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How to build a health system in the developing world?

By Eliah aronoff spencer | 07 May, 2011

With all the mhealth, ehealth, and cloud solutions now available, we are nearing the point where a "complete" health system can be built from inexpensive or free resources. People have discussed an "open mHealth ecosystem" as opposed to a "stove-pipe" approach. But how do those in developing countries who are trying to build health infrastructure approach the problem? With so many solutions and so many "one-off" projects-- can we provide a road map or instruction manual for IT professionals in the developing world? Gerry Douglas' recent publication in PLOS is an inspiring start, as are many discussions here on GHD. What are the next steps?

Replies

 

Timothy Cook Replied at 8:19 PM, 7 May 2011

People in developing countries w/o an existing infrastructure have an
advantage in that they are not tied to legacy applications. The major
hurdle still is that all of the existing applications to date are not based
on a common information model. This causes issues with semantic
inter-operability. Therefore limiting the quality of the collected data.
This is incredibly important when it is recognized that healthcare
information collection and analysis; on a personal as well as global level.
Is a long term issue. Too many institutions want something "right now",
instead of being willing to put in the long-term work for quality results.

Some of us have been studying this for several years. The multi-level
approach seems to be a reasonable answer. This approach can be found in
the CEN 13606 specifications, the openEHR specifications and in a more open
and technically modern approach is MLHIM http://www.mlhim.org

MLHIM only has a small lab in Brazil at this point. But if we could secure
funding then we could build the information infrastructure need for
long-term healthcare improvement through valid information structures.

Regards,
Tim



--
================
Timothy Cook, MSc
Project Lead - Multi-Level Healthcare Information Modeling
http://www.mlhim.org

LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
Skype ID == timothy.cook
Academic.Edu Profile: http://uff.academia.edu/TimothyCook

You may get my Public GPG key from popular keyservers or
from this link http://timothywayne.cook.googlepages.com/home

A/Prof. Terry HANNAN Moderator Replied at 8:01 PM, 8 May 2011

I would like to offer "resource" materials for this discussion. The documents attached will hopefully ad value to this discussion. To me they offer the opportunity of knowing what has worked and where the difficulties exist. Terry hannan


Dr Terry J. Hannan MBBS;FRACP;FACHI;FACMI
Consultant Physician
Clinical Associate Professor School of Human Health Sciences, University of Tasmania
Department of Medicine, Launceston General Hospital Charles Street Launceston 7250
President Australasian College of Health Informatics(2007-9)
Visiting Professor Universita Degli Studi, Dr Modena e Reggio Emelia, Italy. Sep-Nov 2010
Ph. +61 3 6348 7578
Mob. 0417 144 881
Fax + 61 3 6348 7577
Email

Timothy Cook Replied at 8:27 PM, 8 May 2011

Any available resources such as this are valuable. When can I find them?

Thanks,
Tim

Leo Anthony Celi Replied at 8:42 PM, 8 May 2011

Hi, everyone,
The Partners in Health-Sana-Institute for Healthcare Improvement course on
Health Information Systems to Improve Quality of Care in Resource-Poor Settings
offered this term at MIT is available to the public on the web. The first half
has been uploaded; the rest should be ready by the end of the month. Here is
the link:

http://sanamobile.org/class.html
We have close to 20 hours of lectures. We will be indexing them over the
summer.

Additional written materials can be found here:
http://stellar.mit.edu/S/course/HST/sp11/HST.184/materials.html
Cheers,
Leo

A/Prof. Terry HANNAN Moderator Replied at 8:50 PM, 8 May 2011

Tim, it looks as if the attachments were lobbed off by the GDHOnline
system so here they are. Please let me know if they help. Terry

Dr Terry J. Hannan MBBS;FRACP;FACHI;FACMI
Consultant Physician
Clinical Associate Professor School of Human Health Sciences,
University of Tasmania

Department of Medicine, Launceston General Hospital
Charles Street Launceston 7250

President Australasian College of Health Informatics(2007-9)

Visiting Professor, Universita di Modena, e reggio emelia, Italy
(Sept-Nov 2010)

