People often ask me why did we develop Task Planning in openEHR (NB: if the status is showing as ‘Retired’, this is an error in the specifications website), doesn’t BPMN do everything needed?
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If musicians can solve interoperability, why can’t we?
Today, pianists from every country in the world can read and play Bach. Without dropping a note or missing a beat.
Why is it so hard in the information-rich technical domains?
The history of ‘solving interoperability’ has generally been via attacking the problem at the data level. In musical terms, this is like making a special representation for every cantata, every symphony, every mass, with no underlying common notation. The work is endless.
Only short-term, non-scalable fixes are available with this approach. Any hope of a permanent solution relies on addressing the semantics of the domain of interest, far upstream from data.
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Posted in Computing, Health Informatics, standards
Tagged interoperability
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The future of healthcare IT
[Image: from CatSalut website]
A slide on the future of HIT, from the openEHR conference hosted by the Catalan Health System (CatSalut), 06 June 2023, Barcelona.
WHAT
- knowledge-based – computational representation of foundational knowledge: ontologies, terminology
- model-based – computational representation of operational knowledge: information and process definitions
- process-based – patient care pathway as first order computational entity: derived from local or published computable guidelines
HOW
- Take all hidden semantics out of the software and DB schemas and represent them as first-order entities, created by domain experts, not IT people
- Realised in a services-based open platform, based on terminology, models, model-driven software, and care pathway execution
- Used to create a system for representing and tracking care pathways, and at each task and decision point, we have a transparent user/computer interaction – not a pile of hidden ‘business logic’
- Voice interaction – voice + models allows for constrained vocabularies (efficient for voice) and goal-oriented navigation rather (user-driven) not form-based navigation (developer-driven); documentation is created ‘on the way’
- Machine learning – use of AI created via supervised training of blank LLMs to perform patient-specific reasoning on the data
RESULT
Signs of success:
- Engineering: we get rid of applications – evolve to ‘task-oriented IT’
- Administrative: we get rid of ‘referrals’ – evolve to ‘straight-through care’
- Clinical: single-source-of-truth medications list, no more ‘med rec’ – evolve from institutional copies to a true ‘digital twin’
- Patient records: we get rid of separate clinical documenting – ‘documenting while doing’
- => a patient-centric care experience.
openEHR turns 20 today
openEHR was officially created on 13 March 2003, 20 years ago today. Prof David Ingram thought of the name, and he and a small band of optimists – Dr Sam Heard, Dr Dipak Kalra, David Lloyd and myself – launched into building and open architecture for the electronic health record.
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Posted in Computing, Health Informatics, openehr
Tagged archetype, e-health, openEHR, standards
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Why using expressions in workflow is wrong
One of the basic elements of design common to all workflow languages, including YAWL and BPMN, is the inclusion of logical expressions on decision nodes. This seems harmless, and we followed it in openEHR’s Task Planning specifications. However, it is clear that this is a basic error, and that any workflow containing such expressions is unmaintainable and semantically unreliable.
Continue readingA Lingua Franca for e-health takes shape with GraphiteHealth
Colleagues in e-health often say to me: why don’t you make openEHR easier to map to <insert popular interop standard> (used to be HL7v3, then HL7 CDA, now, HL7 FHIR… DSTU2/3/4/5?).
To which I usually reply: if you are implying there is any easy way to connect to today’s favourite message formalism, there’s not, there are only moderately difficult ways – which is why no-one has an automatic converter.
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Posted in FHIR, Health Informatics, openehr, standards
Tagged #graphite, archetype, CEM, openEHR
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The Health IT Platform – a definition
Following on from various posts in the past, including my 2014 post What is an open platform?, I thought it might be time to post a succinct (as possible) definition of the platform idea, for e-health.
As stated in that post, the key thing to understand about a platform is that it represents progress away from being locked-in to a monolith of fixed commitments, toward an open ecosystem. This is true both technologically and economically.
Continue readingWhat is interoperability?
There are some rather obscure definitions of health IT’s favourite term interoperability floating around, for example:
Continue readingDirections in clinical guideline programming – CHA2DS2-VASc
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 a score be programmed?
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Posted in Computing, decision support, Health Informatics, openehr, standards
Tagged cds, CIGs, CPGs, guidelines
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Design-by-Contract (DbC) v Test-Driven Design (TDD)
Another bit of software engineering knowledge from my archive relates to two well-known formal quality methods used in software development. This is from a presentation made at ETH Zurich in 2010.
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Posted in Computing
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