The OSHIP has Launched

The Open Source Health Information Platform (OSHIP) project is now public. It is a Python [] implementation of the openEHR [] specifications Release 1.0.1
OSHIP is not a clinical application. It is a Python framework for quickly building future-proof, inter-operable healthcare applications based on a multi-level modeling principle [] that has already been proven in implementations.

The current landscape is that most (especially public) funding for healthcare IT projects typically come in rather small packages. Maybe a disease registry now, an MPI later and a population surveillance application to follow. In each case, the awards go to an academic group, a company, etc. and they deliver what the customer has specified. It works great for a long time and then they want to try to share some information. This is the hard part. All were written independently, on a budget without knowledge of each other. How can we even consider automated decision support across these environments? Now, someone must pay for data integration services. This is generally doable at a cost but there is usually semantic loses in the information exchange. As an additional example. What happens when a family physician needs to refer a patient to a specialist? Typically the specialist only wants an extract of the patient record and likewise the family physician only wants results in a summary format. Even if they have the same EMR, most of these systems can’t exchange information due to customization factors at each end. So, someone has to produce the needed information (usually in hardcopy) and it is sent via FAX to the other end where it may or may not be entered into another electronic system.

The healthcare IT industry has been working on these issues for over 40 years. You may enjoy the juxtaposition of these two videos:
How far have we really come in healthcare IT compared to other industries? Why is this? Well, the answer is because healthcare information management is really difficult and expensive and because there are so many stakeholders involved in the management, provision and delivery of healthcare. Mostly the incentives are so misaligned throughout the industry that we haven’t been able to make any real progress in interoperability. This is true of free and non-free healthcare software vendors.

The openEHR Foundation was created to maintain and promote a set of healthcare specifications developed by a core group of software engineers and health information scientists based on a mantra of ‘implementation, implementation, implementation’. This focus on creating specifications that actually work in software is quite different than standards by committee as seen so often in various IT settings. Based on almost 20 years of research, development and implementation []. openEHR specification Release 1.0.1, was released in 2007. [ ]These specifications as well as the knowledge models (archetypes) are under governance committees consisting of experts from around the world. These committees take input from implementers, developers, medical experts and any other interested party in order to produce the most implementable and therefore useful and inter-operable healthcare IT applications available. The openEHR Foundation and the subject committees are open to other memberships including, individual, industry and governments. Please contact a member of the Board of Directors with your interests: []

openEHR implementations are already proven to be capable of exchanging information via HL7v2.x and HL7v3.x (within the scope of the semantics defined by those standards). openEHR also defines its own extract mechanism between compliant systems for full semantic information exchange. The specifications are closely aligned where possible and completely mapped to healthcare information standards and specifications in the specification documents. This gives implementers complete access to all interoperability possibilities. The openEHR specifications have been selected as part of the CEN (European) healthcare IT standards and they are ISO candidates. Please see [] and other links for more information on this area.

So, no matter where in the world you are; the openEHR specifications are the way to go if you are a healthcare IT developer or healthcare applications company. If you aren’t a Python [] developer then check the resources section for information about your chosen development environment. If yours isn’t there then you should become the first to develop an implementation in your language.

While the OSHIP source code is considered by software management standards to be in an ‘alpha’ state because it is technically incomplete at this time. It is important to recognize that OSHIP stands on thousands of lines of well implemented and well tested open source code that is used in thousands of applications around the world. Also, the specifications are complete and proven. Leveraging these resources means that OSHIP can and will grow to maturity in a matter of weeks or months instead of years. OSHIP uses a combination of technologies to aid the developer. The innovative script sets up an isolated environment on your system so that any libraries used or system path changes do not effect the rest of your applications. The complimentary tool, buildout, provides users/developers positive identification and automated downloading of dependencies from places like the Python Package Index [] and SourceForge [] without first knowing where they are located. To see how easily applications can be built using Python with OSHIP, take a look at this tutorial: [] of course you’ll already have a virtualenv setup when you install OSHIP and you do not have to get or use zopeproject. The focus is on the simplicity of using the z3c.* packages to develop applications in record time based on a solid model.

The OSHIP infrastructure already offers:
1.Internationalization (i18n)
2.Localization (i10n)
3.Robust, configurable and granular security model.
4.Segregated demographics and clinical sections for easy de-identification of information.
5.A choice of web server front-ends (Apache, Twisted, Zserver, Paste and more including developing your own cross platform Python GUIs)
6.A choice of back ends (ZODB- Object database, PostgreSQL,MySQL,ORACLE,MS-SQL,etc.)
7.A framework capable of managing multiple servers with redundancy.
8.Rapid web-based forms and application creation and customization.
9.A solid, inter-operable and future-proof knowledge model.
10…. much much more.

How? All because of open source software and open specifications.

Even the world’s largest healthcare IT initiative has recognized the benefits of this approach: [ ]the UK-NHS is actively engaged in the knowledge modeling activities related to openEHR archetypes and templates.

OSHIP uses the liberal MPL 1.1 license that allows free and non-free use of the code base. Those that know me well, will wonder why I have made this choice as an ardent supporter of free software in healthcare and my reason is simply:

“A rising tide lifts all boats.”
~President John F. Kennedy
Remarks in Pueblo, Colorado, August 17, 1962, Public Papers of the Presidents: 1962, p. 626.

The proliferation of the openEHR specifications will benefit everyone world-wide; on a variety of levels. This can only be done by providing open access and unrestricted access. This is a primary mission of the openEHR Foundation. []

The OSHIP project is looking for interested academic centers, individuals and companies to get involved to speed the development of this project. Please see the Resources section below for more information.

The first International Workshop on OSHIP will be held near Rio de Janeiro, Brazil July 21 – August 1, 2008. [] The first three days are open to any interested party and the actual application developers (10 days) are being chosen by a selection committee. The applicant bios that I have seen so far are very high quality candidates; almost exclusively with people holding post-graduate education and with experience in healthcare IT implementations. If you would like to attend the first three days please contact the organizers at [ Workshop]

There is no fee for attending this workshop; attendees are responsible for their own travel, lodging and miscellaneous expenses.

If your organization is interested in hosting a 3-5 day workshop on OSHIP and openEHR please contact me for further details.

Tim Cook []
More info at: []


You can join the OSHIP Developer’s mailing list here: []

You can download OSHIP from Sourceforge at:

or you can get the latest from the openEHR Foundation’s SVN server at:
Installation and usage instructions are on the wiki at: []

The openEHR mailing lists are at:

If you prefer; there are also Java, Eiffel and Ruby open source implementation projects and tools dedicated to these specifications:
[] (use the Software Projects menu link)

There is also a suite of commercial C# applications as well as various open source tools available at:

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