Ph. 61 3 6348 7578
Mob. 0417 144 881
Fax 61 3 6348 7577
Email

Web/Blog: www.austemrs.com.au

A/Prof. Terry HANNAN Moderator Replied at 8:53 PM, 8 May 2011

HI Leo, the web links do not seem to be responding on my PC. Terry

Dr Terry J. Hannan MBBS;FRACP;FACHI;FACMI
Consultant Physician
Clinical Associate Professor School of Human Health Sciences,
University of Tasmania

Department of Medicine, Launceston General Hospital
Charles Street Launceston 7250

President Australasian College of Health Informatics(2007-9)

Visiting Professor, Universita di Modena, e reggio emelia, Italy
(Sept-Nov 2010)

Ph. 61 3 6348 7578
Mob. 0417 144 881
Fax 61 3 6348 7577
Email

Web/Blog: www.austemrs.com.au

Timothy Cook Replied at 8:57 PM, 8 May 2011

They worked okay for me by just opening in a new tab. I'm using Firefox on
Linux so maybe it is a browser issue?

Thanks for the resource Leo.

Cheers,
Tim



--
================
Timothy Cook, MSc
Project Lead - Multi-Level Healthcare Information Modeling
http://www.mlhim.org

LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
Skype ID == timothy.cook
Academic.Edu Profile: http://uff.academia.edu/TimothyCook

You may get my Public GPG key from popular keyservers or
from this link http://timothywayne.cook.googlepages.com/home

Joaquin Blaya, PhD Moderator Replied at 3:50 PM, 9 May 2011

Eliah,
Great questions and you touched on a lot of different points that I think are worthwhile separating out.

One thing is stove pipe versus inter-operable systems and I think Tim's response is a great one. If you get organizations to demand to talk to each other before they buy a system, this would happen much faster.

The other I think is using mobile systems for different systems, and there are great cases for that, such as community healthworkers using open data kit (ODK), commcare and other mobile solutions. I think these are very useful tools, but for now won't replace a solid clinical and administrative system where most of the patient data is stored.

And finally there's what you mentioned about we based services so that organizations don't have to worry about the technical details of the system. Unfortunately the service-provided systems that I've seen still don't resolve the interoperability issue which was the first point, I don't know if anyone has a different experience and if so I'd love to hear about it. But I do agree with you that these types of services will lower the bar for organizations (who have a good internet connection) to use them. However, in the end, this usually isn't the biggest barrier to implementation. It tends to be human factors such as a decision maker deciding to implement, the organization having the funding and human resources to implement the system among others.

Joaquin

Eliah aronoff spencer Replied at 9:53 PM, 9 May 2011

Hi all, great thoughts! Issues are really quite diverse, from human usage and HCI to interoperability and usability. Responding to Joaquin-- some of this is covered in Ida Sims mhealth paper. I'm wondering if we should consider a forum (either here or on HUB with the mhealth folks) delineating the health needs by pt, provider, system etc, find a way to log current solutions and start to draw connections regarding interoperability. Would look like a graph with need/solution nodes and edges drawn in where standards exist. This issue came up at a recent Fogarty meeting and all seem to agree there is no common place for interested parties to look at this. I've jokingly referred to this as oMASH (open mobile architecture for sustainable health). Clearly the problem is not having the pieces add up to less than the sum.....I'm also worried that partial tech use leads to worse outcomes. PS, great paper on your Peru work and EMR review. Also, Mary Kratz has started to talk about a standards network/requisite for all government funded projects. A little leadership from the top wouldn't hurt. Agree ODK and the Dimagi work is a great start, clearly the pih and oMRS/Baobab work as well. Thoughts on putting this together without creating yet another resource? Last, the inSTEDD folks have talked about hopping into this space with some cloud solutions with built in standards. Another good place to look is the Columbia white paper on barriers to Mhealth published last year. One thought is to have a resource on GHD, "how to build a health system". Your recent papers as well as recent reviews might be a worthwhile start....

Romano Grossi Replied at 9:30 AM, 10 May 2011

I'm working on the project TeleHealthcare here in Brazil, is implementing OpenMRS
making adjustments necessary to suit it to the safety standards WEB, but only in the security software
  is not enough, have raised the requirements for information security globally.

Telecommunications infrastructure to
Training of staff according to the norms of SI
Whether or not to use encryption in mobile units of data: Pen drivers, hard drives, PCs ...
Implementation of VPNs.
Restrict access to the DataCenter, physical surveillance, software, hardware (Biometrics, Tokens desktop ...)

