Observation vs. diagnostic investigations

[thomas.beale]

Sylvia M. Webb wrote:

1. Are any of our existing UML modeling tools capable now of rendering such a complete enterprise model… one that combines atomic data elements, archetypes, ontologies, vocabulary systems, care-related requirements, and temporally coordinated processes into a single model? If not, how many separate modeling methodologies/tools would have to be combined to accomplish this?
   [==>SMW] What are the disadvantages of several models or views as long as their existence is known and you can develop interoperable applications from them?

well that’s the thing isn’t it - a non-trivial computational framework is needed to make them all interoperate - there needs to be technology to make it happen.

2. Are free/inexpensive “reader” tools available that would enable [non technical] reviewers of such a model to dynamically examine the part of it that corresponds to the part of healthcare with which the reviewer is familiar or interested?
   [==>SMW] Not for business process models that I am aware of. For data models, this is GEFEG’s specialty providing the models are in UML or XSD. We are working on a free Reader for HL7 and are committed to supporting VEBC. I would like to do the same for openEHR but I am overloaded with work and free software doesn’t pay the bills ;-).

also, UML / XSD are only useful for some things. They’re not good at constraint modelling, and they’re not good at expressing computerised clinical guidelines for example.

3. What would an industry consortium look like if it was organized expressly for the purpose of creating, vetting, and maintaining/evolving such a model for all of healthcare? (Vision E-Business Council is attempting to do this for the Vision Care industry). While such a consortium would obviously require expert representation from all provider domains, it would have to also represent providers’ direct trading partners and supporting technology partners… essentially, all interested parties in one organized healthcare conversation. Eventually, I assume that even patients’ would have an interest in reviewing and commenting on such models.

I don’t know about this - I think that would probably be asking too much - at least today.

As such, the industry consortium would become the most clear, vetted, and unified voice of healthcare into international standards bodies like ISO, HL7, etc.
[==>SMW] A single consortium for all of healthcare would never accomplish any real work. IMHO, what we need is collaboration amongst all healthcare industry groups and a commitment not to duplicate effort. Such a project is just beginning in UN/CEFACT for other industry groups.

I believe that standardization efforts from this point forward should concentrate on building out the various sections of this Enterprise Model, corresponding to the different specialty domains of healthcare. The resulting standard model could simply be published… in a machine-understandable form… as our Consensus Industry View of how things are most efficiently done.

Countless different local implementations could be publicly or secretly mapped to such a public model. If each software vendor made his map public, however, all others would be able to infer an interoperability-mapping from it. Local vocabularies, concept-models, and message structures, for example, would not have to be identical in form to our Standard Model, in order to achieve interoperability. If all parties simply maintained a prescribed type of mapping to the master reference model, then systems should be [relaiively easily] mapable to each other.

yes, that’s the dream! I think we’re getting somewhere with that…

By moving the standardization efforts away from specific message templates and data dictionaries and toward a global Enterprise Model, large trading partners like payers and manufacturers would be able to continue their beloved practice of “dictating” information requirements to smaller providers… as long as all such dictations and mandates were expressed in standard, machine-understandable forms.
[==>SMW] ok.

certainly I don’t think specific message templates have a long term future - clinical reality (and technology) is just too fluid for that kind of thing.

In the US we have recently completed a $15 Billion demonstration (HIPAA) of the fact that it is impossible to persuade large stakeholders to adopt identical message structures and data dictionaries… even if you threaten them with the wrath of the federal government. On the other hand, if we have a standing, universally visible, best-practice enterprise model for healthcare… then no mandates will be needed… except, maybe, to pay the cost of maintaining the standard model. This cost would be minuscule, compared to the cost of trying to mandate HIPAA-like standardization efforts at the message level… which are doomed anyway. Each stakeholder should perceive the obvious economic advantage to itself [and also to its partners, of course] of ensuring that a non-ambiguous mapping is maintained between its system and the standard model. Why would a software developer not want to conform to such a model, if one existed??
[==>SMW] I believe it will be equally as difficult to convince large stakeholders to adopt a single enterprise model. This is human nature. I do see a need and movement towards a single enterprise architecture but not a single enterprise process or data model.
Software developers will not want to adopt such a model if they do not see how they can make a profit. At least today, it is not possible to go directly from some business and data models to XML schema languages. A good example of this limitation is the OAGIS standard. This means added development and maintenance costs. From a commercial software developers perspective, you must also keep in mind a desire or need to support legacy processes where such a model would not be used. While this should not be an issue for large software houses, it can be a real issue for smaller software companies.

