Says the European Commission
(report:)
http://www.ebusiness-watch.org/studies/special_topics/2007/documents/Special-study_01-2008_ICT_health_standards.pdf
(sorry previous was the bad english)
Hi Bert,
I just had a quick scan of the report but read the parts on HL7 and
openEHR carefully.
There are two issues I want to comment on:
1) In the HL7 part it says nearly half of the assessed end-users are
using HL7 (version not mentioned but it must be v2.x) and more
importantly 90% of respondents envisages HL7 to be important in future.
That implies a big plus for HL7.
2) The major issue is the focus on open source in openEHR part. The
report seriously lacks the main philosophy of openEHR here! openEHR is
all about open systems - not just open source (although is the case as
in other domains). I am not going to write long on these two paradigms
here but as a research fellow on open systems I feel kind of responsible
to put few words on it 
Open Systems vs. Open Source: The former is a broader concept which is
an effort to enable different IT systems to talk to each other without
much external effort and also have the capability of running on
different platforms; whereas the latter is all about making source code
of software publicly available and let other developers to read, change,
share and run the software without any limitations (in most cases
without any charge).
Open Systems requires us to conform to relevant open standards (such as
open specs of openEHR) and have publicly available and well documented
descriptions for interfaces, behaviour and file formats. As can be
inferred, it is perfectly possible to build open systems by using
closed-source. But “openness” is not an all or nothing paradigm here;
there are levels. By using open source in developing open systems one
may ensure a higher degree of “openness”.
I will try to read more of the report - but "open systems" should be the
main focus. It is is a buzzword which I think may attract more vendors
and result in widespread implementations.
Cheers,
Thanks to Bert in bring this article to our attention. Although I haven't
read every word, I did not see the reference that HL7 was too expensive.
To my knowledge, HL7 is the most widely used standard by the large HIS/IT
vendors. I think some of the references to v2.x vs v3 were interesting.
It is true that v3 has yet to penetrate the US as far as messaging is
concerned. On the other hand, CDA - also a v3 standard is gaining
increasing use in the US. A number of health care facilities are using CDA
to define notes/summaries in a number of clinical domains.
The discussion of open, open source, and openess is quite interesting. I
believe that HL7 is open in the sense that anyone can particiapte in
creating the standards. It is closed in the sense that the standards it
creates have a price, altho relative low. HL7 look at integrating true
open source into is structure and finally decided the gains were not worth
the effort. I participate in a couple of open source organizations, and
the openess is quite interesting, surprising and challenging.
I think the article is an excellent reference. I disagree with some
statements about HL7, but I doubt if anyone could write an article that
everyone would agree with all the content.
Ed Hammond
Koray Atalag
<koray@cs.aucklan
d.ac.nz> To
Sent by: For openEHR clinical discussions
openehr-clinical- <openehr-clinical@openehr.org>
bounces@openehr.o cc
rg
Subject
Re: HL7 too expensive, too complex
12/02/2008 09:10 and inconsistent
PM
Please respond to
For openEHR
clinical
discussions
<openehr-clinical
@openehr.org>
Hi Bert,
I just had a quick scan of the report but read the parts on HL7 and
openEHR carefully.
There are two issues I want to comment on:
1) In the HL7 part it says nearly half of the assessed end-users are
using HL7 (version not mentioned but it must be v2.x) and more
importantly 90% of respondents envisages HL7 to be important in future.
That implies a big plus for HL7.
2) The major issue is the focus on open source in openEHR part. The
report seriously lacks the main philosophy of openEHR here! openEHR is
all about open systems - not just open source (although is the case as
in other domains). I am not going to write long on these two paradigms
here but as a research fellow on open systems I feel kind of responsible
to put few words on it
Open Systems vs. Open Source: The former is a broader concept which is
an effort to enable different IT systems to talk to each other without
much external effort and also have the capability of running on
different platforms; whereas the latter is all about making source code
of software publicly available and let other developers to read, change,
share and run the software without any limitations (in most cases
without any charge).
Open Systems requires us to conform to relevant open standards (such as
open specs of openEHR) and have publicly available and well documented
descriptions for interfaces, behaviour and file formats. As can be
inferred, it is perfectly possible to build open systems by using
closed-source. But “openness” is not an all or nothing paradigm here;
there are levels. By using open source in developing open systems one
may ensure a higher degree of “openness”.
I will try to read more of the report - but "open systems" should be the
main focus. It is is a buzzword which I think may attract more vendors
and result in widespread implementations.
