Dear Colleagues,
Let me explain by means of a metaphor what we must expect from the killer app for health ICT.
What the present situation is, using the Message Paradigm.
Compare it with the Two Level Model Paradigm.
We all know what to expect from the healthcare of the future.
We all know what the ICT-requirements are that are capable to support the healthcare of the future.
I know where to look for the killer Applications.
I know on what models and standards, they can be based.
EN13606 and openEHR.
EN13606 part 1 is published as European standard.
And is accepted (but not published yet) as ISO standard.
The other parts will follow soon.
Metaphor: the letter
When we accept that health ICT is about informing a colleague or your self by means of a letter at a later point in time and or other place in the word, then the Microsoft Word word editor is the example of the killer app we need.
Why?
What we expect from an application for writing letters is that it is a tool that can be used to write about anything we care, or have to, write about.
Avionics, banking, my children, health, etc.
The word editor is completely agnostic about model of the world people are in and write about.
What is the present situation translated to the metaphor?
What is the method of the Message Paradigm HL7 is using and CEN was using in the past?
People from the healthcare world define a restricted syntax, medical dictionary, text phrases, all assembled in a logical structure.
For each clinical domain people meet and produce this.
What they have produced in effect are sets of fixed electronic forms in a fixed structure. And each domain will produce its own set, own text phrases and dictionary.
All the sets of unique electronic forms are specific for each clinical domain and are used in countries, regions, or the whole world.
Since each community is using its own dictionary and dialect, it results in many variations expressing the same concept.
System vendors are overwhelmed by the number of electronic forms, each form needing specifically developed software to process it.
It is obvious that it takes a lot of discussion and complex consensus to produce these electronic forms and in addition a lot of time to implement these forms in an uniform way in regions, countries or the whole world. (if possible at all) This results in static, in flexible, consensus based electronic forms that can not be adapted fast enough for the ever changing health care. And it places a lot of constraints on nation, regional or local variations that have to be expressed and exchanged. So people start to use work arounds with the electronic forms.
The result using the metaphor
The ICT-application functions as a very dedicated application that can process a limited set of electronic forms.
In effect this Message Paradigm results in the situation that any system vendor (it could be Microsoft in my example) writes unique software for each electronic form defined in a community.
In present healthcare it will be hundreds or thousands of vendors that will produce proprietary applications that process the electronic forms.
For each new version of the electronic form large communities of healthcare providers and software vendors will have to go thru the whole process.
The ICT tools used are very context dependent. They contain a lot of domain knowledge.
Semantic interoperability will come at a very high cost. it will be inflexible, limited and incomplete at best.
What is the situation using the new paradigm?
A new paradigm is used. The Two Level Model paradigm.
This means that the software tool is completely agnostic about dictionaries, and text phrases used in any domain.
It is gnostic about the syntaxe (the generic structure of each possible letter or document) since not only must humans be able to read the text. Computers need to a model based syntaxe in order to process the information.
In the metaphor there is one application that functions as a generic tool based on a standard.
Healthcare providers using a second tool produce letter as they see fit.
They use dictionaries as they see fit; text phrases as they see fit.
It is in their domain that they must come to the definition of concepts they need.
It is their responsibility to become and stay interoperable.
Whatever they decide the process using a specific editor. On the screen they see what they have agreed, but the output of this so called Archetype Editor is machine readable.
The Archetype Editor (freely available as open source and based on a published specification, is based on a second computer processable model.
All text they produce as kinds of letters are conformant to the unified generic syntaxe.
Any time they can change the content of the letters, the documents. On the fly these letters and documents can be processed by systems.
The result using the metaphor
It acts like any normal word-processor. Each community is able to decide what in a specific context they have to (or want to write) in what kind of document.
Microsoft (or any competitor) will not have to rewrite software to accomodate new documents.
The healthcare application is able to process all possible letters/documents because they are conformant to the unified generic syntaxe.
Without re-programming all possible variations of letters can be processed.
All data, information, and knowledge in the letters can be read, stored, retrieved, presented and exchanged without the need to write software.
Instantaneously new letters/documents can be defined and processed.
Any community can come to agreements about the content of the letter/document with the type of content they need.
This community can be small (N=1, N=2, ..) Or very large (Region, Country, Cardiology, ENT, …)
There is plug-and-play semantic interoperability between conformant systems and users.
Systems become extremely flexible.
The ICT-tools used, are really generic tools that can be used in all possible contexts.
The ICT-tools do not contain any domain knowledge.
It knows how to store, retrieve, present and exchange all possible documents and all concepts that are defined in any community.
Semantic interoperability will come at very low cost. It will be very flexible and comprehensive.
Gerard Freriks
conexis
