Hi,
I wonder if there are any current collaborations or collaboration plans between openEHR Foundation and IHTSDO (which is the organisation that owns and maintains SNOMED CT.)
Regards
Mikael
Hi Mikael, there have been some approaches in the past, currently I think the is no formal work between openEHR and IHTSDO (we know who they are 
A number of approaches have been made in the recent past by openEHR and CIMI, led by Dr stan Huff. The outcome is that IHTSDO do not appear to be currently interested in a formal working relationship with the content modelling communities (openEHR, Intermountain Healthcare, CIMI, ISO 13606, ...).
I personally don't understand why, but this is the line they are taking. I'm not aware of any new plans.
None of this precludes openEHR actively using IHTSDO-issued standards and specifications, which we do. ADL / AOM 2 and tooling has now been converted to using IHTSDO concept referencing URIs for example.
- thomas
Hi Tom,
I found the responsible person at IHTSDO for the collaboration with openEHR Foundation. According to her, there are active discussions to be able to soon sign a collaborative agreement between IHTSDO and openEHR and then continue to work with how SNOMED CT and openEHR artefacts practically can be used together.
IHTSDO also states over and over again that SNOMED CT needs to be implemented together with good information models to reach its full potential and IHTSDO hosted (at least) the CIMI autumn meeting in Amsterdam last year. I therefore don't understand your very negative attitude towards IHTSDO collaboration Tom.
Regards
Mikael
yes it does keep saying such things doesn't it? However, it needs to actively work _with_ other organisations on this. Terminology is not a standalone proposition...
Note that openEHR has never done anything other than cooperate and propose various kinds of formal relationship with IHTSDO - we've spent a lot of time on that. Limited results so far...
- thomas
Hi Mikael,
Ian McNicoll and I have had a number of discussions in recent months with IHTSDO to discuss licensing arrangements around SNOMED inclusion in archetypes and CKM. This is ongoing and slightly tricky as the licenses need to be with end-users of archetypes or CKMs, not just the openEHR Foundation itself.
I agree that it would be great to see some more interaction between the two organisations at the data modelling level, and you can see from Thomas’ email that there have been attempts over the years, but little traction.
I was pleased to see that IHTSDO has developed an expert Modelling Advisory Group a few months ago, so much so that I nominated for a position thinking that this would be an opportunity to further the inter-organisational collaboration, only to be unsuccessful. I wonder if anyone else from openEHR nominated and was successful.
I would definitely like to see more collaboration - the end result could be a powerful disruption for the ‘little data’.
It would also be good to hear that people inside IHTSDO are agitating for more engagement with openEHR.
Regards
Heather
Dr Heather Leslie MBBS FRACGP FACHI
Consulting Lead, Ocean Informatics
Clinical Programme Lead, openEHR Foundation
p: +61 418 966 670 skype: heatherleslie twitter: @omowizard
While the reasons for collaboration may be different, I felt like I should report that we have been working very successfully under a collaboration agreement between the International Council of Nurses and IHTSDO on the development of equivalency tables between the International Classification for Nursing Practice (ICNP) and SNOMED CT. I have no reason to doubt the possibility a similar arrangement between the openEHR Foundation and IHTSDO.
With best wishes
Nick
Nick Hardiker RN PhD FACMI
Professor of Nursing and Health Informatics | Associate Dean (Research & Innovation)
School of Nursing, Midwifery, Social Work & Social Sciences
MS1.12, Mary Seacole Building, University of Salford, Salford M6 6PU
t: +44 (0) 161 295 7013
n.r.hardiker@salford.ac.uk | www.salford.ac.uk
www.seek.salford.ac.uk/profiles/HARDIKER514.jsp
Director, eHealth Programme, International Council of Nurses
Professor (Adjunct), College of Nursing, University of Colorado Denver, USA
Editor-in-Chief, Informatics for Health and Social Care
Hi,
My impression is that IHTSDO prioritize collaboration with organizations with products that are actively used in IHTSDO:s member countries. I guess that might be the reason why collaboration with for example WHO (ICD, ICF), Regenstrief Institute (LOINC) and International Council of Nurses (ICNP) have been prioritized in favor of openEHR. Proprietary information models are also more common than openEHR models and collaboration with the organizations (companies) behind the proprietary information models are probably done via IHTSDO's Vendor Liaison Forum.
Regards
Mikael
-----Ursprungligt meddelande-----
I don't personally have any opinion about prioritisation (there are obviously many factors relevant to each case), but openEHR archetypes are being used in:
- Australia
- Slovenia
- Norway
- Brazil
- NHS England
- Scotland NHS
under official government projects, and in those countries plus Russia, New Zealand, Netherlands, Sweden, Uruguay, UK, South Korea, Switzerland, Poland and China in deployed solutions.
In addition, CIMI (an archetype initiative) is becoming an official part of HL7 and will slowly find use in the US (at least), and 13606 archetypes are being used in Spain, Brazil, and I don't know how many other countries.
These locations are potential places for SNOMED to be used more (other than UK, arguably).
If the IHTSDO mentality is to find places where SNOMED is already being used and concentrate on that, that's a misunderstanding of how things work in the real world. Terminology gets used as an enabling tool, not a headline project - it's only an interesting proposition when there are information models and health data computing platforms & solutions in place that can use it.