Cheers,
... I disagree with some
statements about HL7, but I doubt if anyone could write an article that
everyone would agree with all the content.
I think the report is a turkey - it makes statements about HL7
that the HL7 people disagree with, and makes statements about
openEHR the openEHR people disagree with - and not in a
"we interpret things differently" way, but more in a "wow they
really missed the point way"..
I mean starting the openEHR section with a discussion about
the open source movement so completely misses the point
that I worry about anything else in the report..
It reads to me like a bunch of web 2.0 e-business paradigm
shifting consultants who got asked to write a report on e-health,
so they've downloaded some organisational 'mission' statements, did a
survey and then wrote it up. I think its level of insight is
marginal.
Andrew
thanks Andrew
it's hardly a new thing. There's been similar reports in Australia
in the past.....
Glad we're not the only ones
Grahame
Andrew Patterson wrote:
Dear Ed,
I think Bert referred to the text below, but that’s not the point.
(p.21) “High adoption costs in SMEs: Small or medium-sized ICT manufacturers may not be willing to adopt commonly used standards because these are very complex and thus difficult and expensive to implement. This applies for example to HL7 version 3. It may be less costly to develop proprietary standards on their own.”
The point is that this is an official EU report, which will influence governments in (at least) the national EU states as well as the EU government themselves.
Although I agree with many of the comments of the other responders, this report is a ‘fact’ for those decision makers, at least until some new ‘official’ report show up that states something different.
In my opinion the follow passage is important for the people on this list:
“Nearly all interviewees agreed that there is a lack of widely used e-health standards. There was also agreement that there is a lack of sufficiently developed e-health standards, a lack of e-health standards harmonisation activities, and that there are too many conflicting e-health standards.”
The message I read is that we have to harmonize quickly between those standards that are conflicting. Only then the ‘market’ can reach it’s full potential. Personally I think DCM could play a role to speed up this process.
For ‘us’ the following recommendation in the report is a big plus:
(p.65) ‘Consider open standards: Use of open standards may further strengthen collaboration and adoption. For example, in the SeBW e-health expert survey, 64% of the respondents were of the opinion that openEHR should be important in the future (see section 3.2.2 for survey results and section 2.3.8 for details about openEHR). Moving towards open standards in e-health may gain more support in the foreseeable future due to the increasing demands of participation and support in the standards development process. It can be considered as one possible model for sustainable international standards development.’
To become an even stronger open standard organization ‘we’ have to work on the perception that the outside world has about openEHR. As a member I know that we fulfill to all the requirements listed in this report (see below), but for one or another reason we haven’t been able to bring this across to the outside world. So please, besides all the excellent work we’re doing on open standards, let’s work on that too (the PR thing J ).
“… for (openEHR) to become a success model, several issues have to be addressed, for example to assure that all members are trustworthy and participate without hidden agendas or that committee leaders are appointed in an open process reflecting the interests of all stakeholders. Objectives that need to be fulfilled include verifiable results, i.e. solutions that do not discriminate any player. Furthermore, sustainable management models must be established to assure the survival of such activities.”
Cheers,
Stef
Thanks, Stef, for explaining, I should have done it myself, but it was a
busy moment, but the news seems so important that I wanted to post a
right away, without explanation.
Stil very busy. too busy, to answer to questions, I see that this is not
very polite, please excuse me for that.
Specially the points Stef mentions are very important.
For the Dutch readers, there is a very good ICT/Health news-website in
Dutch only. I can recommend, http://www.qure.nl
It is not free, but one can take a free tour for one month.
That is where I found this document, and that is where also it is
summarized.
Bert
Koray Atalag schreef:
Hi Bert,
I just had a quick scan of the report but read the parts on HL7 and
openEHR carefully.There are two issues I want to comment on:
1) In the HL7 part it says nearly half of the assessed end-users are
using HL7 (version not mentioned but it must be v2.x) and more
importantly 90% of respondents envisages HL7 to be important in future.
That implies a big plus for HL7.
Yes, that is true, but the report also mentions that the standard will
not be followed properly, because of its complexity, and that is also
experienced in the previous versions of HL7.
2) The major issue is the focus on open source in openEHR part. The
report seriously lacks the main philosophy of openEHR here! openEHR is
all about open systems - not just open source (although is the case as
in other domains). I am not going to write long on these two paradigms
here but as a research fellow on open systems I feel kind of responsible
to put few words on it
It is a widely spread misunderstanding that OpenEHR is open source. It i
an open specification, with implementations which are some open source,
some partly open source, and some closed source.
