Archetypes/DCMs MIA in SDOs

Curious to note that there is very little apparent interest in detailed clinical information models (DCMs) of any brand or flavour in the major Standards Development Organisations (SDO’s) – they are effectively Missing In Action when compared to the likes of CDA and IHE profiles.

The ISO 13972 DCM specification took a long and tortuous time to travel through the ISO TC 215 processes. Engagement with 13972 during its development, and from what I can observe now it is on the verge of publication has been rather sparse.  A further piece of work is now starting in ISO regarding quality criteria for DCMs but it also seems to be struggling to find an audience that understands it, or even cares.

I don’t quite understand why the concept of DCMs has not been a big ticket item on the radar of the SDOs for a long time as it is a major missing piece of any standards-based framework. Groups like CIMI are raising awareness, alongside the openEHR work, so momentum is gathering, but for some reason it seems to keep a very understated profile compared to new opportunities like FHIR in HL7.

The work of messages, documents, profiles and terminologies are clearly important for interoperability, but standardisation of clinical content models working closely with terminologies can potentially make the work required to develop messages, documents, and profiles orders of magnitude easier.

Let me test a metaphor on you. Think of each message, document or profile as a sentence and each archetype or DCM as a word, a building block that is one component of each sentence. By focussing on the building a specific sentence, we are working backwards by trying to determine the components, and the outcome is still just that single sentence. However if we start by standardising the words/archetypes, then once they are stable it is relatively simple to construct not only one sentence for a specific purpose, but the potential is a much greater output in which many more additional sentences can be created using a variety of words in different combinations. If we manage the words (archetypes) as core building blocks and get them right, then we allow a multitude of possible sentences (messages/documents/profiles) to proliferate.

The ‘brand’ of archetype/DCM solution does not concern me so much as raising awareness that clinician-led, standardised clinical content is a significant missing and overlooked piece of the international eHealth foundations puzzle.

2 thoughts on “Archetypes/DCMs MIA in SDOs

  1. It’s probably not that the big SDO’s are not interested in things like archetypes/DCMs (they all have groups that participate in such efforts), but that they have problems connecting with, or motivating, the clinical community to actually create and agree on a significant body of clinical models, i.e. to cover what one would need for an average EHR. What’s in it (short term) for the clinical community ?
    Personally I don’t believe it’s up to the SDOs nor health IT implementers to convince the clinical community of the value of models such as archetypes/DCMs. The realization that there’s value in this should primarily come from within the clinical (healthcare informatics) community. If they can’t convince their peers – then how can an SDO be successfull in doing so?

    • Hi Rene,

      My comment is all about the openness of the people involved in standards globally – the activity of any SDO is a reflection of the interests and passions of the people attending and doing the work. It is not usually a top down directive that determines the work done, but innovations and proposals from the bottom up. There is not just much interest in DCMs by mainstream standards attendees.

      It is very pleasing that we are now having some discussions with Graeme and Lloyd re some collaboration in FHIR – brilliant. This doesn’t mean we will be successful, but at least exploring is a positive step forward to harmonisation in this area, and at worst learning about the difficulties of harmonising.

      Attempts to engage with IHE International re use of archetypes and clinical engagement have resulted in advice for me to go away and read “IHE for Dummies”! I won’t say any more about that conversation.

      From my point of view it is not the clinical community who are the blocker, it is a narrow view by those who are driving entrenched technical initiatives. Now that is a pretty normal human thing, really. We are all busy trying to make a difference, but sometimes we need to be open to the ideas and value that others can bring to the table.

      The old “Not invented here, go away” needs to change in this era of globalisation, crowd sourcing and online collaboration!


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