The openEHR platform live in Norway

Posted on June 8, 2013 by wolandscat

I had the pleasure of being invited to the annual DIPS Forum Tromsø, Norway 2-5 June 2013, to present on openEHR. DIPS is the main Norwegian hospital information system supplier, and the DIPS forum is its annual user/vendor meet-up. (Presentation – YouTube; 32 mins).

Tromso 2013

Something possibly unique is going on in Norway. DIPS is a vendor that originated in hospital IT, and morphed into something like a normal company. Abnormally, it remains very close to its users in the clinical community, under a visionary clinical and engineering leadership that has its eyes firmly on the long term, while never forgetting its audience.

The DIPS Forum is evidence of this relationship: 24 years long, with 650 or so attendees in 2013, it’s larger than an HL7 meeting, and yet consists almost 100% of users from only one country, and only one vendor (plus the odd foreigner;-). My impression is that what the user community really appreciates is the relationship and engagement. It’s the kind of thing bureaucrats dream of creating by ‘programmes’ or ‘reorganisation’ but in fact it can only ever really be ‘grown’ into place. It’s what ensures the product, while probably not perfect on any given day, keeps up with (and sometimes probably overtakes) user needs and aspirations. Continue reading →

Posted in Health Informatics, openehr | 2 Comments

Identifying complex knowledge artefacts

Posted on April 24, 2013 by wolandscat

Based on a lot of experience, thinking and gnashing of teeth of colleagues Ian McNicoll, Heather Leslie, Sebastian Garde who work on the Ocean Clinical Knowledge Manager (CKM) product, as well as many others using archetypes and archetype tools more generally, I have produced a major update to the openEHR Knowledge Artefact Identification specification draft, here.

Lifecycle management with semver.org versioning.

This specification is designed to answer the following needs for complex, designed artefacts like archetypes, templates and terminology subsets:

  • ‘ontological’ (human readable) archetype, template and subset identifiers
  • machine identifiers
  • references to identified artefacts from other artefacts
  • recording knowledge artefact ids in data
  • lifecycle management and states;
  • dealing with transfer and forking;
  • supporting integrity and non-repudiation.

It combines the concept of lifecycle management for knowledge artefacts with a solid versioning model, mostly lifted from the excellent specification at semver.org.

I have taken a lot of care to ensure this specification works equally well with artefacts produced by other organisations, particular non-openEHR archetypes and similar models. It now needs community input and feedback… i.e. feel free to pull it to pieces.

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DCMs & archetypes – why we need 3 layers

Posted on October 9, 2012 by wolandscat

This post is inspired by a slightly out-of-control discussion among people in the CIMI group. It’s a good discussion. The latest question that has come up is whether a DCM (Detailed Clinical Model) is a ‘model of use’ (i.e. some kind of data set) or a ‘model of meaning’ (i.e. some kind of ontological definition).

Continue reading →

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Models from Intermountain Health – pioneering lessons

Posted on September 22, 2012 by wolandscat

I am back this week from a week in Salt Lake City, visiting Dr Stan Huff’s group at Intermountain Health, a globally recognised centre of excellence for clinical computing. I should have been 10 years ago, but better late than never. Stan has quietly been pioneering model-based health computing for nearly 20 years, featuring Clinical Element Models (CEMs) and terminology.

Intermountain / Caradigm CEM browser

It started with the ASN.1 models used in the (still deployed) 3M system, and progressed through the CEML form (a light-weight XML format developed by Joey Coyle, who just submitted a PhD thesis on the topic) to the current CDL format. CDL stands for Constraint Definition Language, and was co-developed by GE and Intermountain for the Qualibria product. Continue reading →

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Ontologies in health: ready for prime time? IAO versus openEHR

Posted on September 3, 2012 by wolandscat

A lot of ontology work has been going on for some years that comes loosely under the BFO and OBO activities, which stand to improve how computing in health is done. BFO is the Basic Formal Ontology, and OBO is the Open Biological and Biomedical Ontologies. Work from these efforts is currently being used to better structure the upper level of SNOMED CT, in cooperation with the IHTSDO, its owning organisation.

