Thomas you’ve described an issue I’ve dealt with ever since I began teaching Health Informatics! It is continuing to be an issue. The HI knowledge domain is huge in depth and breadth. That’s why micro-credentials are most useful. openEHR is applicable to all aspects. Your short list is helpful.
We need a comprehensive program showing how these micro-credentials scaffold knowledge and skills, from one module to another. This also enables people to pick and choose what they need most now (just in time learning, gap training) enabling them to build on what they already know.
One way to deal with the current disorganisation and confusion is to de-compose required knowledge and skills relative to roles (not positions or disciplines) and identify pre-requisite foundational knowledge and skills the course design builds on. Where possible we focus on generic content that can be applied to a variety of instances. Pre-requisite knowledge and skills may be from foundational software engineering or computer science or programming or clinical or management or genetics or information management or statistics or any other foundational disciplinary knowledge. We need to identify not only the key foundational knowledge and skills each course but also provide resources for further reading/study to enable people to get up to speed. We are making use of the SFIA framework and any other framework where relevant. This education program is all about design…just like you do for architectures.
I cannot help but add an observation about two extremes:
- Thomas is fully aware of the complexity of HI and openEHR.
- Evelyn is fully aware of the knowledge and skills of the stakeholders.
It is a (sad) reality that the attention span, knowledge and skills of (some) HI stakeholders are often comparable to children learning new things.
Maybe what is needed are “children books” for HI/openEHR. Short, with many pictures, limited in scope. Intendent to be read in less than 30 minutes. Each such “book” would build on the previous ones in a series (there would be different series/paths focused on different stakeholders).
Some prefer reading, others prefer watching. Accordingly there should be books and videos to cover both approaches to learning.
Some examples of such “learning paths”:
I do think we should distinguish what can be properly openEHR material and what can be more general health-informatics-as-it-should-be material. For example, the concepts of knowledge driven platform are not openEHR specific; openEHR is just an instance of realising such an idea. However, much of what we want to promulgate that the openEHR community has arguably created in terms of general paradigms isn’t in health informatics courses or textbooks - platform, clinical modelling, multi-level methodology, how to use terminology and so on.
So there is a gap here: a large block of knowledge (typically the kinds of things you see on our blogs) that isn’t taught in any standard health informatics course, but also isn’t an openEHR specific.
On the other hand, openEHR industry trainers tend to train based on openEHR specifics, and they provide these concepts in passing.
It is a strategic question in my mind as to whether the openEHR Education Program should be trying to develop syllabus for and teach the missing conceptual pieces. I don’t think it should be - the missing piece is wider than openEHR, and it would also be hamstrung by being labelled as ‘openEHR’.
If there is appetite (probably yes) and resources (questionable) to build this corpus of material, then I think it should be done in a separate organisation, which could be a fellow-traveller open source education project - call it ‘Domain-centred Health Informatics Education’ or similar. We could set this up today.
If we did this, then it provides a clear(ish) separation of paradigmatic and conceptual material, and openEHR-specific material and practices. The result would be to make the openEHR Education Program more limited and focused, closer to what is already being taught in the industry context, rather than trying to be a university level course.
I think the governance and certification needs for both areas of education would the crystallise out more easily than they are now.
The highmed symposium featured a lot of speakers that said something about their why from different perspectives:
(My very rough summaries)
@patrikgh : MD “openEHR solves my problems”
@TomazG : ceo “data for life platform (is a good business model, JH)”
@johnmeredith : national it architect “key part of national infra”
erik: consultant, “openEHR is part of smart system for complex care”
@jpieraj : “openEHR as a regional infra”
@bna : product vendor:” with openEHR I know I can handle all clinical requirements”
@ukpenguin, Proffessor: “Convergence on open standards is essential“
Edit: videos here Events
@thomas.beale I’m in total agreement with your observations. When I refer to the need to identify foundation knowledge and skills (pre-requisites) I simply use that as a method to provide context. The openEHR program itself and especially certification processes must be based exclusively on openEHR content which has built on those fundamentals. In other words they are embedded. Other education providers need to provide courses that teach those contextual fundamentals. We need to alert our target audience to the most relevant foundational knowledge required with some references to enable those with identified foundational knowledge gaps to get up to speed in any way they can.
