Hi Bert, Unfortunately pattern by itself won't result in good archetypes. Mind you, I think the RM classes are brilliant and they have been the cornerstone for our modelling experience. In fact I suspect that the lack of these classes is a large part of the reason why other modelling paradigms such as CIMI have not been able to progress as far and as fast they had wished.
Clinical medicine is messy, by definition. Our experience is that we often identify patterns and then we routinely come across as many examples that break those patterns. The slow progress that results is the result of refining those patterns to work as universally as possible in the clinical scenarios and how to deal with apparently outlying data points. Then you need to consider clinical diversity that takes into account the range of clinicians; differing professional requirements; differing professional levels of details; needs of specialists vs generalists; clinical context; institution and location; cultural differences; language differences; personal health records; requirements for public health and research.... I could go on. We need to identify what a concept is and the appropriate scope; ensure minimising overlap as well as minimising gaps between concetps. Good archetype design is just not as simple as what you yearn for, despite how logical it seems to you. Our job would be much easier if it were so. The only practical way forward is to start with good representations of clinical data and then get broad review from ALL experts - to ensure that the clinical data is fit for use as well as to ensure that they are implementable. As CKM Editors we try to get developers involved in reviews but they are often in the minority - not because they are not invited but mostly because they don't respond. We have a large list of technicians who were part of the companies who funded the original openEHR sprint. Some responded immediately with 'Accept' just to try to accelerate the archetype to get a published state. Most ignore the invitations to participate. DIPS engineers have been the most consistent participants and many modifications in archetypes arose from their participation in reviews - this has reflected their requirements for clinical content as well as their suggestions regarding the technical implications of the archetype design. The adverse reaction archetype is a case in point - eventually we had 221 reviews from 92 individuals in 16 countries PLUS an unknown number of participants from HL7 Patient care and FHIR communities. Health informaticians and IT experts comprised at least a third of reviewers - engineer engagement to this level is not our usual experience and if my memory is correct, most of the technical input came from the HL7 community, not openEHR. Patterns have been identified and more are being refined... but don't expect them for all concepts, there will always be lots of unique models. Representing data that real clinicians can use will not be solved by patterns alone. Engaging clinicians is critical. Ontologies are useful but don't necessarily cater for the entire reality that is clinical practice. Engineer review and input would be much appreciated if it were available. Why don't you agitate to get more engineers participating in the reviews? I would gladly invite anyone who is willing to engage. Get them to adopt an archetype today and join in the collective effort - the resulting archetypes can only be better for everyone. Regards Heather -----Original Message----- From: openEHR-technical [mailto:[email protected]] On Behalf Of Bert Verhees Sent: Friday, 16 February 2018 2:41 AM To: For openEHR technical discussions <[email protected]> Subject: Archetype pattern An interesting wiki from Heather Leslie https://openehr.atlassian.net/wiki/spaces/healthmod/pages/90507705/Archetype+Design+Patterns She concludes that pattern are necessary, I agree with that, and she also concludes that clinicians are better modelers then technicians. Well, that depends, of course it is very important to have domain-knowledge when modeling data, and clinicians have the best domain-knowledge. So from that point of view, she is right. But what we have seen until now is that clinicians create archetypes with unpredictable paths. And that is bad, because it makes it very difficult to find data and it makes it easy to miss important data, because some data were on a path where one did not expect them. OpenEhr works fine to find data which are on a known or predictable path, but what if data are on an unknown path? Let me explain by comparing this to a classical relational health-application. There are similarities. I have seen classical relational systems which experienced a wild-grow in number of tables, I have seen once in a prestigious university-hospital where they had a grown of 7000 tables in 20 years, more then one per day!! No one understood the meaning of all the tables and data, no one dared to use data he did not understand, many data were and still are redundant. Every new development in the ICT starts with designing new tables. How can in such a situation a clinician research a persons medical record, even with the help of the current technical staff, this is often impossible. So, important information can get lost. Adding to this are software-updates which often cause a clean-up, and that clean-up is also done by people who do not always know what they clean up. People live long, and a medical problem they had 30 years ago can be important to find to solve a current problem. So old data, and understand them, and be able to find them, can be important. This can also happen with archetypes. Every new development in a application can start with a new archetype, and at a moment there can be thousands. It is impossible for a clinician to search all possible paths for medical information, even with the help of the current technical staff this can be impossible. The old data-hell situation will not be solved by OpenEhr if there is not something behind it. And that something, that is: PATTERN It is not only a clinical thing to understand how pattern in paths are best modeled, it is in fact also a technical thing. Clinical knowledge is not stable, the thinking about clinical facts change all the time, what now is important is tomorrow maybe not. So the pattern need a technical, mathematical base, that, something like Codd-normalization, but of course then applicable to archetypes. The Wiki from Heather Leslie is a good starting point for the design of pattern and stop the proliferation of paths. I described an approach to solve this problem in a blog, one and a half year ago. http://www.bertverhees.nl/openehr/medical-data-context/ I had some discussion about that, but many had problems against the use of SNOMED in this context. So, maybe read it and forget SNOMED ad find something else to structure the medical data. Bert _______________________________________________ openEHR-technical mailing list [email protected] http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org _______________________________________________ openEHR-technical mailing list [email protected] http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
