I’ve been meaning to write this for a while, but you know how things go.
While at HIMSS12 in Las Vegas last month I was asked to do a little review work. That’s not all that uncommon. People ask me to do things on occasion; review a blog post, review an app, give my opinion on something and so on. But this was completely different as Dr. Heather Leslie (@omowizzrd), Director of Clinical Modeling for Ocean Informatics and Editor for the openEHRÂ Clinical Knowledge Manager asked me to review an archetype. A what? Yeah, that was my response when Heather and I first spoke about the topic nearly two years ago.
According to good ol’ Merriam-Webster an archetype is “the original pattern or model of which all things of the same type are representations or copies: also : a perfect example“. Simple enough, but still too vague for my brain so I went in search of a better explanation which I found at Heather’s blog – Archetypical.
According to the Archetypical site “openEHR archetypes are computable definitions created by the clinical domain experts for each single discrete clinical concept – a maximal (rather than minimum) data-set designed for all use-cases and all stakeholders. For example, one archetype can describe all data, methods and situations required to capture a blood sugar measurement from a glucometer at home, during a clinical consultation, or when having a glucose tolerance test or challenge at the laboratory. Other archetypes enable us to record the details about a diagnosis or to order a medication. Each archetype is built to a ‘design once, re-use over and over again’ principle and, most important, the archetype outputs are structured and fully computable representations of the health information. They can be linked to clinical terminologies such as SNOMED-CT, allowing clinicians to document the health information unambiguously to support direct patient care. The maximal data-set notion underpinning archetypes ensures that data conforming to an archetype can be re-used in all related use-cases – from direct provision of clinical care through to a range of secondary uses.” That gave me a better understanding of what they were trying to do.
Anyway, when Heather asked me to review the Adverse Reaction archetype I was a little hesitant. The projects I’m asked to be involved with are typically much smaller in scale. This was something different and I felt a little intimidated. My gut reaction was to politely decline, but when someone asks you to do something face to face it makes excusing yourself for some lame reason a lot harder. So I agreed with more than a bit of trepidation.
The openEHR project utilizes a system called the Clinical Knowledge Manager (CKM). In the most basic terms, the CKM is an online content management system for all the archetypes being designed by the openEHR project, and it’s impressive. A more in depth description can be found  here.
Logging into the system was simple. The email invitation I received to review the Adverse Reaction Archetype contained a link that took me to the exact location I was supposed to be. From there things got a bit more complicated. The CKM is easy enough to navigate, but the amount of information and navigational elements within the system is staggering. It took me a while to figure out exactly what I was supposed to do. Once I figured it out I was able to quickly go through the archetype, read what other comments people had made and make a couple of minor notes myself. One thing I could never completely figure out was how to save my work in the middle and continue later. Sounds simple enough, but for whatever reason it just wasn’t obvious to me. I ended up powering through my “review” in one extended session because I was afraid I’d lose my place.
The archetype itself was impressive. It’s clear from the information and detail that people have spent a lot of time and effort developing the adverse reaction archetype. There’s no question that a lot of great minds had been involved in this work. The definition made sense as did the data that was being collected and presented. The archetype offered flexibility for information gathering that included the simplest form of adverse reaction to complex re-exposure and absolute contraindication notation (this is sorely missing in many systems I’ve used over my career). Overall I had little insight to offer during the review, only a couple of minor comments.
I’d say the entire process was pretty straightforward with some minor complications. Like everything else I’m sure the process would get easier over time and multiple uses.
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