In een bericht met de datum 27-1-2007 10:54:32 West-Europa (standaardtijd), schrijft gfrer@luna.nl:
Hi Tim,
Agree. As a public health epidemiologist, I am personally interested in
how openEHR might perform in the setting of population-based data
collections, where millions (or tens or hundreds of millions) of records
and large aggregate queries, such as cross-tabulation queries - are the
norm. We know that traditional normalised relational databases don't cut
the mustard for such purposes, keen to see whether openEHR does.
I don't agree with this.
The big mistake would be to use the Archetypes paradigm as a golden
hammer (so beautiful it can replace screwdrivers as well).
The very basic of Archetypes is that they are used for description.
If you want to build classification databases, it is really not wise, to
use "two levels modeling".
1) Assemble descriptions of several clinical situations. By
descriptions, I mean natural language descriptions in the form of
full-text, unencoded clinical histories and progress notes etc, abetted
by investigation results, diagnostic images and their reports, and
perhaps even photos of the patient and so on. A dictated, textual report
which runs to 4 or 5 or more pages from a fastidious and diligent
specialist physician to a GP might be good raw material.2) Train at least two independent groups of clinicians and
informaticians (but not people with personal investments of time or
otehr interests in the development of openEHR i.e. not anyone on this
list) in the use of openEHR, including the creation of archetype
definitions and templates.3) Give these groups access to the same repository of openEHR archetype
definitions and templates, and access to the same set of openEHR
software tools, and ask each group to independently a) select and/or
construct a set of archetype and template definitions which they feel
are required to capture the information in the clinical material (as
described above) provided to them, and b) to capture the clinical
scenario information in the openEHR structures that they create.4) Have a third party compare in some pre-defined way the two openEHR
versions of the original clinical scenario, using a predefined scoring
system (which would need to be developed, or do such things exist?).
Alternatively, the two groups might exchange their openEHR
representations and rate each other.There are lots of variations on this theme, but this sort of evaluation
would seem to test the "impedance" and information loss at: a) the
human->openEHR interface; b) the openEHR<->openEHR data exchange
interface;, and c) the openEHR->human interface. All of these interfaces
matter, and even if openEHR is a great technical solution, it is how it
works in the real world, which is what an evaluation like the one
outlined above aims to test, is what matters.
I don't agree there either.
Archetype building is in the domain of expertise capture. The Archetype
concept, as a component of two levels modeling is only there to provide
information systems with the ability to seamlessly follow the natural
evolution of the medical field, while remaining consistent and robust.
Good expertise capture will lead to good Archetypes in the same way this
proper analysis would have give birth to a good "single level modeling"
software. The big difference is that, when release 2 is needed, the
former system just needs the change of some xml files while the other
needs change in the database and in a bunch of software code.
I understand from your proposed test that you think something like
"since it is easy to build Archetype, lets get it done by non experts
and see if they can do something good". I don't think it is the good
direction either to understand the concept or to test it.
Two level modeling and Archetypes will eventually become a universal
paradigm in complex domains programming, in the same way multi-tier or
multi-components paradigms are basic good practices. There David More is
wrong to criticize, and it is probably because he is not a programmer
and don't really understand what is at stake here.
On the other way, I must say that I won't blame him when he says that
trying to force a community to use something by establishing it very
early as a standard is at least "unwise". Paradigm are successful if and
only if they address real life needs better than other existing paradigms.
Trying to establish standards to give birth to the "ultimate horse cart"
when the first cars are appearing is just a way to publish that you are
missing the point.
We are on the verge of a major paradigm shift in ICT for health: moving
from "single viewpoint snapshots records" to continuity of care
"concurrent engineering". I am confident in the fact that Archetypes are
a major concept to build modern system... the value of openEHR will come
from its ability to ease and lead the continuity of care paradigm shift,
not necessarily from its ability to give tools for EHR extracts exchange
(honestly, would it be that needed, then it would have happened more
earlier ; GEHR already existed last century).
My 2 cents,
Philippe