# Please respond by Nov. 5th: Known Free/Open Source EHR/EMR Deployment Count.

**Category:** [Technical (archive)](https://discourse.openehr.org/c/technical-archive/156)
**Created:** 2008-11-03 20:35 UTC
**Views:** 5
**Replies:** 27
**URL:** https://discourse.openehr.org/t/please-respond-by-nov-5th-known-free-open-source-ehr-emr-deployment-count/14836

---

## Post #1 by @Ignacio_Valdes

The un\-official, Draft 7 of the upcoming American Medical Informatics
Association Open Source Working Group white paper to be voted on
November 9th can be found http://ignaciovaldes.com/amia. It will be
voted on for ratification on November 9th\-11th or so\. Action is needed
on your part to answer the question: If open source is so great why is
no one using it? There is no aggregate data that I can find to counter
this opinion\. If you know of a Free/Open Source EHR/EMR deployment and
could please send three pieces of information on each deployment that
you have by Wednesday November 5th: General Location, software version
and most importantly NUMBER OF PATIENTS IN SYSTEM\. This paper could
have national impact with this data\. Please respond by email to
ivaldes@hal\-pc\.org if you are able to obtain this data\.

\-\- IV

---

## Post #2 by @Tim_Cook2

There is a very simple answer\.  The current crop of offerings doesn&#39;t
solve the problem of interoperability\.

I note with interest that your paper has a \(very short\) section on
standards\.  Yet openEHR not 13606 do not appear ANYWHERE in the
document\.  Yet you posted on two openEHR mailing lists for comments\.

Until the fundamental problem of interoperability is addressed you can
rant, rave and write about open source in healthcare but it is simply
more of the same\.  When organizations like AMIA, and HIMSS look at and
promote the fundamental concepts of a viable information model, they
will make progress\.

Until then, the US healthcare industry will continue to suffer from
their &quot;not invented here&quot; attitude\.

Cheers,
Tim

---

## Post #3 by @Tim_Cook2

BTW:  I was going to vote No\.  But when I clicked on the &quot;vote&quot; button
it registered it as a vote for the paper\.  Kind of a screwy voting
system I think\.

---

## Post #4 by @system

Tim Cook schreef:

> ```
>
> ```
>
> > ```
> >  Action is needed
> > on your part to answer the question: If open source is so great why is
> > no one using it?
> >
> > ```
>
> ```
>
> There is a very simple answer.  The current crop of offerings doesn't
> solve the problem of interoperability.
>
> ```

Closed source doesn't solve the interoperability-problem either, at least it didn't last twenty years, but it is used a lot.
So your answer does not seem right to me.

The license model has nothing to do with interoperablity.

(sorry, open door, couldn't resist)

Bert

---

## Post #5 by @Tim_Cook2

Hi Ignacio,

Thanks for your reply\.

> 3\.5 million patients in FOSS systems in the US private sector so far
> with only about 1/3 of those asked giving answers\.

Hmmm, I&#39;m not sure what you mean by this\. ????

> The vote was for
> obtaining a voting quorum, not the actual vote\. The actual vote will
> be done at the os\-wg business meeting and by private email\.

Well, you probably should explain this better if you present it to the
public\.

>  While I
> have invited public input such as yours, the vote is only open to AMIA
> os\-wg members\.

See above\.  Of course I still have a rant about AMIA\.  When I founded
the OSWG I wanted at the very least the mailing list to be open to the
public\.  That would have opened up AMIA to a broader community\.
However, the leadership there seems to remain isolated in their actions
and thinking\. I still have hope that you and others will be able to
change that eventually\.

> With regard to OpenEHR 13606, how would you like it to
> appear in the paper? \-\- IV

Well, IMHO, openEHR is a better engineered version of 13606\.  While I
have a deep respect for you personally, I see it as very telling about
the mindset in the US about real information models in healthcare\.  This
mindset is certainly one of the reasons why I no longer reside/work in
the US\.

As far as the way I would like to see them appear appear in the paper is
FAR beyond the capability of an email\.

BTW: I found your comment in the paper about VistA being a &quot;de\-facto
standard&quot; to be quite disconcerting\.  Where is this model published?
Where are their engineering specs?  Being a software engineer yourself,
I continue to wonder how you support this model and yet do not embrace
and support openEHR?

Cheers,
Tim

---

## Post #6 by @Tim_Cook2

hi Bert,

> &gt;
> Closed source doesn&#39;t solve the interoperability\-problem either, at
> least it didn&#39;t last twenty years, but it is used a lot\.
> So your answer does not seem right to me\.

