A clinical modelling conversation...
thomas.beale at openehr.org
Thu Aug 16 07:41:19 EDT 2018
A few thoughts come to mind:
* sets of archetypes could potentially be developed closer to
completion by the grass-roots level, before submission to CKM, which
would reduce editorial time, if better guidelines on development
rules, patterns, etc i.e. the fabled handbook existed
o consider a set such as for ante-natal care + birth + post-natal
(6 weeks) - there might be 50 archetypes implicated here, with
(we hope) at least half being generic (e.g. lab tests used in
pregnancy are mostly not unique to pregnancy) - there is a lot
of work here.
* It might be a better approach if development teams were to try to
develop whole packages to a reasonable level, rather than just
submitting single archetypes and wait for results of review
o whole package generally would be based on some process, care
pathway etc, not just a data-oriented view. E.g. pregnancy;
chemo+ monitoring; etc
* if the fabled handbook of patterns and criteria for good archetypes
existed, more editors could be trained.
* is there any reason not to have just more people on the editorial
group, e.g. 10?
* is it time to agree a set of major clinical sub-specialties (< 20)
and designate an owner for each one (i.e. an editor; some editors
could own more than one area)?
* we possibly need to distinguish two layers of archetypes, which
would potentially change how editorial work is done:
o generic all-of-medicine archetypes:
+ vital signs
+ many signs and symptoms
+ a reasonable number of labs
+ general purpose assessment / evaluations, i.e. Dx, problem
description etc, many things like lifestyle, substance use
+ ?all of the persistent managed list types: medications,
allergies, problem list, family history, social situation,
o the specialties, for each:
+ specific signs and symptoms
+ specific physical exam
+ specific labs
+ specific plans
o more than one relationship between specialty archetypes and
generic ones is possible, e.g. some are just new; some are
formal specialisations in the ADL sense.
My guess is there is a number of issues to consider. Whether any of the
above are the main ones I don't know.
On 03/07/2018 08:41, Heather Leslie wrote:
> Dear Colleagues,
> This email is jointly sent by the openEHR Clinical Knowledge
> Administrators, Silje and Heather.
> Following recent email threads, we would like to establish some common
> understanding and expectations about the current clinical modelling
> effort and effect that we hope might stimulate a constructive and
> innovative conversation within the openEHR community about moving the
> clinical modelling work forward.
> Let’s say that publication of a typical archetype takes four review
> rounds. Each review round runs for 2 weeks. If we had dedicated
> Editors who can turn those archetype reviews around immediately then
> we can take a draft archetype and publish it 8 weeks later. The
> reality is that there will be some lag times so the reality might be
> closer to 10 or 12 weeks, but we’re not talking 6 months or years.
> Let’s also say that the typical Editorial time for each review round
> is 3 hours – an hour for an Editor to do the editing and one hour each
> for two Editors to facilitate the comments. So let’s add in one hour
> preparing an archetype for a review round and we have a total of 13
> hours editorial time per archetype. Simpler archetypes and well-known
> scales or scores can be published in one or two review rounds. More
> complex ones like the adverse reaction archetype has taken tens of
> hours, possibly closer to a hundred, but worth the effort to get it
> right because of its importance in clinical safety. However we’re not
> talking unsustainable hours per archetype to get the majority published.
> Within the typical standards environment where review of information
> models are done en masse in 3, 6 or 12 month cycles, our agile and
> dynamic approach to archetype review and publication is outrageously
> fast and requires only a modest budget. And the priorities can be
> driven by the implementer community.
> We really need a different conversation happening about the archetype
> development process, one that recognises the efficient and value for
> money that we have put in place but is largely untapped, rather than
> complaining that the work to date is not complete enough, not focused
> on the right topics, not <insert whatever you like here> enough.
> The practical reality is that by far the majority of the Editorial
> work is not resourced, so there is a limited strategic plan apart from
> the Archetype ‘Sprint’. Rather that the work is largely opportunistic:
> * dependent on archetypes that are volunteered as a result of real
> life implementations;
> * translations by those reusing archetypes in different geographical
> contexts; and
> * reviews occurring when people ask and then volunteer to
> participate in the process.
> The Norwegian Nasjonal IKT work is a perfect example of this – so many
> of the archetypes published in the international CKM in the past
> couple of years are the direct result of the Norwegian priorities for
> content, driven and facilitated by the Norwegian Editors but with
> enormous value contributed by international input. Nasjonal IKT have
> effectively funded the majority of this work to support their national
> program, gaining the enormous benefit of international collaboration
> and input, and in return making available high quality archetypes for
> the rest of the international openEHR, and broader, community. They
> recognise this as a win-win situation.
> The source of most of the limited funding that has recently been made
> available for editorial work in the international CKM is Norway’s
> Nasjonal IKT membership fees, which have been deliberately directed
> toward the international clinical modelling effort on request from
> Nasjonal IKT. A few hours a week of dedicated editorial time has
> already increased the international CKM activity manyfold in recent
> months. This includes timely responsiveness to community requests and
> contributions, for the very first time. It would be exciting to see
> this grow and expand through member organisations joining and
> specifically allocating some of their fees towards the clinical
> modelling effort.
> With only modest, strategic resourcing, the collective benefit will be
> orders of magnitude larger than any single organisation can achieve by
> itself. The impact of this can extend way beyond the openEHR
> international community but to other standards organisations and
> digital health in the broadest sense.
> Kind regards
> Silje Ljosland Bakke and Heather Leslie
> /Clinical Knowledge Administrators for the openEHR CKM/
> *Dr Heather Leslie*
> MB BS, FRACGP, FACHI, GAICD
> M +61 418 966 670
> Skype: heatherleslie
> Twitter:**@atomicainfo, @clinicalmodels & @omowizard
> openEHR-clinical mailing list
> openEHR-clinical at lists.openehr.org
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Project, Intermountain Healthcare
Management Board, Specifications Program Lead, openEHR Foundation
Chartered IT Professional Fellow, BCS, British Computer Society
Health IT blog <http://wolandscat.net/> | Culture blog
<http://wolandsothercat.net/> | The Objective Stance
-------------- next part --------------
An HTML attachment was scrubbed...
-------------- next part --------------
A non-text attachment was scrubbed...
Size: 7056 bytes
Desc: not available
More information about the openEHR-clinical