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
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--
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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