The Australian Digital Health Agency is actively engaging with the healthcare community to develop computable clinical content definitions known as Detailed Clinical Models (or DCMs). Each Detailed Clinical Model is inclusive of all data attributes and potentially terminology bindings that are useful to describe a single, discrete clinical concept for use in a broad range of clinical scenarios.

Examples of DCMs include:

Problem/Diagnosis;
Adverse Reaction;
Medication order;
Blood Pressure measurements; and
Symptom.

What will the collaboration produce?

The collaboration process in the Australian Digital Health Agency's Clinical Knowledge Manager (CKM) will result in a library of archetypes (initially openEHR archetypes) based upon requirements identified by Australian clinicians and other health domain experts, and drawing from comparable work overseas. To create the DCMs, these archetypes will be transformed into platform and reference model agnostic models (based upon ISO 11179). They will then be uploaded to the National Information Component Library that the Agency is in the process of building.

CKM is being used to gather and formalise requirements for the DCMs and to support the life cycle management of each DCM through a collaborative, online review process. This provides an important vehicle for clinicians and domain experts to validate that the clinical requirements have been met, and warrant that the resulting published DCMs are safe, high quality and fit for purpose.

What can be done with the DCMs produced?

Published DCMs will become a core national resource for expressing clinical content in a consistent, re-usable and standardised way. Multiple DCMs can be constrained and/or combined together into implementable specifications that can be used across all of Australia's eHealth activities, including the Personally Controlled Electronic Health Record (PCEHR) and all information exchanges such as Health Summaries and eReferrals.

Recent enhancements (Dec 2012) to the Agency's CKM achieve two main objectives:

Modifications to the user interface to simplify the interface and allow users to focus on specific projects and components.
Modifications and additions to CKM and associated tooling to create a model and terminology based end-to-end tool chain.

The first objective has been achieved by adding finer grained governance components, known as 'sub-domains', each with underlying 'project' sub-components. This means that clinical models can be 'owned' and developed more easily by various groups and jurisdictions in the Australian eHealth community. Users now have a more customisable view of the application and can narrow their view to specific artefacts. The help system has been improved through enhancements to the navigation functions and understanding of functionality for new users.

The second objective has been achieved by adding functionality to enable an end-to-end tool chain with the following characteristics:

clinical models (archetypes) that are reviewed and agreed on by domain experts
templates that are built from archetypes and meet the Agency's specifications for various work programs
a transformation engine that can automatically produce outputs based on the templates, such as XML schema, SCS documents, CDA implementation guides, CDA instances and Schematron etc.
connection to the Agency's UML-based architectural documentation via a UML output from the tool.

Importantly, the new tool chain allows end-to-end visibility and governance of the artefacts that are produced and published in this environment.

Who should get involved

The Agency invites any interested individuals to self-register in the Clinical Knowledge Manager and become actively involved in the CKM online community and DCM development process. This includes the broadest range of clinicians, health domain experts and consumers. We encourage organisations to nominate to join the community review process on behalf of their organisation.

There is a very important need for non-technical contributions from grassroots clinicians to warrant that the clinical content of each DCM itself is correct and appropriately defined. Review of the more technical aspects of each DCM will be covered by team members who have been identified as having technical, terminology and informatics experience.

For more information:

For further information on the status on archetype development and the DCM work program please click here.
To view video instructions on using the Clinical Knowledge Manager please view our YouTube video here.
Alternatively, you can contact the DCM team at support-email help@digitalhealth.gov.au