A clinical modelling conversation...

Heather Leslie heather.leslie at atomicainformatics.com
Tue Jul 3 03:41:53 EDT 2018

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
M +61 418 966 670
Skype: heatherleslie
Twitter: @atomicainfo, @clinicalmodels & @omowizard
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