Recently Gartner released a survey of EHR suppliers in the Norwegian market, as commissioned by the Norwegian Ministry of Health and Care Services. In the report, they stated the following (bullet and footnote, page 26 of PDF file):
“OpenEHR and archetypes is an example of CIMIs1 (Clinical Information Modeling Initiative). CIMI and thus OpenEHR are regarded by Gartner to be an immature standard.“
“1 The OpenEHR is not a standard that is visible in the Hype Cycle for Healthcare Provider Technologies and Standards, 2013, it is part of several initiatives mentioned as CIMI “Clinical Information Modeling Initiative” in the Hype Cycle. CIMI is very low on the hype. There is still a long way to go before the impact of CIMI or other detailed clinical modeling efforts becomes clear to the developers and users of EHR systems. We include it on the Hype Cycle primarily to keep it on the radar screen of academic users and other developers of clinical systems. “
This doesn’t seem right to me; for some reason they make openEHR out to be a part of CIMI. Could anyone comment on this? This evaluation by Gartner has been cited in several other (Norwegian language) reports on health IT in Norway, and if it’s incorrect or inaccurate we might need to make a statement about this as soon as possible.
Kind regards, Silje Ljosland Bakke
Coordinator, National Editorial Board for Archetypes, National ICT Norway
Adviser, R&D dept, E-health section, Bergen Hospital Trust
Thanks for noting this. I’ll resist the urge to write a long, really long response and just say that I think you’re right. This does not sound right (the understatement of the year for 2014 so far…)
I’ll leave the details to members of openEHR who regularly advice CIMI…
It’s completely wrong of course. It just means the researchers don’t know what they are talking about. I would suggest that you indicate to whoever needs to hear a few facts on CIMI:
I think the main point for this report is your statement on what openEHR is in relation to CIMI. I don’t know why they’ve brought CIMI into this at all really, since neither DIPS nor the National ICT governance is relating our work to CIMI at all. Where would they have got this kind of misconception from?
well, as you know Gartner does love their hype-cycle. I guess they tend to view things from that perspective. How they think CIMI is strongly connected with openEHR, or even anything like the same kind of thing is a mystery. I imagine that some of us here, or the board could produce a statement on openEHR / CIMI, but really I think it would make more sense if the relevant Norway authority (MoH or whomever) was to make that request. - thomas
Here’s another statement from one of the mentioned reports (translated from Norwegian language). This also seems like a bit of a misunderstanding to me. Would anyone like to comment?
“National ICT has chosen archetypes as a method for structuring EHR data. It is unclear whether other options have been considered, for example SNOMED-CT in combination with ICD-10 as used in many of the leading systems internationally.”
I have a strong feeling that “someone” in the Norwegian MoH have ordered a report that gives them a reason to choose a big vendor of EHR from the US… Like, let me think of a randomly chosen one - NOT - , Epic.This is political, and has nothing to do with the type of rationale that exist in normal people.
Still, it’s worth correcting. Any ammunition in that battle from the openEHR community is appreciated.
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Here’s another statement from one of the mentioned reports (translated from Norwegian language). This also seems like a bit of a misunderstanding to me. Would anyone like to comment?
“National ICT has chosen archetypes as a method for structuring EHR data. It is unclear whether other options have been considered, for example SNOMED-CT in combination with ICD-10 as used in many of the leading systems internationally.”
In the video http://vimeo.com/106445729 Wes Rishel politely discusses where HL7 FHIR could be placed in the the hype-cycle. The video is quite informative regarding how the curve works.
At 2:22 into the video the “peak of inflated epextations” is discussed in relation to implementations etc. I think it would be safe to say that openEHR (at least RM 1.0.2. with ADL 1.4) has passed that stage ages ago. Somebody should make a similar interview with
Wes regarding openEHR. I think it would get may views and blog visits to whoever does it…
And now to the statement:
“National ICT has chosen archetypes as a method for structuring EHR data. It is unclear whether other options have been considered, for example SNOMED-CT in combination with ICD-10 as used in many of the leading systems internationally.”
Whoever wrote that needs an update on the relationship between…
a) Concept Model or “Ontology” (Includes terminology systems like SNOMED-CT and ICD-10) and
b) Information Model (detailed information structures for example clinical ones based on archetypes).
A classic (somewhat informatics-nerdy but good) explanation of all this (plus decision support rules) is Alan Rectors et al’s paper “Models and Inference Methods for Clinical Systems: A Principled Approach” available via http://scholar.google.se/scholar?cluster=12087444569850179215 I have not heard anybody seriously questioning the main conclusions of that paper.
To create an EHR system you need information models (“b” above) to put the terminology codes (“a” above) in. Information models like openEHR support the use of both ICD-10 and SNOMED CT.
The practical choice regarding information model (b) today is probably to either pick/trust a specific vendor’s proprietary information model (for example what Epic uses internally) or to pick something vendor neutral (for example openEHR or ISO 13606). If you see vendor-lock-in as mainly positive or negative should probably infuence your choise…
So regarding what “options have been considered” in Norway, the National ICT seems to have picked one of the vendor neutral options.
It could have been understandable if they in the report asked for the rationale behind picking a specific information model (b) over another such model, but not to say that concept models (a) could be used instead of information models (b).
Please forward this information in some suitable way to decision makers…
amusing, that indicates the report writers really don't have a clue about the domain. Hope the Norwegian government didn't spend too much taxpayers money on that report, it's worthless.
Gartner mostly writes reports on behalf. The conclusion is often also on behalf, it is part of the order.
The price of such a report is several hundred thousands Eur or above a one million.
Interesting is not Gartner, interesting is who paid for the report and with which purpose.
