[FOSS_health] Re: interoperability

[Tim C]

On 01/06/07, David Forslund <forslund at mail.com> wrote:
>
> It was this full integration that was the goal of the original GCPR
> project some 7+ years ago.  It was well along in a phased development
> cycle, when the DoD pulled out. The VA continued in a limited way which
> I think was the basis of this demonstration referred to here.  Wrapping
> them on the screen isn't sufficient. EsiObjects could do much more than
> this, in my opinion.


That is an interesting model for achieving interoperability, quite different
to HL7 or other messaging approaches and different to the CORBA approach
too, more akin but slightly different to the embedding method I mentioned.
Definitely a method applicable to open source health software, though, and
one which is hard to apply to closed-source software.

 The biggest issue the GCPR faced was the
> terminology mapping between the systems (even between DoD systems
> running the same software).


Yes. Has *any* fielded system solved this issue? I don't mean solved it in
theory by explicitly binding to terminologies, as openEHR archetypes are
designed to do, but solved in practice, with multiple, independently
implemented instances of a system demonstrating spontaneous semantic
interoperability without additional mapping effort?

My guess is "no", because it needs agreed standards for the representation
of so many concepts in any sort of reasonably comprehensive system. Just
binding to SNOMED CT is not enough, because the use of SNOMED CT per se does
not remove ambiguity. Explicit subsets and explicit post-coordination of
SNOMED Ct concepts for each data item to be represented is required to avoid
all ambiguity, where that is possible. In other areas, the best SNOMED CT
can do is (dramatically) reduce he scope for ambiguity, but manual mapping
is still going to be required, I strongly suspect. There are still plenty of
ways to skin a cat even when using SNOMED CT as its designers intended, and
even more if you use it badly.

Tim Churches

Tom Jones wrote:
> > It's the "looked like" that is the problem. There was not, to my
> knowledge,
> > true integration of information such that an allergy to a medication
> > registered in the CHCS DoD system triggered an alert if the medication
> was
> > ordered on the same patient in the VistA VA version. And one can go on
> from
> > there. The read only visual display was not matched by data re-use
> across
> > systems
> >
> > Tom
> >
> > -----Original Message-----
> > From: foss_health-bounces at oshca.org [mailto:
> foss_health-bounces at oshca.org]
> > On Behalf Of K.S. Bhaskar
> > Sent: Tuesday, May 29, 2007 3:50 PM
> > To: foss_health at oshca.org
> > Subject: Re: [FOSS_health] Re: interoperability
> >
> > David --
> >
> > There was a successful proof of concept showing data from both CHCS (DoD
> > version) and VistA (VA version) integrated in the same browser screen
> > using Esi Objects to wrap both flavors of the same application so that
> > they looked like an integrated system.  I actually saw a demonstration
> > of this a few years ago.
> >
> > However, even though the technical feasibility was demonstrated, I
> > understand that the rollout was not funded because it was not the
> > officially blessed way to integrate information.
> >
> > Others may have better insight into it, but perhaps too much management
> > can ruin any worthwhile project, as the saying goes...  [Yes, I confess
> > to being a manager!]
> >
> > Regards
> > -- Bhaskar
> >
> > David Forslund wrote, On 05/29/2007 06:19 PM:
> >
> >> I agree. The original GCPR project between the VA, DOD and IHS actually
> >> involved the identical software at all the sites, but configured
> >> differently at each site and were totally non-interoperable as a
> result,
> >> even though much of it was open source (VistA).  The HDTF solution
> >> chosen dealt specifically to deal with this problem and it helped in
> the
> >> solution.  HL7 had been used but HL7, itself, doesn't mean systems are
> >> interoperable.    Low level database replication is likely to be a poor
> >> interoperability platform in my experience.  If one has total control
> of
> >> all the sites, one might get away with it.  Otherwise, forget it.
> >> Mapping XML structures between sites should work well in this
> situation,
> >> once one knows how to do the appropriate transforms.
> >>
> >
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