Memory Clinic / Older Adult Mental Health

Heather Leslie heather.leslie at oceaninformatics.com
Mon Nov 16 22:24:09 EST 2015


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 ☺

Kind regards

Heather

Dr Heather Leslie MBBS FRACGP FACHI
Consulting  Lead, Ocean Informatics<http://www.oceaninformatics.com/>
Clinical Programme Lead, openEHR Foundation<http://www.openehr.org/>
p: +61 418 966 670   skype: heatherleslie   twitter: @omowizard



From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of Ian McNicoll
Sent: Tuesday, 17 November 2015 1:58 AM
To: For openEHR clinical discussions <openehr-clinical at lists.openehr.org>
Subject: Re: Memory Clinic / Older Adult Mental Health

Hi Matt (and Dave),

Welcome to the list. Apologies for me being a bit slow on the reply. I was travelling most of last week , then involved in an openEHR workshop in London at he end of the week - the first of many to come and supported by NHS Code4Health.

I would be happy to have a chat on phone/web to get you up to speed on possible next steps. I am delighted that Dave has offered possible use of the HSCIC CKM to allow you to get feedback on your archetypes. Just in case that proves problematic, you are very welcome also to use the 'UK CKM' partially funded by NHS Scotland and Code4Health by the Ripple and Handihealth projects.

It might seem odd to outsiders that the UK seems to have both an 'official' HSCIC CKM and an unofficial UK CKM but, at least for now, they do have quite different goals and governance arrangements. The Uk CKM is 4-country and more orientated towards supporting local and in-system archetype production, whereas the HSCIC CKM is dedicated to the use of archetypes of English messaging and API standards, with a somewhat more constrained governance process, required by an official standards organisation.

@Dave - we share your ambition to get clinicians involved from various specialties in the international work - the international CKM is the obvious home for this, the only challenge being the difficulty of having paid editorial time to keep the process moving. Right now those of us engaged at this level are fully occupied doing the 'Industry sprint' core archetypes.

One option for Matt's project might be for us to work up the cognitive disorder archetypes locally (in one of the UK CKM's) then, when we have a reached a reasonable level of maturity, promote these to the international CKM. Our colleagues in Norway, New Zealand are likely to be very interested.

Exciting stuff.

@Matt - please feel free to get in touch directly. We can also look at getting the archetypes implemented in one of the NHS Code4Health demo projects such as RippleOSI - see http://idcr.rippleosi.org/#/

Regards,

Ian





Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: ian at freshehr.com<mailto:ian at freshehr.com>
twitter: @ianmcnicoll

[https://docs.google.com/uc?id=0BzLo3mNUvbAjT2R5Sm1DdFZYTU0&export=download]
Co-Chair, openEHR Foundation ian.mcnicoll at openehr.org<mailto:ian.mcnicoll at openehr.org>
Director, freshEHR Clinical Informatics Ltd.
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL

On 16 November 2015 at 14:25, Barnet David (HEALTH AND SOCIAL CARE INFORMATION CENTRE) <david.barnet at hscic.gov.uk<mailto:david.barnet at hscic.gov.uk>> wrote:
Vebjørn

I’ve suggested to Matt that he can (subject to management agreement) use the HSCIC (health and social care information centre) CKM (ckm.hscic.gov.uk/ckm<http://ckm.hscic.gov.uk/ckm>).

Your suggestion that clinicians in Norway would be interested in contributing is very encouraging.


On that subject - An open question
As a thought on contributors, it seems to me that the major contributors to archetypes are the countries who run a CKM (Norway, UK, Australia etc.) and whatever reach the openEHR foundation has. As contributing to archetypes is not dependent on using openEHR in a country (realm/jurisdiction etc.), is there a way to tap into a more “global” interest? I am aware that clinicians regularly present at venues around the world sharing best practice. It would be nice if we could tap into these groups to spread the openEHR collaboration message?

For example, cardiology has the http://www.world-heart-federation.org/ boasts a large number of members from around the world.

For example, it would be nice for Matt to be able to post to an online message board to say an archetype is ready for review, and be able to target geriatrician groups (national level groups such as Royal Colleges in the UK perhaps) around the world. Or is that just a “pie in the sky” idea?

