Semantic scalability – the core challenge in e-health?


A few months ago I posted on what makes a standard or set of standards in e-health investible. The headline requirements I can summarise as follows:

  1. platform-based: the standards must work together in a single coherent technical ecosystem, based on common information models, knowledge definitions, and interfaces;
  2. semantic scalability: there must be a sustainable way of dealing with both the massive domain diversity and change, and the massive local variability;
  3. implementability: is the standards ecosystem available in a developer-friendly form?
  4. utility: does the standards ecosystem actually bring real value?
  5. responsive governance: does the ecosystem, and its constituent standards have a maintenance pathway?

In the above, I use the word ‘standard’ to mean anything that is in wide use, as per this post.

In the above, #1, and #3-5 are about technical and management issues. They need to be well understood and carefully addressed. But they can be solved. Most importantly, they are of ‘constant size’, more or less, if we agree that the relentless churn in software platforms essentially produces the same thing every time, solved in slightly different ways.

It is #2 that really matters – the question of semantic scalability. This is the one characteristic that directly reflects the domain subject matter itself: biomedical knowledge, clinical information, workflow, practices and processes.


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Barriers to open source in the NHS


There is a discussion going on on the NHS Technology Community site on what the barriers to open source are in the NHS, and how to address them. The posts are interesting, but one thing is lacking: a statement of what it is people are trying to achieve, other than solving local problems. I made a post that may interest others more widely, as follows (slightly adjusted here).

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No SQL databases, documents and data – some misunderstandings


A good friend pointed me to this post: why you should never use MongoDB. It’s a very interesting post, about how bad MogoDB turned out to be for dealing with social network data. It’s not that MongoDB is bad per se, just that you have to understand what it is, what it could be used for, and when it won’t work.

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Does anyone actually understand what terminology is for?


I really wonder sometimes. A few months ago, an international organisation that has been looking at how to solve the requirement for scalable, sustainable content modelling (research data sets) did some trialling on the use of archetypes. This worked fine as far as it went. I subsequently received an email to do with what they would do, that contained the line

“There has also been talk in our senior management about using SNOMED for this type of requirement”.

More recently, a colleague from Norway posted on the openEHR list various quotes from a Gartner report that was commissioned by the Norwegian government. The one most relevant here is (this comes from a Norwegian report):

“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.”

Where to start with this? It appears that the authors don’t know the difference between terminology and information models.

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What is a ‘standard': legislation or utilisation?



Bert Verhees, a colleague from the openEHR community made this post recently to the openehr-technical mailing list:

OpenEHR is not a standard, it is a formal specification.
 ISO, What is a standard: 
 "A standard is a document that provides requirements, specifications, guidelines or characteristics that can be used consistently to ensure that materials, products, processes and services are fit for their purpose."

I’ve grappled with this question many times over the last 20 years. My current thinking is as follows.

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Health interoperability standards are a pre-platform concept. Discuss.


There is a growing recognition that we need an open platform concept to solve e-health interoperability and reuse problems. Some evidence of this I noted in my recent post ‘What is an open platform’, including various US-based cross vendor platform alliances. The great value of a well-designed open platform is that it enables two things:

  • a growing platform-based economy of producers to collaborate technically while operating commercially and/or in an open source mode
  • adaptation to the constant stream of new requirements.

This is in contrast to the typical de jure standard based on a particular use case: it solves a locked down definition of the problem in a locked down way. Read the rest of this entry »

openEHR 2014 Roadmap Meeting, Sep 16/17, Oslo


Last week saw the first major face-to-face international openEHR community meeting, which took place in Lilletstrom, near Oslo, at premises kindly organised by DIPS asa, openEHR Industry Partner and major EHR supplier in Norway.


The remaining hard core at end of day 2 (photo: Dr Shinji Kobayashi)

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