openEHR-clinical Digest, Vol 35, Issue 21

Clinical (archive)
1

Dear Heather,

Thank you for the invite. The GCS comment has been submitted. I updated the UML version a while ago based on feedback from HL7 and LOINC community. In particular a note of scoring an item is not possible, and proper LOINC codes were changed.

It is available in the github repository Detailed Clinical Models. DCM.

Further, we have an interest in anatomical Locatìon, which DCM we recently started, albeit for a specific use case. What to do to team up? And would it not be good to get CIMI folks and various HL7 clinical groups involved?

If you say urineanalysis POCT. What does the POCT stand for and mean?

Vriendelijke groet,

Dr. William Goossen

Directeur Results 4 Care BV
+31654614458

2

Hi William,

Thanks for participating in the GCS review. I look forward to you participating in others.

The concept description for Urinalysis POCT is: “Qualitative and semi-quantitative test array using reagent test strips to indicate possible abnormalities in a sample of urine, often performed as part of Point of Care Testing (POCT)”

We are attempting to work with the FHIR/HL7 patient care team for the Adverse Reaction archetype at the moment. At present the review is effectively stalled while Grahame is trying to harness a collective response. This has been the situation since mid November and unfortunately rapidly becoming an unworkable proposition.

We choose to work using rapid iteration from 2 week reviews which is quite the extreme opposite to the HL7 balloting process, and unless we can work out a way forward in the very immediate future, openEHR may need to consider withdrawing and proceeding on our own, which is not an ideal solution.

In the first couple of review rounds many HL7-ites participated directly and the models were enhanced significantly. Now it seems that a collective approach has been adopted which is effectively killing our collaboration.

Can you suggest a more efficient way to engage with your HL7 colleagues?

Regards

Heather

From: openEHR-clinical [mailto:openehr-clinical-bounces@lists.openehr.org]

On Behalf Of WILLIAM R4C

Sent: Friday, 13 March 2015 5:05 PM

To: openehr-clinical@lists.openehr.org

Subject: Re: openEHR-clinical Digest, Vol 35, Issue 21

Dear Heather,

Thank you for the invite. The GCS comment has been submitted. I updated

the UML version a while ago based on feedback from HL7 and LOINC

community. In particular a note of scoring an item is not possible, and proper

LOINC codes were changed.

It is available in the github repository Detailed Clinical Models. DCM.

Further, we have an interest in anatomical Locatìon, which DCM we recently

started, albeit for a specific use case. What to do to team up? And would it

not be good to get CIMI folks and various HL7 clinical groups involved?

If you say urineanalysis POCT. What does the POCT stand for and mean?

Vriendelijke groet,

Dr. William Goossen

Directeur Results 4 Care BV

+31654614458

Send openEHR-clinical mailing list submissions to

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Today’s Topics:

  1. RE: More reviews FW: openEHR archetype Sprint reviews for

participation (Heather Leslie)

  1. Re: openEHR-clinical Digest, Vol 35, Issue 18 (WILLIAM R4C)

Message: 1

Date: Fri, 13 Mar 2015 05:15:00 +0000

From: Heather Leslie <heather.leslie@oceaninformatics.com>

To: For openEHR technical discussions

<openehr-technical@lists.openehr.org>, For openEHR clinical

discussions <openehr-clinical@lists.openehr.org>

Subject: RE: More reviews FW: openEHR archetype Sprint reviews for

participation

Message-ID:

<SIXPR06MB0942F6D35716BF16009380CFD070@SIXPR06MB094.apcprd06.p

rod.outl

ook.com>

Content-Type: text/plain; charset=“us-ascii”

And a couple more for good measure :). Please log in and adopt the

archetype<https://openehr.atlassian.net/wiki/display/healthmod/Adopt+an+

> archetype> if you would like to participate in any of the reviews below.

Problem/Diagnosis -

http://www.openehr.org/ckm/#showArchetype_1013.1.169

Symptom - http://www.openehr.org/ckm/#showArchetype_1013.1.195

Regards

Heather

From: openEHR-technical

[mailto:openehr-technical-bounces@lists.openehr.org] On Behalf Of

Heather Leslie

Sent: Friday, 6 March 2015 5:56 PM

To: For openEHR technical discussions; For openEHR clinical

discussions

Subject: More reviews FW: openEHR archetype Sprint reviews for

participation

Hi again,

Further to my recent email, two more reviews have commenced:

  • Family History -

http://www.openehr.org/ckm/#showArchetype_1013.1.1900

  • Glasgow Coma Scale -

http://www.openehr.org/ckm/#showArchetype_1013.1.137

Again, if you would like to participate in any of these, please register, log in

and adopt the archetype and the Editors will add you to the review team.