Open Systems vs. Open Source: The former is a broader concept which is
an effort to enable different IT systems to talk to each other without
much external effort and also have the capability of running on
different platforms; whereas the latter is all about making source code
of software publicly available and let other developers to read, change,
share and run the software without any limitations (in most cases
without any charge).Open Systems requires us to conform to relevant open standards (such as
open specs of openEHR) and have publicly available and well documented
descriptions for interfaces, behaviour and file formats. As can be
inferred, it is perfectly possible to build open systems by using
closed-source. But “openness” is not an all or nothing paradigm here;
there are levels. By using open source in developing open systems one
may ensure a higher degree of “openness”.
There is still a lot to do before OpenEHR will be truly an open system,
at this moment it is an open specification.
There is lack of published and standardized API's.
I am going having standarized Java API, but that is on anther level.
I guess this is everywhere the situation, we are all inventing the API
by ourselves. This is a disadvantage of not having the specification
completed.
I don't know if this has changed in 1.0.2, I wait for the definite
version, before I read it (too busy)
Thanks for commenting on this
Bert
I think the article is an excellent reference. I disagree with some
statements about HL7, but I doubt if anyone could write an article that
everyone would agree with all the content.
I couldn't agree more.
There is also a lot of confusion, if you know how less decision-makers
know about standard internals, it is shocking.
That is why I am glad that there are some OpenEhr implementations with
more or less commercial success, it is also marketing for the specification.
We need that.
Bert
It reads to me like a bunch of web 2.0 e-business paradigm shifting consultants who got asked to write a report on e-health, so they've downloaded some organisational 'mission' statements, did a survey and then wrote it up. I think its level of insight is marginal.
It is not a report that has much explicit knowledge to win for people in this list, but it tells us about the level of argumenting/thinking at decision makers
It tells us how you can possible effectively communicate with these people.
And besides that, Openehr is mentioned in the European Community, that is a good thing, also, it can bring (important) people to think again about HL7 and OpenEhr.
In the same context, a Belgium professor Jozef Aerts wrote: Ten good reasons why an HL7-XML message is not always the best solution
http://www.xml4pharma.com/HL7-XML/HL7-XML_for_CDISC_Standards.pdf
Bert
The report was done based on a survey of 94 responding 'experts',
whoever they were. They didn't get openEHR at all, and made some errors
to do with other standards orgs in the report. I don't see open source
as a burning issue - open data and open (service) interfaces are what
matter to clinical users (particularly secondary - medical research &
public health) and system vendors respectively. Open source is a nice
development paradigm - but mainly for software where the developers are
more or less the same pool of people as the users - hence Linux, Samba,
Apache, Zope, and all the other big projects. Health software is
specialised and to make open source fly it needs to be funded and
directed in my view - hence the Open Health Tools (OHT) initiative.
Based on the evidence to date, anyone who thinks that organic open
source EMR or other projects are going to magically solve e-health
interoperability is dreaming.
Ed's comment about not wanting to spend the effort on open source
directly in HL7 reflects this reality (and I think it was most likely
the correct decision). openEHR's open source projects only solve
interoperability problems because they are 100% based on the open
specifications (i.e. some kind of standard), not because they are open
source.
- thomas beale
William E Hammond wrote:
Stef Verlinden wrote:
Good to hear. If we can be of any help, please let us (I trust I can speak for all the openEHR users) know.
I’m aware of the huge task that’s on your (and Sam’s, Dipak’s and all the others I forget to mention) shoulders and if we can help you to make your ‘flight’ easier we would be glad to do so.
Cheers,
Stef
As discussed by many of you and readers of these comments, the time is now
to move forward safely with these initiatives.
The level of evolution is not necessarilly required from the creators of
this innovation but the manner OpenEHR is used on the ground level. I see
many factors need clarification and introduction of new dimensions to move
forward...
Such as:
Open source is a burning issue for developing countries...and specially the
space do not have the resources to contract experts from the north to
introduce these innovations to the operational level.
For clinicians the ACCESS TO INFORMATION what is matters, specially for the
countries where a computer is a luxery.........even a well model of
information in paper is a progress for current documentation. So the fast
changes in developing template and exchange of data may be as critical for
developed countries but in poor countries this expertise does not
exist........they do not see the differences between GOOD QUALITY data
elements and what is the power of STANDARDS....that is the strenghts of
OpenEHR.....