This study is part of the overall project, you need specialized group in each area, signing non-disclosure

They can send suggestions and criticisms, I have articles and papers about IT Governance and Information Security
Hug

Timothy Cook Replied at 9:56 AM, 10 May 2011

Hi All,
A very interesting discussion IMHO.

I have just a few more comments/points. I would like to set the context that
the solution is not yet a short-term one. We need to think long-term. The
value that is in healthcare information is enormous in planning healthcare
delivery, research outcomes and measurement and evaluation (M&E) results.

Regarding demanding inter-operable systems. The current concept in this area
is messaging. Whether it is HL7v2, HL7v3, CEN 13606 extracts or SDMX-HD
messages. These are helpful, no doubt. However, without a consistent means
to know what the semantic context was at the point of collection; the data
from one system is not necessarily representative of the data from another
system. In other words, the semantics are locked up in the source code and
data model of each system and are almost guaranteed to be different. So
mapping from each system to a common message format has to be performed,
leaving the full semantics of each behind; establishing a new set of
semantics from the message format. Therefore the context of the data
received is different from when it was gathered.

On the issue of legacy systems. One of the major barriers to new concepts in
information modeling is the existence of legacy systems that exist in
nations where most of the research and development is being performed. This
fact no doubt effects the research process. Legacy systems in combination
with the way computer scientists are taught to develop systems is a
revolving door of the same old thing in new clothes. Computer scientists
approach a project by analyzing the domain. Creating a data model. Building
the functionality to accomplish that project. This works wonderfully until
you want to exchange the information between applications. I am not
suggesting that all projects underway be stopped until there is a better way
ready to be deployed. But we do need to accept the famous quote by Albert
Einstein “Insanity: The act of doing the same thing over and over again,
expecting different results.”, definitely applies here.

Joaquin mentioned ODK and commcare in contrast with solid clinical and
administrative systems. I fully agree that both of these (ODK & commcare)
are useful tools in todays environment. I must admit a great deal of
ignorance about the details of both of these tools. But I have investigated
each of them, on the surface. First of all, they are aimed only at mobile
applications. Secondly they target only the Java language as an
implementation platform. While popular, Java is not the end-all be-all
solution in every case. More specifically, the ODK misuses XML technologies
by expressing constraints in an instance document. Constraint definition are
the domain of XML Schemas. Since the XML document cannot actually enforce
constraints; then it is required to bind them to a specific programming
language. Which may be okay if every other application you ever want to
exchange information with can process the (Java) odkbuild files. That is not
a likely scenario though considering the breadth of value in healthcare
information.

Joaquin also mentioned that there are various barriers to actual
implementation. Interoperability being one. Coincidentally there is a
discussion on the issue of barriers to adoption at EMR and HIPAA (a
decidedly US centric bias) on this issue.
http://www.emrandhipaa.com/katherine/2011/05/08/helping-doctors-adapt-to-emrs...
the consensus so far is that the major barrier is complexity of the
applications. IMHO, the obvious answer is more purpose specific
applications. Reducing the training and usage time for specific
functionality. This is also in keeping with the ideas of mobile applications
especially designed for resource constrained parts of the world. Once again,
in order for the information collected to be meaningful across all usage
scenarios, semantic interoperability rears its ugly head.

In response to Eliah aronoff spencer's great question: “Thoughts on putting
this together without creating yet another resource? ” Very interesting
pulling all of these concepts together and just to toss in one more
additional aide to interoperability is the use of the NCI Enterprise
Vocabulary Services (EVS) Project (LexEVS)
https://cabig-kc.nci.nih.gov/Vocab/KC/index.php/LexBig_and_LexEVS#What_is_Lex...

The wide use of major vocabularies/terminologies is essential for semantic
interoperability. Unfortunately it is of an after-thought at best when
developing healthcare applications. Though not all are available freely
everywhere, that is changing and the ones that are available are very
valuable.

Romano Grossi discussed work in Brazil on the incredibly important aspects
of system and data governance and security. This is not the domain of MLHIM,
but the domain of each specific application. Every political jurisdiction
will have differing requirements and how the best practices should be
applied. Romano's work in researching and collecting resources for this is
appreciated and hopefully there can be a place where this collection may be
made available to developers.

