openEHR Transition Announcement

Announcements (archive)
1

Dear All,

I am writing on behalf of the new Transitional Board of openEHR to share our plans to take openEHR to a new level of operations; a new structure, business model and governance. Our vision is the creation of a thriving community that works collaboratively to benefit humanity through efficient and effective electronic health records (EHRs) that support the highest quality health care for the least effort.

Until now, the openEHR Foundation has functioned as an owner of intellectual property, governed by University College London and Ocean Informatics, with board members Prof David Ingram (UCL), Prof Dipak Kalra (UCL) and Dr Sam Heard (Ocean).

With the support of the considerable community of Members and via engagement of a new category of sponsoring organisational Member known as ‘Associates’ - Companies, Universities and Governments - the Transitional Board proposes a number of changes:

  • The openEHR Foundation becomes an operational non-profit organisation with paid key staff and resources;
  • The Board (of governance) of the Foundation is extended to up to 10 people with a shift to election by the openEHR Associates;
  • Members who participate are recognised by their peers, may take on decision-making roles, and have the right to commit changes to the key development assets of the Foundation.

The Members will participate individually and, through qualification by peer recognition, will control the development within the three Programmes that are building the key assets:

  • The openEHR specifications of the logical health record and attendant services as well as the methods for describing the content using archetypes (Detailed Clinical Models) and templates; and
  • The openEHR archetypes and templates to be used within systems and for message content between systems to achieve interoperability; and
  • The openEHR software projects, to provide open source development of tools to support the uptake and use of the specifications and templates.

A group of Members will be needed to bootstrap each of these programmes and determine the working arrangements that are suitable to the products that they are managing at the current stage of development.

The Associates will determine who governs the Foundation by nominating and voting on new members of the Board. The Board will appoint key Operational staff and will approve the leader of each of the Programmes. The Programme Leaders will be appointed by Qualified Members working in that Programme, subject to Board approval. We believe this will create the right balance between the ‘ground up’ creation of openEHR through participation of Members and ‘top down’ governance.

The first step is to share with you a white paper providing more detail on the proposals and to ensure that the Members are reasonably satisfied that this is the right direction to head.

Some key activities have been proceeding in the background and are reaching a point of maturity. It has taken us some time to gather more clinical champions in this endeavour and companies that can use and work with the tools in their early stages of development. It has also taken quite some time for Thomas Beale to work out how to provide a seamless pathway between definition of archetypes, specialisation of archetypes to ensure development scalability, to meet jurisdictional requirements, and templates that allow tailoring for actual use in specific settings. The result is ADL/AOM 1.5. He has, as usual, been totally committed to this work and it is probably very important for me to say, it is “no mean feat”.

There is a lot to do. Most important are:

  • Begin to showcase development teams and software using openEHR successfully in clinical settings;
  • Finalise ADL/AOM 1.5, including its succinct XML expression, and integrate it into existing and emerging tools;
  • Update the openEHR reference model to version 1.1 bringing our collective knowledge to bear on the new features and changes while ensuring backward compatibility;
  • Begin an open source software project for tools, web-based if possible, to author archetypes, templates and terminology reference sets directly interacting with the Clinical Knowledge Manager and equivalent repository and review tools; and
  • Establish a mechanism for Associates to formally endorse archetypes (and possibly in the longer term templates) for international use.

The Board has been changed to manage the transition until we are in a position to take nominations from Associates. Prof. David Ingram will become President and remain on the Board. Dr Bill Aylward from Moorfield’s Eye Hospital (the Open Eyes Project) will join Dr Ian McNicoll with his long advocacy of health care computing (British Computer Society) and Dr Jussara Rotzsch who has been involved in establishing openEHR as the Brazilian national EHR model. Professor Dipak Kalra and I will remain and I become Chair of the Board initially. The new Board will now actively seek Associates to engage in this important work and to provide secure governance into the future.

At present many of our key participants are being drawn into national programmes. Whilst this is encouraging, we need to bring this work, where appropriate, back to the international community as quickly as possible. It is clear that governance that is acceptable to these national programs and industry is a very important step. It is also our belief that standard SDO processes are not suitable for our work and we have instead modelled our future on collaborative engineering efforts. Our products must be fit for purpose, stable and have an update cycle that is in tune with our domain.

