[FOSS_health] Re: interoperability

[David Forslund]

Tim C wrote:
> On 01/06/07, *David Forslund* <forslund at mail.com 
> <mailto: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?
I agree.  I don't think there is such a thing as "spontaneous semantic 
interoperability".  The major effort of the GCPR was to provide semantic 
interoperability between essentially identical systems (VA, DoD, IHS) 
that had different semantics.  They were developing a metadata 
repository that would do the mapping so that each site could see the 
"foreign" data in their on semantic view.   Just running the same system 
at multiple locations is no guarantee of semantic interoperability.  
Interoperability takes deliberate effort, but with the right 
representations of the data and the processes involved, the effort can 
be made "easier".   I think it requires more than data translation, but 
process translation, too.

Dave
>
> 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>
>     [mailto: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 <mailto: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.
>     >>
>     >
>