openEHR-clinical Digest, Vol 35, Issue 7

Clinical (archive)
1

Dear Tom,

Thanks for your comments.

It is getting a long tail, so I will break it down in small pieces.

Glad we agree on the need for binding to ontologies.
I see no need to wait for BFO 2.0 where 1.0 is available.
Our model challenge will be exactly to handle such differences of different ontologies all the time.

Glad we agree on GCM being helpful in analysis.

My point of no EHR implementations is supported again by your answer. Yes there are many CKM instances and archetype developing projects.

I followed your link to who is using...

I SEE NO REFERENCE to a hospital I can visit running an EHR using archetypes. Similarly No GP or No nursing system in your list. It all seem to be pilots and trials or systems with viewers and partial functionality.

Vriendelijke groet,

Dr. William Goossen

Directeur Results 4 Care BV
+31654614458

2

well, the ontology specialists, including Stefan Schultz and Barry Smith say otherwise. There are issues that need to be solved specifically germane to ontology use in SemanticHeathNet, that BFO 2 should solve. But BFO2 is just one element. As you know, the ontology side of things also potentially involves OGMS, IAO, and other things that all need work internally, and for which integrations with DCMs are only just being understood. well I don’t - I don’t see what use it is. I was saying just the opposite. Please see this page - The second column is the name of the hospital, health authority, or other provider that is using an openEHR system. The only entries on this page are real contracted systems, no demonstrations. Row 1 happens to mention 140 hospitals. Row 2 mentions 50 GP sites. If you don’t want to visit Australia, fair enough…

3

Hello William,

The mental institutes GGZ Friesland, GGZ Noord-Holland-Noord and GGZ Drenthe are all customers of Code24 where our openEHR based solutions are extensively used in their production environment. At site GGZ Friesland an openEHR server cluster is operational with more than 7 million openEHR objects.

I would suggest we meet up in the near future to talk further about these real world implementations. Of course a site visit at one or more of our customers is also possible.

Best regards, Martin

4

Thanks Martin

Can I ask other openEHR vendors to equally report on successful deployments both here and by updating the web page that Thomas pointed to?

William has a point that openEHR has been guilty of hiding its successful evolution from research to implementation. I know of a number of other projects that have been deployed or are near to doing so.

Implementers -we need you to tell us of your success.

Ian

5

I think there are other venues where success stories are useful. What could be useful is a Case report paper demonstrating the added value of the OpenEHR approach (e.g. refuse of resources like archetypes, etc). We have had a few papers taking 13606 as a starting point. I know there are journals that are open for such contributions. We have had a few papers taking 13606 as a starting point. I haven’t seen many of the OpenEHR community being active at e.g. the implementation mailing list of AMIA (but that requires membership of AMIA). Getting out the message in the American hemisphere is also useful.

Regards

Jan

6

Hi,

IHTSDO has recently released their (non-academic) report “Building the Business Case for SNOMED CT” which also includes a number of case studies in Appendix A. I believe that something similar would be useful for openEHR. The report is linked from http://www.ihtsdo.org/news-articles/building-the-business-case-for-snomed-ct .

Regards

Mikael

7

My point of no EHR implementations is supported again by your answer. Yes there are many CKM instances and archetype developing projects.

I followed your link to who is using...

I SEE NO REFERENCE to a hospital I can visit running an EHR using archetypes. Similarly No GP or No nursing system in your list. It all seem to be pilots and trials or systems with viewers and partial functionality.

Please see this page - http://www.openehr.org/who_is_using_openehr/healthcare_providers_and_authorities

The second column is the name of the hospital, health authority, or other provider that is using an openEHR system. The only entries on this page are real contracted systems, no demonstrations.

Row 1 happens to mention 140 hospitals. Row 2 mentions 50 GP sites. If you don't want to visit Australia, fair enough...
· Most hospitals in Norway now have openEHR in some form, via DIPS Arena.
· Ljubljana Medical Centre is the Marand Think!EHR system, fully openEHR.
· Slovenia's national e-health network is openEHR
· Moscow's health record system is openEHR (recently transitioned from pilot to production project)
· Code24 has systems in Netherlands and I think in Romania.
· etc

Hopefully this is clear now.

