I would like to have a discussion about the consequences of bad modelling.
Usually if the modelling is good we know how beautiful that can be, but what happens if it’s not? What are the further issues? What are the lessons learn? What was done to avoid these situations?
For me openEHR it’s really great and has an awesome proposition to address many issues on current healthcare IT situation - which it’s why I decided to go further on working with this technology, although it’s not a easy one to start and requires some special knowledge and time to learn. But nevertheless, I think it is really necessary to have an open topic about what can happen when bad modelling is being done and the further consequences on AQL’s and deployment on different instances of openehr platforms.
(I will also try to be brief otherwise I would write a neverending post )
From my side, I work with openEHR models and platforms and tools for 3 years. When I started, it required a lot of time to read the documentation from AM and RM models, understanding the structure and create my own archetypes and using the archetypes from ckm, creating templates, learning how aql’s works, and many many others, but I enjoyed it so much that I decided to do my master thesis about openEHR. I have some of these templates from many projects already deployed on production and I would say that 90-95% of them are using CKM archetypes. Currently my main work is doing the full stack per se, if we can call it in that way - archetype, templates, forms, clinical terminologies, aqls/views.
I have been working on many models lately - which I will be soon sharing with the openEHR ckm - and as I said I always try my best to use archetypes from CKM or from national instances to do my templates - even if that takes me more time to implement. If in any case I need to create a new archetype I always try to share it with ckm.
With this, I had the opportunity during these 3 years to check other models (many of them deployed and in production) that were made all around the world by many people on different companies. What I have been realising is that many of these models can be done using purely the archetypes available from CKM but they haven’t and most of the time the reason is “we don’t have time for that research or to construct that”. OR archetypes are downloaded from ckm and internally changed (not even specialized) and added on templates and deployed that way - usually the reason appointed is “we didn’t know we could not do that”. With this then there are problems on the AQLs because it’s not getting what was expected. I could point many other cases but these two could be a good start for a discussion.
I see many people doing models without having the sufficient knowledge to do it (although this can be quite subjective depending on your level of experience) - I also didn’t had it when I started and I keep asking and studying/learning everyday - but I feel that using modelling tools like archetype and template designer can transform something that it’s not that easy into something that seems to be a “piece of cake” - we can see currently many models around that are not really that sharable (interoperable?) since everything has been changed in a not correct way or not created nicely (archetypes and templates).
What are your feelings about this? What would you suggest to fix it? Did you saw this happening too?
I am afraid that a great technology that is so useful and it’s turning big and well known can be stabbed slowly with these cases (I guess we could - more or less -use the an analogy from FHIR with different versions and everyone tweaks it a bit here and there, not following the specifications and then it’s different everywhere).
PS: i don’t exactly know what’s the best place for this post - on clinical or development - i see them as a whole matter for this topic.