Free membership for participants and free access to the assets of the Foundation remains a fundamental principle going forward. Our commitment to open specifications, open software and open clinical models, unrestrictive to commercial use, remains unchanged.

We hope you will join with us enthusiastically in the next phase of development of the Foundation and comment freely on the attached paper. There will be many views on what we need to do and how we might best achieve it. The Board is very interested in alternative ways to balance the needs of industry and governments with those of the developers and users of the system.

Let’s make the future of eHealth work efficiently for all.

Yours sincerely, Sam Heard

Acknowledgements: Thank you to David Ingram, Dipak Kalra, Thomas Beale, Martin van der Meer and Tony Shannon for assisting in the planning.

openEHR Transition White Paper

2

A significant move. Congrats to the leaders.

Ed Hammond

W. Ed Hammond
Director, Duke Center for Health Informatics
2424 Erwin Rd, 12th Floor, Room 12053
Phone: 919.668.2408
Fax: 919.668.7868
Assistant: Naomi Pratt
Email: naomi.pratt@duke.edu
Phone: 919.668.8753

3

[forwarded on behalf of Ed Hammond]

4

Very good news indeed. This is exactly what is needed to bring openEHR to where it belongs, at the center of the healthcare.

Just out of curiosity, who are these Associates, will they raise sufficient money and how long will it take before these become plans effective. The sooner the better is my idea:-)

Cheers,

Stef

Begin doorgestuurd bericht:

5

Hi,

Not so long ago we have discussed about a governance and organization model to the openEHR community, and we have talked about regional/national openEHR communities (http://www.openehr.org/wiki/display/oecom/Foundation+Organisational+Structure). I can’t find this mentioned in the whitepaper.

I think if we want to have a global impact on the ehr scene, we need to support those communities also, and define ways to coordinate the work of the community as a whole.

What do you think?

(attachments)

ATT00001 (174 Bytes)

6

Hi Pablo

It needs to be added.

Thanks Sam

7

Great, please let me know if I can help.

8

Thanks Pablo,

I am aware of the very excellent work being done around the world,
often with insufficient publicity and I too think that regional
support should be added to the White Paper but we should discuss
further what sort of top-down assistance might be realistic to achieve
in the short-term.

We all hope that the suggested changes lead to more resources becoming
available but it would be difficult to assume that this will be the
case, given that membership and access to Foundation materials will
continue to be free of charge.

So, my question back, is

"What sort of support would you like to see, given that significant
central resourcing is not likely in the short term?"

I know Thomas has some ideas about ramping up the software repository
and I am very keen on the idea of a non-CKM archetype/ template
'nursery' (more elsewhere) and I could imagine that one or both might
be useful at regional level.

Would it be sufficient for the Foundation to give 'official status' to
regional affiliates e.g. openEHR Japan, or are there other practical
suggestions as to how best to support regional affiliates?

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317

mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

9

Hi!

So, my question back, is
"What sort of support would you like to see, given that significant
central resourcing is not likely in the short term?"

[...]

Would it be sufficient for the Foundation to give 'official status' to
regional affiliates e.g. openEHR Japan, or are there other practical
suggestions as to how best to support regional affiliates?

I would guess that an 'official status' recognition and thus links in
online (and some offline) information resources would be a major
thing, more imoportant than funding, especially if this also allowed
the regional organisation to arrange "official" openEHR
gatherings/conferences etc. It would be reasonable if the local
organisation could keep money left over from such (possibly partly
commercially sponsored) gatherings/conferences.

Of course it would be reasonable if the foundation had some
requirements on official local organisations, like having:
- open membership
- statutes matching regional democratic traditions and the openEHR
goals (internal governance rules or whatever the swedish word
"stadgar" should be translated to)
- proper accounting and audit
- a duty to have a dialogue with the central openEHR foundation
regarding plans involving using the openEHR tradmark for events etc
- ...probably more...

For local organisations I think bottom up comunity driven governance
with elected boards etc is the only way to go, not top-down.

Best regards,
Erik Sundvall
erik.sundvall@liu.se http://www.imt.liu.se/~erisu/ Tel: +46-13-286733

10

Thanks Erik,

These feel like very sound proposals, in particular the focus on
bottom-up local development.

Pablo, Shinji - would Erik's suggestions be the kind of support that
you would hope to have?

