Hi Matt, Vebjørn, Ian, everyone,
As co-lead for the openEHR clinical modelling programme and administrator for the international CKM, I endorse the comments about collaboration from my colleagues to date.
We certainly have a strong desire for collaboration at every opportunity, between different communities within the openEHR domain and cross SDOs, hence the recent joint work between the FHIR/HL7 Patient Care communities with openEHR to develop a ‘FHIR archetype’ for adverse reaction that will be implemented as a FHIR resource and an openEHR archetype, yet will be aligned in the clinical content.
As an Australian who has just returned home in the past 24 hours from training and workshops in Norway, Sweden and UK , my message is always the same: the value from the international openEHR CKM is the transparency, broad collaborative input from clinicians and other domain experts. We want to share the archetypes and templates; we appreciate all contributions volunteered, large and small, from any source, and our intent is to develop a free and credible central resource of computable clinical content that is implementable and deemed ‘fit for use’ by clinical and domain experts.
Many have said to me that there should be only one CKM, but that doesn’t allow for national control of archetypes which will form the basis of their national clinical content standards – this has clearly been a necessary requirement for the Norwegian national program and UK HSCIC and will be the same for others into the future. I can completely understand why they want to manage their own standards.
That said, there is a subsequent choice that can be made by these organisations or eHealth programs – to actively collaborate (and minimise divergence), or to work independently and potentially create conflicting archetypes.
The Norwegian Nasjonal IKT has chosen to work in close collaboration with the openEHR sprint – running parallel archetype reviews in Norwegian and contributing the feedback into the international reviews. This is about humans choosing to work together. It is a great operational model that can potnetially be replicated with other CKMs if they want to participate in the same or similar ways. Others are starting to explore this approach to collaboration, which will likely fast track development of national approaches.
While we cannot dictate that others follow that philosophy, I will always encourage it. We will all benefit, and especially our patient care, when we put aside our philosophical differences and contribute to enhancing the available pool of archetypes, no matter what the original source, rather than ‘reinventing the wheel’ or taking the ‘not invented here’ approach to working in splendid isolation.
What we have in the international CKM at present is a significant body of work, that embodies a huge amount of rigour, research and effort. Until recently this was achieved purely by volunteers. In the last 12 months there has been a modest stipend available to Editors to facilitate the openEHR Sprint, although I estimate it has probably covered only about 10% of the actual Editor effort. The CKM content may not be perfect but is gradually evolving into a high quality resource for clinical content, a go to place for anyone interested in creating non-openEHR clinical models as well as for the openEHR community. The archetypes being added now are higher quality and based on patterns that have undergone refinement through hard work and implementations – they are not theoretical constructs, but practical data patterns that are supporting clinical recording patterns.
I am very proud of the efforts of the openEHR community, of the commitment of a group of apparent competitor vendors to jointly fund refinement of some of the hardest archetypes we will ever have to publish, of the philosophy of willingness to break down the clinical data silos. It is a great privilege to be part of this work.
And there are a number of ways to participate. As Ian has suggested, work locally to begin with if you like, but with a willingness to send new breakthroughs into the international CKM or go direct to the international CKM and let the models filter back down to the local instance. It doesn’t much matter which way. Propose how you would like to work and we will try to facilitate
In recent weeks I’ve been talking with groups who are building archetypes on sexually transmitted disease, radiotherapy for cancer, dental programs, fracture registries, operation notes, hearing programs. I’m hopeful that these will gradually be contributed to the international CKM, just as they will be able to leverage the work already available for download and use.
We have some simple ways to try to align CKMs where the custodians are willing, but full federation is technically difficult and very complicated from a knowledge governance point of view. It is not just a challenge about technical or knowledge governance solutions but involves human-human communication and political challenges as well. We continue to work towards this as our goal.
Tapping into the expert communities is a great idea. I welcome any willingness to contribute to model development/enhancement and to endorsement that archetypes are clinically ‘fit for use’. I would love to see some professional clinical colleges taking on a leadership role for archetypes that are relevant for their clinical domain – so far no takers at the official level. Other organisations of expertise – same applies. There is not current capability/budget for the Foundation to solicit this kind of interest or to market, so it is up to us as individuals to facilitate this.
Matt, on the day you posted your email question, Ian and I were winding up a 2 day training course, run on behalf of NHS Code4Health and sponsored by Apperta Foundation and Microsoft. I showed them your email. So there are others in the UK clinical software development ecosystem who are starting their archetype journey as well. I have no doubt that Ian McNicoll and our colleagues at Code4Health and Apperta will be resources to help navigate. And myself, from an opposite time zone J
Kind regards
Heather
Dr Heather Leslie MBBS FRACGP FACHI
Consulting Lead, Ocean Informatics
Clinical Programme Lead, openEHR Foundation
p: +61 418 966 670 skype: heatherleslie twitter: @omowizard