Well, I&#39;m not sure how my answer doesn&#39;t seem right\.  Maybe it is the
things that I assumed and left out, given the audience?  Of course the
closed source model hasn&#39;t provided the solution\.  But neither has the
open source community\.

If you look at open source successes you will see that they are a result
of open specifications/standards\.

Let&#39;s take Ethernet for example\.  Without a doubt, IBM&#39;s Token Ring
technology was HUGELY superior\.  It was a difficult decision for me in
the 1980s\.  I was lucky and went with the open standard of Ethernet\.  It
catapulted my career at that point\.

Since then, other open standards have proven to be very successful\. They
have basically CREATED the Internet\.

> The license model has nothing to do with interoperablity\.
>
> \(sorry, open door, couldn&#39;t resist\)

No apologies required\.  In fact, you made my point\.  It isn&#39;t about the
software license as much as it is about the specifications\.  If we do
not join together in a standard information model then we \(FOSS
community\) will only be more of the same\.

MAYBE\!\!\!???? AMIA &amp; HIMSS will get a clue?

Cheers,
Tim

---

## Post #7 by @Tim_Cook2

Well, this is quite telling in itself\.  openEHR is NOT an application\.
It is a set of well engineered specifications\.

\-\-Tim

---

## Post #8 by @system

Tim Cook schreef:
> hi Bert,
>
>>
>> Closed source doesn&#39;t solve the interoperability\-problem either, at
>> least it didn&#39;t last twenty years, but it is used a lot\.
>> So your answer does not seem right to me\.
>>&nbsp;&nbsp;&nbsp;&nbsp;
> Well, I&#39;m not sure how my answer doesn&#39;t seem right\.  Maybe it is the
> things that I assumed and left out, given the audience?  Of course the
> closed source model hasn&#39;t provided the solution\.  But neither has the
> open source community\.
>&nbsp;&nbsp;

There is no relation between interoperability and license model of the
product\.

That both closed and open source apparently fail to produce
interoperaility in health\-care systems has nothing to do with its
license model, but with other circumstances\.
Bert

> MAYBE\!\!\!???? AMIA &amp; HIMSS will get a clue?
>&nbsp;&nbsp;

Yes we can\!

---

## Post #9 by @Tim_Cook2

Well, that&#39;s kind of \(though not exactly\) like asking how many actual
patients are entered into an HL7 system\.   It is non\-sensical to ask
such a question\.

OpenMRS probably has more patients entered than any other FOSS
application\.  However that doesn&#39;t mean that it is THE application to be
used by everyone/everywhere\.

MY point was that the paper should be rejected because it doesn&#39;t
address the underlying issue\.  That underlying issue is that for FOSS
healthcare applications, to be successful in the traditional FOSS sense,
must be based on truly open, available and well engineered
specifications\.  Not unlike how Ethernet trumped Token Ring\.  It was
open and available for everyone\.  From the hardware layer to the top,
the Internet exists today because of open and available specifications\.
Once healthcare wakes up to this idea we can count on real progress as
well\.

Cheers,
Tim

---

## Post #10 by @Tim_Cook2

Hi Ignacio,

> I will re\-phrase\. Can anyone tell me how many actual patients does
> anyone have in any system that conforms to the OpenEHR specification
> that is FOSS licensed?
>
> \-\- IV

Re\-phasing isn&#39;t necessary\.  I think that everyone understood your
question\.  The problem is that your metric is nonsensical\.

As a US veteran I have no choice in which EMR my records are stored\.
Nor does the physician have a choice in which application they use\.  So
you can measure the number of patient records in VistA\.  But really is
that any measure of it&#39;s validity?  No it isn&#39;t\.  It is mandated by the
organization not via some engineering principles but by simple
availability\.

While I understand that you haven&#39;t had time to study the openEHR specs\.
I do believe that it is incumbent upon you as the leader of the AMIA
OSWG to do so or appoint students/academics to do so\.

Even some FOSS application developers have called for a common data
model\.  What they do not yet realize is that what they really want in a
common information model\.  openEHR represents this requirement\.  But
when they look at it they want something simpler\.  However, as Albert
Einstein said; Keep everything as simple as possible, but no simpler\.

Healthcare information is complex\.  Therefore the \(openEHR\) information
model is necessarily complex to some extent\.  You will either study and
embrace it or you will be a victim of the constantly evolving &quot;data
model&quot; of other systems that are never inter\-operable\.

