HL7 CDA, Clinical Modelling and openehr

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1 HL7 CDA, Clinical Modelling and openehr Thomas Beale NHS Scotland, February 2007

2 Thomas Beale Introductions Chief Technology Officer Ocean Informatics Senior Researcher, Centre for Health Informatics, UCL Chair ARB openehr Foundation 5 years int l standards work 20 years experience in software engineering 12 years working with clinical people

3 openehr Health Computing Integrated Care Pathway Mgt Health Integration Decision Support Health Information Application Development Knowledge Management Knowledge Discovery

4 openehr Health Information Data Retrieval Queries Health Integration Archetypes Reference EQL Health Model Information TOM (data types, secure EHR) Application AOM Knowledge ADL Development Management Templates Data Entry & validation Data Viewing

5 Health Information RM SM { domain patterns { core{ terminology service EHR Security EHR Extract Demographic Composition demographic service Common EN13606 CDA Rel 2 virtual EHR Integration Data Structures Data Types EHR service Support (identifiers, terminology access) archetype service Template OM } openehr Archetype Profile AM? Archetype OM

6 Observation Encounter investigator observations patient opinions actions Substance Administration Act published personal knowledge experience base instructions administrative events investigator agents Supply Organiser Procedure ActReference

7 Standard state machine

8 Archetypes The components of the Reference Model are like LEGO brick specifications Archetypes = instructions/designs constraining the use of LEGO pieces to create meaningful structures Information model Instances Archetype A Archetype B

9 Archetypes and Templates Diabetic checkup Tingling feet Feeling tired 76 kg 124/92 7.5% Excellent control Archetypes FH Weight BP HbA1c Issues Assess Antenatal visit Back pain 66 kg 102/64 mmhg 142/min NAD, see 4/52 Template Template

10 Integrated Care Pathways Patient start start GP INSTR celebrex INSTR ACE inhib dose resume freq Specialist INSTR Cor bypass schedule Hospital ADMIN admission suspend perform ADMIN discharge

11 Reporting on Instructions INSTR Celebrex (GP) Start (patient) Start (patient) dose (GP) Resume (GP) INSTR ACE inhib (GP) freq (GP) INSTR Hip repl. (specialist) Schedule (specialist) ADMIN Admission (hospital) Suspend (hospital) Perform (hospital) ADMIN Discharge (hospital)

12 The openehr EHR Archetypes Templates Queries openehr Extract Comprehensive Entry model LINKing openehr Distributed Versioning EHR State model of Instruction & Actions Archetype-based Querying Formal Terminology integration openpgp digital signing Virtual EHR web service

13 Queries from Archetypes Archetype-path Based Queries openehr EHR

14 SELECT Queries o/data[at0001]/events[at0002]/time, o/data[at0001]/events[at0002]/data[at0003]/items [at0013.1]/value FROM CONTAINS Composition c[openehr-ehr-composition.encounter.v1] CONTAINS Observation o[openehr-ehr- OBSERVATION.laboratory-lipids.v1]

15 openehr Application Development Query Builder Template Designer Virtual EHR API openehr EQL Health openehr Template Integration Object Model openehr Health Virtual Information EHR API Application Application Development Development Knowledge Management

16 Archetype Editor openehr Knowledge Management openehr ADL (CEN, ISO) Terminology Terminology Subsetting toolsubsetting Language Health Integration Archetype Repository Health openehr Information OWL Archetype Ontology Knowledge Application Management Knowledge Development Management

17

18 openehr Health Integration Health Integration Health Integration Health Information Application Development Knowledge Management

19 A Universal EHR HL7v2 msg HL7v2 (archetyped) CDAr2 (text) Extract CDAr2 (struct) Integration Archetypes mappings Clinical Archetypes Clinical Archetypes openehr EHR CDAr2 (copied) CDAr2 (generated) Extract openehr Extract Clinical Archetypes openehr Extract

20 Conclusions openehr is a fully integrated, knowledgeenabled platform, EN13606-capable Can accommodate textual and structural CDA documents Archetypes and templates provide control over data entry, querying and terminology binding

21 Figure 2006 Koray Atalag

22 Questions Release March 2007

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