This week I finished the HL7 Fundamentals Course, where v2, v3 and the corresponding Reference Information Model (RIM), from which the Clinical Document Architecture draws its specification and shortly FHIR.
From this course, I learned that some people behind HL7 v3 and thus RIM, were the same people, who also worked on openEHR in the beginning. In addition, several naming concepts such as Participation, Template and so forth can be found in the standard HL7 v3 and the open specification openEHR. Finally, the naming of RIM and Common Information Model (CIM), suggests some deeper similarities.
Consequently, I wanted to ask, in this community, how distinct the RIM and CIM actually are? And where they intersect?
The HL7v3 RIM was created by Woody Beeler, Gunther Schadow and other key HL7 personalities at the time (just pre 2000). I went to HL7 meetings as an Australian government standards representative during 2000 - 2006 and later as part of the UK gov team.
I remember doing a presentation on archetypes in about 2002. The RIM builders did not want to hear it. I wrote a 25 page technical analysis of HL7v3 in 2004 or so, which showed why it was unlikely to be workable (major modelling problems; etc.) I provided this to the AU and UK government efforts at the time. Neither group could find any technical error, but nevertheless, both proceeded on the v3 pathway, to later regret (particularly in the UK).
openEHR was started by two groups who had worked previously on the GEHR project - the UCL Centre for Health Informatics and Multi-professional Education (CHIME) department led by Prof David Ingram, and Dr Sam Heard and myself from (at that time) Australia. Sam and Dr Dipak Kalra and others in the UK formed the original group who did the earliest architectural conception of openEHR.
We tried to get some collaboration with HL7 back in those days, but unfortunately without success. The adoption of HL7v3 ended up costing the UK, US, Australia and others many billions. It was declared by Grahame Grieve (lead of FHIR) in 2013 to have failed (the blog post is linked here, although it appears the original blog is now unavailable).
Participation was an HL7 thing (it’s part of a conceptually sound pattern of participation of actors / entities in acts, but HL7v3 tried to use it for everything). In openEHR we reused the concept, although today’s version is mainly influenced by Basic Formal Ontology (BFO). ‘Template’ was an early idea among some people attending HL7 including Angelo Rossi Mori (Italy) . There was a Templates SIG and then a WG for some years. This group tried hard to get HL7 to adopt elements of the openEHR domain modelling approach (i.e. archetypes) but in the end was unable to convince others.
David Ingram’s open access book Health Care in the Information Society, which documents the rise of health informatics as a discipline, including openEHR
I do know of CIM meaning Clinical Information Model (conceptual similar to archetypes) as defined in iso13972:2022. They used to be called Detailed Clinical Models in a preceding iso norm. (IIRC)
They are mostly used in the Netherlands to model zibs.
It’s mostly data type definitions (similar to openEHR data types) and modelling strategies (policy), but not information classes(like openEHR RM EHR model), no formal modelling language (other than UML) like ADL and no persistency semantics (contribution etc) and no implementation specifics like rest-api specs.
And there is CIMI a stranded (?) initiative to do modelling jointly.