Introduction to openehr Archetypes & Templates. Dr Ian McNicoll Dr Heather Leslie

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1 Introduction to openehr Archetypes & Templates Dr Ian McNicoll Dr Heather Leslie

2 Traditional Application Development Clinical Knowledge Data Model Ocean Informatics 2010

3 Tradi&onal Informa&on model

4 2 level modelling Clinical Knowledge ARCHETYPES Easier and cheaper to build and maintain Contains only generic knowledge and business rules Data Model Ocean Informatics 2010 Much smaller and simpler

5 openehr 2 level modelling Reference model : Datatypes and generic structures Blood pressure archetype

6 Archetypes Dictionary definition => a model or prototype openehr archetypes are: Computable models of discrete clinical concepts Maximal data set Universal use case Model a range of concepts: Simple and straightforward concepts blood pressure ; weight ; symptom Complex compound concepts such as medication order, family history Ocean Informatics 2010

7 Archetypes 2 Can be standalone local use case BUT Archetypes are most useful when Shared Re-used Clinical Knowledge Manager knowledge Potential for a SINGLE, SEMANTIC MODEL of clinical content Ocean Informatics 2010

8 Single Semantic Model BP System A BP BP Published archetype BP System B BP BP System C System D Ocean Informatics 2009 Shared EHR Repository

9 Class Process Compositions Sections Entries Published evidence base Personal knowledge base Clusters Domain Expert 2 Evaluation clinically interpreted findings measurable or observable Observations 1 Time/Event series; State 3 Instructions Ocean Informatics Admin Entry order or initiation of a workflow process Subject 4 Actions Recording each activity Investigator s agents

10 ENTRY: Features Feature Eval Obs Inst Act Protocol how and basis for recording b! b! b! b! History allows time-series and aggregates b! State records patient states that may influence interpretation b! Pathway work flow steps and states b! 10.10

11 Designing an archetype Clinician involvement required Maximum Data Set; Universal Use-Case Ocean Informatics 2010

12

13 Action State Model Ocean Informatics 2009

14 Medication Order : Pathways Ocean Informatics 2009

15 Multilingual Archetypes Each archetype is translated once No language of primacy English Japanese German Dutch Spanish Portugese Danish Swedish Turkish Farsi Ocean Informatics 2010

16 Archetype output

17 openehr Templates Templates are formal specifications defining a particular aggregation of archetypes In practice Context, purpose, clinical domain or location. Constrain the component archetypes to make them 'fit for purpose', including addition of mandatory items; specifying terminology subsets for real-time usage; assigning default values. combining archetypes data entry defs, reports, or messages. Ocean Informatics 2010

18 Clinical application/ screen TEMPLATE Multiple ARCHETYPES Data Repository Ocean Informatics 2010

19

20 Ocean Informatics 2008

21 1.21 Templates

22 Archetypes Re-use Diabetic checkup Tingling feet Feeling tired 76 kg 124/92 7.5% Excellent control Archetypes Issue Weight BP HbA1c FH Assess Antenatal visit Back pain 66 kg 102/64 mmhg 142/min NAD, see 4/52 Template 1 Template 2 Ocean Informatics 2010

23 1.23 Reusability

24 Templates - the openehr workhorse? Archetypes get the glory but templates deliver the content. Most demand for archetyped content will originate as requests for datasets Diabetes shared care e-referral Data entry forms Clinicians can and do engage with archetype development But many others will want to focus solely on their own dataset focused requirements

25 Terminology bindings One to one term-bindings Terminology agnostic Generally at archetype level Constraint / termset bindings Terminology agnostic Abstract definitions Any Orthopaedic diagnosis Generally at template level Ocean Informatics 2010

26 Record of BP 120/78, Sitting, large cuff Term bindings: Blood pressure finding -... (finding) Sitting blood pressure -... (observable entity) Blood pressure -... (observable entity) Blood pressure taking -... (procedure) Diastolic blood pressure -... (observable entity) O/E - blood pressure reading - On examination - blood pressure reading (finding) Blood pressure cuff -..., device (physical object)

27 Snomed: Any Histopathology test Local terminology: Any local Diagnostic service Term bindings to specific gradings Ocean Informatics 2010

28 Archetype-enabled system BP GP vendor A Specialist vendor B BP BP BP Published archetype BP Specialist vendor B TRANSFORMATION Archetypes/Templates BP PHR D BP Hospital Vendor C Ocean Informatics 2009 Shared EHR Repository

29 Distributed care GP Community Nurse Active state Podiatrist Endocrinologist Patient Ocean Informatics 2009

30 The openehr artefact ecosystem Code Skeletons UI Forms Reference Model Archetypes Templates Data Sets XML Schemas Messages Terminology Mappings/ Subsets Semantic Queries HTML Display

31 Versatile health data HL7v2 XML HL7v2 (archetyped) CDAr2 (text) CDAr2 (structured) Extract openehr Extract Archetypes, templates openehr Repository Archetypes, templates PDF CDAr2 (generated) Extract openehr Extract Research data

32 Dutch Hospital Ocean Informatics 2009

33 Ocean Informatics 2009

34

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