as long as the ‘enterprise model’ of which you speak is small and as invariant (while still being rich enough) as possible. But everyone needs to get onto the same page as to what an appropriate ‘enterprise’ or ‘reference’ model is.

• thomas

• If you have any questions about using this list, please send a message to d.lloyd@openehr.org

[Sam (Sam Heard)]

Kaely

Good to see you out in the open. This is a key point. Everyone has seen proprietary systems as including the EHR architecture. The openEHR camp believe that there will be 100s of proprietary systems - but if we can get the basic comprehensive EHR service together - cope with the miriad of issues that arise in this space (and are not dealt with at the moment) - people will congregate around this and use it.

So, if there is sufficient support for a good EHR service - open and available - it should make providing applications a lot easier. And standards become less of an issue as the mapping of data to a common EHR service is a once only experience and then everyone can use it.

This is not nirvana - but it should make it all a little easier.

Sam

[Tim_Benson1 (Tim Benson)]

I have a couple of points about the value of one or many models…

First, it is always best to use a single UML model, not to split it. So one model is best. Only in this way can you achieve coherence. I would go further and say that it is almost impossible to keep two or more separate models fully consistent with each other. Any large model must be created using a professional-quality UML modelling tool, which needs to include everything known about the project. Note that in UML a model is the totality of information known about a project, while diagrams are just single views into the model. A big model has dozens, if not hundreds of diagrams.

Second, any model should have a single purpose. One only. I have been working on models to specify interoperability. Such models are quite different from models of the real world and of database structures. Any attempt to use a model outside the tightly defined purpose for which it has been created is doomed to failure.

As far as I know the available tools do not provide any help in mapping between two or more models of the same domain with different purposes.

I use Poseidon for UML (version 2.6) which comes in several versions. The three of most interest are Enterprise (which allows more than one person to work on the same model) priced at $3,000, Standard which gives an individual modeller all you need ($250), and Community which is FOC.

Tim

Tim Benson
Abies Ltd, 93 Milespit Hill, Mill Hill Village, London NW7 2RS, UK
020 8906 3121, mob: 07855 682037, fax 020 8906 3206
tim.benson@abies.co.uk http://www.abies.co.uk

[Amnon_Shabo]

Dear Kaely,
You are asking:
   "How can a purely commercial model (the independent health records
      banks) effectively operate in a highly subsidized (and arguable
      distorted) health system? Doesn't there need to be value for health
      care providers, health care consumers and other players? How is this
      achievable in a purely commercial model if the health system itself
      is not purely commercial?"

The idea of Independent Health Records Banks has many aspects which I've
not described in my message. Attached please find a paper that describes it
in detail. Note that such banks will be established further to new
legislation which will mandate the regulation of the banks by the public,
so it's not really "purely commercial". In addition, "Independent" refers
to the fact that they will be independent of provides, insurers, government
agencies, etc. thus avoiding conflicts of interests commonly found today
(e.g., HMO organizations).

On the economic side, a major shift is accomplished by cutting the
archiving costs for providers and letting them focus on information
technologies for their ongoing medical operations. This will happen since
the new legislation will no longer require a provider to keep patient
records and consider the bank's EHR as the only medico-legal record.

