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Paper presented at Medical Informatics Europe 2009, Sarajevo Topic: Identifying issues around engaging Clinicians in clinical content development in EHRS and the progress being made in clinical content collaboration using openEHR. Authors: Heather Leslie, Sebastian Garde, Sam Heard, & Ian McNicoll; Ocean Informatics, Australia
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ENGAGING CLINICIANS IN CLINICAL CONTENT: Herding Cats Or Piece Of Cake?Heather Leslie, Sebastian Garde, Sam Heard, & Ian
McNicoll
‘Herding Cats’OR‘Piece of cake’
Premise: Herding cats is hard[Search for ‘Herding Cats’ on YouTube!]
‘Herding Cats’OR‘Piece of cake’
piece of cake1.One slice of cake. 2.(idiomatic) A job, task or other activity that is easy or simple to do.
“Sure, no problem. It'll be a piece of cake.”
© Ocean Informatics 2009
Clinicians & EHR Content
Should clinicians be involved in the development of clinical content?
Universally the response is generally ‘Yes’
So, why is it hard for grassroots clinicians to get involved?
1. Processes2. Content Models
© Ocean Informatics 2009
What are the barriers?
ProcessesContent Models Traditional
software development is driven by technical requirements
Standards organisations are not easy to get involved Technical focus Jargon $$$ & Time
Technically driven Not usually human
friendly
© Ocean Informatics 2009
Litmus Test: Involving
cliniciansProcesses
Content Models
Is it easy for grassroots clinicians to get involved and contribute?
Can grassroots clinicians make sense of the clinical content?
© Ocean Informatics 2009
What is reasonable and realistic?
Should Clinicians have to change? Become technically competent so that
they can engage with technicians, informaticians, vendors and standards organisations
OR Should the Health IT domain change?
Create opportunities and mechanisms to harness clinician contributions, whatever their ability or availability
© Ocean Informatics 2009
Clinicians should be driving the EHR
content development...
...IT is the delivery tool© Ocean Informatics 2009
Opportunities... Processes
Modify the EHR development approach clinical & technical
Educate clinicians Jargon, Reference Models etc
Enable clinicians to participate Accept any/all contributions At times/methods convenient to clinician Minimise disruption to their clinical
practice
Content Models Make the models more human-friendly© Ocean Informatics 2009
© Ocean Informatics 2009
What is openEHR?The openEHR Foundation is a non-profit established in 2001= open source specifications for a logical EHR architectureCommunity >1500 people from >85 countriesPurpose: Semantic interoperability of healthdata
© Ocean Informatics 2009
openEHR approachSeparation of technical and clinical content domains
© Ocean Informatics 2009
TechnicalDomain
Clinical KnowledgeDomain
ARCHETYPES
© Ocean Informatics 2009
openEHR approachSeparation of technical and clinical content domainsClinical content models Archetypes
= computable definition of clinical concept Maximal dataset for universal usecase
eg Blood Pressure, Diagnosis, Family History Formats/Views:
1. Structured definition – Design & Review2. Mindmap - Review3. Technical specification - ADL
Templates = aggregations for archetypes for a clinical scenario eg
Antenatal visit or Discharge Summary
© Ocean Informatics 2009
Archetype Editor:• 3 open source tools
Archetype Authoring:• Clinician input is critical• Training: 2-3 days intensive
plus ongoing mentoring
Level of Difficulty: MODERATEWho? EXPERTS (if aiming for high level semantic interoperability)
Template Editor:1 commercial tool
Template Design:• Reflect requirements of real-life clinical scenario;
Should be authored by clinicians with direct knowledge of clinical needs
• Training: 0.5-1 day
Level of Difficulty: EASYWho? ANYONE
Terminology Subsetting Tool:1 commercial tool (linking directly to archetypes/templates)
Subset design:Clinical input is criticalSpecialised training in SNOMED required – 3-5 days
Level of Difficulty: HARDWho? EXPERTS
Clinical Knowledge Manager= international library/repositorywww.openehr.org/knowledge
Launched in April, 2009
CLINICAL COLLABORATION – Health 2.0 approach
• Archetype Publishing & Governance
• Translations; Terminology binding
• Next steps: Templates, Subsets, ‘Sandpit’
• Federation of repositories
Level of Difficulty: EASY Who? ANYONE
View 1. Structured Definition
View 2. Mindmap view
View 3. Archetype Definition Language
Blood Pressure archetype PUBLISHED: 31 clinicians and informaticians from 13 countries8 review rounds of 2 weeks each
Is this perfect?NO but it is an agreed representation of current clinical practice...
What have we achieved?• Consensus view of range of clinicians,
different geographical locations, range of domains
• Pragmatic starting point, can evolve
Reviewers can comment on each archetype one data element at a time.Editor facilitates the accumulated comments and consolidates the changes in the archetype.Then initiates the next review round ...
How many archetypes will we need?
~50 archetypes will model core clinical content~1500-2000 will model the majority of EHR
ONLY 10 agreed archetypes to ‘save a life’
Conclusion:‘Herding Cats’OR‘Piece of cake’
Archetypes are EHR content models specifically designed for use by clinicians
There is some early and real progress being made in international collaboration in clinical content by clinicians using openEHR
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