Cheers,
Tim

---

## Post #11 by @thomas.beale

I also don&#39;t think that the metric means much, but for the record, there
are 4 million patients in an openEHR server \(v0\.95\) in Australia, some
thousands \(ultimate design vlume 1,000,000 EHRs\) in the Netherlands, and
probably some thousands in Brazil \- that I know directly about\. None of
these products are open source, but the data and interfaces are
completely open\.

Tim Cook wrote:

---

## Post #12 by @William_E_Hammond

Thomas,

I am very impressed with these statistics\.  I was not aware of the
penetration of openEHR into that volume of use\.  Congratulations for a hugh
success\.  Can you help me identify the actual systems that are in use in
Australia, Netherlands and Brazil\.  I am specifically interested in the EHR
systems that use openEHR\. We need to build on those successes\.

Thanks for sharing this information\.

Best Regards,

Ed Hammond

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Thomas Beale
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;thomas\.beale@oce
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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Known Free/Open Source   EHR/EMR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;11/06/2008 12:02          Deployment Count\.
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I also don&#39;t think that the metric means much, but for the record, there
are 4 million patients in an openEHR server \(v0\.95\) in Australia, some
thousands \(ultimate design vlume 1,000,000 EHRs\) in the Netherlands, and
probably some thousands in Brazil \- that I know directly about\. None of
these products are open source, but the data and interfaces are
completely open\.

Tim Cook wrote:

---

## Post #13 by @Bruce_Wilder

Ignacio,

I cannot provide you with any numbers, but have a few
comments as to why open source systems are not widely
deployed:

1\) Physicians, and probably many institutions, don&#39;t
really understand the concept of open source code, and
the potential advantages, which include cost savings,
protection against obsolescence, and the ability to
meaningfully influence the architecture of the EHR
system, among others \( I have made a few inroads with
organizations such as the American Medical
Association, the American Public Health Association,
and the American Bar Association\)\.

2\) The word open suggests to many that there is no
security \(where in fact, and as you point out in your
draft, systems may be more secure \(also see HIMSS
White Paper, June 2008\)\)\.

3\) Proprietary systems are heavily marketed\.  No one
is marketing open source EHR to a comparable degree
\(you make this point, but perhaps it could be
elaborated upon\)\.

HR 6898, introduced 9/15/08 \(Stark, D\-CA, and Camp,
R\-MI\) and referred to the House Committees on Energy
and Commerce, Ways and Means, and Science and
Technology, includes making available  open source
\(VistA or comparable\) EHR at a nominal cost, and
provides for a consortium to govern the development
and updating of such a system\.   Its recent White
Paper on open source EHR notwithstanding, HIMSS now
opposes these provisions\.  There was similar \(and
successful\) opposition to a plan by David Brailler,
when he was the ONCHIT, to promote open source EHR
three or four years ago\.  The impetus behind both of
these opposition fronts is protection of the
proprietary interests of EHR software vendors, couched
in terms of the protection of innovation \(but, as you
seem to say, traditional copyright protection isn&#39;t
the exclusive path to innovation, e\.g\. Encarta sold
for $500\+ a few years ago, and is now available on
eBay for around $25 if anybody is stupid enough to buy
it instead of using Wikipedia\)\.

Cheers,

Bruce

> The un\-official, Draft 7 of the upcoming American
> Medical Informatics
> Association Open Source Working Group white paper to
> be voted on
> November 9th can be found
> http://ignaciovaldes.com/amia. It will be
> voted on for ratification on November 9th\-11th or
> so\. Action is needed
> on your part to answer the question: If open source
> is so great why is
> no one using it? There is no aggregate data that I
> can find to counter
> this opinion\. If you know of a Free/Open Source
> EHR/EMR deployment and
> could please send three pieces of information on
> each deployment that
> you have by Wednesday November 5th: General
> Location, software version
> and most importantly NUMBER OF PATIENTS IN SYSTEM\.
> This paper could
> have national impact with this data\. Please respond
> by email to
> ivaldes@hal\-pc\.org if you are able to obtain this
> data\.
>
> \-\- IV
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> openEHR\-technical mailing list
> openEHR\-technical@openehr\.org
>

http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical
>
Bruce L\. Wilder, MD MPH JD
Interprofessional Systems, Ltd\.
436 Seventh Avenue, Suite 1050
Pittsburgh, PA  15219\-1826
Tel 412 683\-6015  \(Toll Free 1\-866\-594\-6015\)
Fax 412 683\-6430

Changing health care for the 21st century

---

## Post #14 by @system

Thomas Beale schreef:
> I also don&#39;t think that the metric means much, but for the record, there
> are 4 million patients in an openEHR server \(v0\.95\) in Australia, some
> thousands \(ultimate design vlume 1,000,000 EHRs\) in the Netherlands, and
> probably some thousands in Brazil \- that I know directly about\. None of
> these products are open source, but the data and interfaces are
> completely open\.
>&nbsp;&nbsp;

Oh, I didn&#39;t know that, can you show me where I find some information
about the interfaces? I am very interested, it is my main concern now,
to define a decent interface, I have already tried so many solutions\.

