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INTEROP19|
H E A L T H
I N T E R O P E R A B I L I T Y
S Y M P O S I U M 2 0 1 9
Pragmatic
standardisation of
clinical models
S i l j e L j o s l a n d B a k k e

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Aboutme
• Silje Ljosland Bakke
• Registered nurse, health informatician
• Information architect @ Nasjonal IKT
• Board member & clinical co-lead @ openEHR
• @siljelb

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“Pragmaticstandardisation”…? 🤔
Calvin and Hobbes by Bill Watterson for August 11, 1995

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What’supin
Norway?
• Standardising clinical information
• Using openEHR
• Been at it since 2014
• arketyper.no is world leading
• Almost 600 participants
• Implementers closely involved
• Working closely with openEHR Clinical

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Howdoyoumodel
the(clinical)world?
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/

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Principlesformodellingtheclinicalworld
• Clinical information models must be defined by healthcare professionals ⇒ There
must be a very low threshold to participate
• Healthcare changes all the time ⇒ Models must be changeable when needed
• Model content must be predictable ⇒ Tight governance is required
• Vendors and solutions come and go ⇒ Models must be independent of vendors
• Clinical modelling is difficult and expensive ⇒ Modelling must be done once and
shared freely
• Persistence and exchange must be based on identical models ⇒ Models must be
suitable for a variety of use cases

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Thisrequirespragmaticstandardisation
• Gradually and step by step instead of all in one go
• Constant maintenance instead of 5 year revision cycles
• Careful selection of what to standardise and what not to
• Standardisation of one reusable concept is infinitely better
than no standardisation

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Clinician
engagement
• Clinicians are busy
treating patients
• Traditional
standardisation
processes unsuitable
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/

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Sohowtoget
cliniciansengaged?
• Make participation
quick and easy
• Give them something
they want
• Seeing is believing
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/

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Howmuchshouldwe
standardise?
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/

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Whatmustbestandardised?
• Only information for reuse or sharing must be standardised
• If the information is only relevant within the context where
its originally recorded, the definition can be local
Misunderstanding alert!
Reuse or sharing does not necessarily imply exchange between solutions.

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Threequestionsabouttheneedtostandardise
1. What kind of information is this, and what is its context?
2. Will the information be reused in a structured way within
the context where it was recorded?
3. Is it likely the information will be reused outside of the
context where it was recorded?

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Example:

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1. Cancer diagnosis w/ ICD-10 code, diagnostic certainty and
date of confirmation. Context: Cancer investigation and treatment
2. Yes, both for clinical and registry use
3. Yes, for example for CDS, analytics, or reimbursement
Answer: Should be standardised

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1. TNM clinical classification 6th edition, primary tumour, colon
cancer. Context: Cancer investigation and treatment.
2. Yes, both for clinical and registry use
3. Perhaps?
Answer: Should be standardised if possible

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1. Obscure registry specific questions about lymph node metastases,
no standardised codes, phrased as a questionnaire.
Context: Cancer registry
2. Yes, for registry use
3. Probably not
Answer: Choose your battles…

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Whatifyouwanttostandardise,butrunoutof
time?
• Make sure there’s agreement on
a modelling pattern
• Agree on a standard way to
differentiate pre-standard from
standard models
• Next time, start modelling work
at an earlier stage? 😉

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Structure isn’tNirvana
• Structured information isn’t a goal in itself
• Structuring should be done when it has
clear, identified value
• It must be possible to capture nuances using free text
• For some use cases, free text is adequate or better

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Thanks for listening!
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/