Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, December 08, 2010

I Wonder How Successful This Will Be. I Suspect Most Clinician’s Eyes Will Just Glaze Over.

NEHTA popped this up a few days ago.

Detailed Clinical Models

NEHTA is actively engaging with the healthcare community to develop computable clinical content definitions known as Detailed Clinical Models (DCMs). Each Detailed Clinical Model is inclusive of all data attributes and potentially terminology bindings that are useful to describe a single, discrete clinical concept for use in a broad range of clinical scenarios. Examples of DCMs include: Problem/Diagnosis, Adverse Reaction, Medication order, Blood Pressure measurement, and a symptom.

If you would like to become actively involved in developing these DCMs, please self-register using the ‘Sign Up’ button in the top right of the Clinical Knowledge Manager (CKM) screen

What will the collaboration produce?

The resulting library of DCMs will be a cohesive and consistent set of clinical content specifications, based upon requirements identified by Australian clinicians and other health domain experts, and drawing from comparable work overseas. These will be uploaded and stored in the NEHTA Clinical Knowledge Manager (CKM), an online tool that will not only hold the library of DCMs but also support the life cycle management of each DCM through a collaborative, online review and publication process. Importantly, clinicians and domain experts will be able to validate that the clinical requirements have been met, and warrant that the resulting published DCMs are safe, high quality and fit for purpose.

What can be done with the DCMs produced?

Published DCMs will become a core national resource for expressing clinical content in a consistent, re-usable and standardised way. Multiple DCMs can be constrained and/or combined together into implementable specifications that can be used across all of Australia’s eHealth activities, including the Personally Controlled Electronic Health Record (PCEHR) and all health information exchanges, such as Health Summaries and eReferrals.

What is the work program?

Priorities for DCM development and review will initially be based on the needs of the NEHTA work program and the needs of the Personally Controlled Electronic Health Record (PCEHR). Initial development priorities are core clinical concepts:

  1. Medications & Immunisations
  2. Adverse Reactions
  3. Medical History (including Problems and Diagnosis)
  4. Lifestyle Risk Factors
  5. Family History
  6. Social History
  7. Laboratory and pathology tests (including general laboratory, microbiology and anatomical pathology)
  8. Requested Services
  9. Diagnostic Imaging
  10. Clinical Synopsis

Who should get involved?

NEHTA invites any interested individuals to self-register in the Clinical Knowledge Manager and become actively involved in the CKM online community and DCM development process. This includes the broadest range of clinicians, health domain experts and consumers. We encourage organisations to nominate individuals to join the community review process on behalf of their organisation.

There is a very important need for non-technical contributions from grassroots clinicians to warrant that the clinical content of each DCM itself is correct and appropriately defined. Review of the more technical aspects of each DCM will be covered by team members who have been identified as having technical, terminology and informatics expertise.

More information can be found here:


I encourage all who are interested to go and have a look. The site is found here:


What is interesting is that what NEHTA is offering here looks very much like a rebranding of what is found here:


This has been under development for a couple of years. Most usefully there is an explanatory video (Quicktime Format) found on this page which explains what the intent of the Clinical Knowledge Manage is as without a bit of explanation it is not all that intuitive.

This is the direct link:


It will be interesting to see if NEHTA sponsorship results in more actual clinical input and to what use that input is put.

Time will tell I guess.



Dr David G More MB PhD said...

Note: elsewhere it is pointed out that NEHTA is using the CKM on a six month trial basis.


Dr Ian McNicoll said...

Hi David, Glad to see you have picked up on this new project.

Firstly, a conflict of interest declaration!! I am a former Scottish GP turned informatician, now working for Ocean Informatics UK on international and vendor archetype development and more peripherally with the NEHTA DCM project.

Your sub-headline "... Most clinicans' eyes will just glaze over" is IMO well made but I do not think we should expect or require any other reaction from the vast majority of clinical staff who have neither the time or interest to get involved. What is important is that the CKM approach represents some sort of scalable mechanism for involving the minority of clinicians who ARE interested in e-health record standards. In the past, such involvement could only be achieved by immersion in highly technical jargon and would normally involve regular attendance at long, generally boring meetings or wading through pages of documentation. It would also normally mean having to work through some sort of national or professional representative body, excluding those who do not wish that sort of commitment.

Even in a geographically and numerically small nation like Scotland this approach was just not achievable and a lot of expensive clinical time and effort has gone to waste.

The CKM web-based collaboration is far from perfect but I honestly believe it represents a huge step forward in opening up these standards discussions to front-line clinicians, allowing them to contribute to review and comment with minimal effort or ongoing commitment, spending as much or as little time on reviewing the models as they feel is valuable to them.

Perhaps I only care deeply about the definition of 'Active/Inactive' in a Diagnosis/problem model. I only need to comment on this aspect, then log off and do something much more interesting. You, OTOH, might find this aspect of the discussion arcane and futile - if so, just walk on by and comment on the stuff that IS important to you. No need to sit through a long meeting dominated by a dull 'Active /Inactive definitions' debate.

I think there is a separate problem with getting clinicians engaged with informatics at all. In the UK, secondary care clinicians still feel completely disengaged from this sort of work, whilst paradoxically UK GP systems are now so well-designed that they are regarded as commodities, with a false impression in the GP community that most of the informatics problems have been solved. It is just not seen as an interesting 'speciality' to many young GPs.