This week I had the opportunity to read a new paper by André Q Andrade, Maurício B Almeida and Stefan Schulz, entitled “Revisiting ontological foundations of the OpenEHR Entry Model” (PDF). This paper seeks to analyse the openEHR ‘clinical investigator ontology’ which Dr Sam Heard and I published in a MedInfo 2007 paper, using the Information Artefact Ontology (IAO) as the reference. Continue reading →

Posted in Health Informatics, openehr, Philosophy | Tagged , , , , , | 3 Comments

The power of the openEHR archetype formalism – visualised

Posted on June 28, 2012 by wolandscat

I made a new beta release of the ADL Workbench today, a tool whose core is a parser and 3-pass validator for archetypes written in the openEHR Archetype Definition Language. Today’s release includes visualisation that really shows how archetypes form a layer above standard information models. The basic idea of archetypes, for those who don’t know, is to be able to configure particular structures of reference model instances to represent specific domain content. For example, the following shows the Indirect Oximetry archetype. The tree column shows the information model (or as we call it in e-health more often, ‘reference model’) classes and properties in blue. So an Indirect Oximetry is a structure made from OBSERVATION, HISTORY, POINT_EVENT, etc and a bunch of ELEMENTs, each having specific meanings in the context of the oximetry Observation.

Continue reading →

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The CDA ‘dual-content’ conundrum

Posted on January 28, 2012 by wolandscat

In his recent blog post, Eric Browne highlights what may be a problem in the design of the Australian PCEHR, due to the well-known CDA feature allowing dual forms of content – text and structured, supposedly equivalent – to be stored in the one document. If Eric’s examples are representative of real data in the future PCEHR system, there is definitely a problem. In any case, there is a general problem, to do with common misuse of the CDA architecture, which itself should be changed to remove such possibilities. Continue reading →

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CIMI group goes with openEHR archetypes & UML profile

Posted on December 14, 2011 by wolandscat

The Clinical Information Modelling Initiative (CIMI) group led by Dr Stan Huff (Intermountain Health, Utah) met here in London 29 Nov – 1 Dec to make a final decision on formalism, from the two remaining – openEHR archetypes and various forms of UML (previous posts on CIMI: DCMs & RM, on formalisms). Instead of simply choosing one, the group made a more strategic choice of designating openEHR ADL/AOM 1.5 as the core formalism, with a corresponding profile of UML being developed to enable the more numerous UML-based developers (e.g. VA, NHS etc) to use archetypes within their UML toolchains.

Here is the public announcement resulting from this meeting.

Continue reading →

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CIMI: purpose-built or jury-rigged?

Posted on November 14, 2011 by wolandscat
In recent weeks, the Clinical Information Modelling Initiative (CIMI), led by Stan Huff, has followed its stated process and is nearing a voting process in which a shared health domain modelling formalism is chosen. Proponents of each of the candidate formalisms have been asked to post arguments supporting their work.
A supporting statement for openEHR archetypes as the optimal formalism is posted here, on the CIMI wiki. We have not included any beautiful tool-based views, nor even the ‘latest and best clinical models’, following Stan’s request for the ‘raw’ technical view of the syntax. Accordingly, the only thing with even any colour in it is these screenshots of an ADL archetype in a raw text editor, with syntax highlighting on.
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DCM – Data Types and Reference Model considerations

Posted on September 11, 2011 by wolandscat

Following the DCM meeting convened by Dr Stan Huff (Intermountain Healthcare) in Washington in July, reported in an earlier blog post, there is a further meeting this week in San Diego, which will discuss the issues of ‘data types’ and ‘reference models’ for the purpose of DCM (detailed clinical models).

I created two slideshows to explain my views on these matters (DCM_and_data_types and DCM_and_reference_model [both PDF]). Below is an extract of my arguments in these slideshows, based on experience, for adopting a particular approach to data types and reference model within the stated mission the DCM forum, which is to find formalism and attendant models in which to express universally shareable detailed clinical models. Naturally, my view on ‘the answer’ to that question is ‘openEHR (ADL/AOM) archetypes, templates and terminology’, but what I am providing below is not an argument supporting that, but one proposing how to proceed with respect to the ‘underlying models’.
Continue reading →

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