Adventures of a clinician in HL7!

I've just survived my first HL7 meeting, although amused colleagues tell me that I may not fully recover! ‘Clinician newbie’ to HL7 though I was, for my sins I am becoming increasingly drawn into work within other standards organisations, and my clinical work is no longer with patients but in working with clinicians to develop clinical content models for use in electronic health records. I have some experience of the world of health informatics.

Held relatively nearby in Sydney, it was too good a chance to miss attending an Australian HL7 meeting, and it was an ‘interesting’ experience. The meeting was certainly very casual with a plethora of geeky T-shirts and pony-tails – definitely not the norm at the ISO meetings I’m more familiar with. Some defied this stereotype and still wore their business suits, despite jet-lag and it being a weekend – there are definitely certain individuals that I’ve met over the years who I can only believe must paint the fence in a suit... I particularly remember a certain medical registrar that I worked with many years ago, who always turned up to a resuscitation in Emergency in the middle of the night with a tie perfectly knotted – go figure! But I digress...

I’m told that as the meeting was held outside the US, there was a different flavour of attendee – certainly many from Australia and New Zealand took the opportunity to attend for the first time. I gather many ‘regulars’ didn’t attend and so many of the clinically-related working groups did not meet at all, which was rather disappointing. I spent time in the Patient Care working group and attended the Clinical Interoperability Council. Unfortunately I’m still rather clueless about the remit of the CIC... for clarification in the future perhaps, but clinician-driven approaches to EHR development is a critical way forward, in my opinion.

There was certainly an emphasis on education at this meeting, and it appeared to be very successful with many first-time attendees getting involved, including myself. I attended the Introductory and Advanced tutorials on CDA.

Some highlights:

  • Without a doubt the absolute highlight was non-work related - the evening ‘networking reception’ held during a sunset cruise on Sydney Harbour (see the photo above). Rather spectacularly, the organising committee somehow arranged for some rather large yachts to breathtakingly race around us just before sunset. Brilliant!
  • Sharing a beer, or three, with Keith Boone. I was chuffed when he blogged that he was coming to meet me! And I’m pleased to report that I seemed to have some impact on him after showing some of our collaborative work happening on the openEHR CKM.
  • A refreshing open-mindedness towards our work in openEHR. I particularly like the symmetry – I attended Bob Dolin’s Advanced CDA tutorial, and Bob attended our openEHR sessions! We do have potential to learn from each other.

The outcomes:

I've definitely been encouraged by some of the HL7 meeting outcomes with respect to openEHR. There was definitely a different attitude towards exploring openEHR/HL7 collaboration:

  • A DCM feasiblity demonstration project has been proposed - with input from the Patient Care, Models & Methodology and Templates groups.
    • Start with archetypes as the base
    • Establish adornments that map these to the V3 Ontology (Structured Vocabulary and RIM)
    • Create tools that then consume these to produce useful HL7-V3 artifacts (templates, or such)
  • An afternoon was spent discussing openEHR & RIMBAA - focussing on the commonalities between openEHR and HL7 RIMBAA implementation issues
  • The opportunity to provide tutorials on openEHR within a formal HL7 meeting – the previous attitudes have been more confrontational than collaborative! Which approach will prevail? Rather than how can we learn from each other! The introductory session in the morning was focused on background and clinical knowledge management. The afternoon had a range of speakers with expertise in application of openEHR/ISO 13606 in the HL7 environment

For the future:

  • I'd love to have a chance to engage with the Clinical Interoperability Council - to explore how we can collaborate across technical approaches so that at least as clinicians we can ensure that the clinical content in our desktop EHRs is consistently represented, high quality and 'fit for purpose'. The DCM feasibility project outcome will heavily influence if and when this could productively occur.
  • As clinicians we have to ensure our access and input to these technical processes, otherwise we won't end up with systems that support us to provide care to our patients. And I challenge the standards bodies to 'demystify' the technical - to remove the technical barriers that prevent grassroots clinician input and restrict participation to those very few who can bridge the world of software engineering with clinical practice.

Other posts from the meeting:

  • Rene Spronk: Ringholm - HL7 and openEHR are cooperating (finally)
  • Keith Boone (@motorcycle_guy):
    • Triplets
      • @motocycle_guy: @omowizard An archetype, a DCM and a template walk into an #HL7WGM event, stroll up to the bar ... and the bartender says...
      • @omowizard: @motorcycle_guy ...identical triplets I presume! #HL7WGM
    • Convergence - regarding templates, detailed clinical models and archetypes