But most importantly, these new players are the only chance to see a true
EHR finally emerging, as I don't see any existing stakeholder capable of
sustaining an EHR for the entire lifetime of an individual. A usable and
useful EHR is the main value for health care consumers and their insurers
will likely to support it by funding the basic account they will open in
their bank of choice (note that these will be multiple and competing
banks).
Thanks,
Amnon.
(See attached file: IHRB-Shabo.PDF)

             Kaely.Woods@healt
             h.gov.au
                                                                        To
             16/11/04 00:08 Amnon Shabo/Haifa/IBM@IBMIL
                                                                        cc
                                       Christopher Feahr
                                       <chris@optiserv.com>,
                                       crylla81@tiscali.it, "'Eric
                                       Browne'"
                                       <Eric.Browne@MontageSystems.com.au>
                                       , Gerard Freriks <gfrer@luna.nl>,
                                       "'Heath Frankel'"
                                       <heathfrankel@pacific.net.au>,
                                       openehr-clinical@openehr.org,
                                       owner-openehr-clinical@openehr.org,
                                       "'Sam Heard'"
                                       <sam.heard@bigpond.com>,
                                       smwebb@edatasystemsintegration.com,
                                       "'Tom Beale'"
                                       <thomas@deepthought.com.au>
                                                                   Subject
                                       Re: Archetype vs. ontology
                                                                           
Dear Amnon, and others

This latest post has brought me out - time to stop lurking! Not to comment
on the original question of how an archetype compares to an ontology, but
the fundamental question of how to establish a broadly shared EHR.

My viewpoint is of someone working in a government that channels a
reasonable proportion of its budget towards supporting a national health
system. In responding I must stress that this is NOT an Australian
government position - purely my own observations, and does not seek
represent the position of others in the bureaucracy or the government.

While not a "techo"crat, it is clear that even most simplistically viewed,
there are a couple of key success factors to achieving the nirvana of
shared, longitudinal EHRs:
   1. standards - critical for interoperability
   2. change management - how we change the way that people work with the
      systems (healthcare providers and consumers/patients)

      I see a role for governments in supporting these, particularly
      consistent with the extent that it is active in the health system.
      Putting all the apples in one basket is a high risk strategy, but
      standards can help overcome remove the barriers to interoperability -
      even between proprietary systems.

      How can a purely commercial model (the independent health records
      banks) effectively operate in a highly subsidized (and arguable
      distorted) health system? Doesn't there need to be value for health
      care providers, health care consumers and other players? How is this
      achievable in a purely commercial model if the health system itself
      is not purely commercial? Public -private partnerships are clearly
      worth exploring in such situations.

      If we all call the tune will the piper lead us to reason? Somehow I
      think someone needs to pay to effect such change!

      Kaely Woods

   Amnon Shabo
   <SHABO@il.ibm. To: Gerard Freriks <gfrer@luna.nl>
   > cc: Christopher Feahr
   Sent by: <chris@optiserv.com>, crylla81@tiscali.it, "'Eric
   owner-openehr- Browne'" <Eric.Browne@MontageSystems.com.au>, "'Heath
   clinical@opene Frankel'" <heathfrankel@pacific.net.au>,
   hr.org openehr-clinical@openehr.org,
                  owner-openehr-clinical@openehr.org, "'Sam Heard'"
                  <sam.heard@bigpond.com>,
   15/11/2004 smwebb@edatasystemsintegration.com, "'Tom Beale'"
   09:16 PM <thomas@deepthought.com.au>
   Please respond Subject: Re: Archetype vs. ontology
   to Amnon Shabo
                                                                          
      Hello all,
      My 2 cents: one vendor/system sounds bad (think of it when your ms
      windows
      crashes the next time) and standards (with all the respect.... and I
      do
      have a lot of respect... are not a magic solution. What we really
      need
      is a way to sustain a lifetime-cross-institutional EHR for each
      person, and
      the inevitable way to achieve it (imho) is by establishing new
      players in
      the field - Independent Health Record Banks that will solely focus on
      that
      mission while providers will finally get rid of the burden to archive
      medical records that they created (records that will always be only
      part of
      the whole EHR). Reconciling the various inputs from the provides
      along the
      lifetime of an individual (when I'm sure that may systems and
      standards
      will be replacing each other), and coming up with a useable and
      useful EHR
      at any given time and any point of care, will the banks'
      responsibility and
      speciality.
      Thanks,
      Amnon.

