# Open Source EHR at the Americal Academy of Family Physicians ...
**URL:** https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758
**Category:** Technical (archive)
**Created:** [18 August 2003 12:31 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758 "2003-08-18T12:31:38Z")
**Posts on this page:** 11
**Page:** 1
### Author:  [@Angelo\_Rossimori](https://discourse.openehr.org/u/Angelo_Rossimori)
#### Post date: [18 August 2003 12:31 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/1 "2003-08-18T12:31:38Z")
Dear friends,
perhaps someone of you knows more about this initiative ?
---
### Author:  [@Christopher\_Feahr](https://discourse.openehr.org/u/Christopher_Feahr)
#### Post date: [18 August 2003 23:29 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/2 "2003-08-18T23:29:37Z")
My understanding is that it is evolving from the "CCR" (continuity of
care record) project involving the state of Massachusets and the ASTM
medical records standards project outlined at:
[http://www.astm.org/cgi-bin/SoftCart.exe/COMMIT/COMMITTEE/E31.htm?L+mystore+qkvm5991+1061259141](http://www.astm.org/cgi-bin/SoftCart.exe/COMMIT/COMMITTEE/E31.htm?L+mystore+qkvm5991+1061259141)
Personally, I would like to see all EHR-related standards work... at
least in the US... coordinated under the umbrella of HL7. At the
moment, the CCR project does not appear to be headed toward HL7.
Christopher J. Feahr, O.D.
Optiserv Consulting (Vision Industry)
Office: (707) 579-4984
Cell: (707) 529-2268
[http://Optiserv.com](http://Optiserv.com)
[http://VisionDataStandard.org](http://VisionDataStandard.org)
---
### Author:  [@USM\_Bish](https://discourse.openehr.org/u/USM_Bish)
#### Post date: [19 August 2003 21:30 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/3 "2003-08-19T21:30:17Z")
> Personally, I would like to see all EHR-related standards
> work... at least in the US... coordinated under the umbrella
> of HL7. At the moment, the CCR project does not appear to be
> headed toward HL7.
I really don't know if HL7 would be the way things would go
unless they remove the image that they belong to an
exclusive club. The response I received from HL-7 (India) is
placed below for your perusal.
Dr USM Bish
----------------------\----------------------------
> You could receive the same from HL7 Inida. This is provided
> along with HL7 India membership. ( membership fee is Rs
> 35,000)
>
> regards
>
> Saji
>
> \> On 2003-04-10 at 03:14:04
> \>
> \> I am interested in obtaining the full HL-7 specs valid as on
> \> date. It is requested, that I may kindly be advised from
> \> where I could obtain the same.
> \>
> \> USM Bish
----------------------\----------------------------
---
### Author:  [@Christopher\_Feahr](https://discourse.openehr.org/u/Christopher_Feahr)
#### Post date: [20 August 2003 00:18 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/4 "2003-08-20T00:18:28Z")
Dr. Bish,
I'm not sure that I understand your comment about HL7 being an
"exclusive club"... although you seem to be alluding to the cost of
membership. I have only dealt with individual membership dues which run
about $500/yr. While it's true that other classes of membership are more
costly, I believe this reflects the present operational costs of an ANSI
accredited standards committee. X12 costs are similar.
I agree that from the provider perspective, the costs to participate in
HL7 are often seen as prohibitive... particularly when time, travel, and
lodging costs are considered for meeting attendance. The same is true
of X12N and UN/CEFACT, which explains the dearth of provider input to
these organizations. It also helps to explain why the US govt. is
presently attempting to force big-payer-inspired EDI standards onto our
entire healthcare community, when the X12 EDI model is clearly of no
value to \>300,000 provider organizations. However, there were no
provider-centric standards that the government could have adopted in
lieu of X12's... because there are no provider-centric SDOs, or even
Insurance-centric SDOs with significant provider input. HL7 is
"provider-centric" in theory, but all SDOs end up being "dues-paying
member"-centric in actual operation... something that can be changed.
simply by having provider associations participate as members.
Providers need an SDO that is focused on the functional requirements of
\*healthcare\* delivery in all 30 or so major specialty domains and care
settings. From SDO-maintained functional models, vendors should be able
to design provider systems with reasonable levels of interoperability...
and any sort of EHR system that a user may require.
This approach to standards development is not supported by the
part-time, all-volunteer, big-enterprise-member SDO model used by HL7.
Providers require a standards organization with a predictable revenue
stream and reliable, full-time human resources. But... that means
provider associations and specialty societies must step forward... as
HL7 members... and insist on a mechanism for getting their members'
needs baked into our global standards. HL7 will always adapt to the
needs of its members, as it has for 15 years.