Thanks
Bert

---

## Post #15 by @thomas.beale

William E Hammond wrote:
> Thomas,
>
> I am very impressed with these statistics\.  I was not aware of the
> penetration of openEHR into that volume of use\.  Congratulations for a hugh
> success\.  Can you help me identify the actual systems that are in use in
> Australia, Netherlands and Brazil\.  I am specifically interested in the EHR
> systems that use openEHR\. We need to build on those successes\.
>
> Thanks for sharing this information\.
>
> Best Regards,
>
> Ed Hammond
>&nbsp;&nbsp;

\*Ed,

I should stress that these are pure openEHR systems; systems based on
archetypes of some kind include Systematic \(SSE\) in Aarhus, Denmark, and
Obstet in Australia\. Both companies have expressed serious interest in
&#39;going official&#39;, and I happen to know that their architectures are
sufficiently close to the archetype / template idea that it is feasible\.
I dont have any numbers on EHRs in these systems but I would expect in
the hundreds of thousands, based on the catchment areas they serve\.
Although I said at the beginning that I don&#39;t think it is that useful a
statistic, it&#39;s not a bad brut measure of uptake, so let&#39;s see if we can
gather some better numbers, for interest&#39;s sake\.

One reason for success of at least our own EHR server \(Ocean
Informatics\) is that its performance is good \- sub\-0\.5 second for
everything so far, with a typical concurrent load equivalent to about a
1,000 bed hospital\.  I don&#39;t yet have performance numbers for harder
population queries, but mundane population queries across 10,000 \-
250,000 EHRs are fast\.

This isn&#39;t the place to advertise, but I think it is reasonable to at
least allow the community to know that real performance is indeed
possible and feasible to implement in openEHR\. If others agree, it may
be the time to do a bit of a poll and start putting harder data on the
&#39;who is using it&#39; webpage\.

\- thomas

---

## Post #16 by @thomas.beale

There is another, simpler reason: open systems rather than open source
code is a far higher priority for clinical and secondary use users\.

\- thomas beale

Bruce Wilder wrote:

---

## Post #17 by @William_E_Hammond

Thanks\.  I agree that things are moving ahead\.  I wish we could remove some
of the animosity \(maybe I am reading it worng\) towards HL7 \(not from you\),
and close the gap between the two efforts\.

best Regards\.

Ed

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Thomas Beale
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;thomas\.beale@oce
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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Known  Free/Open   Source
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;11/06/2008 01:11          EHR/EMR      Deployment Count\.
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William E Hammond wrote:
> Thomas,
>
> I am very impressed with these statistics\.  I was not aware of the
> penetration of openEHR into that volume of use\.  Congratulations for a

hugh
> success\.  Can you help me identify the actual systems that are in use in
> Australia, Netherlands and Brazil\.  I am specifically interested in the

EHR
> systems that use openEHR\. We need to build on those successes\.
>
> Thanks for sharing this information\.
>
> Best Regards,
>
> Ed Hammond
>

\*Ed,

I should stress that these are pure openEHR systems; systems based on
archetypes of some kind include Systematic \(SSE\) in Aarhus, Denmark, and
Obstet in Australia\. Both companies have expressed serious interest in
&#39;going official&#39;, and I happen to know that their architectures are
sufficiently close to the archetype / template idea that it is feasible\.
I dont have any numbers on EHRs in these systems but I would expect in
the hundreds of thousands, based on the catchment areas they serve\.
Although I said at the beginning that I don&#39;t think it is that useful a
statistic, it&#39;s not a bad brut measure of uptake, so let&#39;s see if we can
gather some better numbers, for interest&#39;s sake\.

One reason for success of at least our own EHR server \(Ocean
Informatics\) is that its performance is good \- sub\-0\.5 second for
everything so far, with a typical concurrent load equivalent to about a
1,000 bed hospital\.  I don&#39;t yet have performance numbers for harder
population queries, but mundane population queries across 10,000 \-
250,000 EHRs are fast\.