I have raised several questions and I think the fair thing to do is offer at
a glimpse at an answer to them. The fundamental thing is really
interoperability. I think that we have agreement on that. We already know
that the way things have been done, doesn't solve the problem. The concepts
that I promote concerning using a multi-level approach are not ones that I
dreamed up in the middle of the night all by myself. Yes, they are based on
my research, my thinking and my implementation experiences. But that work
has included research and implementation projects going back more than two
decades in Europe and Australia as well. The National Institute of Science
and Technology – Medicine Assisted by Scientific Computing (INCT_MACC
http://macc.lncc.br/principal.php?lang=1 ) in Brazil is home to the
Multi-Level Health Information Modelling (MLHIM http://www.mlhim.org) Lab.
The core goal of this lab is to produce specifications for an information
model with a computable reference model implemented using modern XML
technologies. We have a number of specific tools and other artifacts being
developed in collaboration with others ( https://launchpad.net/mlhim ). A
founding principle to insure that the artifacts continue to be open and
available to anyone was to equally share ownership with everyone that
participates in any meaningful way. This means spell-checking, posting a bug
report, etc. The only other requirement is to join the MLHIM Owners group on
Launchpad ( https://launchpad.net/~mlhim-owners ). There is research and
implementation work to be done and every additional person and group that
participates adds richness and validity to the solutions.

In an abbreviated explanation. MLHIM provides for software written based on
a common reference model in any OO programming language the ability to store
and process information from any other application. This is accomplished by
providing constraint definitions for any concept as an XML Schema “data
model” that can be shared by other applications. These concept constraint
definitions CCDs) are developed by domain experts using a graphical tool so
there is no need for them to understand XML Schema development. The open
governance model for CCDs allows for collaboration among a group of experts
as well as multiple versions of the same concept when there is disagreement
about a concept. This alleviates the age old barrier of experts disagreeing
leading to stalemate. It also allows richer input than can be had by a small
group of experts sitting around a conference table. The Healthcare Knowledge
Component Repository (HKCR) is an open source content management system
still in development that will provide the collaboration platform for CCDs
and eventually computable clinical guidelines based on the same reference
model for true decision support at the point of care; wherever that care
happens to be.

Some may notice similarities with the OpenMRS “Concept” approach. There are
also significant differences. Especially concerning the long-term
availability of CCDs and their governance across the timeline as the science
of healthcare changes.

The MLHIM Lab is open to add all interested collaborators. If you or your
group has an interest in learning more about this. Please contact the Lab
Director, Luciana Tricai Cavalini, MD, MSc, PhD at
<>

On a personal note. This voyage has been mostly a labor of love and passion
for me for more than a decade. However, passion only goes so far. :-) I am
available for employment as a research associate, consultant, etc. Either
full or part time for anyone interested in working on MLHIM based projects.
Though I will also freely answer questions and discuss MLHIM in general on
the MLHIM Owners mailing list. However, employment leads to directly
tutoring your team and focus for your project(s).

I surely appreciate you taking the time to read this far and look forward to
welcoming new collaborators with the MLHIM Lab.

Sincerely,

Tim Cook

================
Timothy Cook, MSc
Project Lead - Multi-Level Healthcare Information Modeling
http://www.mlhim.org

LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
Skype ID == timothy.cook
Academic.Edu Profile: http://uff.academia.edu/TimothyCook

You may get my Public GPG key from popular keyservers or
from this link http://timothywayne.cook.googlepages.com/home

Joaquin Blaya, PhD Moderator Replied at 10:06 AM, 10 May 2011

Eliah,
Really great post and a topic that we've talked a lot about with people in this field. One thing we've joked about is a choose your own adventure book, (http://en.wikipedia.org/wiki/Choose_Your_Own_Adventure) where depending on your different needs, infrastructure and other variables it guides you on the different paths to implementing a health IT system.
The other conversation we've had with Dimagi, GHDonline and others has been an Amazon type site where groups can put description of their project and systems, and users can rate them. I believe the HUB is an example of that, though I have to admit that I haven't used it very much.
We have tried to have some kind of repository for information as well (what you mentioned about publications on how to build a health system), that is harder than I originally thought, but we will talk here at GHDonline and see if that's feasible and post a suggestion.

