How to fix CKM biggest issue

pablo pazos pazospablo at
Sat Mar 14 16:22:35 EDT 2015

Hi Ian,
As I said, my opinion is about the technical aspects, and I tried to separate this view from the management process problems, so I think there would be no confusion, just another complementary opinion.
For me the problem with the process is the one mentioned by Gustavo: I can't get my archetypes on the CKM directly to share them with others, in my case with students. If I want to teach them about the whole archetype management process, I can't do much with the current CKM functionalities besides archetypes translation. I want them to upload, review, translate, approve, download, create new versions, upload new versions, etc, etc.I would say this is another use case for the CKM that currently is not part of the CKM, because you mention that the challenges are about "funding" and "professional support". I don't think my use case needs neither of both, but I think it can generate qualified professionals capable of doing such work. So IMO what you mention and my use case are two faces of the same coin. Without accessibility to all the functionalities of the CKM to everyone (the tool aspect), it would be difficult to generated the knowledge needed to manage the knowledge on the central CKM and on each country (process aspect). After having trained professionals, "funding" is a total different beast.
GitHub is not open source, but anyone can download it and create local repositories that can be versioned in a distributed way, even without using Github servers. Also I can create my own GitHub like servers (
I mentioned GitHub because everyone knows it. But Git, the core technology of GitHub is open source:
Basically what GitHub adds to Git is the cool views and the social aspect, but technically speaking, Git does all the versioning management work (repos, branches, pull requests, etc.).
About Git not being a "managed", I think all the contrary, pull request reviews are just that: a way to control what should or shouldn't be part of the main source of truth, a.k.a. master branch.

For the record, I'm not trying to troll the initial discussion by setting the focus on technical aspects.

Kind regards,
Eng. Pablo Pazos Gutiérrez

From: ian at
Date: Sat, 14 Mar 2015 16:13:18 +0000
Subject: Re: How to fix CKM biggest issue
To: openehr-clinical at

Hi Marcus/ Pablo,
I think the comparison/ contrast to Github is instructive, because, of course GitHub is a hugely successful product which is highly supportive of open-source development, but it is not itself open-source. It is a proprietary tool. If you truly feel that tooling to support collaborative working itself necessitates an open source license then you should close your Github accounts and look elsewhere.
I would very much like to see a future where levels of sponsorship, industry engagement, national funding etc, etc made it possible for CKM and other similar tools to be open-sourced but we are simply not in that position right now. All of the key authoring tools are open-sourced or free, (and all, I understand, will be open-sourced within a short period).

CKM was built to perform a very specific role i.e to help informaticians manage the complex process of crowd-sourcing clinical input, working out the impact of version changes, handling translation work, term-binding work, terminology building, particularly at international or national level. It is not needed to build an archetype, build a template or build a termset. It is not needed to display an archetype or template or termset. All of the resources are mirrored to GitHub and all of the specifications and information necessary to perform these activities are freely available.
CKM is a highly specialised tool with limited focus, primarily on national and international asset management. It is not needed to build openEHR systems, any more than GitHub is needed to build open source software.
Alternative repository management tools are starting to appear, such as the 13606 Assocn. CIMM. I am sure David and Diego will not mind me saying that, as things stand, CIMM is a fair way off providing CKM -style functionality. 
I think we are in danger of confusing some real and significant issues around community engagement with the Foundation governance process.  The issue of CKM licensing is model has, in my view, no practical impact on the concern that Pablo raised. Don't confuse the tool with the process. 
Even then I think we need to be aware that there are probably two quite different requirements here.