(attachments)

IHRB-Shabo.PDF (257 KB)

[kaely.woods]

Thanks for the elaboration Amnon.

This is quite a different model to the EHR model being developed and implemented in Australia, HealthConnect, which is not designed to replicate or replace primary clinical systems, but to capture summary data from these “events”.

Great food for thought - thank you.

Cheers
Kaely

Amnon Shabo SHABO@il.ibm.com

16/11/2004 10:08 PM


|
To: Kaely.Woods@health.gov.au
cc: Christopher Feahr chris@optiserv.com, crylla81@tiscali.it, “‘Eric Browne’” Eric.Browne@MontageSystems.com.au, Gerard Freriks gfrer@luna.nl, “‘Heath Frankel’” heathfrankel@pacific.net.au, openehr-clinical@openehr.org, owner-openehr-clinical@openehr.org, “‘Sam Heard’” sam.heard@bigpond.com, smwebb@edatasystemsintegration.com, “‘Tom Beale’” thomas@deepthought.com.au
Subject: Re: Archetype vs. ontology |

• | - | - |

Dear Kaely,
You are asking:
“How can a purely commercial model (the independent health records
banks) effectively operate in a highly subsidized (and arguable
distorted) health system? Doesn’t there need to be value for health
care providers, health care consumers and other players? How is this
achievable in a purely commercial model if the health system itself
is not purely commercial?”

The idea of Independent Health Records Banks has many aspects which I’ve
not described in my message. Attached please find a paper that describes it
in detail. Note that such banks will be established further to new
legislation which will mandate the regulation of the banks by the public,
so it’s not really “purely commercial”. In addition, “Independent” refers
to the fact that they will be independent of provides, insurers, government
agencies, etc. thus avoiding conflicts of interests commonly found today
(e.g., HMO organizations).

On the economic side, a major shift is accomplished by cutting the
archiving costs for providers and letting them focus on information
technologies for their ongoing medical operations. This will happen since
the new legislation will no longer require a provider to keep patient
records and consider the bank’s EHR as the only medico-legal record.

But most importantly, these new players are the only chance to see a true
EHR finally emerging, as I don’t see any existing stakeholder capable of
sustaining an EHR for the entire lifetime of an individual. A usable and
useful EHR is the main value for health care consumers and their insurers
will likely to support it by funding the basic account they will open in
their bank of choice (note that these will be multiple and competing
banks).
Thanks,
Amnon.
(See attached file: IHRB-Shabo.PDF)

Kaely.Woods@healt
h.gov.au
To
16/11/04 00:08 Amnon Shabo/Haifa/IBM@IBMIL
cc
Christopher Feahr
chris@optiserv.com,
crylla81@tiscali.it, “‘Eric
Browne’”
Eric.Browne@MontageSystems.com.au
, Gerard Freriks gfrer@luna.nl,
“‘Heath Frankel’”
heathfrankel@pacific.net.au,
openehr-clinical@openehr.org,
owner-openehr-clinical@openehr.org,
“‘Sam Heard’”
sam.heard@bigpond.com,
smwebb@edatasystemsintegration.com,
“‘Tom Beale’”
thomas@deepthought.com.au
Subject
Re: Archetype vs. ontology

Dear Amnon, and others

This latest post has brought me out - time to stop lurking! Not to comment
on the original question of how an archetype compares to an ontology, but
the fundamental question of how to establish a broadly shared EHR.

My viewpoint is of someone working in a government that channels a
reasonable proportion of its budget towards supporting a national health
system. In responding I must stress that this is NOT an Australian
government position - purely my own observations, and does not seek
represent the position of others in the bureaucracy or the government.