This isn&#39;t the place to advertise, but I think it is reasonable to at
least allow the community to know that real performance is indeed
possible and feasible to implement in openEHR\. If others agree, it may
be the time to do a bit of a poll and start putting harder data on the
&#39;who is using it&#39; webpage\.

\- thomas

---

## Post #18 by @Dr_Carola_Hullin_Luc

Dear Ed,
I got the that feeling TOO, and I wish we can get some type of working
FRAMEWORK that allow TWO AMAZING approaches to get some kind of
interoperability to JOIN forces together\. I gather, at the operational
level, that is it is EXTREMELLY difficult to separate the GOOD FOR society
and business iniciatives that somehow REWARDS materially all the great
innovation created\.

I am personally live everyday the prevention of great PROJECTS of EHR in
developing countries due to the lack of understanding of the balance
between, resources and people\- needs\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-

Hope is what I reckon will allow us as human being to DO THE RIGHT THINGS
every day\.

Cheers Carol

Melbourne Australia

---

## Post #19 by @William_E_Hammond

Thanks for sharing those sentiments\.  Where there is hope there is a chance
of success\.

Ed

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&quot;Dr Carola Hullin
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Lucay Cossio&quot;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;carolhullin@hotm                                          To
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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sent by:                  &lt;openehr\-technical@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;openehr\-technical                                          cc
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\-bounces@openehr\.         &quot;For openEHR technical discussions&quot;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;org                       &lt;openehr\-technical@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Subject
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Re: Please respond by Nov\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;11/06/2008 01:47          5th:Known    Free/Open   Source
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PM                        EHR/EMR      Deployment Count\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Please respond to
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;For openEHR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;technical
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;discussions
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;openehr\-technica
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;l@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Dear Ed,
I got the that feeling TOO, and I wish we can get some type of working
FRAMEWORK that allow TWO AMAZING approaches to get some kind of
interoperability to JOIN forces together\. I gather, at the operational
level, that is it is EXTREMELLY difficult to separate the GOOD FOR society
and business iniciatives that somehow REWARDS materially all the great
innovation created\.

I am personally live everyday the prevention of great PROJECTS of EHR in
developing countries due to the lack of understanding of the balance
between, resources and people\- needs\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-

Hope is what I reckon will allow us as human being to DO THE RIGHT THINGS
every day\.

Cheers Carol

Melbourne Australia

---

## Post #20 by @thomas.beale

William E Hammond wrote:
> Thanks\.  I agree that things are moving ahead\.  I wish we could remove some
> of the animosity \(maybe I am reading it worng\) towards HL7 \(not from you\),
> and close the gap between the two efforts\.
>
> best Regards\.
>

\*Ed,

I think think the biggest problem with respect to HL7 is the
message\-centric approach to clinical content modelling\. I really don&#39;t
understand why HL7 doesn&#39;t want to use archetypes and templates, to
express clinical and related content\. It works and is &#39;good enough&#39; for
now, and most importantly, it supports reusability \- i\.e\. it is a
single\-source modelling framework\. In HL7 it is very difficult to reuse
an RMIM for a display screen, a data capture form, as a basis for
generating a piece of code, and as a source of any number of XML\-based
outputs, including messages \(these are now working in production\), also
PDF and HTML variants\. Let alone as a basis for writing re\-usable
queries and expressing Snomed data bindings\. The querying is working in
real systems now, and we are working in earnest with IHTSDO on the
Snomed side of things\. It&#39;s not perfect of course, and more work is
required in areas like representation of process \(e\.g\. care plans\), but
the reuse capability is very high\.

Now, groups of clinicians working on archetypes and Snomed have already
expressed the desire not to have to rebuild what they create in HL7
messages or CDA templates or any other concrete technology\. Nor do we
want to have to write queries that are specific to each of these forms,
or define more than one kind of Snomed binding\.

\- thomas

---

## Post #21 by @Eric_Browne

Ed,

In an attempt to &quot;close the gap&quot;, I have penned an article indicating how
HL7 might make use of openEHR archetypes to overcome some of the inherent
shortcomings of RIM based modelling for CDA document entries\.

You can read it at:

http://www.openehr.org/wiki/display/stds/openEHR+Archetypes+for+HL7+CDA+Documents

Interested in your thoughts about how this could be progressed\.

regards,
Eric Browne

Ed Hammond wrote:

---

## Post #22 by @William_E_Hammond

Thanks Eric\.  I&#39;ll take a look when I get a chance \(soon I hope\) and give
you my comments\.