Of course many openEHR educators provide courses that include aspects of anyone or many of those associated knowledge domains. That’s what differentiates openEHR education providers and courses offered. For example we (GeHCo) focus on data and data supply chains as that is our area of strength.
Thank you Joost, all very useful from each of their perspectives. The why I’m looking for are benefits realised by the users/recipients of care openEHR applications serve. Many of those are listed on the openEHR vision page.
I also agree with your observations, the gap in HI really exists and explaining openEHR without proper preparation of concepts is difficult.
You mention: “If there is appetite (probably yes) and resources (questionable) to build this corpus of material, then I think it should be done in a separate organisation, which could be a fellow-traveller open source education project - call it ‘Domain-centred Health Informatics Education’ or similar. We could set this up today.” I agree with this too. Probably another target group (modelers) can be approached with these knowledge.
For developers, I think more examples of openEHR prototypes, with coherent implementation of an Archetype and one or more Templates could help them thinking in openEHR terms. Simple prototypes without security and complex SoS enterprise systems. In my view developers can learn directly from code examples, and even extract conceptual thinking from coding.
Then there is another issue that is not mentioned here and adds extra complexity to openEHR. It is “open”. The openness points to extendability in the sense of adding new functionality in already existing systems, but also points to openness for other clinical professionals to add to the models and extend domain knowledge. For as far as I know this openness has not been offered in other systems in production in healthcare.
New posts here mention “open platforms”. I have some questions about the term open platform: Which party or which company has control over the platform? There is a suggestion of openness of control, but there are no agreements about this or mandatory monitoring open to users and organizations, we know that when the platform conforms to the openEHR specification it operates in a specific predictable way, but users of the platform have no control over the operations. I do not say that this is a lack, maybe I have missed specifications about the openness of platforms, but I would like a more transparent description of open platforms in relation to openEHR.
Hi Deborah,
this is a very good question and I like to give my 2 cents from a user and vendor perspective :
Which party or which company has control over the platform
This depends on the use-case. I’m quite sure the EMR vendors in the Nordics will have some say in what extensions are allowed (for patient safety reasons). In the case of our national COVID-19 platform, control is in the hands of the operating non-profit organization. It can be hospitals in other cases.
we know that when the platform conforms to the openEHR specification it operates in a specific predictable way, but users of the platform have no control over the operations
They can, if they like to. Just pick one of the open source solutions and start building and operating the open platform.
maybe I have missed specifications about the openness of platforms, but I would like a more transparent description of open platforms in relation to openEHR
From my point of view, “open platform” describes a design principle/philosophy and not such much a concrete specification. From a technical perspective, an open platform can be understood, roughly speaking, as vendor-neutral and with 100% open APIs. We are building such platforms in HiGHmed and within vitagroup but we still see some variations of the ingredients and architectures:
- Do we use IHE XDS for being able to access documents from multiple repositories at runtime or do we load them into a dedicated multimedia storage?
- Does the platform follow an event-driven architecture?
- What is the authentication mechanism?
- What is used for access control: ABAC, RBAC based on IHE APPC/BPCC or something else?
It would surely be the next step to standardize the “open platform” as one distinct specification (then maybe with a different name). However, I would choose an evolutionary approach driven by markets and vendors and see if a reference architectures emerges which finally could be the foundation for a standard (likely in the sense of IHE profiles or similar).
Blog posts that may be of interest here:
Further reading… “Defining an Open Platform” … Apperta Foundation
In October 2017, we published “Defining an Open Platform” to make the case for open platforms and lay out a blueprint for an open platform architecture at a level of detail that would allow any willing party to build a first generation implementation of an open platform that would be interoperable with any other.
Our proposal is based on HL7 FHIR, SNOMED-CT, IHE-XDS and openEHR and draws on pioneering work globally and in the UK that have proven how these standards can be used to build an open platform.