I think it would be great to hear from the community if such a page/resource would be useful. I believe it could include references to publications that would be useful in creating your health system, unfortunately if we did this it would only be able to include the actual publication for things that were open, for proprietary articles/publications we would only be able to put the citation.

Warm regards,

Joaquin

___________________________________________________________________
Chief Technology Officer, eHealth Systems Chile
Research Fellow, Harvard Medical School/Partners In Health
Moderator, GHDOnline.org

Timothy Cook Replied at 10:53 AM, 10 May 2011

I believe the "choose your own adventure" is a valid concept in this case.
As mentioned before, one key to usability is to have purpose specific
applications. This is especially true for applications built to run on
mobile platforms.

When discussing implementing an entire system it is difficult to gather a
set of best practice references. The complexity of healthcare is only part
of the problem. Then add in political aspects with national and local
regulations and the fact that there may be subtle differences across
social/cultural boundaries. It is (almost?) impossible to take one
application and deploy it everywhere.

This may be "preaching to the choir" but for those newly involved in health
IT this is a good post on the complexities.
http://frectal.com/book/healthcare-change-the-way-forward/healthcare-openehr%...
(openEHR archetypes are essentially equal to MLHIM CCDs).

Joaquin, I believe that a location to collect references to best practices
etc. is a great project. Probably organized by concept w/o regard to
specific applications.

Regards,
Tim

--
================
Timothy Cook, MSc
Project Lead - Multi-Level Healthcare Information Modeling
http://www.mlhim.org

LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
Skype ID == timothy.cook
Academic.Edu Profile: http://uff.academia.edu/TimothyCook

You may get my Public GPG key from popular keyservers or
from this link http://timothywayne.cook.googlepages.com/home

zainab rizwan Replied at 12:00 PM, 10 May 2011

Dear all, I'm a physician and a hospital administrator, involved in a telecare project based in karachi pakistan. the ideology for a quick affordable healthcare system is here but unfortunately with all the tools available there is a sustainability matter which has still to be resolved. But the need for virtual clinics in rural areas is great. The projects which have been launched have not lasted long as political and financial constraints have shut such projects down.

Vishal Marwah Replied at 12:03 PM, 10 May 2011

Hi Folks,

Great discussion!

Is anyone is the community involved/familiar with the *SMART platform*. (
www.smartplatforms.org) ? They are a group based out of Harvard, and are in
the process of creating an iphone-like platform for healthcare apps that
will be substitutable. It seems efforts are also underway to transform
OpenMRS into a SMART container.

Technologies like these may have low barriers to entry in the evolving
Health IT systems in developing countries.

Would anyone like to share their thoughts of the future implications of such
platforms, and how far are we from adoption in developing countries?

Regards,

Vishal

Yaw Anokwa Replied at 10:27 AM, 13 May 2011

tim,

i wanted to respond to some of the assertions you made about the openrosa (and odk) tools.

1. they are not aimed at just mobile applications. yes, most of popular tools run on phones, but many of the openrosa tools are server and web based. desktop-based tools are also in process, but in the meanwhile, openrosa makes it quite easy to connect to other systems -- openmrs, salesforce, drupal are all examples of systems people have connected openrosa systems to.

2. the tools are not all in java. there are also ruby and python implementations as well. i suppose i'm not clear why this even matters. what language would you like to see tools written in, and why?

3. the xforms standard we use was set by the w3c, the same folks who brought you html and a host of other web standards. is it your claim that the xforms standard misuses xml?

4. .odkbuild files have nothing to do with java (odk build is a ruby rack application). the files are designed for odk build to share odk build forms with each other. no more, no less.

finally, i should note that odk was explicitly designed to be a generic system. if we do something that makes life in the healthcare domain hard, it's because we are trying to support a usecase in another domain.

yaw

Timothy Cook Replied at 10:52 AM, 13 May 2011

Thank you for these corrections.
As I said I plead some ignorance and it was obviously worse than I thought.
:)
As far as languages go; 'not' being tied to one was my point and you cleared
that up.

--Tim

Kizito Mrema Replied at 6:59 AM, 16 May 2011

HINT: A bit off topic.

