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.”

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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

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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

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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?

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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

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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

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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

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openEHR approachSeparation of technical and clinical content domains

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TechnicalDomain

Clinical KnowledgeDomain

ARCHETYPES

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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

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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