next clinical steps in openEHR? SOAP+/-Emergency Summary via Opereffa+CKM?

Clinical (archive)
1

Dear all,

Many thanks Stef and others for the recent encouraging emails since the
Opereffa announcement.

Now that folk has have a little time to digest that news, I wanted to
follow up with an email probing about next steps for the openEHR
clinical community to take.

#Recap on direction of travel- need for an openEHR showcase
I have made the case in the past that the focus of our work must be
about helping healthcare staff improve their services with better
information and better tools.
While I believe that openEHR Foundation has the underpinning knowledge
and framework to unleash a wave of innovation in healthcare, I am still
   seeking a showcase which we can widely point newcomers to which
explains the vision and potential on offer.

#top 5 priorities for clinical community
My previous post asking for top 5/10 priorities for the clinical
community highlighted key issues namely;

1-improve communication & educational materials about openEHR
2-clearer mechanisms for clinicians to get involved & network around
openEHRs work
3-tools for the clinicians to develop openEHR solutions (archetypes,
templates, UI etc)
4-clearer mechanisms around archetype, template governance etc
5-additional work to ensure close between openEHR solutions and Decision
Support/Business Rules engines.

Earlier this year, on being asked about openEHR in 2009, I gave my view
of what way we could begin to tackle these issues..

http://www.nabble.com/openEHR-in-2009-and-beyond..-a-view-of-the-way-forward-td21623065.html#a21839379

#recent release of public tools to help us
In the few months since then there has been significant developments
from the tooling point of view with the public release of both;
Opereffa (OpenEHR Reference Framework & Application).
http://opereffa.chime.ucl.ac.uk/
CKM (Clinical Knowledge Manager)
http://www.openehr.org/knowledge/

#next steps.. where to focus?
Given the diverse spread of folk involved in openEHR (both physically
and philosophically) we have been thinking about next steps for the
community to take, focussed on demonstrating clinical benefit, using and
building on the tools now available... in order to meet some of the top
5 aspirations mentioned above.

First and foremost, I would always encourage folk to look to their local
situation to explore and identify where the greatest clinical need is
and think about how an openEHR solution could meet their needs.
We need to be sharing the learning, methods and tools required to ensure
developments and improvements happen from the ground up.

In parallel, we could/should now begin to increasingly harness the
collective intelligence (aka "wisdom of the crowds") of the
international community to tackle some high priority clinical areas
together.
I would welcome ideas and thoughts on these areas, though 2 clear items
come to mind.

#Potential areas to focus our efforts over the next 6 months
1) Firstly, as has been mentioned before, we have stated one of the
ambitions within the Opereffa work was to begin with (and now further
develop & showcase) support for generic SOAP noting, which has wide
international medical (indeed clinical in the widest sense) utility and
potential benefit.
http://en.wikipedia.org/wiki/SOAP_note
(Some must have seen that the first opereffa arcetypes are teeny tiny,
yet they already support a very crude form of SOAP noting)

2) Secondly, as we steadily increase the review and improvement of key
archetypes via CKM, there is a very good case to be made for ensuring we
get those archetypes right for a clinical setting.
Some key archetypes, as Heather Leslie so neatly suggested as 'the 10
archetypes that can save a life" to me recently, may be well worth a
collective focus to support a Emergency Patient Summary.
They would fit well with/form the underpinnings of the SOAP noting,
overlap with many national ambitions in this area (nb also the EU
epSOS), and with my Emergency Medicine hat on could be a very valuable
resource internationally.

#this iterative approach might set the "cat among the pigeons" ;o)
I would also add that a clear focus on these clinical areas will
undoubtedly expose and raise many technical issues inc archetype design,
template spec, UI issues intertwined, role of terminology in archetypes
etc etc.
If that sets a "cat among the pigeons" for some, my sense is so be it,
with the best of possible intentions.

# not seeking perfection - just some useful clinical tools in 6months
Let me be (politely) clear, I am not suggesting perfect semantic
solutions to these clinical requirements, if that takes us some years to
achieve.
What I believe we are after is the next iteration in the development of
   openEHR, a couple of clear and useful/exemplar clinical tools, that
can help me/you as a clinician to;
1)chart my clinical findings as I see any patient and
2)share some key findings in a patient summary with clinical colleagues
..thereby also helping explain openEHR to clinical colleagues

#Your thoughts and feedback please on ...
So, I would now welcome some related thoughts and feedback....

