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Wednesday, January 12, 2011


Today's Q2 meeting in Templates with Structured Documents, Patient Care, Vocabulary and Tooling was a continuation of several discussions (of which my post on Triplets is one) that have occured over the week regarding templates, detailed clinical models and archetypes.  The focus of the discussion was the refresh of the HL7 Templates Draft Standard for Trial use.

The Templates DSTU was both a great success and a great failure for HL7.  It was successful in its ability to clarify what an HL7 Template is.  There are now over 1000 templates that conform to the HL7 definition of what an  HL7 template is, used in national and international programs all over the world, including the US, the EU, and Asia.  In fact, I've participated in the development of a set of more than 100 templates through IHE and HL7 that have been reused in national programs in those regions.  It's even the same set in those regions, which provides a remarkable amount of consistency in clinical information found in CDA documents.

The failure of the Templates DSTU is a failure not in the details of what a template is, but rather in the information that is used to keep track of it, locate it, vet it, et cetera.  The XML representation of that metadata has gone largely unused.  When we reviewed the Templates DSTU for the Template Registgry Requirements project, we found it lacking in several places.

We discussed working on some common definitions that would help us parse all of the terms that I mentioned in Triplets, and to define the concepts, identify super concepts, and describe the various differences.  So you could imagine that we would have the concept of an Archetype, and that would be specialized to describe HL7 based archetypes and openEHR based archetypes.  Similarly with Templates and/or Detailed Clinical Models.

The audience in the room was generally supportive of this idea, and there seems to be a general consensus that this would actually have value not to just HL7 but also to openEHR.  Apparently this is a shift in the relationship that has changed recently, spawned by nobody knows what.

A point which I made to the room.  We, sitting in the room, are the people who care about these distinctions.  To the average healthcare provider, they are meaningless.  It is to ALL our benefit to have a common way to describe these things that we ALL understand and to promote its use, because no matter what we call it, Doctors just want it all to work together.

In that veign, I learned of a remarkable piece of work done by Heath Frankel.  He was able to create a solution which took information from an HL7 Version 2 message, store it into an OpenEHR based repository, map from the OpenEHR structuire to the IHE Referral Summary, and then submit it to an XDS registry.  I've known about the technical feasibility of this for some time.  I wrote a few months ago on converting from Version 2 to CDA.  I've also generated CDA from several EHR database structures from several different vendor's systems in my career. 

I think about combining this idea with the notions that Robert Warden has about Neutral Mapping.  I can envision a world where their exists a neutral mapping between the OpenEHR Information Model and the HL7 Reference Information Model.  I believe this to be readily managable for a core subset that has yet to be determined.  If this were to exist, I can see ways in which existing OpenEHR tools could be used to benefit the development of HL7 Detailed Clinical Models and HL7 and IHE Templates, that clinicians could use.

I've recently seen some demonstrations of tools which already in use in this space, and after sitting down and putting all the pieces together, my brain just exploded.

I'm sure most of you by know are wondering if I'm headed into the Dark Side of openEHR.  Fear not, I still remain a huge fan and strong supporter of HL7 and IHE.  But what I see here are some possibilities and synergies in convergence that would greatly benefit all of healthcare IT.  The real challenge will be whether there is a way to truly take the best of both worlds forward.


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