Clinical Knowledge Repository requirements

I’ve been hearing quite a lot of discussion recently about Clinical Knowledge Repositories and governance. Everyone has different ideas – ranging from sharing models via a simple subversion folder through to a purpose-built application managing governance of combinations of versioned knowledge assets (information models, terminology reference sets, derived artefacts, supporting documentation etc) in various states of publication.

It depends what you want to achieve, I guess. In openEHR it became clear very quickly that we need the latter in order to provide a central resource with governance of cohesive release sets of assets and packages suitable for organisations and vendors to implement.

In our experience it is relatively simple to develop a repository with asset provenance and user management. What is somewhat harder is when you add in processes of collaboration and validation for these knowledge assets – this requires development of review and editorial processes and, ideally, display transparency and accountability on behalf of those managing the knowledge artefacts.

The most difficult scenario reflects meeting the requirements for practical implementation, where governance of configurable groups of various assets is required. In openEHR we have identified the need for cohesive release sets of archetypes, templates and terminology reference sets. This can be very complicated when each of the artefacts are in various states of publication and multiple versions are in use in ‘on the ground’ implementations. Add to this the need for parallel iso-semantic and/or derived models, supporting documents, and derived outputs in various stages of publication and you can see how quickly chaos can take over.

So, what does the Clinical Knowledge Manager do?

  1. CKM is an online application based on a digital asset management system to ensure that the models are easily accessed and managed within a strong governance framework.
  2. Focus:
    1. Accessible resource – creation of a searchable library or repository of clinical knowledge assets – in practice, a ‘one stop shop’ for EHR clinical content
    2. Collaboration Portal – for community involvement, and to ensure clinical models that are ‘fit for clinical use’
    3. Maintenance and governance of all clinical knowledge and related resources
  3. Processes to ensure:
    1. Asset management
      1. uploading, display, and distribution/downloading of all assets
      2. collaborative review of primary* assets  to validate appropriateness for clinical use
        1. content
        2. translation
        3. terminology binding
      3. publication life cycle and versioning of primary assets
      4. primary asset provenance, differential and change log
      5. automatic generation of secondary**/derived assets or, alternatively, upload and versioning when auto generation is not possible
      6. upload of associated***/related assets
      7. development of versioned release sets of primary assets for distribution
      8. identify related assets
      9. quality assessment of primary assets
      10. primary asset comparison/differentials including compatibility with existing data
      11. threaded discussion forum
      12. flexible search functionality
      13. coordinate Editorial activity
      14. share notification of assets to others eg via email, twitter etc
    2. User management
    3. Technical management
    4. Reporting
      1. Assets
      2. Users
      3. Editorial activity support

In current openEHR CKM the assets, as classified above, are:

  1. *Primary assets:
    1. Archetypes
    2. Templates
    3. Terminology Reference Set
  2. **Secondary assets:
    1. Mindmaps
    2. XML transforms
    3. plus ability to add transforms to many other formalisms, including CDA
  3. ***Associated assets:
    1. Design documents
    2. References
    3. Implementation guides
    4. Sample data
    5. Operational templates
    6. plus ability to add others as identified

While CKM is currently openEHR-focused – management of the openEHR artefacts was the original reason for it’s development – with some work the same repository management, collaboration/validation and governance principles and processes, identified above, could be applied for any knowledge asset, including all flavors of detailed clinical models and other clinical knowledge assets being developed by CIMI, or HL7 etc. Yes, CKM is a currently a proprietary product, but only because it was the only way to progress the work at the time – business models can always potentially be changed 🙂

It will be interesting to see how thinking progresses in the CIMI group, and others who are going down this path – such as the HL7 templates registry and the OHT proposed Heart project.

We can keep re-inventing the wheel, take the ‘not invented here’ point of view or we can explore models to collaborate and enhance work already done.

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