We need a  much better way for good candidates for international archetypes to find their way into the international repository, probably to Incubators in the first instance. Some of the upcoming technical changes to the tool will help this but we also need to develop clear policies of how and when this is appropriate. The Foundation repository is primarily designed to manage set of archetypes as a 'source of truth' with new content flowing through in a relatively controlled but coherent fashion. Managing the governance of these 'semantic assets' requires much more care and precision than 'source code' 
This is quite different from the position in e.g Github which is essentially a tool which allows some degree of socialisation between otherwise siloed repositories. This is great for allowing assets and source code to be exposed, forked and re-used but it lacks the control and coherence that is required by 'managed' national and international standards development.
I actually think we need both kinds of environment, and there is nothing to say that both environments need to be instantiated in the same tool.
@Marcus - there is actually very little metadata in archetypes. The translation support that Silje asked for is already supported in the AOM, and in some archetype editors such as LinkEHR. It is not supported in the openEHR archetype editor but as this is an open source tool, I will be working on that problem later today :).
I think there is a lot to be said for using Git to manage some of the versioning and asset management activities we need, indeed I do that all the time when working on local projects, but none of this kind of metadata is carried in archetypes anyway. The kind of versioning and governance metadata that we do need is equivalent to the metadata used by RubyGems or npm, needed for distributed source control, and the new versioning metadata that will be carried in archetypes is compliant with Semver which underpins npm. 
ADL is actually a very readable language, given the complexity of information it needs to convey. 
It is, of course, unfamiliar but it is perfectly possible to produce xml, json, yaml ... serialisations of the Archetype Object Model which is the real source of truth.
XML serialisation is fully supported by the LinkEHR and openEHR Archetype Editors, Thomas's Archetype Workbench exports these other formats and the template designer output is all expressed as XML.
The problem is that these non-ADL serialisations are actually much more difficult to read and understand than raw ADL, once, of course, you get your head around ADL.
@Pablo - CKM does make use of a proprietary document management system but the real challenge here is not technical, it is how we find a funding model that would sustain the kind of professional support that a tool like CKM requires. This is not a hacker project, it requires sustained investment, proper maintenance and a proper business model. So far it has not been possible to persuade the wider informatics community to collaborate on the kind of joint funding that would make commercial sense to a prospective supplier.
This is an important discussion. I'm glad to hear people being supportive of all the great work that has been done, particularly by Heather Leslie and Sebastian Garde. It is not easy to develop a first-of-kind product.
I think we have a great opportunity to discuss how to expand CKM editorial capacity, review current editorial policy around community involvement and to see how other non-CKM applications might fill some of the gaps that have been identified. I will certainly raise this via the new Board and, of course, discuss further with Heather in our capacities as CKM editors and Heather's position as Clinical program lead.
Let's not mix that discussion up with an equally important issue of how we can secure the funding necessary to sustain development and support for repository tooling in the future. I don't think there would be much objection to the principle that an open-source licensing model would be preferred but that can only happen if the commercial model makes sense for potential providers.


Dr Ian McNicoll
mobile +44 (0)775 209 7859
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Director, freshEHR Clinical Informatics
Director, openEHR Foundation
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL

On 14 March 2015 at 13:20, Marcus Baw <marcusbaw at> wrote:

On 14 March 2015 at 04:53, pablo pazos <pazospablo at> wrote:
For me the biggest concern, besides the limited publishing capabilities or non editors, is that the CKM is made over proprietary software, that doesn't allow us to create our own instances of the CKM for free, and share archetypes in a distributed / versioned way, like GitHub does.

​Pablo, you've nailed the problem here. The CKM is proprietary.

"All contributions to CKM is on a voluntary basis, and all CKM content is
 open source and freely available under a Creative Commons licence​" From openEHR Foundation website:

There's a disconnect there. I have in the past been in the middle of trying to explain openEHR to open source 'purists' and been left with some uncomfortable questions to answer about the tooling used not being freely available.  (no, despite what may appear to be my OSS zealotry I am actually not even close to being a Richard Stallman-esque OSS purist)

'community' computing is very definitely moving away from anything that is dependent on proprietary platforms, towards cross-platform, open source, generic systems. Open source languages, and Git for version control.

If we could find some way to wrap ADL in a more readable language then perhaps we really could just use GitHub for archetype sharing one day! One of the primary reasons for reliance on a GUI is that ADL in its raw form is so unreadable. If it could be read and understood in a text editor then there would be less need for a GUI. I accept that clinician led review would still benefit from a GUI. 

Another benefit of using a mature version control system such as Git is that some of the metadata about archetype authoring and details of who did a certain translation could reside in the version control commit history and would therefore not need to reside inside the archetype itself. This would reduce the size of archetypes, and would also obviate some of the problems such as the one Silje mentioned on another thread - in which there isn't room to record more than one translator.

BTW this post is very definitely not intended as a criticism of any individuals, and I recognise the massive amount of hard work that has gone before to even get where we are now.



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