I’ve been chatting to Stephen Lynch from CSC (here in Australia) about the holy grail of healthcare interoperability, “Semantic Interoperability”, which is a follow up to this post on my blog. Stephen sent me this link:
Enjoy reading that link – it’s just the right thing to read if you can’t sleep some night ;-). Stephen says:
Interoperability isn’t about “semantic interoperability”, it’s about shipping around “the facts” for the end-user to make their own interpretation and value judgement on of what’s presented in front of them, in as efficiently accessible and user friendly manner as possible to facilitate and enable “decisions”…While so much energy is bogged down and caught up in this “semantic interoperability” futile quest, the longer e-health will be caught in its present groundhog day mode and glacial progress
Well, I think that all we want to do is ship around the facts, but we don’t really even know what they are. My response was:
I kind of feel as though I’m watching one of those human powered flight competitions, and everyone knows it’s a hilarious joke except the dreamers making the flying machines
Stephen responds:
And I think the meaningful insight here around “semantic interoperability” is that the current advocates do not appreciate and understand the equivalent “principles of flight” (weight, lift, thrust, drag) in their flying competitions and disastrous/humorous flight attempts around “semantics”, and are therefore destined to continue to fall off the end of the peer, while the pragmatic and insightful Wright Brothers realise the dream with their very pragmatic, incremental and truly based on scientific approach to the mastery of the principles of flight.
And gives another reference:
This is a subject I’m going to pick away at slowly – like I said in my last post, I think we’re actually trying to get to un-semantic interoperability, and we’re deeply confused about our goals. Partly that’s because of the lack of clinical standards, and I’m going to take that up in my next post.
I would suggest the basic concept of ‘semantic interoperability’ is clear enough: if we ship some bytes around, can a receiver system (without employing AI or NLP) know that the received fact is ‘measured systolic phase value of systemic arterial BP = 110 mm[Hg], averaged over 4h, taken while patient lying down, no exertion’. If just that text is passed, the receiver system built on generic software (i.e. not using special prior knowledge of message texts) can’t safely (or maybe at all) determine what it means, whereas if it is structured and/or semantically ‘marked’ in an appropriate way, it can.
And secondly, can a sender system reliably generate the appropriate structure?
And thirdly, can we describe all this sufficiently formally that software can be built that will reliably make it happen over all (or let’s say ‘most’) health data?
NB: there are of course levels of ‘knowing’ on the receiver side. Knowing that the value that has been received is a BP that can be graphed with other BPs is basic; knowing that systolic BP IS-A pressure-in-vessel of systemic circuit and so is diastolic is another; knowing that systolic pressure when lying, no exercise of 180 is a serious problem is another…
Thanks for sharing this and for the link to some late evening reading 🙂 I am just now listening to a nice Youtube video by Steven Pinker, the author of the other reference: The Stuff of Thought: Language as a window into human nature http://youtu.be/5S1d3cNge24