Ed

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&quot;Eric Browne&quot;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;eric\.browne@mont
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;agesystems\.com\.au                                          To
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&gt;                         &quot;For openEHR technical discussions&quot;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sent by:                  &lt;openehr\-technical@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;openehr\-technical                                          cc
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\-bounces@openehr\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;org                                                   Subject
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;HL7 and openEHR\. was Re: Please
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;respond by Nov\. 5th:     Known
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;11/06/2008 07:12          Free/Open    Source      EHR/EMR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PM                        Deployment Count\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Please respond to
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;For openEHR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;technical
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;discussions
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;openehr\-technica
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;l@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
Ed,

In an attempt to &quot;close the gap&quot;, I have penned an article indicating how
HL7 might make use of openEHR archetypes to overcome some of the inherent
shortcomings of RIM based modelling for CDA document entries\.

You can read it at:

http://www.openehr.org/wiki/display/stds/openEHR+Archetypes+for+HL7+CDA
\+Documents

Interested in your thoughts about how this could be progressed\.

regards,
Eric Browne

Ed Hammond wrote:

> Thanks\.  I agree that things are moving ahead\.  I wish we could remove
> some
> of the animosity \(maybe I am reading it worng\) towards HL7 \(not from

you\),
> and close the gap between the two efforts\.
>
> best Regards\.
>
> Ed
>
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Thomas Beale
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;thomas\.beale@oce
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;aninformatics\.com

To
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&gt;                         For openEHR technical discussions
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sent by:                  &lt;openehr\-technical@openehr\.org&gt;
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;openehr\-technical

cc
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\-bounces@openehr\.
> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;org

Subject

---

## Post #23 by @William_E_Hammond

There is no HL7\.  It is an organization with many members\.  Most people who
believe that HL7 is just message\-centric are outside people, plus, I admit,
some are in HL7\.  In my opinion, the CDA, and certainly level 3, are
templates/archetypes in compositiopn\.  I further believe that the CDA will
adopt clinical statements\.  On the other hand, I find that messaging still
has its place\.

Given that, I think openEHR has excellent archetypes that have intellectual
value\.  In my opinion, there is considerable interest in archetypes in HL7\.
I particularly believe the board is committed to this direction\.  We
certainly have several persons on the board that are strongly committed to
that direction\.  Thinking HL7 as only message\-centric is coupled with v2 of
which there is still a strong following\.
I think the furture will be different\.

Ed

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Thomas Beale
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;thomas\.beale@oce
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;aninformatics\.com                                          To
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&gt;                         For openEHR technical discussions
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sent by:                  &lt;openehr\-technical@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;openehr\-technical                                          cc
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\-bounces@openehr\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;org                                                   Subject
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Re: Please respond by Nov\.     5th:
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Known  Free/Open   Source
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;11/06/2008 05:20          EHR/EMR      Deployment Count\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PM
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Please respond to
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;For openEHR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;technical
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;discussions
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;openehr\-technica
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;l@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
William E Hammond wrote:
> Thanks\.  I agree that things are moving ahead\.  I wish we could remove

some
> of the animosity \(maybe I am reading it worng\) towards HL7 \(not from

you\),
> and close the gap between the two efforts\.
>
> best Regards\.
>

\*Ed,

I think think the biggest problem with respect to HL7 is the
message\-centric approach to clinical content modelling\. I really don&#39;t
understand why HL7 doesn&#39;t want to use archetypes and templates, to
express clinical and related content\. It works and is &#39;good enough&#39; for
now, and most importantly, it supports reusability \- i\.e\. it is a
single\-source modelling framework\. In HL7 it is very difficult to reuse
an RMIM for a display screen, a data capture form, as a basis for
generating a piece of code, and as a source of any number of XML\-based
outputs, including messages \(these are now working in production\), also
PDF and HTML variants\. Let alone as a basis for writing re\-usable
queries and expressing Snomed data bindings\. The querying is working in
real systems now, and we are working in earnest with IHTSDO on the
Snomed side of things\. It&#39;s not perfect of course, and more work is
required in areas like representation of process \(e\.g\. care plans\), but
the reuse capability is very high\.

Now, groups of clinicians working on archetypes and Snomed have already
expressed the desire not to have to rebuild what they create in HL7
messages or CDA templates or any other concrete technology\. Nor do we
want to have to write queries that are specific to each of these forms,
or define more than one kind of Snomed binding\.

