > > The Alkmaar hospital will make its choice after the summer, he says\. >   But he didn't say 'before <whatever deadline one can imagine here>' :\-P So we'll wait and see\.\.\. Roger --- ## Post #21 by @system > Never say never\! If they have enough momentum \(being funded by large > companies\), their functional coverage can become more and more > extensive, making such a national EPD obsolete indeed in the long run\. It is a bit off topic, but Nictiz, will never declare their work as obsolete, how would you feel if you had for 7 years an excellent salary, and in the end your product is obsolete before it is finished? So, Nictiz will never allow any third party/standard, if it is Google, Microsoft, or OpenEhr, to have a fair chance on the market they control\. The blame would be unbearable\. --- ## Post #22 by @thomas.beale The MS and Google systems in principle could one day do the job. Neither have any semantics at the moment, nor distributed deployment capability. MS are aware of the lack of semantics - I talked to them recently. They are investigating archetypes+templates for filling out the layer between the Common User Interface (being designed with NHS) and the persistence (generic storage). - thomas beale Bert Verhees wrote: --- ## Post #23 by @thomas.beale Roger Erens wrote: > \.\.\. Probably it's time > for openEHR to gear up some PR\-machinery\. The propaganda should be > backed up by tutorials, screencasts, lectures, workshops, flyers, > working demos, etc\. >   it always is time for that\! But this community belongs to everyone on this list\. People here could help with this, at least with concrete suggestions on improvements to available material, or even better, by creating some new explanatory materials \(which the so\-called experts would always be happy to review\)\. > And finally, on the risk of being pedantic, but following these tips > would really make reading the mailing lists on PDA's \(as many clinicians > do own\) much more comfortable: > > http://www.netmeister.org/news/learn2quote.html >   Many of us use the old style unix/usenet quoting approach \(pretty much as explained at that link in fact\); I hear MS Outlook users saying they can't handle that\. What problems do you experience Roger? \- thomas beale --- ## Post #24 by @thomas.beale Thomas Beale wrote: --- ## Post #25 by @Stefan_Sauermann Tom, thanks\! I am losing track of all the possibilites to discuss and check\. Before I log in there: What expects me there? Stefan Sauermann \[mailto:openehr-clinical-bounces@openehr.org] Im Auftrag von Thomas Beale --- ## Post #26 by @thomas.beale Stefan Sauermann wrote: --- ## Post #27 by @system > > The MS and Google systems in principle could one day do the job\. > Neither have any semantics at the moment, nor distributed deployment > capability\. I don't understand the latter\. A patient can access Health Vault with his/her browser from anywhere? So it doesn't matter where 'in the cloud' the system is deployed? > MS are aware of the lack of semantics \- I talked to them recently\. > They are investigating archetypes\+templates for filling out the layer > between the Common User Interface \(being designed with NHS\) and the > persistence \(generic storage\)\. > That's very interesting\. Thanks for sharing\. Roger --- ## Post #28 by @system > Roger Erens wrote: >   >> \.\.\. Probably it's time >> for openEHR to gear up some PR\-machinery\. The propaganda should be >> backed up by tutorials, screencasts, lectures, workshops, flyers, >> working demos, etc\. >>   > it always is time for that\! But this community belongs to everyone on > this list\. People here could help with this, at least with concrete > suggestions on improvements to available material, or even better, by > creating some new explanatory materials \(which the so\-called experts > would always be happy to review\)\. >   You're very right\. OTOH, everybody's very busy, so some focus is needed\. A 'champion' who does some roadmapping, coordinate efforts of contributors, reports to insiders and outsiders would be beneficial to openEHR 'spreading the word'\. >   >> And finally, on the risk of being pedantic, but following these tips >> would really make reading the mailing lists on PDA's \(as many clinicians >> do own\) much more comfortable: >> >> http://www.netmeister.org/news/learn2quote.html >>   > Many of us use the old style unix/usenet quoting approach \(pretty much > as explained at that link in fact\); I hear MS Outlook users saying they > can't handle that\. What problems do you experience Roger? >   Sometimes a message gets quoted in its entirety\. And then a following reply to that message holds both previous messages entirely\. And so on\. There are threads where this happened even five times or more \(like the GUI\-hints in templates, ultimo June\)\. When you access such a post, you have no idea whether you need to scroll down \(because that's where MS Outlook puts the quoted material\) all the way in order not to miss a valuable comment, or you can skip the careless quoted material\. On a PDA with its limited screen estate, that's a lot of scrolling, I