The Clinical Knowledge Manager (CKM) is one of the most significant initiatives in health informatics today. And, as recently noted by Dr Heather Leslie on the openEHR Discourse forum: “the International CKM community quietly passed a major milestone – over 4,000 registered users from 120 countries!”
“The archetype library is more than just a resource: it is a global public good.”
Built on the openEHR framework and powered by Ocean Health Systems, the CKM a living, ever-evolving library of structured clinical knowledge artefacts – archetypes and templates – that underpin interoperable health records. What’s more, it’s a community-driven, open-source, globally governed platform and 4000 users reflects more than just registrations. It signifies global consensus on the value of clinician-led, semantically sound, and application-agnostic content models. “The archetype library is more than just a resource,” Dr Leslie says, “it is a global public good.”
Enabling full life cycle management of clinical artefacts, the CKM invites clinicians and informaticians alike to collaborate on reviews, suggest changes, translate content, and ultimately help shape digital health models that are internationally relevant and clinically rigorous. Participation is voluntary, but the impact is cumulative.
Thomas Beale puts it in perspective: “This is by far the largest clinical modelling repository and community in the world… 20–50 times the size of anything here in the US, and 10 times better semantically.” Crucially, the scale and quality of the CKM are not the results of top-down directives, but rather the results of sustained, ongoing efforts of committed experts and a dedicated, distributed, global community.
“No-one has done more than Heather to make this happen, and as the original author of the archetype formalism, I never imagined that we’d see it serve its purpose at this scale. A great milestone. This is what can happen if you hand the responsibility of modelling the domain to those who actually understand it. Heather said maybe 15 years ago that we had to have some way of getting an hour a week from clinical professionals, who have close to no spare time. So it can’t be meetings, standard WGMs or any other time-wasting modality (Heather, feel free to correct my paraphrasing here). Hence CKM. How prescient! The rest of the domain is still trying to do this kind of activity in those old ways.”
“This is by far the largest clinical modelling repository and community in the world… 20–50 times the size of anything here in the US, and 10 times better semantically.”
Thomas Beale credits Sebastian Garde for making the CKM real: “This could only have been done by a world-class health informaticist who is also a world-class software engineer.” The quiet persistence of this team over nearly two decades has built a resource that’s shaping the future of digital health.
Sebastian Garde reflects: “Many congratulations to everyone involved – what a journey (or shall I say: rollercoaster ride) it has been so far! It is truly amazing to see CKM’s global reach today – spanning 120 countries worldwide. This work is laying the foundations for a digital health ecosystem, globally – tackling many challenges along the way with few resources, but a lot of commitment to get there and a strong belief that this is needed.
Back in 2007, one of the major challenges we faced was the lack of visibility of what openEHR has to offer.The early openEHR specifications were available, and we had a prototype of the Archetype Editor, but that was about it.
“Making archetypes publicly available and presenting them in a clinician-friendly way has given broader visibility to the openEHR approach as a whole and has been, I believe, a key enabler for what openEHR is today.“
It may sound trivial today (at least to the openEHR community), but the breakthrough was this realisation that we didn’t need to keep reinventing the wheel. That instead, clinical models need to be developed and managed so that they can be reused and shared as widely as possible – across organisations, health systems and countries. This is assuming they are modelled comprehensively, are of high quality and ideally reviewed by clinicians from around the world.
This realisation has driven us to focus on the problem of how to actually govern these models effectively and make them easily available and ‘clinician-friendly’ – trying to hide the technical details or present them in a way that does not require an in-depth knowledge of openEHR to understand the clinical side of the models.
In all this, you cannot overestimate the contributions and support of the following persons: Dr Heather Leslie, Dr Ian McNicoll, Dr Sam Heard, Thomas Beale, Dr Rong Chen (for the Java Reference Implementation!) and Prof Evelyn Hovenga.
This is a photo I took of the very first idea for CKM as far as I remember, sketched on a whiteboard – probably taken in early 2007.
I never took such pictures, and I don’t think my mobile even had a camera at the time. But for some reason, I had a real camera with me that day. I must have known we were on to something that day, so I took this picture. You can see we came up with the idea of a CRB – I think Clinical Review Board – responsible for the overall governance.
And an Orphan Committee for orphaned archetypes in need of a home. Plus A LOT of committees, organised along professions and clinical specialities. These committees have evolved into more flexible CKM teams and later into CKM Projects and Incubators.
And you can even see a 1.0.1 Sem Ver making a first appearance at the bottom right
For all I got wrong – at least I chose nearly the right colours for an openEHR branding…!
From a sketch on a whiteboard in 2007 to a mature, clinician-friendly, and globally recognised platform, CKM has come a long way. Prof Evelyn Hovenga recalls the early days: “We persisted despite numerous setbacks… We kept looking for that tipping point of acceptance and use… It’s nice to see that we’ve finally made it.”
CKM is not just a repository. It’s a model for how digital health infrastructure should be built; collaboratively, transparently, and with clinical leadership.
It’s also a call to action. Join the CKM community.
Deeper dive…
Watch Dr Sebastian Garde’s insightful EHRCON24 presentation covering the technical capabilities of the CKM, and what it may hold for the future of health informatics
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