\- thomas

---

## Post #24 by @Hugh_Leslie1

Hi Ed

I think that there is a sense of 'competition' from both sides of the fence unfortunately as people push their ideas and people who are passionate about what they are doing work towards a common goal of ubiquitous interoperability. I think that openEHR people have had to push very hard to get to where we are at the moment with very limited resources and so at times the passion may come across as animosity. On the other hand, there has been a lot of opposition in the past to openEHR from many in the HL7 community. There are positive things that come out of this I think as challenging the status quo can lead to better outcomes and rigorous, open minded debate is a good thing.

I think that as long as we all have open minds and are willing to look out of the box, then we should be able to move things forward. We are certainly seeing many jurisdictions in the world moving strongly towards openEHR for clinical modelling and the logical record architecture.

For your interest, apart from the systems that Tom has already mentioned, we are starting to see vendors moving to openEHR for their clinical repositories. In Australia alone, there are at least 6 system vendors that are building systems based on openEHR repositories and interestingly, not all of these are using Ocean tools either. We are also working with a large research database for the Cancer Council in Victoria, Australia to bring 18 years of longitudinal data into an openEHR repository to future proof it.

regards Hugh

William E Hammond wrote:

---

## Post #25 by @grahamegrieve

Ed:

&gt; On the other hand, I find that messaging still has its place

Yes\. HL7 is not just interested in clinical records and logical record
architecture but also in capturing healthcare processes, both
administrative and clinical\. &quot;messages&quot; is simply the way that we
describe the agreed processes\. Increasingly, we will be migrating to a
services\-based language to describe the processes\.

Hugh:

well put\.

We will need to search for a productive way forward so that
instead of looking across the technical gulf at each others
strengths and trying to decide whether to critise, we can
actually share strengths\.

Grahame

Hugh Leslie wrote:

---

## Post #26 by @thomas.beale

William E Hammond wrote:

---

## Post #27 by @William_E_Hammond

Of course, it depends on the definition of singlesource modeling\.  HL7 is
pursuing a course that uses a common process but multiple expert groups to
create the clinical content\.  I also think we still do not know how far to
take templates/architypes\.  For example, I think developing a template for
a general physical examination will never be used by the diverse clinical
community\.

The real question is how will openEhr and HL7 work together\.  We we compete
with a tension in each contact, will we work separately with redundancy and
mapping from one group to another, or will we find a process that permits
use to work jointly\.  I personally think the clinical content of templates
is by far the most valuable component of this work\.  We could live with
mapping \- although in my opinion, this is not the best result\.

There are many variables and we obviously need a dedicated commitment to
making something work\.  Perhaps ISO is the vehicle for that interaction\.
Both groups seem to be moving ahead with success in both groups\.  Maybe
that is what will be for the moment\.  I don&#39;t know if an unbiased
discussion is possible, because the players for both sides think we are
doing it the correct way\.  And there is also that thing called momentum\.

I read and remember your comments on groups developing standards earlier
inthe year\.  Ideally we will be able to choose a course of action designed
to produce the best results\.

Thanks for the exchange\.

Ed Hammond

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Thomas Beale
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;thomas\.beale@oce
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;aninformatics\.com                                          To
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&gt;                         For openEHR technical discussions
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Sent by:                  &lt;openehr\-technical@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;openehr\-technical                                          cc
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\-bounces@openehr\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;org                                                   Subject
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Re: Please respond       by    Nov\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;5th:   Known       Free/Open
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;11/07/2008 01:33          Source       EHR/EMR     Deployment
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PM                        Count\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Please respond to
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;For openEHR
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;technical
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;discussions
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&lt;openehr\-technica
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;l@openehr\.org&gt;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
William E Hammond wrote:
> There is no HL7\.  It is an organization with many members\.  Most people

who
> believe that HL7 is just message\-centric are outside people, plus, I

admit,
> some are in HL7\.  In my opinion, the CDA, and certainly level 3, are
> templates/archetypes in compositiopn\.  I further believe that the CDA

will
> adopt clinical statements\.  On the other hand, I find that messaging

still
> has its place\.
>
> Given that, I think openEHR has excellent archetypes that have

intellectual
> value\.  In my opinion, there is considerable interest in archetypes in

HL7\.
> I particularly believe the board is committed to this direction\.  We
> certainly have several persons on the board that are strongly committed

to
> that direction\.  Thinking HL7 as only message\-centric is coupled with v2

of

---

## Post #28 by @system

Dear Ed,

Good to hear from you\. It is important that we get a formal solution in this
space and that it works for clinicians\. I know there is a push from everyone
to get things working and I attended the DCM group from the outset and over
a few years\. This was set up to be outside HL7 by HL7 participants to try
and get some progress and is now within the HL7 space\. I know you are making
mighty efforts to get the clinicians involved within HL7\.

