The openEHR Clinical Knowledge Manager (CKM) is an international, online clinical knowledge resource. It has gathered an active Web 2.0 community of interested and motivated individuals focused on furthering an open and international approach to clinical informatics - an application- and message-independent lingua franca for sharing health information between individuals, clinicians and organisations; between applications, and across regional and national borders. All contributions to CKM is on a voluntary basis, and all CKM content is open source and freely available under a Creative Commons licence.
The initial focus of CKM development has been threefold:
- creation of an archetype library;
- development of a formalised review process to achieve content consensus and archetype publication; and
- governance of archetypes.
Further, template upload has recently been added, and capability for terminology subsets, such as SNOMED CT, LOINC and ICD.x, is planned in the near future.
Archetypes are the foundation for a shared and re-usable library of computable clinical definitions - a single logical record architecture. This SLRA can provide a solid foundation supporting the capture, storage, sharing, integration, aggregation, inferencing and querying of data - a standardised, data-driven approach to eHealth.
Contributors to CKM include clinicians, informaticians, software engineers, terminologists, administrators, consumers and medical/informatics students. They come from a broad range of professions and disciplines, and from over 50 different countries. CKM's has started with a small core of testers and grown by 'word of mouth' through the existing openEHR community. It is part of a growing Web 2.0 momentum of using the internet as a strategy to 'harness the collective intelligence' in a collaborative approach. Participants are able to contribute online at their convenience.
Archetypes within CKM have been developed by a broad range of domain experts - largely clinicians and informaticians. They are created independent of CKM and offered to the community as a draft 'straw man' for review and refinement. Registered users can make comments about any aspect of each archetype at any time. A formal content review process can be initiated on each archetype and once consensus is reached on the clinical content and design, the archetype can be published. After ensuring that the content is stable and published, translations and terminology binding can be added to the archetype specification, and similar team review processes for archetype translations and terminology binding are in development to ensure peer review and quality output.
All registrants, including clinicians, can participate in CKM archetype publication through a number of designated roles - Editor, Reviewer, Translator & Terminology binder. Inputs from all experts are welcomed as each can potentially enrich the content of each archetype with domain expertise. Clearly clinicians need to drive the clinical content of the clinical archetypes, but others contribute further aspects to the quality of the archetype - for example, ensuring that the design of the archetype is technically optimised, has correct terminology binding, is translated correctly etc.
Participating as a Reviewer requires no specific training. Contributions can start with as little as grammar and spelling corrections; through incorporation of clinical content expertise; openEHR implementation; technical requirements; to optimisation of terminology binding. All contributions are welcomed, acknowledged and incorporated where possible, with feedback by Editors seeking to educate as well as achieve consensus.
Translators volunteer their services, and it is anticipated that the proposed formal peer review process of translations will ensure that the translations of the original published archetypes are of good quality. It is anticipated that Terminology binding will operate in the same manner, and we will be seeking the input of expert terminologists to drive this work.
The Editorial task is not trivial and requires a significant initial commitment of training in openEHR and CKM, plus ongoing time and effort to facilitate the reviews of each archetype through to content consensus and publication. Editors are assigned to edit an archetype on the basis of their domain expertise, commonly working in small teams. Clinicians and informaticians are appointed as Editors for all clinical archetypes; software engineers and demographics experts are leading the editing of demographic archetypes.
Non-registered users can browse the CKM application, viewing and downloading all artefacts. Registration is required for active participation. As CKM is designed to be transparent in its processes and activities, all registered users can view the models, comments, background documentation, revision/version history, review comments, etc. They can participate by making comments per archetype, contributing background reference material, adopting archetypes and participating in those archetype reviews, and following archetype progress via a watchlist and notifications.
Some national eHealth programs are setting up their own national instance of CKM, which is federated with the international openEHR CKM. This will enable them to select archetypes from the international pool, add their own national archetypes to suit local requirements, and effectively establish a national clinical knowledge resource for their clinicians, organisations and vendors.