NCVHS, DHHS, CMS, and the agencies behind the Consolidated Health
Informatics initiative (DOD, Veterans Adm, Indian Health, Homeland
Security, etc.)... are unanimous in selecting HL7 are the lead SDO for
health care in the US. The federal govt. is particularly interested in
the EHR work and is expecting HL7 to take the lead there, as well.
There has never been a better opportunity or a more obvious need for
massive provider input than around these "EHR" issues.
It's time providers got themselves onto the Big SDO Radar Screen. At
this time, HL7 appears to be our best entry point for providers in the
US and abroad.
Best regards,
-Chris
Christopher J. Feahr, O.D.
Optiserv Consulting (Vision Industry)
Office: (707) 579-4984
Cell: (707) 529-2268
[http://Optiserv.com](http://Optiserv.com)
[http://VisionDataStandard.org](http://VisionDataStandard.org)
---
### Author:  [@David\_Forslund](https://discourse.openehr.org/u/David_Forslund)
#### Post date: [20 August 2003 02:04 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/5 "2003-08-20T02:04:02Z")
I'm a member of HL7, but I believe the requirement to pay for the standards is
not the best approach. Once the standards are complete, they should
be entirely free. It is reasonable to charge for the participation
and influence in the process to create the standard. It isn't the membership
fee that I object too, but the fact that the standards can't be obtained
without paying.
Dave
---
### Author:  [@hoptimis](https://discourse.openehr.org/u/hoptimis)
#### Post date: [20 August 2003 13:22 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/6 "2003-08-20T13:22:18Z")
To give to HL7 the name of an “exclusive club” is very strange; could you give some explanations?
---
### Author:  [@David\_Forslund](https://discourse.openehr.org/u/David_Forslund)
#### Post date: [20 August 2003 13:37 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/7 "2003-08-20T13:37:41Z")
I don’t know that it merits the name of an “exclusive club”, but the “open” standards that the
HL7 produces are only available to paying members, which makes them a little less than open,
in my opinion. This is a practice followed by other SDO’s, but not by all open standards bodies.
---
### Author:  [@USM\_Bish](https://discourse.openehr.org/u/USM_Bish)
#### Post date: [20 August 2003 20:51 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/8 "2003-08-20T20:51:23Z")
---end quoted text---
If you see the mail that I attached, all that I asked is a
place where I could obtain the HL-7 standard (still under
evolution) for study and knowledge. The reply I got from
HL-7 (India) was that I need to be a member of HL-7.
There are two issues which are discrete:
a) Membership of a core group.
b) Access to standards themselves.
Linking these two issues, to my assessment is definitely
incorrect. For all computer related standards there is an
well established system of RFCs, and is available openly for
perusal and contribution, specially so in the evolving
stages.
When an International Standard (presently 11 odd countries
being signitory) is under evolution, it is logical that the
standards themselves be open to suggestions, rather than
being restricted by alternate clauses.
The term "exclusive club" may be rather harsh, but I was at
a loss to find some alternate term of describing the
situation. Sincere apologies.
As it stands, unless you are a member of the HL-7, you are
denied access to what is "cooking" ! More openness is
expected from any standards forming body, if it needs to
evolve to an internationally accepted standard ... like all
other internationally accepted standards in vogue.
Bish
---
### Author:  [@David\_Forslund](https://discourse.openehr.org/u/David_Forslund)
#### Post date: [20 August 2003 15:45 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/9 "2003-08-20T15:45:36Z")
Actually, I think the situation is the reverse. It is usually fairly easy to get the preliminary versions
of a standard from HL7 for free (from their web site), but you have to pay for the final approved versions.
The OMG policy is a little different. It is easy to get both preliminary and final copies of standards
from the OMG for free, but you can't really participate in the formation of the specification standard
without being a member. This doesn't mean that others can't make suggestions, but the responsibilty
of finalizing the standard lies solely with the members.
This latter state is true for HL7, too, since only HL7 members can vote on a standard. But in HL7, once
the standard is approved as final, it costs money to get it. I think this is true of other bodies such
as ANSI and ISO.
Dave
---
### Author:  [@USM\_Bish](https://discourse.openehr.org/u/USM_Bish)
#### Post date: [21 August 2003 01:00 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/10 "2003-08-21T01:00:07Z")
I would assume that the path set by Object Management Group,
W3C Consortium etc would be the expected thing. It is fair
enough to keep the policy making aspects inhouse, but
availability of the standards themselves need to be open.
Bish
---
### Author:  [@David\_Forslund](https://discourse.openehr.org/u/David_Forslund)
#### Post date: [20 August 2003 20:15 UTC](https://discourse.openehr.org/t/open-source-ehr-at-the-americal-academy-of-family-physicians/15758/11 "2003-08-20T20:15:54Z")
I agree with you. I don't like the HL7 policy. The side effect that is bad is that "selling" the specification
becomes a conflict of interest issue, because it generates revenue.
Dave