The foundation governance structure within the Clinical Knowledge Manager is known as a Domain.
A Domain comprises:
- the entire library or repository of primary assets (archetypes, templates and terminology subsets); plus
- all secondary assets (automatically generated); and
- any related assets for each.
Administrators for a domain have the top-level governance authority responsible for the entire library or repository of clinical knowledge assets. Domains are most commonly managed under the auspice of a national or international jurisdiction or organisation.
Each stand-alone instance of CKM currently operates as a single domain. For example, the openEHR international domain is www.openEHR.org/ckm. A list of all CKM instances ist available here.
Oversight of each domain will be managed by one or more appointed Clinical Knowledge Administrators, who will be responsible for the governance and processes underpinning the domain as a whole, and where relevant, ensuring that the archetype set uploaded work together as a coherent whole.
Each Domain has two environments - one that it strictly governed such that all changes and activities are carefully tracked, such that downstream effects for implementers can be assessed and managed; and another that is totally ungoverned and effectively operates as a 'sandpit' or asset nursery to foster informal collaboration, innovation and new asset development.
Each CKM domain has two levels of structure within the strictly governed environment:
One or more models, and their related assets, that are being used as the library for a specific jurisdiction- or organisation-based activity, clearly identifiable within the domain instance. It allows for assets to be grouped logically or practically, and may enable some degree of preliminary or independent work to occur under the direction of a jurisdiction or organisation, but still within the context and overall governance of the domain as a whole.
Some models may be uploaded and managed by the jurisdiction/organisation; some may be referenced, or shared, from projects within other sub-domains within the same domain instance.
Within a domain, Clinical Knowledge Administrators can set up one or more sub-domains in a similar manner to creating named folders, each of which can contain one or more projects.
A remote Sub-domain is a special sub-domain that allows a 'read only' view of archetypes from another (remote) CKM instance. You can easily identify archetype from a remote CKM from the left hand archetype trees: Remote archetypes are displayed in italics.
Projects are used to facilitate formal collaboration, publication, distribution and maintenance of CKM primary assets for a specific clinical purpose or scenario, and operate under the oversight of a Sub-domain.
Each project comprises a collection of one or more models and a project team. Examples of Projects include: to create a Discharge Summary document; a laboratory report message; or a data entry screen.
Project Leads and Editors will facilitate domain expert reviews of assets until they are fit for the identified purpose.
Features of Projects:
- All assets are 'owned' and managed by the Project Lead and Editors of one identifiable Project.
- Projects are publicly available for viewing by registered and non-registered users.
- Projects are initiated within a specified Sub-domain by a Clinical Knowledge Administrator.
- The Clinical Knowledge Administrator appoints a Project Lead who has responsibility for overall management of the Project
- Clinical Knowledge Administrators or Project Leads can appoint one or more Editors who have responsibility for managing the assets through the collaboration, publication, distribution and maintenance activities.
- The Project Lead or Editors can appoint a team of registered CKM users who will be invited to participate in a collaborative review process on assets from initial draft right through to content publication.
- The Project Lead or Editors can add new assets to the project, as required.
- Assets can be added to a Project:** by direct upload of a new asset by a Project Lead or an Editor ;
- by promotion of an asset from an ungoverned Incubator by a Clinical Knowledge Administrator. This is done at the request of the Incubator owner, and with agreement of the Project Lead/Editors.
- Project teams can be fine-tuned, with individual reviewers added or removed, depending on the nature and content of the asset.
- Each asset can be referenced ( that is, shared or reused in another clinical context) by many Projects. If a non-owner Project identifies additional requirements or modifications needed for an asset, they will need to negotiate this with the Project Leads/Editors of the Project who has ownership of the asset.
- Each Project has a Project-related discussion/communication area.
- Each Project has a Project-related Resource Centre – allowing for central registration of all project-related documentation.
The ungoverned space within a CKM instance operates without the notion of subdomains and all activity occurs within Incubators, which are the ungoverned, but functionally equivalent version of a Project.
Incubators are used to facilitate informal collaboration, innovation and development of new or immature assets. If assets are developed and refined to meet requirements stipulated by the Domain's Clinical Knowledge Administrator, it can be promoted into the governed environment as part of that Project, with permission from the Project's Lead/Editors.
Features of Incubators:
- Incubators can be initiated by any registered CKM user, who becomes the Incubator owner. The owner can then upload a new or immature primary asset, or set of assets into their Incubator.
- Registered CKM users can 'own' multiple Incubators for different purposes.
- Each incubator is identified by a unique name*.*
- All assets within the Incubator are 'owned' and managed by the Incubator owner.
- Incubators are private by default, but can be made public by the Incubator owner, resulting in inclusion of the Incubator assets within the current CKM Search and allowing a Registered User to contact the Incubator owner.
- Incubators consist of a single Incubator owner plus, optionally, any number of Registered users who are invited to participate as Incubator team members by the Incubator owner.
- Team members can view all of the assets within the incubator, even if it is deemed 'private'.
- When an asset or set of assets is deemed sufficiently mature, the Incubator owner can notify the Domain Clinical Knowledge Administrators for permission to transfer responsibility for the selected asset(s), or entire Incubator assets to the CKM domain. If deemed to be aligned with the broader pool of CKM assets, and of value to an identified Project, the assets can be promoted by the CKA to draft status under the auspice of an identified Project.
- Each Incubator can reference another asset from within the same Domain.
- Each Incubator has a Team discussion/communication area.
- Each Incubator has a Team Resource Centre – allowing for registration of all incubator-related documentation.