Hi all
A welcome discussion.
CKM is the public face of much of the openEHR community’s work but it is not the only solution required for seamless archetype management from design through to system development.
At present each vendor is managing their own archetype repository individually, as they should. However requirements for local governance will have lots of commonality. Some vendors suggested that they needed a lite version of CKM for the purpose but I’ve always pushed back because it needs to be connected to CKM to be informed of any changes and updates (or via GIT or whatever tool we use). But the critical thing is the ability to know which archetype version is in which application, which version of each application, where there might even be differences between modules etc. Then if there is a CKM change, the vendor can make an informed decision whether to update or not, and that clearly has significant downstream costs and implications.
I suspect that the reality is that when each new module or app is built everyone uses the latest version of an archetype, whether published or not – from a pragmatic point of view it is an implementer’s best bet of having the most future proof archetype, despite knowing that a draft could evolve and diverge significantly. But the alternative of making a local one will absolutely guarantee a divergent model, so we’re talking about making least worst decisions here.
As curators of CKM Silje and I are very mindful of this. More recently, as a new archetype has been proposed or developed we are trying to ensure it fits with existing patterns and how we perceive (from experience) that the archetype might evolve, to try to mitigate major changes. So it is probably fair to say that as a general rule, the more recent drafts are possibly better quality and less likely to diverge drastically, but there are no guarantees. And of course there is a pool of draft archetypes that have been in CKM for some time, before these patterns were identified - we will gradually endeavour to clean these up, but it will take time.
This clinical modelling effort is clearly still a work in progress. Archetype by archetype the CKM offering is improving and becoming more stable. The famous (infamous) archetype sprint is nearly over, despite the effort being underestimated, the goal, intent and focus was always good. We only need to finalise lab test results and apply those learnings/patterns to imaging, if memory serves me correctly. That will signify completion of an initial core set of archetypes with broad reuse over any EHR application.
Our collection of archetypes is something we should be immensely proud of. This really is a world first - there is no equivalent effort to compare with in terms of public clinical information models. And the repository will continue to evolve and improve, both in terms of numbers of models and quality.
I’ve nearly completed an estimate of the number of hours of modelling effort for the archetypes governed in the international CKM to date. The calculations need some final tweaks, confirmation by some of my co-editors and we’ll make the findings public.
But we do need to consider the other tools required to support and manage the complex governance that has to happen for each implementer, each application, each module etc.
Kind regards
Heather