- thomas
Hi!
Both openEHR and SNOMED CT have good technical foundations regarding versioning, semantic scalability, technical scalability etc. Both communities, although organized a bit differently have a lot of clinicians creating and updating interesting and relevant content. They cover complementary, only partly overlapping areas of the information modeling space needed in current and future healthcare.
The problem is the world they both exist in. Both have previously had problems figuring out sustainable business models for financing the important work they want the world to have, both now seem to have gotten to some kind of fairly stable financial situation, but not stable enough to have surplus and courage to spend resources on formally and practically connecting the two clinical modelling initiatives. (The technical things needed for using them together is already pretty good.)
I think serious clinical modeling cooperation will increase once you have enough of both of their customers/owners/community that are demanding cooperation because they really see the benefits of it, and at the same time have the political/practical option of using them both together (having a SNOMED CT licence for example, or being allowed by local powers to use openEHR). Some of the countries listed by Tom may use openEHR and may also use SNOMED CT today but perhaps in different contexts, not together, that is not enough to get serious collaboration started.
Look at Norway, great clinical grassroots + vendor + hospital-organization work regarding openEHR archetypes and templates, but not a member of IHTSDO and no national policy suggesting that SNOMED CT should be used.
Look at Sweden, an active IHTSDO-member with SNOMED CT translated to Swedish, but no official policy on using openEHR archetyping and not (yet) enough vendors and/or healthcare organizations screaming out loud that they want to use openEHR archetypes and SNOMED CT together or putting resources into supporting such collaborative work.
Both openEHR and IHTSDO organizations want “everybody” to be able to use their “products” (in IHTSDOs case provided that you buy into the organization) so:
-
IHTSDO wants to look as documentation-model-neutral as possible.
-
openEHR wants to look as terminology-model-neutral as possible.
Does anybody else see potential problems in this situation? Having a relationship and staying single without obligations at the same time… 
There are many people reading this list, I wonder, where in the world do you see organizations with enough resources (and/or power) starting to get interested in getting shared practical detailed clinical modelling working for real using both openEHR and SNOMED CT together right now?
I see future potential in the UK, Sweden, Slovenia, the Netherlands for example, other suggestions?
What is the status of Brazil’s current SNOMED CT interest?
In Spain the Ministry of Health has developed 59 ISO 13606 archetypes
binded to 44 SNOMED CT subsets. They are used to model 8 clinical documents
to be shared throughout Spain. Many codes have been introduced as part of
the Spanish extension of SNOMED CT, but as far as I know the intention of
the Ministry is to propose many of those codes as part of the international
release of SNOMED CT.
The archetypes can be downloaded here (zip file, a proper archetype
repository is about to be published):
http://www.msssi.gob.es/profesionales/hcdsns/areaRecursosSem/Rec_mod_clinico_arquetipos.htm
The list of subsets is described in this document (only in Spanish, the
subsets themselves are available for Spanish citizens only):
http://www.msssi.gob.es/profesionales/hcdsns/areaRecursosSem/FactoriaDocs/GUIADESUBCONJUNTOS_HCDSNS2.pdf
David
I might just comment on this bit. The above statements are not quite the same. openEHR make it possible to commit to and use any terminology; it doesn’t rely on any specific terminology, but it does treat SNOMED CT as a sort of benchmark of complexity, and also a source of useful technical elements for binding purposes. But in the end, if you want to bind to an ICD10 value-set, or a SNOMED CT one, or both, you can do that. This is normal because the directionality of the ‘uses’ relationship in health information systems is from information models (like openEHR, archetypes) to terminology, not the other way around. I would not specifically expect IHTSDO to have any commitment to an information model, since one isn’t strictly needed at the technical level, although there is an argument that says that terminology should limit its scope to non-volatile entities (concepts in SCT-speak) and let information models express the structures of information. Ignoring that for now, the main obvious ‘need’ from the IHTSDO side is of vectors for transmission, i.e. information models and platforms that use it and promulgate it. It will get promulgated most effectively by models rather than just instances, i.e. artefacts like archetypes, CDA templates in the US and presumably FHIR profiles. So I would expect more interest in working with the producers of these latter kinds of artefacts - that’s a major route for promulgation of SNOMED - proprietary products being the other main way; maybe proprietary is in fact the main interest? These are just my opinions of course … - thomas
Hi Erik,
Thoughtful insight.
We do need to start dating rather than push straight to an arranged marriage, I think, and I suspect we need some from the respective communities to act as marriage brokers.
The top down approach has not worked despite a number of attempts by well-intentioned individuals or groups, mainly as I understand it because there were influential groups inside SNOMED who voted down a formal arrangement with openEHR – others will know the details but they won’t really make a difference now.
I think success will only come if there is a grassroots push/demand inside SNOMED for purposeful interaction (engagement in both senses, perhaps) by member countries or influential organisations, plus reinforcement and advocacy by those on the inside of SNOMED, like yourself. That is why I nominated (unsuccessfully) for the Modeling Advisory Group – others will need to take on that role on my behalf.
BTW last I heard, Brazil will in final stages of becoming a SNOMED member, but I haven’t had an update since Medinfo.
Regards
Heather