Continuing from openEHR Clinical Modelling Program - the early days…
The situation changed significantly in 2014 when the Norwegian eHealth program acquired their own CKM. From my point of view, this marked a singular turning point in the destiny of the Clinical Modelling Programme.
The Norwegian lead, Silje Ljosland Bakke, joined the Clinical Modelling Program as my co-lead, and she recruited a small team of modellers. Between 2014 and 2017 we ran seven two-day introductory clinical modelling courses and eight advanced modelling workshops. Since 2018, the Norwegian team have run additional training workshops independently. They invested significantly in training clinicians, vendors, and decision-makers about openEHR and established their national governance processes.
In addition, the Norwegian program has invested strategically in building capacity in their national modelling team in openEHR and in training their reviewers. They are a paid organisational member of openEHR, support Silje as a CIC Board member and International CKM Clinical Knowledge Administrator and license and run their own CKM as a national resource. Their modelling team currently comprises 3 experienced members, participating since 2014, and 3 newer members who are rapidly growing in skills. Since 2014 I have met with them weekly to discuss modelling issues, initially in a mentoring role, increasingly in recent years this has been focused on joint and parallel archetype development and reviews.
Overall, during the period 2006 to 2019, I delivered more than 30 2-day openEHR clinical modelling introduction courses in Australia, UK, multiple EU countries, US, Canada, Brazil, China, Japan. In addition, I’ve run many 3-5 day advanced modelling workshops in various destinations over the years. Ian McNicoll attended his first openEHR course in 2007 and was frequently a co-lead from 2009. He has been just as active independently since he left Ocean in the early 2010s.
Very pleasingly, since 2018, the Norwegian team have felt confident to run their own training workshops independently. This was another critical moment, when we could demonstrate that the openEHR approach was transferrable. Our biggest challenge now is to make it scalable.
Between March 2018 and August 2021, the openEHR CIC engaged me on a paid consulting basis for 25 hours per month, continuing my role as Clinical Program Lead. To the best of my knowledge and in that context, the cost to the openEHR CIC and community to achieve the progress outlined in State of the CKM – 2021 has been to pay me for just under 6 hours per week for a period of 41 months. Most of those 6 hours per week has been used to maintain the CKM and support the modelling community – weekly CKA meetings, managing change requests and translations, answering questions from the community, meeting with community partners, training and mentoring new editors, etc.
So, what most people may not be aware of is that by far the majority of archetype publication progress in the International CKM has mostly been driven by an extremely close, deliberate, and strategic weekly collaboration between myself and the Norwegian modelling team. In fact, I’d estimate that >90% of the archetype publication, especially at the accelerated rate of the past 2 years, has been entirely resourced by the Norwegian modelling team – including my consulting time. While this arrangement has worked well to date, largely because the Norwegian priorities for archetype publication have closely mirrored those for the international modelling community, it is clearly not sustainable.
Let me be perfectly clear, if the Norwegian program is reduced or withdrawn, the openEHR modelling program will effectively come to a standstill. And in my opinion, there are only three individuals who are currently skilled enough to design archetypes for, protect the integrity of, maintain, and govern the International CKM – and they all have full-time jobs and live in Norway.
openEHR’s greatest asset is also its largest vulnerability. As the community, the implementations, the contracts and the number of models has grown, the capacity for modelling archetypes fit for the International CKM and training, then mentoring, modellers so that they can become independent Editors and ultimately Clinical Knowledge Administrators, has been ignored. In the first instance because we’ve essentially been in survival mode, and struggling to establish and maintain what we already had.
We have failed to approach the Clinical Modelling Program strategically and ensure that we have increased workforce capacity to support the increased openEHR activity.
Now that I have unfortunately been forced to withdraw my services, unfortunately this leaves Silje to manage the responsibility of the Modelling Program in isolation.
Yes, theoretically CKAs from other CKMs could step in. But could they, should they? If you take a look at the other CKMs you will note that they have different focuses, different content (to be discussed in another post).
There is no succession plan, no redundancy, no Plan B. The future of the Clinical Modelling Program is being made up on the fly. The community should be concerned.
After all, if the Clinical Modelling Program fails or folds, what of the rest of the organisation? If the quality and philosophy of the CKM library is not maintained and protected due to lack of skilled operators, what is the consequence for implementations?