Norwegian national governance of archetypes Silje L. Bakke Archetype coordinator National ICT Norway

Norway You are here! 1750 km 1750 km

Norwegian public hospital system Four Regional Health Authorities (RHAs) 24 Hospital Trusts, each with one or more hospitals 100 % EHR adoption Two main EHR vendors Siemens (Central Norway) DIPS (everywhere else) One strategic coordinating health trust for IT (National ICT) Directorate of Health dept of E-health

openEHR in Norway No clinical use - yet DIPS is implementing openEHR, implementation is being tested in hospitals University Hospital of Northern Norway (Tromsø) has been testing for Gastrolab(?????) Oslo University Hospital will deploy DIPS Arena for Trauma and A&E in Oct 2014

openEHR in Norway, continued National ICT has developed and deployed a national archetype governance scheme Three people employed Leader and two coordinators Total of two full time positions Goals High quality archetypes Semantic interoperability through use of identical archetypes

openEHR in Norway, continued Clinical Knowledge Manaker (CKM) Norwegian CKM online on February 7 2014

Governance organisation

The governance model Development Review Approval

The governance model – development Distributed archetype development Local initiatives define requirements “Do-ocracy” – doers make the decisions Regional resource groups Assist local initiatives National design group Specialist group w/ technical focus Archetypes can be uploaded to CKM as “draft” Facilitates collaborative development

The governance model – review National editorial group Initiates reviews Specifies requirements for reviews Regional resource groups Recruit healthcare professionals for reviews CKM is key Several review rounds Consensus → approval phase starts

The governance model – approval National editorial group Assess quality of review Approves archetypes for publication Approved archetypes are marked as “published” in the Clinical Knowledge Manager

Preliminary results Governance model approved October 2013 Editorial group formed January 2014 CKM in production February 2014 First three archetypes under review Participating clinicians from all over the country Good input from clinicians CKM works well for it’s purpose Some improvement of governance model is needed (si noe mer om registerspesifikke arketyper!)

Clinician response, first time users «Should intrauterine weight be part of this archetype? This is an important parameter for obstetricians.» «Should this field perhaps have an assumed value?» Clinicians get this.

Further plans Get a catalogue of basic archetypes approved BP, T, P, RR, weight, height, MEWS, ++ Priority support for initiatives w/ imminent deployment Oslo University Hospital Improving the governance model Recruit more clinicians for reviews Achieve wider support from healthcare profession and specialist organisations

Will it work? Will we be able to catch and keep the interest of clinicians? …will they agree with each other? Will the vendor support be good enough? Why will it work this time? Each archetype is self-contained and portable, as opposed to earlier approaches Tools, distributed, available online, social media aspect, sense of community Maximum dataset, reduces need for absolute consensus

Prioriterer arketyper som kan gjenbrukes Vise CKM live Graf over brukere i CKM Prioriterer arketyper som kan gjenbrukes Hva mener vi med gjenbruk? Aggregering til styringsdata på organisasjonsnivå og på helsepersonellnivå Registerrapportering Trender på enkeltpasienter (blodtrykkskurve vs blodtrykksmedisinering; derfor Blodtrykk) samt historikk (tdligere operasjoner av samme type) Sammenstillinger (samle forskjellig informasjon i ett bilde) Søk (spesifikk informasjon, «hva slags protese var det igjen?») Prosesstøtte (slippe å eksplisitt skrive hva man ønsker å gjøre) Beslutningsstøtte (derfor MEWS) Oppfordrer til bruk av internasjonalt definerte arketyper, og deling av de vi lager i Norge

Questions? Photo: Harald Hognerud