A)
How would you/could you help/participate/contribute in an effort,
-to invite clinicians internationally to review and improve an online
SOAP note and Emergency Patient Summary
(fyi this could be done by using Opereffa as the online frontend
application and CKM as the archetype repository in the background.)
-that might be either emailing clinicians/having a session with
clinicians or
-might be contributing to Opereffa development/CKM archetype review

B)
What other thoughts/plans/ideas do you have in your own local setting to
tackle a clinical problem using openEHR?
What other points/comments/feedback did you want to make (constructive
or criticisms) of Opereffa/CKM/openEHR at this time?
Honest and open debate welcome please.

I look forward to hearing from you.

Many thanks,

Tony

Stef Verlinden wrote:

Dear Tony, David and Seref,

Congratulations to you (and to the openEHR community).

This is truly very good news, great work and a major milestone for the
openEHR community.
I'm confident that this will boost many efforts that are out there a
helps to focus our energy as well as to show the outside world what
really can be done with openEHR.

Cheers,

Stef

_Announcement of the release of Opereffa by the /open/EHR Foundation_

The /open/EHR Foundation is pleased to announce the early release
of *Opereffa* – /open/EHR REFerence Framework and Application, under
development at UCL.

As healthcare systems are under increasing pressure, internationally,
they are exploring improvements in health information systems, as a
key way to survive and thrive in the 21st century. As a means to
support these efforts, members now working under the umbrella of
the /open/EHR Foundation have been developing and implementing open
specifications for an Electronic Health Record for many years, and
these have since formed the basis of the ISO and CEN 13606 archetype
standard.

In response to a recent exploration of the /open/EHR international
clinical community’s requirements, by the /open/EHR Clinical Review
Board Chair Dr Tony Shannon, an open source clinical reference
application, focused on early clinical benefit and usability, was
deemed to be an important next step for the community.

Dr. Tony Shannon
Consultant in Emergency Medicine, Leeds Teaching Hospitals
Clinical Lead, Clinical Content Service, NHS Connecting for Health
Chair, Clinical Review Board, openEHR Foundation
Honorary Research Fellow, University College London
+44.789.988 5068 tony.shannon@nhs.net

2

Hi Tony. I am the clinical lead for IT systems at the Barts and the Royal London trust. Just to let you know the royal college is working with NPFIT to create national templates including one for Clerking/SOAP notes. Could we use that. Dr. Shivam. MS. FRCS
Sent using BlackBerry® from Orange

  Opereffa+CKM?

Dear all,

Many thanks Stef and others for the recent encouraging emails since the
Opereffa announcement.

Now that folk has have a little time to digest that news, I wanted to
follow up with an email probing about next steps for the openEHR
clinical community to take.

#Recap on direction of travel- need for an openEHR showcase
I have made the case in the past that the focus of our work must be
about helping healthcare staff improve their services with better
information and better tools.
While I believe that openEHR Foundation has the underpinning knowledge
and framework to unleash a wave of innovation in healthcare, I am still
   seeking a showcase which we can widely point newcomers to which
explains the vision and potential on offer.

#top 5 priorities for clinical community
My previous post asking for top 5/10 priorities for the clinical
community highlighted key issues namely;

1-improve communication & educational materials about openEHR
2-clearer mechanisms for clinicians to get involved & network around
openEHRs work
3-tools for the clinicians to develop openEHR solutions (archetypes,
templates, UI etc)
4-clearer mechanisms around archetype, template governance etc
5-additional work to ensure close between openEHR solutions and Decision
Support/Business Rules engines.

Earlier this year, on being asked about openEHR in 2009, I gave my view
of what way we could begin to tackle these issues..

http://www.nabble.com/openEHR-in-2009-and-beyond..-a-view-of-the-way-forward-td21623065.html#a21839379

#recent release of public tools to help us
In the few months since then there has been significant developments
from the tooling point of view with the public release of both;
Opereffa (OpenEHR Reference Framework & Application).
http://opereffa.chime.ucl.ac.uk/
CKM (Clinical Knowledge Manager)
http://www.openehr.org/knowledge/

#next steps.. where to focus?
Given the diverse spread of folk involved in openEHR (both physically
and philosophically) we have been thinking about next steps for the
community to take, focussed on demonstrating clinical benefit, using and
building on the tools now available... in order to meet some of the top
5 aspirations mentioned above.

