openEHR and Clinical Knowledge Manager

Posted on April 24, 2009 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A reader recently commented about something called openEHR. Maybe I was a little swayed by anything that says open since open source has used the term open so much. The idea of an open EHR sounded really interesting to me. I’m still not sure I completely understand the plan of openEHR, but I was put in contact with a fine lady named Heather Leslie who is working with openEHR on a product called Clinical Knowledge Manager (CKM).

I must admit that when I read the various information on clinical knowledge manager’s attempt to create clinical archetypes I was pretty lost. Maybe I’m just dumb or maybe across the pond (the project started in the UK) they are just using different terminology. Possibly it’s a little of both.

When I got this email about clinical knowledge manager the concept of creating clinical archetypes was new to me. I could be wrong, but reading it now they should have just said their creating standards for clinical data. That’s a concept I can understand and appreciate.

From what I can tell, it seems like CKM is essentially a wiki-like platform for displaying and improving these clinical standards (or archetypes if you prefer). I really think that the power of the crowd is the only way clinical standards are going to be defined, so the idea of a wiki-like website where people can collaborate around clinical standards sounds exciting. My only fear with it all is that if I’m having trouble cutting through much of the technical jargon, I wonder how many doctors will want to participate in this discussion. This seems like a really noble goal, but I can help but question if CKM and openEHR are not keeping EHR interoperability simple.

Time will tell how many EHR choose to adopt the clinical archetypes that openEHR creates. That will be the true measure of how valuable CKM will be to healthcare. I will be interested to see how this rolls out and if they can garner enough EHR interest and participation to make it a viable standard.

The following is an email about participating in clinical knowledge manager and more information on how it works:

I’d like to invite and encourage all clinicians to register for theopenEHR Foundation’s new Clinical Knowledge Manager (CKM) -found online at?

CKM is an international repository for?openEHR archetypes and has two primary purposes – that of archetype publication and archetype governance. It is a real opportunity for clinicians to collaborate and agree on clinical content definitions for publication and use in our electronic health records.

openEHR archetypes are open source, computable specifications that define clinical information about a single and discrete clinical concept. For example there are separate archetypes defining a ‘symptom’, ‘diagnosis’, ‘blood pressure’, ‘medication order’, and ‘risk of disease based on family history’. As structured and standardised definitions of clinical content, archetypes are increasingly being recognised as fundamental building blocks of electronic health records, especially when integrated with clinical terminologies such as SNOMED CT. If we all start to record information based on the same archetype, then we can meaningfully and unambiguously share health information between systems, and we can start to query that information across systems.

A primary goal of CKM is to encourage a broad range of clinician input to make sure that the clinical content in each archetype is correct. Absolutely noopenEHR experience is necessary to participate in CKM, although we anticipate you will learn about?openEHR as part of the journey.All participation is purely on a volunteer basis, and you can opt out at any point.

Whilst CKM is still in its relatively early days, we are already seeing the benefits that contributions by grassroots clinicians are bringing to the archetypes currently undergoing team review. Technically oriented openEHR experts support the review process to provide guidance on design and implementation issues, so there are no unrealistic expectations of the clinicians. Contributions of clinical and technical nature are equally and gratefully received;-)

By design, each archetype contains all the relevant information about the specific clinical concept – a maximal dataset which can be used in all clinical scenarios.?? So, for each archetype we are seeking a range of views from a variety of:

  • professions – including every type of clinical expert;
  • geographical locations-to make sure we can capture diverse clinical and cultural practice; and
  • knowledge domains – from general healthcare to all specialist areas.

Please actively ‘adopt’ the archetypes that you would like to be involved in. This will ensure that you will be invited to participate in the review of archetypes that are of interest to you. At other times you may also be invited to participate in a review where we consider that your expertise might provide balance out the current team of reviewers.

While we will strive to achieve maximal datasets for each archetype, we are pragmatic and know that we won’t get it 100% right – certainly not at first try. However, I suggest that a small group of 3-4 clinicians with complementary skills and appropriate expertise can create and develop a draft archetype to approximately 80-85% complete. Further review within CKM by a team of clinicians from a range of professions, countries, institutions, research and health domains will contribute and refine the archetype further – maybe this still will only get it to 90% complete; but maybe much more. Our experience to date shows that maximal datasets are much easier to agree on than minimal datasets!! Over time it will be interesting to see how the models evolve – no doubt a good research topic!

Obtaining agreement on clinical content within archetypes in this manner is a significant achievement, even if in retrospect we find they are not 100% complete at the start. The flow-on benefits that come from sharing a standardised set of clinical specifications for EHRs can potentially transform some eHealth initiatives and is a necessary foundation for the truly sharable electronic health record.

So, all clinicians are welcome to get involved in CKM – we will certainly set you to work very quickly! We expect that by contributing domain expertise and insights, clinicians will also benefit personally by gradually developing openEHR understanding and expertise as part of the experience.

And then of course, there is also the contribution to the good of mankind… ;-)

[Instructions for registering can be found]