# openEHR-clinical Digest, Vol 35, Issue 4 **Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153) **Created:** 2015-03-11 13:16 UTC **Views:** 4 **Replies:** 7 **URL:** https://discourse.openehr.org/t/openehr-clinical-digest-vol-35-issue-4/15349 --- ## Post #1 by @WILLIAM_R4C Hi all, As one of the author's of the criticized paper by Blobel et al, I feel some need to react and give you some thoughts: - OpenEHR after 20 or more years is still largely under construction. I have asked many times to get names and locations of reference sites where I can see a real world archetypes based system in action. No response. - the approach with the archetypes is technology driven: implementation specific, not clinically driven. It lacks the basic conceptual, logical, implementation perspective of ISO 11179. In particular the logical modeling is what Blobel et all discuss. - use and grounding the Modelling in formal ontologies is lacking in any of the Modelling approaches: HL7 templates, HL7 FHIR, OpenEHR archetypes, 13606 archetypes, CEMLS, CIMI, DCM in UML. The articles discussed that with respect to 3 examples. All modelers have a job to do. For justification have a look at semantic health net work. - the GCM model allows a much deeper analysis of domain, modeling and implementation eg through domains on z axis, business bottom up and top down on y axis, and Reference Model – Open Distributed Processing (RM-ODP) system development standard on x axis. OpenEHR, like many others have not a complete picture. Of course you may critique a paper exposing this lack. But it feels like shooting the messenger(s) instead of listening to the message. Guys, you've got work to do. Vriendelijke groet, Dr. William Goossen Directeur Results 4 Care BV +31654614458 --- ## Post #2 by @thomas.beale you're the only person I've ever heard say such a thing. As you can see from , available online for a decade, the Release 1.0.2 has been stable since 2008. Hardly 'under construction' (although specific things are of course always being worked on). The opposite criticism (not enough recent releases) would make more sense. Quite the contrary: see , easily findable from the home page, also visible for a decade in different forms. Also the well-known locations of various national CKMs, containing archetypes used in these systems. (, , , , Moscow CKM offline due to trade war with Russia..., Brazil being moved as we speak.) Quite the contrary - the archetype approach is completely clinically driven, as everyone knows. Unlike every other effort I know of, including HL7v3 and FHIR, openEHR archetypes are built by clinical people, in a separated space (CKM). Technical people don't even come into it, unless they are also docs or health informatics experts who have clinical / lab / other relevant expertise. I'm not trying to criticise HL7 or FHIR here, merely pointing out that openEHR clinical modelling is literally in a dedicated clinical / health informatics space. Getting clinician input into FHIR's clinical models and more technical input into openEHR's was one of the motivations for the recent HL7+openEHR Adverse Reaction joint review (admittedly well after the paper publication). Why an academic paper would report the opposite is a mystery. As I said to Jan Talmon, statements demonstrably contrary to reality don't help the reputation of the journal at all. ISO 11179 is a meta-data and registry standard, it has no clinical content. Whether it has value for standardising meta-data in registries is another (implementation) matter, unrelated to the design concepts of clinical modelling. That is more or less true. Semantic Health Net and also years of IHTSDO activity shows just how difficult it is to get even the most basic agreements on how to do this. Even BFO, which is a much needed as an up upper level underpinning ontology has not yet been released as BFO 2.0, which is sorely needed. I would say it is widely recognised that the ontology / model relationship needs major attention. Well, speaking as an engineer and software engineer, I would beg to differ. RM/ODP isn't a formal approach to domain analysis, it's a system engineering meta-model - a way of formalising different aspects (viewpoints) of systems. I have actually talked with people involved in RM/ODP development at ISO (being one such person, but also others) and they agreed that RM/ODP is specifically weak in representing any domain / semantic viewpoint (it weakly represents it via the 'enterprise' viewpoint). I actually produced a health informatics-specific version RM/ODP years ago that was presented at HL7. It was met with mild interest, and subsequently never used again. Including by me. The GCM cube is one of those things that looks nice on paper, and noone can say it's wrong, but it doesn't provide any useful analytical output. It's not dissimilar from Zachman, FEAF and other similar enterprise modelling grids. These are designed to help systems engineers not forget specific aspects of system design. I have been aware of the GCM cube since about 2003, and have never found a use for it other than a general explanatory one in academic papers. If you are going to claim that GCM should be used to help clinical domain modelling, you have to say how it is going to do this. The paper doesn't do that. well, that's true at least. We need to have some work to do tomorrow... We always have work to do. But apart from the ontology question it's probably not where you think it is. Publishing academic papers that ignore well-known available evidence and projects, and make numerous assertions unsupported by relevant evidence doesn't help the common cause I'm afraid. - thomas --- ## Post #3 by @pablo I would agree with Thomas comments, and add that "Not having a complete picture" is a different way to say "openehr has a scope". No one can solve all the problems, and different groups are focusing in different problems, no one has a complete picture or a solution to all the problems on healthcare informatics and interoperability. --- ## Post #4 by @Koray_Atalag Hi William, I’m sorry but that paper has many obvious factual errors which I’d have assumed a very careful and knowledgeable person like yourself would not have missed. Whatever the reason I think it is a scientific responsibility to correct these errors and it is our intend to do just that. --- ## Post #5 by @Kalra_Dipak Hi William, I’m sorry but that paper has many obvious factual errors which I’d have assumed a very careful and knowledgeable person like yourself would not have missed. Whatever the reason I think it is a scientific responsibility to correct these errors and it is our intend to do just that. --- ## Post #6 by @thomas.beale Hi Dipak, we already decided to do just this in an offline group of potential paper contributors\. I have already asked Jan if a new paper is of interest to IJMI, and he says he is open to the idea\. Although I agree that letters of complaint are not in general of much interest, I do have to say that in this case, the paper appears to almost willfully avoid reference to significant available evidence \(at the time\) that is contrary to many of its assertions, while failing to provide much evidence or analytical argument behind other assertions it makes\. These comments pertain not only to archetypes by the way, but to misunderstandings of 13606, the HL7 RIM, and basic errors to do with what ADL/AOM actually is \(since it's an object of critique in the paper, it needs to be at least slightly understood by the authors\)\. Anyway, I don't have time to go further on this\. I hope our main interest is that papers in respected journals are properly evidence based, make a reasonable attempt to understand the objects of critique \(or say why they are not amenable to critique\) and to provide defensible analytical arguments where appropriate\. If that doesn't happen, journals that should be scientific will instead end up in the post\-modernist category, of the kind that Alan Sokol so successfully skewered a decade ago <http://en.wikipedia.org/wiki/Sokal_affair>\. \(Readers can find a new chapter in post\-modernist academic nonsense right here <http://crookedtimber.org/2015/03/09/carte-blanche/>; perhaps a new Sokol affair is on the way\)\. I'm a reviewer for a few journals, and my rejections to date on these kind of grounds have been agreed by the editors\. So I don't think I'm completely alone on this\.\.\. \- thomas --- ## Post #7 by @Talmon_CRISP Hi William, --- ## Post #8 by @Koray_Atalag Hi Dipak, What you are suggesting seems to be a very sensible way to approach this. Fully agree that there is no point in returning back as damage has been done but the whole point would be to contribute a more balanced view on this very important topic. I’d personally feel very comfortable if you could lead this effort and will contact you offline to discuss further. --- **Canonical:** https://discourse.openehr.org/t/openehr-clinical-digest-vol-35-issue-4/15349 **Original content:** https://discourse.openehr.org/t/openehr-clinical-digest-vol-35-issue-4/15349