For me the most significant aspect is that control of the data AND the data definitions passes from the tech vendor to the ‘customer’ -usually a health organisation. This can be an initial challenge as most health organisations do not immediately have the skills or capacity to undertake the work of maintaining the semantic cohesion necessary inside a platform-based environment, so this tends to be outsourced to specialist informatics consultancies. However, at least in the UK, organisations are starting to build up the learning and capacity to take more of this ‘in-house’ .
This is a fundamental change in the ‘locus of control’ and I think will prove to be the most compelling reason for institutions and localities to adopt ‘open platform’, though for some health IT vendors, openEHR is just a better way to handle complex health data management.
Thank you all for replies on the open platform question! I will answer after reading the links.
Hmm that’s a hard question to answer in text, easier in a meeting, because it’s not straightforward.
It’s a story about a boy that likes helping people, enjoys understanding technology, is a good study, goes to med school, gets fed up with medical culture and terrible IT systems, joins a vendor that uses openEHR. It peaked my interest for various reasons, I was struggling for something to do and got involved in a project where someone had to help a customer do openEHR modelling. Then I discovered with openEHR I’m able to make something that shows up on a screen and I’m again able to help someone, powerful feeling!
Then I got into reading the specs, mostly for intellectual curiosity, and got amazed by how much understanding of the domain of healthcare and health informatics (now my domain!) it contained. Which made me
In parallel I discovered CKM and hoping to contribute/help others I checked the box for receiving review invites. I like the aspiration of being able to contribute a bit to something bigger than my own life. To feel good about myself for the good the modelling program does. To heal my wounds inflicted by terrible IT. And to leave my little mark on the world that might live beyond my life.
Then I got involved with the editorial community and really enjoyed the early pre work meetings with people from all over the world especially @ian.mcnicoll @heather.leslie and @varntzen, because I liked us volunteering for a common cause, the different perspectives people from the other side of the world bring. I also very much enjoyed engaging with these experienced and knowledgeable people. And I got flattered by discovering my views and experience actually were helpful to these giants in the field. Publication of the advance intervention discussions archetype was a real victory moment.
Later on I improved my understanding of the technical side of the specs (studying nights and weekends) and started to find a way to contribute tiny bits to them (mostly typo’s, very gratifying to see my nitpicking being appreciated by them being corrected). Then I started to be more involved on this discourse by helping beginners (even more junior than I am) understand how to do something in openEHR. It’s really nice to be able to help others again with this hard earned skill.
And only recently I start to see the shortcomings of the spec and really enjoy engaging with the technical experts on those, especially @thomas.beale. Convincing him on archived status for persistent compositions was another prove that I have something to offer this great project of openEHR.
As I wrote on twitter (somewhere) the biggest feat of openEHR is the community of informaticians and clinicians investing in deeply understanding each other. Another big consolation for the frustrations of fighting with IT ‘people’ on the tiny stuff of being put into the doctors table, which would save me costly minutes each day when generating the many letters I had to write. And the hit to my ego from being refused without any effort to understand my side. (Probably the IT people have many similar stories from doctors unwilling to understand their problems).
And now I’m a valued member of this great community of crazy smart people solving one of the hardest and most laborious and most important problems in the world by bridging the worlds of medicine and informatics 
That’s why I’m spending an hour of my Saturday morning on writing this message.
A wonderful and impactful personal statement, Joost. Thank you. There are so many important general points and messages embedded there. I’m going to print it out and frame it alongside the certificate of incorporation of the openEHR Foundation, which hangs above my desk at home.
Thank you for sharing this reflective personal journey @joostholslag , you have provided a very useful insight regarding how we need to engage newer generations and you confirmed the value of multidisciplinary collaboration. I’m a nurse who learned about computing in the late 1970s. I have been convinced about the value of adopting openEHR since its early days, working with @Sam, Dr Peter Schloeffel, and @sebastian.garde working out how to teach others about object modelling and its value twenty years ago. This led to the development of the first CKM prototype when we realised there needed to be repository for these models.