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

11

Just to say, I think it would be great to support the excellent efforts
represented in this discussion, to work towards locally governed
repositories of archetypes/templates, evolving synergistically in the
sort of way being discussed. There is an important parallel with
requirements for managing terminology.

I tried very hard to align openEHR within the IHTSDO governance
framework for combining local and global initiative for this sort of
entity, but failed in this because the politics was too hard, as we
reported at the time. IHTSDO seemed, and to me still seems to have the
greatest chance of achieving useful progress towards effective standards
and governance for clinical content, and openEHR should stay as close as
possible to them in this, I believe. There are many clinical and
professional issues still to be explored and resolved as to how
terminology and archetypes should best coexist within such a framework.
There are also licensing issues and realistically the licensing of
archetypes for use in patient care at different levels will have to be
acceptable to those groups responsible for ethico-legal standards that
regulate the clinical professions, and, more immediately, for control of
the licensing of international terminologies. Thus archetype/template
licensing was always bound to be a very thorny and politicised issue for
openEHR and, as a board charged with protecting the openEHR IP for the
ultimate good of the healthcare community, we had to hear arguments from
both within and outside the Foundation in deciding how we should hold
the position. In truth, no one really knows how this issue will play out
and we have to remain flexible in our policy, as we have said. I have
been involved in working groups at a national level on reform of
copyright law, where the kind of argument that is put forward within
openEHR lists is advocated for publication more widely, with similar
push back from interests dependent on controlling completely legitimate
special interests. For what it's worth, I personally am in favour of
society moving towards minimally restrictive licensing of knowledge
artefacts, such as archetypes and terminologies, consistent with good
order. I recognise that the many different perspectives in play about
the underlying issues mean there will be fierce debate and honest
disagreement about what that means and how it can be achieved. Twas ever
thus!

One of the huge difficulties I have observed over the past few years or
so has been the ever growing number of ab initio and, in terms of
outcome, mutually destructive, efforts to define and create standardised
clinical content repositories - from hospital provider and clinical
specialty to national, company product, regional and international
levels. This is happening in many domains beyond healthcare, of course.
There is a need for much more experiment in evolving good practice but
there will never, I feel, be complete unification of such entities. Even
if by some gargantuan effort, something is established globally, it
would tend to fragment at more local levels, much as language itself has
an organic existence between the universal and the local forms. Not
easy to accommodate this basic truth when building and seeking to meet
the evolving requirements of what are essentially very complex
socio-technical entities like standard repositories of clinical content!
What is needed, in my mind, is effective and accessible tooling to
support shared discipline and methodological approach to these
challenges, such that there can be improved, but never perfect or
enduring, interoperability between domains. That's where openEHR has
been trying to help things move forward.

One final point, here. The marrying of global and local data in computer
systems is being highlighted all over the place, well beyond the
confines of health care records, although it's probably true that the
health record carries one of the most complex set of requirements in
this regard. I have seen it called the problem of 'hyper' but have no
idea why that term is used. I suspect there may be useful research to be
done in looking across 'hyper' requirements in a variety of different
domains where content repositories are being built. Maybe one of the
university groups active in openEHR is taking or might take an interest
in this topic.

David I

12

Just to say, I think it would be great to support the excellent efforts
represented in this discussion, to work towards locally governed
repositories of archetypes/templates, evolving synergistically in the
sort of way being outlined. There is an important parallel with
requirements for governance of terminology.

I tried very hard to align openEHR within the IHTSDO governance
framework for combining local and global initiative for this sort of
entity, but failed in this because the politics was too hard, as we
reported at the time. IHTSDO seemed, and to me still seems to have the
greatest chance of achieving useful progress towards effective standards
and governance for clinical content, and openEHR should stay as close as
possible to them in this, I believe. There are many clinical and
professional issues still to be explored and resolved as to how
terminology and archetypes should best coexist within such a framework.
There are also licensing issues and realistically the licensing of
archetypes for use in patient care at different levels will have to be
acceptable to those groups responsible for ethico-legal standards that
regulate the clinical professions, and, more immediately, for control of
the licensing of international terminologies. Thus archetype/template
licensing was always bound to be a very thorny and politicised issue for
openEHR and, as a board charged with protecting the openEHR IP for the
ultimate good of the healthcare community, we had to hear arguments from
both within and outside the Foundation in deciding how we should hold
the position. In truth, no one really knows how this issue will play out
and we have to remain flexible in our policy, as we have said. I have
been involved in working groups at a national level on reform of
copyright law, where the kind of argument that is put forward within
openEHR lists is advocated for publication more widely, with similar
push back from interests dependent on controlling completely legitimate
special interests. For what it's worth, I personally am in favour of
society moving towards minimally restrictive licensing of knowledge
artefacts, such as archetypes and terminologies, consistent with good
order. I recognise that the many different perspectives in play about
the underlying issues mean there will be fierce debate and honest
disagreement about what that means and how it can be achieved. 'Twas
ever thus!