While not a "techo"crat, it is clear that even most simplistically viewed,
there are a couple of key success factors to achieving the nirvana of
shared, longitudinal EHRs:

1. standards - critical for interoperability
2. change management - how we change the way that people work with the
   systems (healthcare providers and consumers/patients)

I see a role for governments in supporting these, particularly
consistent with the extent that it is active in the health system.
Putting all the apples in one basket is a high risk strategy, but
standards can help overcome remove the barriers to interoperability -
even between proprietary systems.

How can a purely commercial model (the independent health records
banks) effectively operate in a highly subsidized (and arguable
distorted) health system? Doesn’t there need to be value for health
care providers, health care consumers and other players? How is this
achievable in a purely commercial model if the health system itself
is not purely commercial? Public -private partnerships are clearly
worth exploring in such situations.

If we all call the tune will the piper lead us to reason? Somehow I
think someone needs to pay to effect such change!

Kaely Woods

Amnon Shabo
<SHABO@il.ibm. To: Gerard Freriks gfrer@luna.nl

cc: Christopher Feahr
Sent by: chris@optiserv.com, crylla81@tiscali.it, “‘Eric
owner-openehr- Browne’” Eric.Browne@MontageSystems.com.au, “‘Heath
clinical@opene Frankel’” heathfrankel@pacific.net.au,
hr.org openehr-clinical@openehr.org,
owner-openehr-clinical@openehr.org, “‘Sam Heard’”
sam.heard@bigpond.com,
15/11/2004 smwebb@edatasystemsintegration.com, “‘Tom Beale’”
09:16 PM thomas@deepthought.com.au
Please respond Subject: Re: Archetype vs. ontology
to Amnon Shabo

Hello all,
My 2 cents: one vendor/system sounds bad (think of it when your ms
windows
crashes the next time) and standards (with all the respect… and I
do
have a lot of respect… are not a magic solution. What we really
need
is a way to sustain a lifetime-cross-institutional EHR for each
person, and
the inevitable way to achieve it (imho) is by establishing new
players in
the field - Independent Health Record Banks that will solely focus on
that
mission while providers will finally get rid of the burden to archive
medical records that they created (records that will always be only
part of
the whole EHR). Reconciling the various inputs from the provides
along the
lifetime of an individual (when I’m sure that may systems and
standards
will be replacing each other), and coming up with a useable and
useful EHR
at any given time and any point of care, will the banks’
responsibility and
speciality.
Thanks,
Amnon.

(attachments)

IHRB-Shabo.PDF (257 KB)

[Amnon_Shabo]

Kaely,
Just a short clarification: the EHR banks are, by no means, meant to
replace "primary clinical systems" - they will only sustain the information
of individuals, created by providers in their "primary clinical systems".
Thanks,
Amnon.

             Kaely.Woods@healt
             h.gov.au
                                                                        To
             16/11/04 13:33 Amnon Shabo/Haifa/IBM@IBMIL
                                                                        cc
                                       Christopher Feahr
                                       <chris@optiserv.com>,
                                       crylla81@tiscali.it, "'Eric
                                       Browne'"
                                       <Eric.Browne@MontageSystems.com.au>
                                       , Gerard Freriks <gfrer@luna.nl>,
                                       "'Heath Frankel'"
                                       <heathfrankel@pacific.net.au>,
                                       openehr-clinical@openehr.org,
                                       owner-openehr-clinical@openehr.org,
                                       "'Sam Heard'"
                                       <sam.heard@bigpond.com>,
                                       smwebb@edatasystemsintegration.com,
                                       "'Tom Beale'"
                                       <thomas@deepthought.com.au>
                                                                   Subject
                                       Re: Archetype vs. ontology

[thomas.beale]

Tim Benson wrote:

I have a couple of points about the value of one or many models...

First, it is always best to use a single UML model, not to split it. So one model is best. Only in this way can you achieve coherence. I would go further and say that it is almost impossible to keep two or more separate models fully consistent with each other.

Hi Tim,

it depends on what you mean by 'one model', 'two models' etc. I guess you probably mean separate models in the UML tool sense. In openEHR, we tend to have a number of models, all based on the same underlying types, to ensure coherence. However, we haven't found many of the commercial UML tools to be that convincing - either for diagrams or semantics. Rose is too expensive and its drawing is not very controllable, Visio is completely hopeless semantically, even if its drawing is better. Objecteering looked interesting for a while. None of them do invariants or pre and post-conditions; invariants are the most important thing in a class model.

