Norwegian national governance of archetypes Silje Ljosland Bakke RN Informaon architect, Naonal ICT Norway Norwegian public hospital system The Norwegian public hospital system consists of four Regional Health Authories (RHAs), with a total of 24 Hospital Trusts, each of which have one or more hospitals. 100% of the hospitals have adopted EHRs. Two vendors dominate the hospital EHR market; Siemens (Central Norway) and DIPS (the three remaining regions). One common health trust, Naonal ICT (Norwegian: “Nasjonal IKT”), acts as a strategic coordinang unit for the hospital sector’s common ICT commitments. openEHR in Norway As of yet, only Oslo University Hospital is using an openEHR based system in a producon environment. DIPS is finalising its implementaon of openEHR, and their soluon is being tested in hospitals around the country. Several other vendors are either in the process of or are looking into implemenng openEHR as part of their products. Naonal ICT has developed and deployed a scheme for the naonal governance of archetypes. The goals of the governance scheme is ensuring a high quality of archetypes as well as enabling semanc interoperability between systems through the use of idencal archetypes. The governance scheme is heavily dependent on a common tool for both collaborave development and sharing of archetypes and templates. For this purpose, Naonal ICT has chosen the Clinical Knowledge Manager (CKM) from Ocean Informacs. The governance model The governance model has three main phases; development, review and approval. Development Development of archetypes is based on a so-called “do-ocracy”, where those who actually spend me and resources doing something decide what gets done and in which fashion. Whoever wants to influence decisions can do so, but only by parcipang acvely in the development process. This has the advantage that as long as someone is willing to spend the resources to do something, it will get done whether or not anyone else is interested in parcipang. To ensure a real possibility of parcipaon in new iniaves, this model also requires a very open and transparent development process, something the CKM does very well. The actual archetype development is done in a geographically distributed manner, using the CKM as a collaborave tool. Requirements are defined by the originang iniave, alternavely in collaboraon with vendors and other parcipants. Re-use of archetypes already developed internaonally is encouraged, but these must be translated into Norwegian and then put through the same review process as locally developed archetypes no maer their approval status at their origin. During this process, the local iniaves can get archetype design assistance from their Regional Resource Group. Review When a development iniave is sasfied with a developed archetype, they can submit it for review. The Naonal Editorial Commiee will then iniate a review of the archetype in queson, and define the requirements of the review, the most important being which professions and speciales should be represented among the reviewers. The Regional Resource Groups in each of the four regions then recruit suitable reviewers, and the archetype is iteravely reviewed and improved unl there is consensus among the reviewers that the archetype is acceptable for clinical use. Approval Once there is consensus on an archetype among the reviewers, the Naonal Editorial Commiee assesses the quality of the review, using parameters such as number of reviewers, geographical and professional spread of reviewers, and if any other stated requirements for the review are met. If the review is considered to be of acceptable quality, the archetype is approved for clinical use. Once approved, the archetype is given a new status “Published” in the CKM, which marks it as stable and suitable for actual clinical use. Deployment The governance model was formally approved in October 2013, and the governance model including online tools at hp://arketyper.no were deployed in January 2014. The Naonal Editorial Commiee was formed with members from each of the four RHAs as well as from the Directorate of Health. The Naonal Design Commiee is temporarily considered to be part of the Editorial Commiee. Two full me posions were created to coordinate the work of the Editorial Commiee. As of August 2015, only the South-Eastern RHA has been able to get a Regional Resource Group up and running. For the remaining four RHAs, the coordinators for the Editorial Commiee are filling this gap unl the regional groups can be put in place. Experiences & results The first year of operaon was mainly spent geng the governance structure up and running, including the recruitment of large numbers of clinicians for review parcipaon. Only 6 archetypes were published during 2014, with the total number rising to 20 by August 2015. All but one are translaons of archetypes adopted from the internaonal openEHR.org CKM (hp://openehr.org/ckm). Success factors The greatest success factor idenfied is the parcipaon of clinicians. The liming factor that led to the approval of only 6 archetypes during 2014 were the lack of clinicians for review parcipaon. Once this number reached a certain crical level (around 150-200), the rate of review increased significantly, and 5 of the 6 archetypes were published in December 2014. Other major success factors are: good tooling; not having to rely on distribung documents with UML diagrams for clinician review resourcing for coordinators to do the praccal work, and for training clinicians and others collaboraon with the sizable internaonal community, which saves a lot of development and review me by providing both a large number of models as well as experienced modellers. Pialls Translaon has proved to be tougher than ancipated, since not many clinicians are bilingually trained in their clinical professions. Project management pracces not taking into account me for designing and reviewing informaon models has also been a challenge, leading to many models not being approved in me for the appropriate project milestone. As menoned, regional resource groups have been hard to get going, which means the work of recruing clinicians and supporng iniaves has fallen on the coordinators and regional representaves. National ICT National Editorial Committee National Design Committee Define review requirements Approve reviews National coordinators Edit archetypes Organise reviews Administer arketyper.no Make sure archetypes are technically sound Conformity w/ other standards/formalisms Regional representatives Regional resource groups Clinicians Participate in reviews Start local initiatives Represent the RHAs in the Editorial Committee Recruit clinicians Support local initiatives Vendors Implement archetypes in software Supplement requirements What are archetypes? Archetypes are formalised informaon models based on the openEHR specificaon An archetype is a collecon of informaon ele- ments relang to a single clinical concept Archetypes are defined by domain experts, and exist independently of vendors and soluons Archetypes are made to be maximum datasets, and can be grown over me Archetypes are not complete data sets, user interfaces or terminologies