One of the huge difficulties I have observed over the past few years or
so has been the ever growing number of ab initio and, in terms of
outcome, mutually destructive, efforts to define and create standardised
clinical content repositories - from hospital provider and clinical
specialty to national, company product, regional and international
levels. This is happening in many domains beyond healthcare, of course.
There is a need for much more experiment in evolving good practice but
there will never, I feel, be complete unification of such entities. Even
if by some gargantuan effort, something is established globally, it
would tend to fragment at more local levels, much as language itself has
an organic existence between the universal and the local forms. Not
easy to accommodate this basic truth when building and seeking to meet
the evolving requirements of what are essentially very complex
socio-technical entities like standard repositories of clinical content!
What is needed, in my mind, is effective and accessible tooling to
support shared discipline and methodological approach to these
challenges, such that there can be improved, but never perfect or
enduring, interoperability between domains. That's where openEHR has
been trying to help things move forward.

One final point, here. The marrying of global and local data in computer
systems is being highlighted all over the place, well beyond the
confines of health care records, although it's probably true that the
health record carries one of the most complex set of requirements in
this regard. I have seen it called the problem of 'hyper' but have no
idea why that term is used. I suspect there may be useful research to be
done in looking across 'hyper' requirements in a variety of different
domains where content repositories are being built. Maybe one of the
university groups active in openEHR is taking or might take an interest
in this topic.

David I

Thanks Erik,

These feel like very sound proposals, in particular the focus on
bottom-up local development.

Pablo, Shinji - would Erik's suggestions be the kind of support that
you would hope to have?

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

13

Just to say, I think it would be great to support the excellent efforts
represented in this discussion, to work towards locally governed
repositories of archetypes/templates, evolving synergistically in the
sort of way being outlined. There is an important parallel with
requirements for governance of terminology.

I tried very hard to align openEHR within the IHTSDO governance
framework for combining local and global initiative for this sort of
entity, but failed in this because the politics was too hard, as we
reported at the time. IHTSDO seemed, and to me still seems to have the
greatest chance of achieving useful progress towards effective standards
and governance for clinical content, and openEHR should stay as close as
possible to them in this, I believe. There are many clinical and
professional issues still to be explored and resolved as to how
terminology and archetypes should best coexist within such a framework.
There are also licensing issues and realistically the licensing of
archetypes for use in patient care at different levels will have to be
acceptable to those groups responsible for ethico-legal standards that
regulate the clinical professions, and, more immediately, for control of
the licensing of international terminologies. Thus archetype/template
licensing was always bound to be a very thorny and politicised issue for
openEHR and, as a board charged with protecting the openEHR IP for the
ultimate good of the healthcare community, we had to hear arguments from
both within and outside the Foundation in deciding how we should hold
the position. In truth, no one really knows how this issue will play out
and we have to remain flexible in our policy, as we have said. I have
been involved in working groups at a national level on reform of
copyright law, where the kind of argument that is put forward within
openEHR lists is advocated for publication more widely, with similar
push back from interests dependent on controlling completely legitimate
special interests. For what it's worth, I personally am in favour of
society moving towards minimally restrictive licensing of knowledge
artefacts, such as archetypes and terminologies, consistent with good
order. I recognise that the many different perspectives in play about
the underlying issues mean there will be fierce debate and honest
disagreement about what that means and how it can be achieved. 'Twas
ever thus!

One of the huge difficulties I have observed over the past few years or
so has been the ever growing number of ab initio and, in terms of
outcome, mutually destructive, efforts to define and create standardised
clinical content repositories - from hospital provider and clinical
specialty to national, company product, regional and international
levels. This is happening in many domains beyond healthcare, of course.
There is a need for much more experiment in evolving good practice but
there will never, I feel, be complete unification of such entities. Even
if by some gargantuan effort, something is established globally, it
would tend to fragment at more local levels, much as language itself has
an organic existence between the universal and the local forms. Not
easy to accommodate this basic truth when building and seeking to meet
the evolving requirements of what are essentially very complex
socio-technical entities like standard repositories of clinical content!
What is needed, in my mind, is effective and accessible tooling to
support shared discipline and methodological approach to these
challenges, such that there can be improved, but never perfect or
enduring, interoperability between domains. That's where openEHR has
been trying to help things move forward.

