Clinical governance questions on Archetype publication and separate CKM instances

Hey everyone. I’m currently in the process of learning more about the clinical modeling side of openEHR. I’ve read content in the confluence, like this (A) and this (B), but I still have some open questions about the governance. I want to understand what it takes to actually publish an Archetype and how the separation of CKM instances weight into it.

  1. What is formally and technically required for an Archetype to reach the “published” status. I saw the lifecycle and learned about phases like the team review. But what team is that?
    Is there any key like at least 5 (active and with good reputation?) reviewers have to accept the proposed Archetype?
    Site (B) further says “The review is conducted by a combination of clinicians and content experts from a broad range of expertise and geographical variation as is possible”. Is this formalized in any way?
    In other words: what kind of promises does a published Archetype implicitly carry?

  2. What is the best-practice (if there’s one) on how separate CKM instances should be used? I read about “remote sub-domains”. Is the idea here, that someone (say the Norwegians) sets their instance up, add the international CKM as remote sub-domain and only add actual national/regional/… specific content to the own instance?
    I know this is an active community discussion with no agreed on common idea. I’m looking from a not necessarly practical perspective and I’m more interested in how things should be.
    Are the “remote sub-domains” also solving the problem of importing remote content, diverting from the original source and creating version conflicts with the original source?
    Can specific Archetypes easily imported back to the upstream international CKM? (Regardless if this just kicks off the normal or a special review process.)

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Hi Jake! This is a really good question, and one that we haven’t had the resources to document in the past. To properly answer your questions would probably require a full day workshop (we’d be happy to come to Leipzig if you invite us, especially now just before Yule :innocent::christmas_tree:), but to try and answer really quickly (with lots of reservations):

  1. It’s up to the editor group when to publish, based on the consensus of the reviewers and the editors’ experience. The team is the reviewers. In practice we operate as a do-ocracy (ie those who do something decide how it’s to be done), so we don’t have predetermined requirements about a size or composition of the reviewer group for each archetype. We sometimes use the requirements set down by the Norwegian National Editorial Board for Archetypes to guide the international reviews, for lack of a formal international editorial board.
  2. The two most synchronised CKMs are, as far as I know, the international and the Norwegian CKMs. The Norwegian team try our best to keep our Norwegian archetypes in line with the international ones, and we also run reviews internationally in parallell with Norwegian reviews when we have new requirements. Because we need to have an archetype owned by our Norwegian CKM to be able to run content reviews in Norwegian, all our published archetypes are copies and not just federated instances. In a perfect world, IMO, we’d have only one CKM with “localisation” domains where the same instance of the archetype could be translated, reviewed and published in that language for that localisation. I wrote some more about this in 2020, here:
    In current practice though, we copy archetypes and translations back and forth between CKM instances. It works, but it’s more labour intensive than it would have to be with the kind of functionality I outlined in my linked post.

Hey Silje, thanks for your answer and the insights. Unfortunately, I can’t access the liked post (“Oops! That page doesn’t exist or is private.”).

You are always welcome in Leipzig, but I don’t think we will organize an actual workshop-day this month. :slightly_smiling_face:

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Sorry, I didn’t realise I had posted that in a restricted category. I’ve moved it to an open one now :smiling_face:

Hello Silje,
thanks for you answers and the link!
You’re mentioning the " the requirements set down by the Norwegian National Editorial Board for Archetypes". Could you briefly explain these requirements - just some key points? This would be very beneficial to me.

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Hi Johannes, and welcome!

I’ll quickly outline how the Norwegian editorial board works: The editorial board is part of the Norwegian national archetype governance program, and as such has no formal role in the international modelling governance. Their main purpose in the Norwegian program is to define the review requirements for each archetype, based on the content and proposed use for the archetype in question. This usually takes the form of “this list of professions and specialties must participate, and this list of professions and specialties should participate” (example in the description here). After reviews have been carried out, the editorial board assesses whether the requirements have been fulfilled, and if the archetype can be published.


Just adding: Members of the Norwegian editorial board are (ideally) appointed by the Regional Health Authorities, which owns the public hospitals in Norway. And also ideally, consists of a mix of clinical professionals and more tech-oriented.

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