- Thomas
Sorry to jump in late on this. I need to check some facts with teams at Cambio. To add to Thomas' list of openEHR archetypes-based systems:

1. openEHR archetypes-based Cambio COSMIC 8.1 has been delivered to our Swedish customer for testing, and will be rolled out to 8 regions (30% of Swedish EHR market) this year and onwards. Keep in mind some of these deployments are among the largest in Europe covering more than half million population with one instance that covers entire healthcare delivery across primary care centres, regional hospitals and University hospital.

2. More excitingly (for more sophisticated use of archetypes), our new Clinical Decision Support product line is built entirely based on openEHR archetypes and Guideline Definition Language (GDL). Last year, our Stroke Prevention CDS application has been tested successfully at 5 clinics in Östergötland. The CDS products will be gradually deployed to our Swedish regions from this year.

I will make sure that the above update included on the main openEHR web site.

Best regards,
Rong

Rong Chen, MD, PhD
VP, Head of Medical Informatics Group
CMIO, Director of Health Informatics
+46 8 691 49 81

Cambio+ Healthcare Systems AB
Stockholm:
Drottninggatan 89. SE-113 60 Stockholm
Vx: +46 8 691 49 00 | Fax: +46 8 691 49 99
Linköping:
Universitetsvägen 14 SE-583 30 Linköping
Vx: +46 13 20 03 00 | Fax: +46 13 20 03 99
Epost: info@cambio.se<mailto:info@cambio.se> | Hemsida: www.cambio.se<http://www.cambio.se/&gt;

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8

Hi All,

Good to see all the openEHR news on implementation. Although I am aware of most of the implementers, I am pleasantly surprised by the further developments in recent months.

People without commitment to our collective effort will rightly question the veracity and applicability of our goal; a technology independent development of an open eHealth platform where the specifications are crowd sourced through the international work of clinicians who can do it from their office or home.

It is the most ambitious project in eHealth around the world. It has survived HL7 v2, v3 and CDA. It works with FHIR and XDS. It is not competing with any of these technology solutions. The time for openEHR is still in the future using the technology of the day. Building something like this is a generational effort - Alain Maskens, David Ingram and the technical leadership of Thomas Beale, Rong Chen and David Lloyd to get it going. Dipak Kalra, Koray Atalag and Evelyn Hovenga have had a lot of influence but Heather Lesley and Ian McNicoll working with Sebastian Garde have made the standardisation of content through clinical participation a reality. Martin van der Meer and now Tomaž Gornik have brought Industry to the table.

Gustavo Bacelar is ready for things to move quicker, as are many. A steady pace so far has given an opportunity for refinement. Moving to the next level will involve clinical leadership of small coherent sets of archetypes. Integration into larger sets will require a different role as will advocacy for our collective solution. We have a lot to learn.

The possibilities for participation and providing solutions to the world are immense. But implementation, implementation, implementation remains our mantra. We will not get this right in one step. A shared eHealth platform which is non-proprietary is a wicked problem. We are a small organising group. We now have industry backing and subscribing members determining who makes decisions. This gives authority to the Management Board and a new energy to the community.

I am looking forward to the Handi Health developments in the UK and the uptake of openEHR as the modelling methodology. Norway is leading industry and government cooperation. No doubt we will see more uptake in Asia with Nousco active in Korea.

Looking forward to working with more of you!

Dr Sam Heard
openEHR Foundation

9

Hi All,

It’s certainly great to learn about all these developments. My next question is has or is anyone undertaking a benefit evaluation study? We need strong evidence to be able to convince the politicians and other high level decision makers to mandate the use of openEHR. Once we have that it should be a lot simpler to obtain the investment funds needed.

Evelyn

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