Introduction to openehr Archetypes & Templates Dr Ian McNicoll Dr Heather Leslie
Traditional Application Development Clinical Knowledge Data Model Ocean Informatics 2010
Tradi&onal Informa&on model
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
openehr 2 level modelling Reference model : Datatypes and generic structures Blood pressure archetype
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
Archetypes 2 Can be standalone local use case BUT Archetypes are most useful when Shared Re-used Clinical Knowledge Manager www.openehr.org/ knowledge Potential for a SINGLE, SEMANTIC MODEL of clinical content Ocean Informatics 2010
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
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 2009 5 Admin Entry order or initiation of a workflow process Subject 4 Actions Recording each activity Investigator s agents
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
Designing an archetype Clinician involvement required Maximum Data Set; Universal Use-Case Ocean Informatics 2010
Action State Model Ocean Informatics 2009
Medication Order : Pathways Ocean Informatics 2009
Multilingual Archetypes Each archetype is translated once No language of primacy English Japanese German Dutch Spanish Portugese Danish Swedish Turkish Farsi Ocean Informatics 2010
Archetype output
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
Clinical application/ screen TEMPLATE Multiple ARCHETYPES Data Repository Ocean Informatics 2010
Ocean Informatics 2008
1.21 Templates
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
1.23 Reusability
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
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
Record of BP 120/78, Sitting, large cuff Term bindings: Blood pressure finding -... (finding) 392570002 Sitting blood pressure -... (observable entity) 163035008 Blood pressure -... (observable entity) 75367002 Blood pressure taking -... (procedure) 46973005 Diastolic blood pressure -... (observable entity) 271650006 O/E - blood pressure reading - On examination - blood pressure reading (finding) 163020007 Blood pressure cuff -..., device (physical object) 70665002
Snomed: Any Histopathology test Local terminology: Any local Diagnostic service Term bindings to specific gradings Ocean Informatics 2010
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
Distributed care GP Community Nurse Active state Podiatrist Endocrinologist Patient Ocean Informatics 2009
The openehr artefact ecosystem Code Skeletons UI Forms Reference Model Archetypes Templates Data Sets XML Schemas Messages Terminology Mappings/ Subsets Semantic Queries HTML Display
Versatile health data HL7v2 XML HL7v2 (archetyped) CDAr2 (text) CDAr2 (structured) 13606 Extract openehr Extract Archetypes, templates openehr Repository Archetypes, templates PDF CDAr2 (generated) 13606 Extract openehr Extract Research data
Dutch Hospital Ocean Informatics 2009
Ocean Informatics 2009