The funding area is A BURNING ISSUE for us to survive or the real needs from
clinicians using ICT for service delivery will never be improved and
interoperability will remain a dream...to see but do not touch.
In regards to the evidence to date......organic open source EMR are a real
solution for spaces that NOTHING EXIST....however, this cannot be confused
with achieving INTEROPERABILITY...since the initial need is ACCESS TO
INFORMATION in the first place.....without a real understanding of
exchanging data or information....well if we start to discuss the level of
KNOWLEDGE of medicine, nursing, health sciences in those
areas.......ARQUETYPES are the only answer.....at this stage-..
Finally, each member of the EHR initiatives has developed an understanding
of the complexity of introducing these technologies to healthcare, and
according to my experience, there is not ONLY ONE SOLUTIONS to any health
system...BUT MANY..........in form of COLLABORATION.....
I would like to add, that the idea is to provide a sense of TRUST for people
who does not got the time or motive to see the power of open EHR...and the
only channel to achieve this is GOVERNANCE FRAMEWORK.......not by
controlling each project that is using openEHR...quite the
opposite......providing the tools to the people who must need it.......
Cheers Carol
Melbourne Australia
Stef Verlinden wrote:
Hi Carola,
Dr Carola Hullin Lucay Cossio wrote:
As discussed by many of you and readers of these comments, the time is now
to move forward safely with these initiatives.
The level of evolution is not necessarilly required from the creators of
this innovation but the manner OpenEHR is used on the ground level. I see
many factors need clarification and introduction of new dimensions to move
forward...
Such as:Open source is a burning issue for developing countries...and specially the
space do not have the resources to contract experts from the north to
introduce these innovations to the operational level.
The more I think about it, the less I am convinced for the health arena
- here I am talking about specialised applications, not Linux or other
infrastructure stuff. And let me point out that I am broadly an open
source advocate. Firstly, there are unavoidable costs of deployment, of
validation of software, validation of archetypes and other knowledge
resources; costs of training, costs of change management and many other
costs. While the wage rate or currency may be lower in some places,
mostly we are talking about people from higher wage categories, so these
costs won't be trivial. Now, in a world where software is being offered
more as a service rather than a product, the way of charging is
different - it is a rental model. So large up-front costs for a software
product are starting to diminish even among commercial suppliers. Then
if we look at what is really valuable to clinicians, and a country in
general, it is the data, not the software. If there are guarantees of
data openness within a strict privacy framework, then automated billing
can be implemented, not to mention public health and research uses of
the data.
There are some arguments for access to the software source code, but
over the last few years I have come to the conclusion that they are far
less compelling than access to standardised data, and also standardised
service interfaces in an open platform.
For clinicians the ACCESS TO INFORMATION what is matters, specially for the
countries where a computer is a luxery.........even a well model of
information in paper is a progress for current documentation. So the fast
changes in developing template and exchange of data may be as critical for
developed countries but in poor countries this expertise does not
exist........they do not see the differences between GOOD QUALITY data
elements and what is the power of STANDARDS....that is the strenghts of
OpenEHR.....
exactly...
- thomas beale
Well said Stef. I know that in the current negotiations around broader governance of openEHR we have these ideas at the front of our minds.
Cheers, Sam
Comment on this here:
http://healthitnerd.blogspot.com/2008/12/europes-turn-to-waste-money.html
From: [openehr-clinical-bounces@openehr.org](mailto:openehr-clinical-bounces@openehr.org)
[[mailto:openehr-clinical-bounces@openehr.org](mailto:openehr-clinical-bounces@openehr.org)] On Behalf Of Stef Verlinden
Sent: Wednesday, 3 December 2008 7:27 PM
To: For openEHR clinical discussions
Subject: Re: HL7 too expensive, too complex and inconsistent
Dear Ed,
I think Bert referred to the text below, but that's not the point.
(p.21) "High adoption costs in SMEs: Small or medium-sized ICT manufacturers
may not be willing to adopt commonly used standards because these are very
complex and thus difficult and expensive to implement. This applies for
example to HL7 version 3. It may be less costly to develop proprietary
standards on their own."
The point is that this is an official EU report, which will influence
governments in (at least) the national EU states as well as the EU
government themselves.
Although I agree with many of the comments of the other responders, this
report is a 'fact' for those decision makers, at least until some new
'official' report show up that states something different.
...
Stupid software. The mail got scrambled (at least for me).
Resending the link:
http://healthitnerd.blogspot.com/2008/12/europes-turn-to-waste-money.html
The Nerd.