Regards

Dave Barnet

From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org<mailto:openehr-clinical-bounces at lists.openehr.org>] On Behalf Of Vebjørn Arntzen
Sent: Mon 16/11/2015 13:55
To: 'For openEHR clinical discussions'
Subject: SV: Memory Clinic / Older Adult Mental Health

Hi, Matt

Re:" Should it be sufficient to use the archetype editor to build and share the work or would it be worth my while then adding the archetypes to an openEHR server to demonstrate use?"
I will strongly advise to use a repository (CKM) to share archetypes you've made. You'll need access to a Project/Incubator in a CKM (e.g. UK CKM <http://www.clinicalmodels.org.uk/ckm/> - the UK clinical models repository). The CKM provides great opportunities to share, discuss and upload new versions as you get feedback. You'll need to get in touch with an administrator of a CKM to obtain the necessary privileges – or to have the administrator handle it for you. It's fairly easy to make stupid archetypes, inviting colleagues and specialists in health informatics to join in the work makes the work easier (but still not easy).

As the Norwegian vendor DIPS ASA is making a shift towards archetypes in their system DIPS Arena, the majority of Norwegian hospitals will need archetypes for almost any thinkable area of health. In that perspective,  I'm quite sure that some geriatricians in Norway will be interested to both contribute and adopt the results.


Regards,
Vebjørn Arntzen
RN, Enterprise Architect, ICT-dept, Oslo University Hospital

Fra: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] På vegne av Thomas Beale
Sendt: 13. november 2015 14:57
Til: openehr-clinical at lists.openehr.org<mailto:openehr-clinical at lists.openehr.org>
Emne: Re: Memory Clinic / Older Adult Mental Health

Hi Matt,

Some potentially useful resources:

  *   Business purpose of archetypes <http://www.openehr.org/releases/AM/latest/docs/Overview/Overview.html#_business_purpose_of_archetypes> - 1 pager on why archetypes are needed
  *   UK CKM <http://www.clinicalmodels.org.uk/ckm/> - a UK clinical models repository
  *   HSCIC CKM<http://ckm.hscic.gov.uk/ckm/> - HSCIC's clinical models repository
  *   Modelling Tools<http://www.openehr.org/downloads/modellingtools>

Re: having to convert archetypes and templates into product specific formats, this is pretty easily doable, since archetypes are highly computable (i.e. don't rely on informal constructs or statements), and there are a number of open source libraries for working with archetypes within tools (e.g. adl-designer<https://github.com/openEHR/adl-designer>, adl2-core<https://github.com/openEHR/adl2-core>).

If you keep an eye on this mailing list, you will get responses from clinical modelling experts and software developers on your more specific questions.

- thomas

On 13/11/2015 12:31, Matt Evans wrote:
I have followed these lists for some years but never posted before. I work in an NHS older adult mental health service in the south of England and the greatest proportion of our workload is in cognitive disorders.

We have significant need to gather a mixture of structured and semi structured or freetext clinical information to support clinical care, audit, service development and research. We have previously worked with UCL CHIME to model the clinical information and built an information system to support these requirements in memory clinic and to some extent older adult mental health more generally. We therefore have some potential archetypes/templates to start from.

The move in the NHS towards larger information systems means that we must now migrate these clinical models in to some sort of representation in the main hospital/Trust information system. Our neighbouring Trusts do the same within their different information systems. As clinicians and researchers we are more than ever interested in sharing the information structures across our organizations but clearly that means across different incompatible systems.

I have experience of the ‘traditional’ way of specifying and communicating information requirements and building them in ‘the big systems’ and it isn’t entirely satisfactory. I hope that building archetypes could be a really efficient way of engaging end users and to communicate the developments.    Regrettably the exercise would merely be for us to demonstrate our common requirement as the archetypes will then have to be translated rather than incorporated in to the different  systems in use by different organizations.

Clearly I need to do some reading of the openEHR pages and specifically the tools. Before we start I’d appreciate any advice people could offer.

Is there active openEHR archetype work within the NHS currently?
Are there archetypes in developments within cognitive/neurodegenerative disorders or mental health?
Should it be sufficient to use the archetype editor to build and share the work or would it be worth my while then adding the archetypes to an openEHR server to demonstrate use?

Thanks for any pointers!



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