I was just wondering on when will 'Yaw' and his ODK team get to settle the
claims, hopefully everything is in the clear now! I was just beginning to
get convinced by Tim's argument.

</rants>

--
*
Kizito S.M.
*Skype: kizoman
GTalk: kizomanizo
Mob: +255 75 543 7887

Timothy Cook Replied at 8:19 AM, 16 May 2011

Hi Kizito,

My errors about ODK have nothing, directly, to do with my main points.
Though I am still curious about what applications there are that can read
the binary odkbuild file since the constraint processing is embedded in the
file. At least that is my understanding.

The core argument that I am making is that a different approach (mulit-level
modelling) is required in order to have semantic interoperability across the
domain of healthcare applications.

The breadth of healthcare concepts means that there cannot be one
application that covers the domain (obvious, I know). So if applications
are designed with a portion of their semantics wrapped up in code and
database structures. Then there is no way to transfer this along with the
data; to other applications.

The solution I am promoting is that there needs to create basically a data
model for a single concept based on an XML Schema. That schema expresses
the constraint information against a generic information model.

The classic example here is blood pressure. When a patient blood pressure
is taken. There are a number of factors effecting what is meant by the
actual numbers. Patient position, patient state, location of measurement,
device used, etc. A blood pressure taken at home is different from in a
general practitioner's office is different from a cardiologists exam is
different from an invasive monitor in ICU. In order for those applications
to meaningfully share the data and especially in order to apply decision
support. All of these factors (and others) must be available.

The MLHIM approach does not enforce "one" single agreement on how these
concepts are designed either. While it would be ideal to have all global
healthcare experts agree on the way to model a concept. This is the real
world and we know that will not happen. The next best thing is to have
these 'data models' (XML Schemas) identified by UUID and available publicly
via a network of content management systems. So if one application receives
instance data and does not currently have that particular XML Schema
(Concept Constraint Definition) then it can be located and imported into the
receiving application.

This approach divides the design processes among the experts in each area.
Computer scientists are tasked with taking care of privacy, communications,
etc. Medical experts are tasked with using a graphical tool to model the
concepts of their domain without the inherent dangerous approach of trying
to convey 'all' those complexities to computer scientists.

We are seeing an acknowledgement of this approach from both the healthcare
and IT worlds as they do not have to attempt to fully understand each
other's worlds.

There will be a second "train the trainers" workshop in July. I understand
it is full but they are looking for a lager lab or possibly scheduling
another workshop sooner.
http://www.mlhim.org/news/winter-course-on-special-topics-in-free-open-source...

I am more than happy to answer more detailed questions on the MLHIM Owners
list:
https://launchpad.net/~mlhim-owners

Cheers,
Tim

--
================
Timothy Cook, MSc
Project Lead - Multi-Level Healthcare Information Modeling
http://www.mlhim.org

LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
Skype ID == timothy.cook
Academic.Edu Profile: http://uff.academia.edu/TimothyCook

You may get my Public GPG key from popular keyservers or
from this link http://timothywayne.cook.googlepages.com/home

Eduardo Jezierski Replied at 2:46 PM, 16 May 2011

Hi Tim!
Thanks for reinforcing that a 'health information system' goes way beyond tools for forms.
In the issues regarding semantic interoperability, as a pattern I am seeing more tools implement the notion of archetypes based on dynamic data types that can be 'tagged' with vocabularies (eg ICD10), packaged up in 'sets', 'trees' or other units that makes them usable in small chunks, and then allowing customization for viewing/editing.
There's a hint of this in OpenMRS's design and I'm not up to speed at all with Andy K's work in the space; and I'm far from being an openEHR expert - so maybe that's where it's headed; but in a recent piece of work around reviewing shared health records infrastructures this 'archetype' pattern (also under different names) kept popping up.
In any case these could be the most fundamental 'models' for the health information; and if tools exist to project these onto e.g. forms, xforms, xml, etc all the better for the ecosystem.
Any other patterns appearing out there? I think it helps to talk about the underlying trends with the specific tools being 'for example' information.

my .02,
~ ej



On Mon,May 16, 2011, at 5:19 , GHDonline (Timothy Cook) wrote:

> Timothy Cook replied to the discussion "How to build a health system in the developing world?" in the Health IT community.
>
> Reply contents:
> "Hi Kizito,
>
> My errors about ODK have nothing, directly, to do with my main points.
> Though I am still curious about what applications there are that can read
> the binary odkbuild file since the constraint processing is embedded in the
> file. At least that is my understanding.
>
> The core argument that I am making is that a different approach (mulit-level
> modelling) is required in order to have semantic interoperability across the
> domain of healthcare applications.
>
> The breadth of healthcare concepts means that there cannot be one
> application that covers the domain (obvious, I know). So if applications
> are designed with a portion of their semantics wrapped up in code and
> database structures. Then there is no way to transfer this along with the
> data; to other applications.
>
> The solution I am promoting is that there needs to create basically a data
> model for a single concept based on an XML Schema. That schema expresses
> the constraint information against a generic information model.
>
> The classic example here is blood pressure. When a patient blood pressure
> is taken. There are a number of factors effecting what is meant by the
> actual numbers. Patient position, patient state, location of measurement,
> device used, etc. A blood pressure taken at home is different from in a
> general practitioner's office is different from a cardiologists exam is
> different from an invasive monitor in ICU. In order for those applications
> to meaningfully share the data and especially in order to apply decision
> support. All of these factors (and others) must be available.
>
> The MLHIM approach does not enforce "one" single agreement on how these
> concepts are designed either. While it would be ideal to have all global
> healthcare experts agree on the way to model a concept. This is the real
> world and we know that will not happen. The next best thing is to have
> these 'data models' (XML Schemas) identified by UUID and available publicly
> via a network of content management systems. So if one application receives
> instance data and does not currently have that particular XML Schema
> (Concept Constraint Definition) then it can be located and imported into the
> receiving application.
>
> This approach divides the design processes among the experts in each area.
> Computer scientists are tasked with taking care of privacy, communications,
> etc. Medical experts are tasked with using a graphical tool to model the
> concepts of their domain without the inherent dangerous approach of trying
> to convey 'all' those complexities to computer scientists.
>
> We are seeing an acknowledgement of this approach from both the healthcare
> and IT worlds as they do not have to attempt to fully understand each
> other's worlds.
>
> There will be a second "train the trainers" workshop in July. I understand
> it is full but they are looking for a lager lab or possibly scheduling
> another workshop sooner.
> http://www.mlhim.org/news/winter-course-on-special-topics-in-free-open-source...
>
> I am more than happy to answer more detailed questions on the MLHIM Owners
> list:
> https://launchpad.net/~mlhim-owners
>
> Cheers,
> Tim
>
> On Mon, May 16, 2011 at 5:59 AM, GHDonline (Kizito Mrema) <
> > wrote:
>
>> Kizito Mrema replied to the discussion "How to build a health system in the
>> developing world?" in the Health IT community.
>>
>> Reply contents:
>> "HINT: A bit off topic.
>>
>> I was just wondering on when will 'Yaw' and his ODK team get to settle the
>> claims, hopefully everything is in the clear now! I was just beginning to
>> get convinced by Tim's argument.
>>
>> </rants>
>>
>> On Fri, May 13, 2011 at 5:52 PM, GHDonline (Timothy Cook) <
>> > wrote:
>>
>>> Timothy Cook replied to the discussion "How to build a health system in
>> the
>>> developing world?" in the Health IT community.
>>>
>>> Reply contents:
>>> "Thank you for these corrections.
>>> As I said I plead some ignorance and it was obviously worse than I
>> thought.
>>> :)
>>> As far as languages go; 'not' being tied to one was my point and you
>>> cleared
>>> that up.
>>>
>>> --Tim
>>>
>>> On Fri, May 13, 2011 at 9:28 AM, GHDonline (Yaw Anokwa)
>>> <:
>>>
>>>> Yaw Anokwa replied to the discussion "How to build a health system in
>> the
>>>> developing world?" in the Health IT community.
>>>>
>>>> Reply contents:
>>>> "tim,
>>>>