Regards

Heather

From: Heather Leslie

Sent: Wednesday, 4 March 2015 3:49 PM

To: For openEHR clinical discussions; For openEHR technical

discussions

Subject: openEHR archetype Sprint reviews for participation

Dear Colleagues,

In the past couple of days a number of archetype reviews have been

initiated.

  • Anatomical Location -

http://www.openehr.org/ckm/#showArchetype_1013.1.587

  • Relative Anatomical Location -

http://www.openehr.org/ckm/#showArchetype_1013.1.1892

  • Adverse Reaction List -

http://www.openehr.org/ckm/#showArchetype_1013.1.1425

  • Health Risk -

http://www.openehr.org/ckm/#showArchetype_1013.1.176

  • Urinalysis POCT -

http://www.openehr.org/ckm/#showArchetype_1013.1.150

If you would like to participate please register, log in and adopt the

archetype and the Editors will add you to the review team.

Kind Regards

Heather

Dr Heather Leslie

MBBS FRACGP FACHI

Director/Consulting Lead, Ocean

Informatics<http://www.oceaninformatics.com/>

Clinical Programme Lead, openEHR

Foundation<http://www.openehr.org/>

Phone - +61 418 966 670

Skype - heatherleslie

Twitter - @omowizard

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Message: 2

Date: Fri, 13 Mar 2015 06:50:27 +0100

From: WILLIAM R4C <wgoossen@results4care.nl>

To: “openehr-clinical@lists.openehr.org”

<openehr-clinical@lists.openehr.org>

Subject: Re: openEHR-clinical Digest, Vol 35, Issue 18

Message-ID: <D9F6A169-CEA0-462E-99BA-

> E2BC95E8B9AD@results4care.nl>

Content-Type: text/plain; charset=us-ascii

Dear Hugh,

Thank you very much for your overview!

I Wil refrain from now on telling about this fata mogana because I am now

convinced there are real world implementations.

Vriendelijke groet,

Dr. William Goossen

Directeur Results 4 Care BV

+31654614458

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Today’s Topics:

  1. openEHR implementations in Australia (Hugh Leslie)

Message: 1

Date: Fri, 13 Mar 2015 03:38:57 +0000

From: Hugh Leslie <hugh.leslie@oceaninformatics.com>

To: “openehr-clinical@lists.openehr.org”

<openehr-clinical@lists.openehr.org>,

“openehr-clinical@lists.openehr.org”

<openehr-clinical@lists.openehr.org>,

“openehr-clinical@lists.openehr.org”

<openehr-clinical@lists.openehr.org>, WILLIAM R4C

<wgoossen@results4care.nl>

Subject: openEHR implementations in Australia

Message-ID:

<211485EAD5374CA5.1-45b1a4cf-30f8-4f11-84f9-

ef1131cb2e46@mail.outlook

.com>

Content-Type: text/plain; charset=“us-ascii”

Hi William,

I think you will find that many openEHR vendors are too busy doing real

implementations to update the openEHR website!

Ocean Informatics has a number of large openEHR implementations in

Australia which are well established.

There is an EHR running on our Multiprac eHealth platform that provides

an EHR for all residents of the Northern Territory as well as all aboriginal

health centres in South Australia and in the Kimberley region of Western

Australia. This system collects data from multiple systems and is being used

for decision support as well as providing a shared EHR for the population.

This system went live about 4 years ago and is being continually added to.

We have a system running across 95% of acute beds in Queensland (some

140 facilities) which is a complex infection control system also running on the

same openEHR based platform. This system collects all the pathology for the

whole state everyday and because it is openEHR data we are able to run

business rules on it to notify infection control practitioners of potential

outbreaks. This system had been live for nearly 3 years.

We also have an integrated care system running in NSW which manages

care planning on the same shared health record platform across the Western

Sydney region. This has been live for about 2 years.

There is a whole lot of other implementations running here and all of

these are pure openEHR implementations.

Regards Hugh

CEO Ocean Informatics

OK Martin,

I look forward to see OpenEHR in action in Friesland and all, would

welcome implementation case reports!

Vriendelijke groet,

Dr. William Goossen

Directeur Results 4 Care BV

+31654614458

Send openEHR-clinical mailing list submissions to

openehr-clinical@lists.openehr.org

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nehr.org

or, via email, send a message with subject or body ‘help’ to

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You can reach the person managing the list at

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When replying, please edit your Subject line so it is more specific

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Today’s Topics:

  1. Re: openEHR-clinical Digest, Vol 35, Issue 7 (Ian McNicoll) 2.

Re: openEHR-clinical Digest, Vol 35, Issue 7 (Talmon (CRISP))

–

Message: 1

Date: Wed, 11 Mar 2015 18:58:12 +0000

From: Ian McNicoll <ian@freshehr.com>

To: For openEHR clinical discussions

<openehr-clinical@lists.openehr.org>

Subject: Re: openEHR-clinical Digest, Vol 35, Issue 7

Message-ID:

<CAG-n1KxJTZV5ZM5LXh09MOFwxQZcXHr4K49Ho=Rnn5Ycw-

> bkFg@mail.gmail.com>

3

Hi Heather and all,

I think the key to long term collaboration and effective alignment depends on strategic partnership between the two organisations. I think both sides have some learnings from the joint review and now it is time for both groups to take these learnings back home and thoroughly discuss and agree on benefits. With my HL7 New Zealand vice-chair hat I will actively push this agenda. So what I’m pointing out here is there is a need for strong leadership from the Foundation in keeping the momentum forward which started with personal efforts. It has to be adopted as a strategic organisational value. I will propose a whole program of activities to the new Board which I am hoping will be shared widely with the larger openEHR community. I think individual efforts by the core openEHR group, mainly from Ocean group historically, have to be internalised and actively supported (=funded) by the Foundation and the wider community. There will be times in the coming, and not so far ahead I believe, we may start with openEHR conferences and maybe even organise Prizes and Awards for different types of contributions. Most of the work you and your tireless colleagues from Ocean have done to foster openEHR will not be forgotten and I’m sure these efforts will pay off in the long term. I’m very optimistic (as ever!) that we will soon have a very transparent and open Foundation working hand in hand with the community – with those who can’t help but contribute just for the love of sharing and carrying forward what I believe the most elegant approach to tackling wickedness of health information. To me these are unavoidable and natural temporary moments of pain in the path for a healthier organisation. I guess we’re about to move from a ‘friendship’ based system of relations, some very convoluted, to one that is more ‘professional and institutional’ – hopefully still very friendly :wink:

Anyway – you’ll be one of my ‘lifetime achievement’ nominees :wink: I mean it! Let’s just keep the ball rolling…I will not take this responsibility lightly you can be assured.

4

Likely

  Point
  Of
  Care
  Testing

Karsten

5

hi Heather

6

Hi Grahame,

We very much understand that you are being pulled in gazillions of directions at present with the explosion of FHIR on all fronts (excuse the pun - I’m sure you’re used to them now) but we are all trying to respond to the needs of our respective communities.

I too would be extremely disappointed if this collaboration had to be abandoned. We have been so pleased to see this collaboration start off so well, and it really is ground breaking for many reasons. However, from a practical point of view, our last review was completed at end of November and we have been very patient while waiting for your end to be ready to proceed. The patience is not so unreasonably now evolving to some impatience, I guess.

We are happy to explore all alternatives to try to progress this in a timely manner for all parties – please suggest an approach and a timeframe. We have all our reviewers ready and looking forward to ongoing participation.

If the worst happens and we can’t continue with this particular model, the progress that we have made to date will go a long way to ensure that the majority of the Adverse Reaction archetype and FHIR resource are well aligned, especially in the areas most critical and relevant to support interoperability at this time. And of course we can all learn from the experience such that when we look to do this next time we might all be wiser and clearer in how to manage it for all stakeholders.J

BTW I’m not sure how many openEHR email listers are aware of the HL7 conversations that you refer to. Ian and I certainly drop in on them on occasions, but we don’t regularly monitor them. If you’d like this community to participate, perhaps an invitation on behalf would encourage an active joint participation.

Kind regards

Heather

7

hi

If you’d like this community to participate, perhaps an invitation on behalf would encourage an active joint participation.

well, consider yourself invited, though I’m not exactly sure what kind of invitation you want here.

k. so I grabbed some time to summarise things because we’ve got to a stable point.

Looking through the tasks that have been recorded against the AllergyIntolerance resource:

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=3008&start=0: revise the definitions of the criticality values. The upshot was these definitions:

HIGH - Exposure to substance may result in a life threatening or organ system threatening outcome.
LOW – Exposure to substance unlikely to result in a life threatening or organ system threatening outcome.
Unable to Determine – Unable to assess with information available.
Unknown – A proper value is applicable but it is not known.

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=5322&start=0 - add ‘reporter’ -aka informant. I think this is already in the OpenEHR reference model

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=5724&start=0 - cater for ‘recorded in error’ - I think this is inherent in the openEHR reference model?

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=5737&start=0 - argument about status values and records. I’m not going to precis this here; it’s an open issue. This community might want to comment, though I’m not entirely sure how well the issue translates in a pure archetype context

http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemEdit&tracker_item_id=5820&start=0 - how do you use comments vs description? At the least, the archetype needs better definitions to differentiate these.

There’s been other ongoing discussions about the comparison with CCDA and/or clinical practice in USA (at least). There’s something solid there which makes the existing design of both the archetype and resource in need of redesign. I’ll be launching discussion of this issue next week on several HL7 lists. Perhaps I should cross-post here too?

Grahame