Engaging Clinicians In Clinical Content


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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

Published in: Health & Medicine, Business
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Engaging Clinicians In Clinical Content

  1. 1. Engaging clinicians in clinical content: Herding Cats Or Piece Of Cake?<br />Heather Leslie, Sebastian Garde, Sam Heard, & Ian McNicoll<br />
  2. 2. ‘Herding Cats’OR‘Piece of cake’<br />Premise: Herding cats is hard<br />[Search for ‘Herding Cats’ on YouTube!]<br />
  3. 3. ‘Herding Cats’OR‘Piece of cake’<br />pieceofcake<br />One slice of cake. <br />(idiomatic) A job, task or other activity that is easy or simple to do. <br />“Sure, no problem. It&apos;ll be a piece of cake.”<br />© Ocean Informatics 2009<br />
  4. 4. Clinicians & EHR Content<br />Should clinicians be involved in the development of clinical content?<br />Universally the response is generally ‘Yes’<br />So, why is it hard for grassroots clinicians to get involved?<br />Processes<br />Content Models<br />© Ocean Informatics 2009<br />
  5. 5. What are the barriers?<br />Processes<br />Content Models<br />Traditional software development is driven by technical requirements <br />Standards organisations are not easy to get involved<br />Technical focus<br />Jargon<br />$$$ & Time<br />Technically driven<br />Not usually human friendly<br />© Ocean Informatics 2009<br />
  6. 6. Litmus Test: Involving clinicians<br />Processes<br />Content Models<br />Is it easy for grassroots clinicians to get involved and contribute?<br />Can grassroots clinicians make sense of the clinical content?<br />© Ocean Informatics 2009<br />
  7. 7. What is reasonable and realistic?<br />Should Clinicians have to change?<br />Become technically competent so that they can engage with technicians, informaticians, vendors and standards organisations<br />OR<br />Should the Health IT domain change?<br />Create opportunities and mechanisms to harness clinician contributions, whatever their ability or availability<br />© Ocean Informatics 2009<br />
  8. 8. Clinicians should be driving the EHR content development...<br />...IT is the delivery tool<br />© Ocean Informatics 2009<br />
  9. 9. Opportunities...<br />Processes<br />Modify the EHR development approach<br />clinical & technical <br />Educate clinicians <br />Jargon, Reference Models etc<br />Enable clinicians to participate<br />Accept any/all contributions<br />At times/methods convenient to clinician<br />Minimise disruption to their clinical practice<br />Content Models<br />Make the models more human-friendly<br />© Ocean Informatics 2009<br />
  10. 10. © Ocean Informatics 2009<br />
  11. 11. What is openEHR?<br />The openEHR Foundation is a non-profit established in 2001<br />= open source specifications for a logical EHR architecture<br />Community &gt;1500 people from &gt;85 countries<br />Purpose: Semantic interoperability of healthdata<br />© Ocean Informatics 2009<br />
  12. 12. openEHR approach<br />Separation of technical and clinical content domains<br />© Ocean Informatics 2009<br />
  13. 13. Clinical Knowledge<br />Domain<br />ARCHETYPES<br />TechnicalDomain<br />© Ocean Informatics 2009<br />
  14. 14. openEHR approach<br />Separation of technical and clinical content domains<br />Clinical content models<br />Archetypes<br />= computable definition of clinical concept <br />Maximal dataset for universal usecase<br />eg Blood Pressure, Diagnosis, Family History<br />Formats/Views:<br />Structured definition – Design & Review<br />Mindmap - Review<br />Technical specification - ADL<br />Templates<br />= aggregations for archetypes for a clinical scenario eg Antenatal visit or Discharge Summary<br />© Ocean Informatics 2009<br />
  15. 15. Archetype Editor:<br /><ul><li> 3 open source tools</li></ul>Archetype Authoring:<br /><ul><li> Clinician input is critical
  16. 16. Training: 2-3 days intensive plus ongoing mentoring</li></ul>Level of Difficulty: MODERATE<br />Who? EXPERTS (if aiming for <br />high level semantic interoperability)<br />
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  18. 18. Template Editor:<br />1 commercial tool<br />Template Design:<br /><ul><li> Reflect requirements of real-life clinical scenario; Should be authored by clinicians with direct knowledge of clinical needs
  19. 19. Training: 0.5-1 day</li></ul>Level of Difficulty: EASY<br />Who? ANYONE<br />
  20. 20. Terminology Subsetting Tool:<br />1 commercial tool (linking directly to archetypes/templates)<br />Subset design:<br />Clinical input is critical<br />Specialised training in SNOMED required – 3-5 days<br />Level of Difficulty: HARD<br />Who? EXPERTS<br />
  21. 21. Clinical Knowledge Manager<br />= international library/repository<br />www.openehr.org/knowledge<br />Launched in April, 2009<br />CLINICAL COLLABORATION – Health 2.0 approach<br /><ul><li> Archetype Publishing & Governance
  22. 22. Translations; Terminology binding
  23. 23. Next steps: Templates, Subsets, ‘Sandpit’
  24. 24. Federation of repositories</li></ul>Level of Difficulty: EASY<br />Who? ANYONE<br />
  25. 25. View 1. Structured Definition<br />
  26. 26. View 2. Mindmap view<br />
  27. 27. View 3. Archetype Definition Language<br />
  28. 28. Blood Pressure archetype PUBLISHED: 31 clinicians and informaticians from 13 countries<br />8 review rounds of 2 weeks each<br />Is this perfect?<br />NO but it is an agreed representation of <br />current clinical practice...<br />What have we achieved?<br /><ul><li> Consensus view of range of clinicians, different geographical locations, range of domains
  29. 29. Pragmatic starting point, can evolve</li></li></ul><li>Reviewers can comment on each archetype one data element at a time.<br />Editor facilitates the accumulated comments and consolidates the changes in the archetype.<br />Then initiates the next review round ...<br />
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  35. 35. How many archetypes will we need?<br />~50 archetypes will model core clinical content<br />~1500-2000 will model the majority of EHR<br />ONLY 10 agreed archetypes to ‘save a life’<br />
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  37. 37. Conclusion:‘HerdingCats’OR‘Piece of cake’<br />Archetypes are EHR content models specifically designed for use by clinicians<br />There is some early and real progress being made in international collaboration in clinical content by clinicians using openEHR<br />