>>>> i wanted to respond to some of the assertions you made about the
>> openrosa
>>>> (and odk) tools.
>>>>
>>>> 1. they are not aimed at just mobile applications. yes, most of popular
>>>> tools run on phones, but many of the openrosa tools are server and web
>>>> based. desktop-based tools are also in process, but in the meanwhile,
>>>> openrosa makes it quite easy to connect to other systems -- openmrs,
>>>> salesforce, drupal are all examples of systems people have connected
>>>> openrosa systems to.
>>>>
>>>> 2. the tools are not all in java. there are also ruby and python
>>>> implementations as well. i suppose i'm not clear why this even matters.
>>> what
>>>> language would you like to see tools written in, and why?
>>>>
>>>> 3. the xforms standard we use was set by the w3c, the same folks who
>>>> brought you html and a host of other web standards. is it your claim
>> that
>>>> the xforms standard misuses xml?
>>>>
>>>> 4. .odkbuild files have nothing to do with java (odk build is a ruby
>> rack
>>>> application). the files are designed for odk build to share odk build
>>> forms
>>>> with each other. no more, no less.
>>>>
>>>> finally, i should note that odk was explicitly designed to be a generic
>>>> system. if we do something that makes life in the healthcare domain
>> hard,
>>>> it's because we are trying to support a usecase in another domain.
>>>>
>>>> yaw"
>>>>
>>>> --
>>>> View this post online:
>>>> <
>>>>
>>>
>> http://www.ghdonline.org/tech/discussion/how-to-build-a-health-system-in-the-...
>>>>>
>>>>
>>>> Unsubscribe or change your email notification settings:
>>>> <http://www.ghdonline.org/users/timothy-cook/edit/>
>>>>
>>>> Contact the GHDonline team:
>>>> <http://www.ghdonline.org/contact/>
>>>>
>>>> You can reply to this discussion by responding directly to this e-mail;
>>> it
>>>> will be shared with all community members and posted as is. Files
>> cannot
>>> be
>>>> added via email attachment and must be uploaded directly to GHDonline.
>>>>
>>>
>>>
>>>
>>> --
>>> ================
>>> Timothy Cook, MSc
>>> Project Lead - Multi-Level Healthcare Information Modeling
>>> http://www.mlhim.org
>>>
>>> LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
>>> Skype ID == timothy.cook
>>> Academic.Edu Profile: http://uff.academia.edu/TimothyCook
>>>
>>> You may get my Public GPG key from popular keyservers or
>>> from this link http://timothywayne.cook.googlepages.com/home"
>>>
>>> --
>>> View this post online:
>>> <
>>>
>> http://www.ghdonline.org/tech/discussion/how-to-build-a-health-system-in-the-...
>>>>
>>>
>>> Unsubscribe or change your email notification settings:
>>> <http://www.ghdonline.org/users/kizito-mrema/edit/>
>>>
>>> Contact the GHDonline team:
>>> <http://www.ghdonline.org/contact/>
>>>
>>> You can reply to this discussion by responding directly to this e-mail;
>> it
>>> will be shared with all community members and posted as is. Files cannot
>> be
>>> added via email attachment and must be uploaded directly to GHDonline.
>>>
>>
>>
>>
>> --
>> *
>> Kizito S.M.
>> *Skype: kizoman
>> GTalk: kizomanizo
>> Mob: +255 75 543 7887"
>>
>> --
>> View this post online:
>> <
>> http://www.ghdonline.org/tech/discussion/how-to-build-a-health-system-in-the-...
>>>
>>
>> Unsubscribe or change your email notification settings:
>> <http://www.ghdonline.org/users/timothy-cook/edit/>
>>
>> Contact the GHDonline team:
>> <http://www.ghdonline.org/contact/>
>>
>> You can reply to this discussion by responding directly to this e-mail; it
>> will be shared with all community members and posted as is. Files cannot be
>> added via email attachment and must be uploaded directly to GHDonline.
>>
>
>
>
> --
> ================
> Timothy Cook, MSc
> Project Lead - Multi-Level Healthcare Information Modeling
> http://www.mlhim.org
>
> LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook
> Skype ID == timothy.cook
> Academic.Edu Profile: http://uff.academia.edu/TimothyCook
>
> You may get my Public GPG key from popular keyservers or
> from this link http://timothywayne.cook.googlepages.com/home"
>
> --
> View this post online:
> <http://www.ghdonline.org/tech/discussion/how-to-build-a-health-system-in-the-...>
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/eduardo-jezierski/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it will be shared with all community members and posted as is. Files cannot be added via email attachment and must be uploaded directly to GHDonline.

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