Electronic Health Records: An introduction to openehr and archetypes

Transcription

1 Electronic Health Records: An introduction to openehr and archetypes Dr. Sebastian Garde CCR Workshop Munich 29 th April 2008

2 Expectations Timely information and reports for ALL professions with a minimum of trouble Customizable and maintainable without too much effort even when knowledge changes; No vendor lock-in The information that is relevant to me in the structure I need it

3 Traditional EHR Approach Application System Technical Development Domain Knowledge

4 However Both the total number of concepts and the rate of change is high SNOMED medical termset codes some 366,170 atomic concepts and 1.46 million relationships Not only is health care big, it is open-ended*: In breadth, because new information is always being discovered or becoming relevant In depth, because finer-grained detail is always being discovered or becoming relevant In complexity, because new relationships are always being discovered or becoming relevant * After A.L. Rector, Clinical Terminology: Why is it so hard?, Methods Inf Med 38 (1999)

5 openehr A way of structuring, storing and managing patient data so that it can be shared and exchanged between different healthcare providers and other stakeholders in a meaningful and secure manner The openehr foundation develops tools and specifications for Electronic Health Records CEN EN (communication)

6 Two Level openehr-approach Technical Development Application System Domain Knowledge Information Knowledge

7 Archetype Intuitive model of clinical content

8 Archetype Formal model of clinical content

9 Example: Archetype Diagnosis Archetype Flexible model of clinical content Archetypes: The building blocks of Electronic Health Records

10 Archetype Entry types Evaluation e.g. diagnosis, adverse reaction Observation e.g. weight, effectiveness of anti-emetics, lab results Instruction e.g. medication order, monitoring Action e.g. procedure, drug admin

11 Clinicians define domain knowledge Empowerment of domain experts: The domain experts create & change the knowledge on their own Standardisation of archetypes helps to maximise the use of information Document data once use multiple times! Data aggregation when reporting Semantic interoperability between systems Enable lifelong electronic records

12 Archetypefinder

13 Archetypefinder Searches inside archetypes

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15 openehr Health Computing Platform

16 Example system: OceanEHR by Ocean Informatics dev.oceanehr.com

17 CCR and archetypes CCR: An openehr template (not a composition archetype) - Composition archetype required and several section archetypes (not specific to CCR) - The same archetypes can be used in Australia (HealthConnect/NEHTA Discharge Summaries), UK, NZ, etc.

18 CCR and archetypes II Most of the required archetypes already exist Flexibility Mulitlinguality Expandability Knowledge management

19 CCR and archetypes III Possible to create the CCR from an openehr template as one of the outputs Populated Template Data Schema --XSLT--> openehr, CDA, CCR,...

20 Outputs Technology independent Semantically inter-related

21 Template Designer

22 Knowledge Manager

23 Archetypes Summary = Formal model of a clinical concept in-use The definition of archetypes is an important step for the realisation of EHRs Archetypes empower the clinician and ensure that the information clinicians need is in the EHR Compelling business case for Level 4 ( semantic ) interoperability openehr provides an appropriate technical infrastructure for this

24 Questions? 12 Apostles, Great Ocean Road, Australia openehr.org EHR.org