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Someday you might deploy more than one implementation, multiple servers, or need a collection of concepts which are different from the CIEL concept dictionary.  There are trade-offs for each of these scenarios:  standalone, master/slave, and central curation.

  • No dependancy on others, so timing depends on you
  • No need to migrate
  • You are the expert
  • Transparency to you
  • No internet required
  • No benefit to the community
  • No advantages from community knowledge, clinical expertise, and medical terminology
  • You are the expert
  • You do all the maintanance
  • Limits for multiple servers and implementation
  • Gain expertise from others
  • Create a collection from the best and multiple sources
  • Flexible for multiple servers and implementation
  • Cloud-based
  • Many different mechanisms
  • Time consuming concept management process

CIEL with subscription
  • The community and experts are constantly improving and expanding concepts
  • Cloud-based

  • CIEL dictionary has too much (ie. clinician searches for "malignant" and finds more than 1000 concepts)
  • Requires internet for updates
Central curation
  • The community and experts are constantly improving and expanding concepts
  • Most flexible option for multiple servers and implementations
  • Cloud-based
  • OCL is not ready for collections



Standalone:  This is could be quickly implemented when there's a single OpenMRS server and implementation, but difficult if it grows to multiple servers and implementations.  An example of this is the implementation at Partners In Health/Malawi (APZU).  The concept dictionary is based on a fork of the concept dictionary in 2008 (AMPATH/OpenMRS concept dictionary and later Partners In Health concept dictionary).  It is difficult to benefit from any maintanance and improvements that are done in the CIEL or "golden" PIH dictionary (ie.  ICD10 and SNOMED mappings, duplicate concept names in pre OpenMRS 1.7, etc.)  The one positive aspect is that concepts can be created quickly and without discussion or reliance.

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Master/Slave:  There are 3 examples of this:

  • CIEL dictionary is the "master" and your implementation subscribes to modifications
  • Multiple servers are connected via sync module.  Concepts are only updated on the sync parent and changes are replayed on the child servers.   This is used at Partners In Health Rwanda (Inshuti Mu Buzima).
  • A "golden" metadata server has curated concepts for various implementation.  Concepts have been managed over time, additional concepts are added from CIEL and locally.  All concepts are managed here and subsets are packaged here using mds or groovy and exported to individual implementation. 

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Partners In Health implementations (Haiti, Liberia, and Lesotho) use centralized concept management and the "golden" server.   The "golden" concept server is maintained in the cloud and used for PIH concept management with a curated set of concepts.  These steps outline the process for creating mds packages for implementations along with the "PIH Concept Management workflow" figure:

  1. If a concept is needed, look if it already exists in that local OpenMRS implementation.
  2. If it doesn't exist in local implementation, check in the "golden" PIH concept dictionary.  The "golden" PIH concept dictionary is deployed on an OpenMRS 2.1.3 server in the cloud.  
  3. If the concept exists on the "golden" concept server but is missing concept terminology (ICD10, SNOMED, etc), check the CIEL concept dictionary.   These mappings can be added directly on the "golden" server OR by creating an metadata sharing (MDS) package from the CIEL dictionary and imported into the "golden" server.  MDS allows that concept data (sources, classes, datatype, mappings, names, etc) can be access and ignored/merged.
  4. If the concept doesn't exist in the PIH "golden" dictionary, use mds to get the concept from CIEL.
  5. If the concept doesn't exist in the CIEL dictionary, propose the concept to CIEL management.
  6. If the concept doesn't have the appropriate locale (ie. French, Haitian Kreyol, Spanish, etc), add to the PIH "golden" server OR propose to CIEL. 
  7. If the concept is specific for PIH, create the concept directly on the "golden" concept server.  For example, there might be a group of Haiti reference laboratories capable of processing MDRTB cultureslist of Haitian insurance companies.  This is not proposed to the CIEL dictionary.