First and foremost, I would always encourage folk to look to their local
situation to explore and identify where the greatest clinical need is
and think about how an openEHR solution could meet their needs.
We need to be sharing the learning, methods and tools required to ensure
developments and improvements happen from the ground up.

In parallel, we could/should now begin to increasingly harness the
collective intelligence (aka "wisdom of the crowds") of the
international community to tackle some high priority clinical areas
together.
I would welcome ideas and thoughts on these areas, though 2 clear items
come to mind.

#Potential areas to focus our efforts over the next 6 months
1) Firstly, as has been mentioned before, we have stated one of the
ambitions within the Opereffa work was to begin with (and now further
develop & showcase) support for generic SOAP noting, which has wide
international medical (indeed clinical in the widest sense) utility and
potential benefit.
http://en.wikipedia.org/wiki/SOAP_note
(Some must have seen that the first opereffa arcetypes are teeny tiny,
yet they already support a very crude form of SOAP noting)

2) Secondly, as we steadily increase the review and improvement of key
archetypes via CKM, there is a very good case to be made for ensuring we
get those archetypes right for a clinical setting.
Some key archetypes, as Heather Leslie so neatly suggested as 'the 10
archetypes that can save a life" to me recently, may be well worth a
collective focus to support a Emergency Patient Summary.
They would fit well with/form the underpinnings of the SOAP noting,
overlap with many national ambitions in this area (nb also the EU
epSOS), and with my Emergency Medicine hat on could be a very valuable
resource internationally.

#this iterative approach might set the "cat among the pigeons" ;o)
I would also add that a clear focus on these clinical areas will
undoubtedly expose and raise many technical issues inc archetype design,
template spec, UI issues intertwined, role of terminology in archetypes
etc etc.
If that sets a "cat among the pigeons" for some, my sense is so be it,
with the best of possible intentions.

# not seeking perfection - just some useful clinical tools in 6months
Let me be (politely) clear, I am not suggesting perfect semantic
solutions to these clinical requirements, if that takes us some years to
achieve.
What I believe we are after is the next iteration in the development of
   openEHR, a couple of clear and useful/exemplar clinical tools, that
can help me/you as a clinician to;
1)chart my clinical findings as I see any patient and
2)share some key findings in a patient summary with clinical colleagues
..thereby also helping explain openEHR to clinical colleagues

#Your thoughts and feedback please on ...
So, I would now welcome some related thoughts and feedback....

A)
How would you/could you help/participate/contribute in an effort,
-to invite clinicians internationally to review and improve an online
SOAP note and Emergency Patient Summary
(fyi this could be done by using Opereffa as the online frontend
application and CKM as the archetype repository in the background.)
-that might be either emailing clinicians/having a session with
clinicians or
-might be contributing to Opereffa development/CKM archetype review

B)
What other thoughts/plans/ideas do you have in your own local setting to
tackle a clinical problem using openEHR?
What other points/comments/feedback did you want to make (constructive
or criticisms) of Opereffa/CKM/openEHR at this time?
Honest and open debate welcome please.

I look forward to hearing from you.

Many thanks,

Tony

Stef Verlinden wrote:

Dear Tony, David and Seref,

Congratulations to you (and to the openEHR community).

This is truly very good news, great work and a major milestone for the
openEHR community.
I'm confident that this will boost many efforts that are out there a
helps to focus our energy as well as to show the outside world what
really can be done with openEHR.

Cheers,

Stef

_Announcement of the release of Opereffa by the /open/EHR Foundation_

The /open/EHR Foundation is pleased to announce the early release
of *Opereffa* – /open/EHR REFerence Framework and Application, under
development at UCL.

As healthcare systems are under increasing pressure, internationally,
they are exploring improvements in health information systems, as a
key way to survive and thrive in the 21st century. As a means to
support these efforts, members now working under the umbrella of
the /open/EHR Foundation have been developing and implementing open
specifications for an Electronic Health Record for many years, and
these have since formed the basis of the ISO and CEN 13606 archetype
standard.

In response to a recent exploration of the /open/EHR international
clinical community’s requirements, by the /open/EHR Clinical Review
Board Chair Dr Tony Shannon, an open source clinical reference
application, focused on early clinical benefit and usability, was
deemed to be an important next step for the community.

