consistently manipulated and viewed, regardless of the technical, organisational and cultural context. This approach also means the actual data models used by any EHR are flexible, given that new archetypes may be defined to meet future needs of clinical record keeping. Recently, work in Australia has demonstrated how archetypes and templates may be used to facilitate the use of legacy health record and message data in an openEHR health record system, and output standardised messages and CDA documents. The prospect of gaining agreement on design and on forms of governance at the international level remains speculative, with influences ranging from the diverse medico-legal environments to cultural variations, to technical variations such as the extent to which a reference clinical terminology is to be integral. The openEHR framework is consistent with the Electronic Health Record Communication Standard (ISO 13606), and the Archetype Object Model 2 (AOM2) has been officially accepted by ISO TC 215 as the draft specification for the 2017 revision of ISO 13606:2. International adoption openEHR archetypes are being used by the National e-Health Transition Authority of Australia, the UK NHS Health and Social Care Information Centre (HSCIC), the Norwegian Nasjonal IKT organisation, and the Slovenian Ministry of Health. openEHR has been selected as the basis for the standardised EHR in Brazil. It is beginning to be utilised in commercial solutions throughout the world, including those produced by the openEHR Industry Partners. Clinical Knowledge Manager (CKM) One of the outcomes of openEHR modelling approach is the open development of archetypes, templates and terminology subsets to represent health data. Due to the open nature of openEHR, these structures are publicly available to be used and implemented in health information systems. Community users are able to share, discuss and approve these structures in a collaborative repository known as the Clinical Knowledge Manager (CKM). Some currently used openEHR CKMs: openEHR Clinical Knowledge Manager NEHTA Clinical Knowledge Manager UK Clinical Knowledge Manager Norwegian National ICT Clinical Knowledge Manager Slovenian MoH Clinical Knowledge Manager See also Archetype (information science) European Institute for Health Records Electronic Health Record Communication (ISO/CEN EN 13606 - EHRcom) Health Level 7 Health Informatics Service Architecture (HISA) HIPAA ProRec SNOMED CT References External links openEHR Foundation website openEHR specifications openEHR 2015 white paper Health informatics Standards for electronic health records