People, particularly those in working in the standards arena, are arguing that we need a formalism for describing archetypes that is independent of any reference model. This is actually an oxymoron. Here are some thoughts.
The Detailed Clinical Models group was formed independent independently of HL7 to try and find a methodology for describing clinical data specifications. Some members of this group have committed to the openEHR methodology, others have continued to seek a 'reference model independent' approach. For the past couple of years the group has been looking at UML and a recent email from a leader in this space has suggested that perhaps UML is not the best approach.
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ISO 13606 is the alternative. It is more generic and based on an earlier work. To proceed with 13606 a set of 'proto-archetypes' are required which mirror or offer the organising capacity of the openEHR entry classes, then specialise these prototypes to produce the actual clinical archetypes. This has advantages - the proto-archetypes can change without changing the reference model. But it also raises new problems: it forces the tooling to be generic and difficult for clinicians to understand; places a large larger overhead on the queries; makes software much harder to write and maintain; and does not guarantee the outcome desired (ie people can do what they like). Also specialisation is pretty rudimentary at present and requires features in ADL 1.5 will make this much more robust but are not part of the standard. Specifically, those building archetypes will have to think about how to do timing, time series, averages, maximums, totals, the state of the patient at the time of measurement rather than the core data (as this is almost unlimited in different clinical and research environments), information about the measurement, the device, where and how it was measured....
So the question that needs adrerssing addressing is, "How suitable is a particular reference model for using with archetypes?" The NHS, Sweden and Denmark and soon probably Brazil and Scotland - have taken a big step in the openEHR direction. People working with openEHR have sorted out how to make this work in a way that will take years to reproduce in another space. The politics is yet to be resolved.
I think the openEHR community have to stare down this idea of a 'reference model independent' archetype formalism - that is what ADL is! It is, afterallafter all, the reference model that makes archetypes work. At present it is the openEHR reference model that makes archetypes work in health care healthcare - it was design specifically for that purpose.
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