can assure you :\-\( \. But then again, that happened at the technical mailing list, so perhaps I'm barking up the wrong tree here :\-\) --- ## Post #29 by @ian.mcnicoll Hi Roger, > I don't understand the latter\. A patient can access Health Vault with > his/her browser from anywhere? So it doesn't matter where 'in the cloud' > the system is deployed? Whilst web\-based Health Vault style patient records will bring many advantages, in terms of human accessibility, unless this is underpinned by strong semantic precision we will gain none of the advantages of computerisation around decision support and particularly workflow support\. Additionally, whilst I strongly support the concept of a patient authored/controlled record, IMO there must also be a place for a clinical record, which may need a different structure and focus\. The clinical record must support a huge amount of detail, technical and operational information, much of which is of little practical interest to the majority of patients but will need to be managed and 'gardened' over time of it is to be of value\. Clinical records are not just statements of fact, they are working documents which require active and careful management if they are to continually reflect the current state of knowledge/opinion about a patient's health\. Ian Dr Ian McNicoll office / fax \+44\(0\)141 560 4657 mobile \+44 \(0\)775 209 7859 skype ianmcnicoll ian@mcmi\.co\.uk Clinical Analyst \- Ocean Informatics ian\.mcnicoll@oceaninformatics\.com Consultant \- IRIS GP Accounts ian@gpacc\.co\.uk Member of BCS Primary Health Care Specialist Group – www\.phcsg\.org --- ## Post #30 by @system Hi Roger > the interoperability between openEHR > based systems and those of the Really Big Companies \(Microsoft's > HealthVault & RelayHealth, Google's Health\)\. They're gaining momentum, > and maybe we can ride on the wave along with them\. Probably it's time > for openEHR to gear up some PR\-machinery\. The propaganda should be > backed up by tutorials, screencasts, lectures, workshops, flyers, > working demos, etc\. >   I see the advent of personal health records in the Web 2/3 environment as encouraging but all the more reason to have a standard EHR that meets the needs of clinicians and people wanting to contribute to their own records\. Everyone is interested in Health, but it is the power of reuse and ability to consolidate information in an environment where it can be queried etc that will be most important\. By way of example, we have been working on the idea of distributed work flow for the past few years\. The idea being if a test is due every year then when it is carried out, the original site of the order will get notified that it has been done \(\+/\- result depending on access\)\. This sort of capability is the basis of the Instruction and Action classes in openEHR\. Semantics, currency of information, support for decision support are all important\. It may be that the Google idea of health records is sufficient for some purposes but it will soon require a major upgrade to make it really robust\. Cheers, Sam --- ## Post #31 by @system > Hi Roger, > >> I don't understand the latter\. A patient can access Health Vault with >> his/her browser from anywhere? So it doesn't matter where 'in the cloud' >> the system is deployed? >>     > Whilst web\-based Health Vault style patient records will bring many > advantages, in terms of human accessibility, unless this is > underpinned by strong semantic precision we will gain none of the > advantages of computerisation around decision support and particularly > workflow support\. I agree\. This clarifies Thomas' former remark\. > Additionally, whilst I strongly support the concept > of a patient authored/controlled record, IMO there must also be a > place for a clinical record, not necessarily being in a Health Vault style system, right? I imagine that's what Thomas intended with his latter "distributed deployment capability" remark\. Looking at Google's Health Data API page http://code.google.com/apis/health/ though, it seems that Google made some start already with this capability by inviting Third\-party Services providers and Data Providers to implement their API\. Speaking of Google, a thought that struck me: maybe one day we'll let their search engine do the querying of archetyped objects\. Then AQL will not be necessary anymore? Roger --- ## Post #32 by @thomas.beale What I meant was that it can't be deployed as separate instances in multiple places \(e\.g\. hospital, GPs, clinics\) and then have content merged on request\. Using it reqires either a\) convincing the providers that HV or Google's version are safe & useful places to put the patient data and/or b\) that their existing systems can be made to communicate some of its health data to the healthvault\. We are some way away from either of these at the moment\. \- thomas Roger Erens wrote: --- **Canonical:** https://discourse.openehr.org/t/chair-of-openehr-clinical-review-board-crb-announced/14884 **Original content:** https://discourse.openehr.org/t/chair-of-openehr-clinical-review-board-crb-announced/14884