Personally I don't see the reason to not just update the version. If the
archetype contains breaking changes it is a v2. I would enforce this even
for drafts, as I have stated before.

I have also seen lately changes in archetype ids. I would expect that the
old archetype with the old id was kept with a deprecated lifecycle status.

Regards

Hi everyone,



I’m seeking some community input around a conundrum that has arisen
regarding archetype governance, or more specifically if we should offer a
new version of an archetype that included breaking changes/corrections
according to the openEHR specifications but which are not critical in terms
of clinical safety – a bit of a grey zone, if you like. If clinical safety
were implicated, the decision would be easy.



The Blood Pressure archetype was published in 2009 and I believe is in
fairly wide use in systems at this point. Currently published version here
<http://ckm.openehr.org/ckm/#showArchetype_1013.1.130>, and which has had
only ‘trivial’, non-breaking changes, including addition of translations,
etc since publication.



Recently the Norwegian community translated the archetype and then
undertook a local review of the archetype. They have suggested some
modifications to the archetype which include updating some of the data
elements around identifying the body location of the BP measurement to be
in keeping with more recent archetype patterns that we have been using,
plus identified that the representation of degrees of Tilt was not using
the UCUM units, plus a few minor additions.



The result is that their new candidate archetype (here
<http://ckm.openehr.org/ckm/#showArchetype_1013.1.2189>) which includes
these changes is regarded as a Major revision under our current CKM
versioning rules and if republished warrants becoming a version 2. That is
all perfectly OK from an academic governance point of view.



There is no doubt that the archetype is a more accurate and enhanced
iteration but the practical implications of republishing as a v2 are not
trivial to implementers.



So I seek your advice on whether we should proceed with further content
review with the intent of re-publishing as a new v2 archetype:

·         *Pros*

o   Archetype data is updated to include correct UCUM units

o   Archetype data is updated to include more ‘modern’ modelling patterns
that are being used increasingly in more recent archetypes

o   New implementers will be able to use the most up-to-date version of the
archetype, rather than using an archetype that has been identified as
having flaws. Otherwise new implementers will continue to implement a
known, flawed archetype into their new systems



·         *Cons*

o   Existing implementers will need to decide whether it is worthwhile to
update to v2. The alternative is to stay with the v1 published archetype as
is and consider updating at some future time.

o   The update of the UCUM unit and body location pattern does not have
major safety implications or significantly impact the modelling quality,
yet will have internal implications in existing clinical systems.

o   Two versions of the archetype will be in circulation, and implementers
will need to manage the interoperability issues that will arise.

o   Norway will likely use the new archetype as their national standard,
diverging from the openEHR CKM content, which is not desired by either
party.



A portion of the diff is attached, which demonstrates the major breaking
changes. There are many other changes that only refer to translations and
are non-breaking in the rest of the diff



This is the first time we have had to update a published archetype and it
certainly won’t be the last. If there were breaking changes that needed to
be made for clinical safety reasons or similar critical reasons I would
have no hesitation in proceeding to v2. If there were non-breaking changes
we would manage the progression with additional minor revisions or patches
– not a problem. This one has breaking changes but no clinical safety
issues, so a bit of a grey zone because of the possible implementation
implications.



I have no doubt that many implementers are already grappling with these
issues if they have implemented draft archetypes, so perhaps you all have
established systems and approaches for this.



I have had some advice suggesting we should leave the archetype as is,
rather than ‘rock the implementation boat’ for little semantic value, yet
I’m not sure that it is our role to be paternalistic. My own inclinations
are that we should govern the archetypes from a pure point of view,
updating and creating new versions if we have to, and allowing CKM to
provide the transparency that will support implementers to make informed
choices.



So:



Option 1: Do nothing. The current flawed archetype will be the only one
available on the openEHR CKM

Option 2: Promote the new candidate archetype to the public trunk as a
potential new iteration – so available for viewing and download, but with
no official status, effectively in limbo until a further review round is
carried out and it is republished.

Option 3: Promote the new candidate archetype to the public trunk, run
formal content reviews on it and plan to re-publish as v2



Please, your thoughts?



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





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