A clinical modelling conversation...

Thomas Beale 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,
            consents, etc
      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.

- thomas



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
>
> www.atomicainformatics.com
>
>
>
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical at lists.openehr.org
> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org

-- 
Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Project, Intermountain Healthcare 
<https://intermountainhealthcare.org/>
Management Board, Specifications Program Lead, openEHR Foundation 
<http://www.openehr.org>
Chartered IT Professional Fellow, BCS, British Computer Society 
<http://www.bcs.org/category/6044>
Health IT blog <http://wolandscat.net/> | Culture blog 
<http://wolandsothercat.net/> | The Objective Stance 
<https://theobjectivestance.net/>
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