Any large model must be created using a professional-quality UML modelling tool, which needs to include everything known about the project. Note that in UML a model is the totality of information known about a project, while diagrams are just single views into the model. A big model has dozens, if not hundreds of diagrams.

Second, any model should have a single purpose. One only. I have been working on models to specify interoperability. Such models are quite different from models of the real world and of database structures. Any attempt to use a model outside the tightly defined purpose for which it has been created is doomed to failure.

yes, I completely agree there - this is the failure of 'domain models' produced by numerous 'experts', embodying no single 'point of view' (my way of thinking about purpose).

As far as I know the available tools do not provide any help in mapping between two or more models of the same domain with different purposes.

I think this will have to change one day due to the tension between integration and change management - for the latter, you want a number of smaller pieces (e.g. data types, data structures, ehr, demographic, EHR extract etc), where a change affects only one piece at a time, but from the modelling point of view, you want seamless integration of all models. To make this happen (e.g. to make 2 distinct models share the same data types model), an ability to import a lower level model is needed in these tools.

- thomas

[thomas.beale]

Amnon's proposal is also not trying to replace primary or 'source' clinical systems. In fact, the EHR bank is not that far from the Australian HealthConnect "HRS" or Health Record Server, which it has already been suggested in Australia might be run by third parties, under regulation. The whole issue of what is a "summary" continues to be contentious when talking of GP systems, but most people agree that you don't want to upload everything from a hospital system.

- thomas

[Mike_Mair]

Dear Sivam,

For an approach to access control, I would like to draw your attention to work that Stephen Chu and I presented at the recent CDA conference in Mexico on Oct 22 (downloadable from http://www.hl7.de/iamcda2004/fprogram.html ). The proposal might also work for the NHS project whether or not the universal container is a fully fledged CDA, or some other similar ‘useful box for putting things in’. Adoption of a standard is going to be a little arbitrary anyway, so why not use something that is already there?

We have tried to think of a way to allow local control of role definitions, while ensuring interoperability by using a limited set of ‘core roles’ (Administrator, Clinician, Researcher, Self) of which the named local roles are blends. They would not need to be on a register. If only we could put archetypes into these boxes (which is under discussion for Release 2 and Release 3 CDA). The enhanced CDA could be at least a short term ‘fix’ for interoperability which would get the process going, and then it might find its own direction.

Regards

Mike Mair
Timaru Eye Clinic
New Zealand

[Christopher_Clay]

This problem of summaries really relates mostly to clinical information. It
was suggested to the government sponsored EHR conference in Adelaide (South
Australia) in 1997? when we were about to get an Australia wide system
within six years on some estimates that the entire system could be paid for
by the money saved by eliminating duplicate tests.
If we could just get the test results available on line and possibly a
system that lets you know when that test was last ordered, enough money
could be saved in Australia to pay for setting up a system in which these
other ideas could be tested.
Pathology tests are already sent to a number of doctors in my city
electronically and are almost all expressed in a standard form that all
medicos understand (and are accompanied by the normal range for the lab
concerned). If there are tests that a doctor does not understand and which
might be relevant to the patient's current problem, she can ring the
ordering clinician and discuss the matter.
Cheers
CDC, Perth

[Philippe_AMELINE1 (Philippe AMELINE)]

Hi Thomas,

The very word we are talking about here is Knowledge management. Archetype and ontology are some (very strategic) components, but are not the "whole thing".

concepts : artificial intelligence (AI) and smart data management.
An example of smart data management is the ability, when you expect a document of 'A' type and that a document of 'B' type arrives, to check if 'A' -is a-> 'B' or 'B'-contains->'A', in order to close the goal "get a A".

So, Knowledge management doesn't only mean expert systems or smart agents, but a system that is globally aware of what it manages.