Dr. Tony Shannon
Consultant in Emergency Medicine, Leeds Teaching Hospitals
Clinical Lead, Clinical Content Service, NHS Connecting for Health
Chair, Clinical Review Board, openEHR Foundation
Honorary Research Fellow, University College London
+44.789.988 5068 tony.shannon@nhs.net

3

Hi,

I would be interested in using clerking notes in medical education, and
I would be interesting in finding out how this develops. Dr Meyer St
George's

4

3 jul 2009 kl. 15.19 skrev Tony Shannon:

B)
What other thoughts/plans/ideas do you have in your own local setting to
tackle a clinical problem using openEHR?

CDSS using Xerostomia as a case study. Should result in a working prototype system
within a few months.

What other points/comments/feedback did you want to make (constructive
or criticisms) of Opereffa/CKM/openEHR at this time?

Template support is critical and lacking.

The whole idea of developing maximal general archetypes requires templates to allow for easy local adaption.

Regards

5

Hi Dr Shivam,

I know the RCP led work on medical documentation standards well, have
been involved with that for some time now within NHS Connecting for
Health and any SOAP & Summary work we do in openEHR should fit well with
that.

I also know the London Programme for IT politics pretty well.
Do you want to explore how this openEHR work can fit within that
environment e.g. at Barts & Royal London?

Regards,

Tony

Dr. Tony Shannon
Consultant in Emergency Medicine, Leeds Teaching Hospitals
Clinical Lead, Clinical Content Service, NHS Connecting for Health
Chair, Clinical Review Board, openEHR Foundation
Honorary Research Fellow, University College London
+44.789.988 5068 tony.shannon@nhs.net

nsshivam@yahoo.co.uk wrote:

6

Thanks Derek,

Are you planning any local project on clerking notes electronically
where this work might help you?

Tony

Derek Meyer wrote:

7

Thanks Olof,

You mention the need for template support is critical, agreed with you.

Can you explain in some more detail what support you would like to
see/what issues you want to raise?
I'm sure the Opereffa/CKM teams would like to understand this
requirement in more depth, it needs to be discussed and debated here..

Are you tackling any local project where a template ready openEHR system
would help you?
Are you able to make a business case for such a project that could
contribute to these openEHR Opereffa/CKM efforts?
(Would welcome discussion for yourself/others on the subject of business
models if you are interested.)

Regards,

Tony

Olof Torgersson wrote:

8

Hi everyone,

I’d like to endorse Tony’s suggestions. I’m very keen to see Opereffa and CKM working closely together, to align the work happening in both tools, and to involve more of the openEHR community actively.

It seems to me that all of the archetypes that would be required for an Emergency Summary would also provide the backbone for the SOAP note. They are also likely to be high priority models that will be commonly sought by implementers. There are a number of draft archetypes already on CKM that can be used to support the Emergency/SOAP note work now - these have largely evolved from the work done in 2007 and 2008 with NHS - so we have a reasonably good starting point already.

We feel that the review process is now functioning quite well in the Clinical Knowledge Manager and are ready to start some more ‘robust’ archetypes. On that basis, you will have seen that the review for the Adverse Reaction archetype was initiated this week and I would like to begin to involve the increasing volunteer reviewers by starting work on more archetype reviews over the next few weeks.

By agreeing clinical content definitions/specifications within Clinical Knowledge Manager, the openEHR community can potentially make a big impact. Just imagine if we could get the key archetypes that could form the basis of an Emergency summary agreed and published over the next 6 months - as Tony described, 10 archetypes to save a life. This would have significant interest and impact internationally. As Tony so wisely stated, the results may not be perfect, but we will have achieved some significant steps forward. Even if only the agreed clinical content was utilised as a shared definition in non-openEHR enabled systems, then openEHR has achieved something previously thought difficult. And if the archetypes are shared in and between openEHR systems, then we are really starting to achieve openEHR’s goals.

The Opereffa project will be able to utilise these agreed archetypes to showcase quality content models within a fully openEHR enabled system - with an Emergency Summary in the first instance, and an evolving SOAP note which in itself will be the common framework for most clinical encounter notes. I think this is very exciting.

I propose to organise a poll in which we, as a community, can vote on the proposed ‘top 10’ archetypes. I think that it is safe to assume that Adverse Reaction will be one of these, so will be looking for 9, or so, more - Diagnosis, Alert, Medication are probably also safe bets.

Keen to hear your thoughts

Regards

Heather