Obviously the openEHR community have been at this a long time and have
targeted the formal expression of clinical content for EHRs from the outset\.
We are a smaller group but now have a number of countries going in this
direction\. Some have considerable experience in HL7 version 3, so we can
assume that what we are doing is at least complementary\. It is the general
belief that the openEHR archetypes developed can be used to constrain HL7
version 2 and version 3 messages, although the choice of how to represent
the clinical content in the HL7 domain has to be hand crafted if the
intended use of all the codes is to be respected\. I do not believe that the
situation will be any different if another formalism is chosen for DCM \(ie \-
then models will have to be hand crafted in HL7 and openEHR\)\.

There is one key reason for using openEHR, and it addresses the issue when
you say that &#39;no\-one will use a single template for physical examination&#39;\.
It is the ability to reuse the archetypes in as many templates as necessary
without creating new semantic expressions\. It is worth looking at the two
approaches:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;openEHR		HL7 v3		HL7 CDA
1\. Information model 	openEHR RM		HL7 RIM		CDA r2
\(Schema\)
2\. Semantic commitment	Archetypes		Message		Template
\(Meaning\)
3\. For purpose		Template		Template
Compound templates \(For purpose\)

While the HL7 methodology has a number of layers, they are used differently
in v3 and CDA\. Also, in the message environment a different schema is used
for each message\. The result is that we need a different transform for the
different paradigms\. This is not a problem but it does mean work\.

A further advantage we are seeing with openEHR is its much smaller
terminology footprint\. Much of the semantics is captured in the archetypes
themselves\. While this does lead to a hue and cry from the terminology
space, it is in fact much more straightforward to express meaning with
relationships and descriptions in a single artefact\. If is often very
difficult to determine what is the appropriate SNOMED code for something
that clinicians can easily understand\. SNOMED&#39;s definitional relationships
may be ontologically correct but they are often not clinically meaningful\)\.
Obviously as the library of archetypes grows we need to keep a tight grip on
the relationships of these semantic expressions\. We are doing this with a
web based controlled authoring environment:

http://openehr.org/knowledge \(beta testing environment \- no link from site\)

This is not being pushed at the moment, but the tools we are using allow
jurisdictions to subscribe to a set of archetypes they want to use or
specialise locally\. They can add locally specific archetypes if necessary,
remembering that if we do not share archetypes then we do not have
interoperability\. We do want to move away from the \(carbon heavy\) 3 monthly
meeting cycle to get this work done\.

I have made many approaches to HL7 and yourself over the years and offered
to bring this work to that community\. I absolutely understand why that might
be difficult in the US context\. The other problem is that openEHR is a
specification for a standard EHR service \(not a clinical application\) which
may be installed within EHR systems or simply expressed as an interface\.
This does go a little against the ethos of the messaging community\.

The detailed clinical modelling work should, in my opinion, use an HL7 or an
openEHR formalism, rather than a new one\. I do not have a problem with UML
or Word or Excel to get ideas down \- but we need a formal expression that
can be used by EHR vendors to produce information in a standard manner\. If
HL7 has a suitable technology for this purpose then openEHR can transform
from that space for use within openEHR based systems\. I would ask you to
consider the converse if it is difficult with HL7 tools, as we will all make
a lot more progress if we are aligned\. The only requirement I have is that
it does not involve reading paper specs or UML and hand crafting the output\.

I look forward to working with the clinical community in whatever direction
this takes\. I have always promised to pack up and go home when there is a
means of sharing data that works\. I am interested also in getting to the
point that a hospital can keep its data and health records and swap clinical
systems when appropriate\! The EHR service\.

William Goosens has approached Dipak and myself and will approach the
openEHR Foundation about the ISO initiative\. If the remit is correct, this
could be a useful initiative\. Meanwhile we will get the formal models out
there for scrutiny and try and maximise clinical participation\. We would
love the clinicians in the US to feel they could participate and feel
confident that the models can be transformed to message and document
specifications\.

There is a lot to be done\.

Cheers, Sam

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**Original content:** https://discourse.openehr.org/t/please-respond-by-nov-5th-known-free-open-source-ehr-emr-deployment-count/14836