openEHR Clinical modelling workshop
openEHR Clinical modelling workshop: Embracing clinical diversity and complexity
Dr Ian MCNICOLLa,, Dr Heather LESLIEa and Silje LJOSLAND BAKKEa
aopenEHR Foundation ,bGlobal eHealth Collaborative, cNasjonal IKT HF
Abstract. openEHR is an open specification for the information model required to underpin an open digital care record platform. A key feature in openEHR architecture is the direct, collaborative involvement of clinicians in the design, review, curation and governance of open source clinical content definitions ‘archetypes’. This workshop will discuss the implications of this evolutionary approach to shared content development based on international, national and vendor-level experience as a means of maximizing benefit within a highly dynamic, culturally-mediated complex system.
Keywords. openEHR, archetype, clinical content, interoperability, platform, open source
1. Introduction
As healthcare moves towards the end of the second decade of the 21st century, the complexity of delivering a coherent eHealth architecture to support agile application development and information sharing, remains a global challenge. While other economies reap benefits from the ‘apps revolution’ much equivalent effort in the eHealth space remains disconnected from core systems, and if anything, the market is consolidating around the shrinking number of vendors able to cope with the complexity of health data implementation and ever-expanding clinical and legislative demands.
Top-down international standards developments have, in general had limited impact, and while newer, lightweight, developer-focused technologies1 hold promise for interfacing between systems, they do not address directly the core difficulty of capturing and rapidly implementing detailed, complex clinical requirements for application development and information sharing.
openEHR2, which grew out of academic enquiry into approaches to EHR architecture3, draws heavily from approaches to distributed open source development in attempting to maximise the implementation of high-quality clinical content models, whilst supporting the competing need to reflect local requirements and innovation.
openEHR is both ‘cathedral and bazaar’ in Raymond’s4 terms. A carefully controlled and slowly developing core ‘cathedral’ information model underpins technical implementation but is designed to consume arbitrary clinical concept models designed and developed by a set of collaborating clinical communities operating rather more as ‘bazaar’, as a means of maximizing value within the highly complex and diverse domain of healthcare documentation.
The emergent methodology draws heavily on the paradigms of open source distributed development5 and ‘crowd-sourcing’. It expects organic and evolutionary development6, anticipates and accepts speciation and ‘forking’ of assets. It tolerates and includes local, national7 and international perspectives to have to be supported, and that full international alignment/ adoption will not be a smooth journey8, understanding that short-term imperatives will always trump longer-term aspirations9. Nevertheless, steady progress is being made, largely due to considerable voluntary commitment from the community with the output of openEHR clinical modelling becoming apparent through implemented national and international standards, as well as significant system implementations.
2. Workshop
Speakers
Dr Ian McNicoll: Co-chair openEHR Foundation
Dr Heather Leslie: openEHR Clinical program joint lead
Silje Ljosland Bakke: openEHR Clinical program joint lead
Workshop structure
3 * 20 minute presentations will be followed by an extended discussion where all workshop participants are encouraged to reflect on what has been presented, and introduce questions or reflections from their experience.
Introduction to openEHR clinical modelling methodology and vendor engagement (Ian McNicoll)
The openEHR clinical modelling approach, originally based on academic research and solid requirements statements, has evolved with experience, particularly driven by international vendor/implementer experience. openEHR introduces some novel paradigms, which can be challenging to those used to more traditional approaches. We will introduce the philosophical and methodological basis for openEHR with reference to real-world vendor experience.
The international perspective: the potential for, and challenges, of international clinical modelling collaboration (Heather Leslie)
One of the core programs of openEHR is the collaborative and largely voluntary development of a library of open source clinical content models ‘archetypes’ with clinical informatics leadership and clinical assurance/review from using web-based tools and broad, democratized clinical input. We will give a a background to the approach adopted and highlight the practical implications, touching on both successes and ongoing challenges.
Developing and governing national clinical model development in a vendor-rich environment. (Silje Ljosland Bakke)
Norway is in almost a unique position in having both a vibrant openEHR vendor community, an active national clinical modelling program and a commitment to use international models where possible This presents clear opportunities but other challenges, particularly around both local and distributed governance and maximising throughput of content production at ‘implementer speed’. We will present experiences and progress to date.
3. Target audience
This session is directed at students, clinicians, clinical informaticians and system implementers who are interested in the clinical modelling methodologies used by the openEHR community, and how these are reflected in clinical requirements gathering/ clinical content development/governance at implementer, national and international levels.
4. Educational goals
Participants will gain a better understanding of the philosophical / methodological background to the openEHR approach and how this has been carried through to relate to real-world clinical modelling challenges and experience, with learning applicable to other related projects beyond those interested in a pure-openEHR approach.
References
[1] HL7 Fast Healthcare Interoperability Resources, https://www.hl7.org/fhir [Accessed March 25,2016]
[2] openEHR Foundation, openEHR.org [Accessed March 25,2016]
[3] Beale T. Archetypes: Constraint-based Domain Models for Future-proof Information Systems. In: Baclawski K, Kilov H. (eds.) Eleventh OOPSLA Workshop on Behavioral Semantics: Serving the Customer (Seattle, Washington, USA, November 4, 2002). Boston, 2002.
[4] Raymond, Eric. "The cathedral and the bazaar." Knowledge, Technology & Policy 12, no. 3 (1999): 23-49.
[5] Curto-Millet, Daniel Adrian. To Be or To Become? An Enquiry into the Changing Nature of Requirements in Open Source Health IT. Diss. London School of Economics and Political Science, 2014.
[6] Leslie, Heather, Sam Heard, Sebastian Garde, and Ian McNicoll. Engaging clinicians in clinical content: herding cats or piece of cake?. In MIE, pp. 125-129. 2009.
[7] Silje Ljosland Bakke, National governance of archetypes in Norway, In: Sarkar, I. N., Georgiou, A., & de Azevedo Marques, P. M. (Eds.). (2015).MEDINFO 2015: EHealth-enabled Health: Proceedings of the 15th World Congress on Health and Biomedical Informatics (Vol. 216). IOS Press.
[8] Sundvall, E. (2013). Scalability and Semantic Sustainability in Electronic Health Record Systems. http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A599752&dswid=-8106 [Accessed March 25, 2016]
[9] Christensen, B., & Ellingsen, G. (2016). Evaluating Model-Driven Development for large-scale EHRs through the openEHR approach. International Journal of Medical Informatics, 89, 43-54.