Category Archives: standards

Directions in clinical guideline programming – CHA2DS2-VASc

Posted on 29/03/2021 by wolandscat

The above shows a typical web form calculator for the CHA2DS2-VASc score, used for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation (AF), primarily for the purpose of deciding the use of anti-coagulant therapy [Wikipedia]. How would such … Continue reading →

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Clinical Decision Logic Fun

Posted on 22/10/2020 by wolandscat

How close can we get to making a clinical decision logic language look like the published guidelines which it is used to encode? Below is an openEHR Decision Logic Module (DLM) example, in the current form of the openEHR Decision … Continue reading →

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Towards a standard analysis of computable guidelines, clinical workflow, decision support and … the curly braces problem

Posted on 24/06/2020 by wolandscat

Why don’t we have widespread clinical decision support (CDS), computable guidelines, clinical workflow (plans), and why don’t the pieces we do have talk to the health record? The first time I heard such challenges framed was around 2000, and even … Continue reading →

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FHIR fixes: why a type hierarchy would help

Posted on 14/11/2019 by wolandscat

One of the principal reasons for why I and others are proposing (some) type hierarchy in the FHIR Admin resources is as follows (my earlier post on this). Working Groups (i.e. committees) building Resources are currently in the situation of … Continue reading →

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FHIR Fixes – the Observation.value problem

Posted on 12/09/2019 by wolandscat

As described in some detail in this earlier post on the FHIR formalism, a number of FHIR Resources contain ‘choice’ attributes of the form attribute[x], such as the one shown above in Observation. These are mapped in the FHIR UML … Continue reading →

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Fixes for FHIR – the Admin Resources

Posted on 11/09/2019 by wolandscat

In this post I revisit the issues with the FHIR Resources described in the earlier post – A FHIR experience: models or just definitions? To summarise: FHIR has no semantic inheritance, only a generic structural inheritance of Resources from abstract … Continue reading →

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Why using HIT standards fails to achieve interoperability

Posted on 06/09/2019 by wolandscat

I started working in the Health IT area in 1994, on a major European Commission funded project. I attended years of standards meetings at HL7, CEN and occasionally OMG and ISO from 1999 to about 2012. And I’ve observed the … Continue reading →

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Improving Process State Representation in FHIR

Posted on 08/06/2019 by wolandscat

In this post I document further observations on the FHIR resources, made during the transcription of the DSTU4 FHIR resources to the BMM format used in openEHR, as described here. This post examines the definition of process state in FHIR … Continue reading →

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FHIR versus the EHR

Posted on 24/05/2019 by wolandscat

One of the many things the FHIR silver bullet hype claims FHIR will solve is the EHR, along with Clinical Decision Support (CDS), Care Pathways, and who knows, paving driveways and launching spacecraft. I have made various arguments against silver … Continue reading →

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A FHIR Experience – the formalism

Posted on 08/05/2019 by wolandscat

This post continues the review presented in the previous post, where I looked at the Administrative resources of FHIR. Here I take a look at the formalism used in FHIR, i.e. how the resources (and profiles) are formally expressed. FHIR … Continue reading →

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