In Odyssee, the ontology is the very kernel of the systems, since it is the langage used to tell the patient health journey, but also to represent the internal knowledge.
The AI components are structured around a Blackboard (we started from Stanford's BBK, now largely adapted) that federates smart agents.
The smart data management components are everywhere else, for example in the data model and interfaces management.

This (somewhat long) introduction to tell that, in the way we use it, Archetypes are data model elements and Fils guides are interface elements of the smart data management category.

A Fil guide is a multi-purpose information element aimed at answering the question "what can I do now ?" for something/someone that is somewhere in a tree (multi-purpose isn't it ;o)).
So a Fil guide is made of two parts : a path (in the form colonoscopy/description/polyp or colonsocopy/*/polyp or */polyp) and a content (currently in the form of a list of ontology concepts that can allow to bring the description one step further, but it can be anything else - say an html page or a function pointer).

When you describe something in the medical field, if there is a genuine "gold standard" description, you have to use a deterministic approach, since the user has to be compliant to the standard. This description becomes part of the information system reference model through an Archetype. And the instanciated data remember the mold (Archetype) they come from.
But in most cases, there is just a fuzzy expertise, and you can just say something like "being where you are, an expert would keep on the description that way" : it is tipically what a Fil guide will do. You have many Fils guides in a big bag, and when the user is somewhere, you find the more relevant Fil guide (if any) : more relevant means the one whose path is the semantically closest from user actual current path. But the Fils guides are just oppostunistic description support in a non deterministic domain. So the data don't remember the Fil guide they come from.

This (too) long description to explain that Fils guides neither belong to the reference model, nor to the ontology, but are interface components in a knowledge management system.

Currently, we have nearly 3500 Fils guides, but most of them are used for our report management system and should be replaced with archetypes.

By the way, the Fil guide engine, that decides which Fil guide to throw, can also decide to throw an Arcehtype if the user has entered a part of domain where a deterministic description should occur. And you also can go beyond the leaves of an Archetype using Fils guides (or just using the ontology by hand).

I hope that all this is understandable ;o)

Philippe AMELINE

[Sam (Sam Heard)]

Philippe

Thank you for this...very informative and I am starting to see how we are converging with your work.

I believe that the 'structured terminology' - fils guide down from the archetype nodes - is an important part - SNOMED are trying to address it generically (ie without archetypes) - I doubt this is possible in one language - and it is certainly not in other languages.

approach that you are taking as qualifying terms (such as adjectives) tend to follow their nouns and the subject, verb, object structure is usual in sentence. I know that moving to English - where qualifiers precede, that such an approach has to be more sophisticated - and in other languages it is far more complex.

What is called for is getting to grips with some key archetypes for interoperability - from a range of stakeholders - and then really having a close look at where more complex terminology is sought. One place I have no doubt it is required is in anatomy....how you describe the location of a lesion or mass. Another is the characteristics of a mass or lesion.....

The high level 'smarts' you are talking about are impressive - and I do not know about this end of things.

Cheers, Sam

[Philippe_AMELINE1 (Philippe AMELINE)]

Hi Sam,

The structured langage is not a direct mapping from natural langage. It is a tree of concepts ordered from generic to specific.

Example (sorry if I don't use the proper medical terms in english) :

polyp
-- location
---- left colon
-- size
---- 3 mm
-- aspect
---- pedonculated

This tree means that you have found a "pedonculated polyp whose size is 3 mm in the left colon"
polyp, location, left colon, size, mm, aspect, pedonculated are concepts taken from the ontology

If you want to make a natural langage sentence out of the tree, you will have to put it in a grammatical generator if order to put all its parts at the right place in a sentence.

Building a generic model for this polyp description tree is absolutely the same work as making an Archetype in openEHR, except that you directly build the Archetype with "semantical concepts" instead of abstract information mapped to terminologies.
You can keep some mappings if you want to put automatic classification at work (for example, this polyp can be classified in ICD) but this mapping is no longer a semantisation concept.

The ontology is a genuine component, and each time you put one of its term in a tree, you automatically get a bunch of inherited properties, for translation purposes, for example.