One final point, here. The marrying of global and local data in computer
systems is being highlighted all over the place, well beyond the
confines of health care records, although it's probably true that the
health record carries one of the most complex set of requirements in
this regard. I have seen it called the problem of 'hyper' but have no
idea why that term is used. I suspect there may be useful research to be
done in looking across 'hyper' requirements in a variety of different
domains where content repositories are being built. Maybe one of the
university groups active in openEHR is taking or might take an interest
in this topic.

David I

Thanks Erik,

These feel like very sound proposals, in particular the focus on
bottom-up local development.

Pablo, Shinji - would Erik's suggestions be the kind of support that
you would hope to have?

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

14

Hi Ian,

So, my question back, is

“What sort of support would you like to see, given that significant
central resourcing is not likely in the short term?”

I think we (local/regional organizations working with and on openEHR) need formal support from the openEHR fundation.

One basic form of support is to recognize the local/regional openEHR organizatons as such.
Other is to recognize our contributions to the community, like mentioning our work on presentations, publications and other public communications (I think a public communications strategy should be traced by openEHR foundation).

If we think of money, there are ways of money support without giving real money: we need software tools (archetype & template editors), we need access to events far away, we need books, educational resources, etc, etc.

The foundation should draw yearly general goals, to the openEHR project as a whole, and to the local/regional representatives. And should follow and coordinate the work and evaluate the results. Those goals could be technical, educational, communicational, among other kinds.

Here is a related thread with some other ideas: http://www.openehr.org/mailarchives/openehr-implementers/msg00889.html

What do you think?

Regards,
Pablo.

15

Hi Ian,

Erik’s ideas are a great start!

16

Hi David,

You mention a big issue: we want to build local archetype and template repositories but we don’t have the tools to do it in a coordinated way with the openEHR CKM.

I think it would be great to have an open & free CKM to start with, and a common generic API to connect our local CKMs to regional CKMs and regional CKMs to the global CKM in a controlled way (in this scenario the versioning of artefacts is a big issue and I think it is not solved at the tool level yet).

AFAIK the to install the global CKM we have to buy some licenses.

17

Thanks Pablo

It's great to see the proposals generate these discussions, which was
our intention as these discussions were needed..

Regarding tools, I'm a keen advocate for open source tools and believe
better tools will be key to more widespread use of openEHR..
..but know I you cant get them for free, so if we want more tools we can
share...
-the community needs to agreed a prioritised set of open source tools
-we need to establish how much they will cost
-we need to find ways to channel funds from those who need the tools to
those who are willing to do the work..

regards,

Tony

Dr. Tony Shannon
Consultant in Emergency Medicine, Leeds Teaching Hospitals
Clinical Lead for Informatics, Leeds Teaching Hospitals
Honorary Research Fellow, University College London
+44.789.988 5068 tony.shannon@nhs.net

18

Dear All,

Having tried for long to make my activity on this subject sustainable in Uruguay I feel that not only there is a need for tools but also support in terms of advocacy.

I have not followed the internal negotiations and processes that led to Brazil adopting this model, but a lot of work was surely put into advocating for OpenEHR not exclusively from a technical perspective. From my experience decision makers find this subject very blurry, so even being technically sound is often not enough.

It is also the case that IT and Health is installed in the political arena, so there is a tendency to put a lot of value into short term wins. Although the benefits of long term development are clear (OpenEHR), reality may not move in that direction because of short sighted decision makers and also lack of investment.

Three areas where advocacy support would be very welcome:

  • Identifying short term wins while building a long term strategy.

  • Academic collaboration with relevant universities.

  • Explaining the social benefit of IT in healthcare.

Other initiatives which would help sustain local/regional teams have to do with making the local counterparts visible in the international scenario. International/central validation of the activity and competencies of local members would very much help them to advocate and position OpenEHR.

my two cents

19

Thanks Rodrigo,

Very helpful comments.

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org