Cheers,

Philippe

Sam Heard wrote:

[Carl_Mattocks]

Philippe, Sam et Al :

Seeking clarification ..

Is it true to say :
the real distinction between an Archetype and an Ontology is that -
the role of an Archetype (item) is to provide contextual constraints
the role of an Ontology (item) is to provide conceptual constraints

an Ontology (item) concept can be applied as an Archetype (item) constraint

an Ontology item must have object oriented properties e.g. it is composed
an Archetype item must have data (info) properties e.g. it has a type

a Set of Archetype items (whether or not linked to a template) may have
info properties that are the equivalent of a particular Ontology (but not
explicitly asserted)

carl

<quote who="Philippe AMELINE">

[system]

Hi,

An other property of the Archetype is that it is derived from a a model that models the structure via which information is stored/represented/ retrieved in a system.

GF

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[Carl_Mattocks]

HI GF :

Do you agree that this can also be true for an Ontology .

carl

<quote who="Gerard Freriks">

[system]

Hi,

I can buy this.
But have you ever seen the UML model behind ICD, ICPC, or even SNOMED?

I know I;ve seen the one behind the CEN/TC251 EN 13606 where a kernel model (UML) representing a generic document will be populated by Archetypes that are derived from a Archetype model (UML).

Gerard

[Carl_Mattocks]

Gerard :

Good point.
I would like to see the UML models .. does anyone have them to share ?

carl

<quote who="Gerard Freriks">

[thomas.beale]

Gerard Freriks wrote:

Hi,

I can buy this.
But have you ever seen the UML model behind ICD, ICPC, or even SNOMED?

I know I;ve seen the one behind the CEN/TC251 EN 13606 where a kernel model (UML) representing a generic document will be populated by Archetypes that are derived from a Archetype model (UML).

more importantly, statements in ICD, Snomed etc, are not in the form of constraints on instances of classes in a reference model.

- thomas

[Koray_Atalag]

Hi,

I would like to comment on this issue because I have been working with
terminologies, ontologies and archetypes for my thesis work and I came up
with a lot of people who required a clear definition of these terms lately.

I can say that the terminologies form the formal words to describe a
clinical (or any other) concept... Ontologies add another level of knowledge
about the meaning and context of these terms; i.e. like combinations of
formal/meaningful sentences derived from these words. However archetypes are
distinct from ontologies from such a point that, it has an underlying
information model which it must conform and IMHO it forms the smallest
indivisible unit for describing real world clinical (or any other) entities.

It is those information items that are represented formally by archetypes
that need to be exchanged among clinical information systems. Tom has a very
cool description that I often use to explain people the distinction among

archetype chain: These I depict the classical
knowledge boundaries in IT.

In my thesis work I am modeling endoscopic examination with archetype and
templates methodology (Or I would say I am trying to...) I am using a
standardized terminology or I would say terminology/ontology) which is
called MST 2 (Minimal Standard Terminology for Endoscopic Gastroenterology)
which is available in 10 languages and already integrated with UMLS. The
MST-colon archetype is the outcome of this work.

I believe the archetype methodology currently promises to be an elegant
solution for interoperability of clinical information among disparate
information systems. Because like all other important things in life (Like
Newtons's laws!) it is simple... I think the next issues to be solved
includes modeling of dynamic behaviour of IS like clinical and other types
of workflows, User Interface issues for generation of Structured Data Entry
(SDE) forms for data entry, simple, intuitive and still powerful querying
and data extraction methods. I agree with Mr. Amnon Shabo that the future
business model of EHR repositories lies in independent HER banks - that's
for sure...We had already discussed these issued in FP6 project preparations
of you remember (HealthMobile). If we could trust the banks to take care of
our money, then why bother to complain about security of health records?
IMHO from whatever point of view, in our non-ideal world, money is more
important than lives of individuals! Look at the misery at Iraq... That's
unfortunately the reality whether we like it or not.

Well bye for now,

Koray Atalag, M.D.