openEHR: a healthcare computing platform for the future · Composition open EHR Archetype Profile Template OM Archetype Query Language Terminology Subset Syntax ... control system

openEHR The Reference Model

Thomas Beale

Sam Heard

© Ocean Informatics 2008

What openEHR

provides

openEHR Semantic architecture

1:N

Templates

1:N

Reference Model

Archetypes

1:N

Terminology

interface

Messages

Querying

Screen Forms

1:N

Reports

Data conversion

schemas Terminologies

Snom

ed C

T

ICD

x

ICP

C


Specification Map

Data Structures

Data Types

DemographicEHR

Security

EHR Extract

virtual EHR

Archetype OM

Support (identifiers, terminology access)

AM

RM

SMEHR

servicearchetype

servicedemographic

serviceterminology

service

{core

Common{patterns

{domain

{ }Integration

Composition openEHR Archetype Profile

Template OM

Archetype Query Language Terminology Subset Syntax


Reference Model – Class model overview


The reference model –

Structure of one EHR

All

versioned


Structure of one Composition

ENTRYs –

where the

data are


Structure of an EHR Extract


Context Model in openEHR

data values

temporal structure

clinical statement

healthcare event

spatial structure

EHR

ENTRIES

organise by: SECTIONS

organise by: FOLDERs

COMPOSITION

Recording EnvironmentHealthcare Events

commit to EHR(Contribution)

recorded in (1:1)

recorded in (1:N)

data-entry session


Time in openEHR

Real-world activities

observation

sample/collection time

measurement/reporting time

healthcare event

data entry

OBSERVATION.COMPOSITION. VERSION.openEHRrecord

COMPOSITION.

commit

time-lag recorded in

OBSERVATION.data

archetyped attribute in

if relevant

context.start_time data.origin context.end_time

generally

= instant event

audit.time


Time in openEHR

radiologist - assess images

data entry

commitimaging report

radiology

OBSERVATION.data.origin

COMPOSITION.context.start_time

COMPOSITION.context.end_time

VERSION.audit.time

openEHRrecord


Time in openEHR

commitvitalnurse obs.


VERSION.audit.time

(hospital) signs commitvital


VERSION.audit.time

signs commitvital


VERSION.audit.time

signs0100 0500 0900

ADMIN_ENTRYmove to wardtime = ...

ADMIN_ENTRY

dischargetime = ...

openEHRrecord


Security Features

Separation


Entries – the clinical information


Entry types

Data Structures

Data Types

DemographicEHR

Security

EHR Extract

virtual EHR

Archetype OM


AM

RM

SMEHR

servicearchetype

servicedemographic

serviceterminology

service

{core

Common{patterns

{domain

{ }Integration


Template OM



Entry types based on process

This process is cyclic & repetitive

Clinicians don’t always document every step

investigator

Investigator

agents


History of Solutions

GeHR Australia – early version of Entry types

based on information categories in

philosophy + problem-solving


History of Solutions – Danish G-EPJ


History of Solutions - Samba


History of Solutions – Act-based

Includes

RICHE

HL7v3 RIM

Many others

Problems

Everything is an act – good for tracking business

process steps, but not natural to physicians

Hard to model typical clinical recordings


Our approach – ‘Clinical Investigator’

Based on

clinical

process

MedInfo 2007

paper f()

observations

evaluation

interventions

clinical investigator system

patientsystem

observations

evaluation

clinical investigator system

interventions

goals

b) control system metaphor

a) problem-solving metaphor

-

+

administrative context

administrative context

goals

observations)(desired

patientsystemobservations)

(desired


Entry types based on process

This process is cyclic & repetitive

Clinicians don’t always document every step

investigator

Investigator

agents


Leading to an Ontology

observation/ intervention

recordedinformation

history opinion

assessment

careinformation

admininformation

proposal

diagnosis risk recommendation goal

intervention

scenario prognosis

instruction

xxx

xxx = observation-related

= intervention-related

observation action

cognitive/temporal

categories

categories

analytical categories

investigationrequestrequest

OBSERVATION ACTION

EVALUATION INSTRUCTION

ADMIN_ENTRY


(with a speculative part for Admin)

admininformation

admission

scheduling

reservation

appointment

completion transfer

discharge referral

commence

task event patient event

ment

emergencycare

birth death

status update



Specification Map

Data Structures

Data Types

DemographicEHR

Security

EHR Extract

virtual EHR

Archetype OM


AM

RM

SMEHR

servicearchetype

servicedemographic

serviceterminology

service

{core

Common{patterns

{domain

{ }Integration


Template OM



RM data types & structures

terminology

support

definitions measurement identification

text

data_types

basic

quantity

assumed typesInteger

BooleanString

Real CharacterInterval<T>

Set<T>

List<T>

inbuilt

date_timetime_

specificationuri multimedia

history

data_structures

item_structure

representation


data_structures


data_structures.item_structure


item_structure.representation


data_structures.history


History – Basic Structure


History - Variations


History – Storing Device Data

Efficiently

14,400 x 1 second

samples from device

5 x Events in

openEHR History


Math Functions


Glucose Tolerance Test


EHR Extract


openEHR Extract Model


openEHR

EHR Extract


Generic EHR Extract


Versioning


Specification Map

Data Structures

Data Types

DemographicEHR

Security

EHR Extract

virtual EHR

Archetype OM


AM

RM

SMEHR

servicearchetype

servicedemographic

serviceterminology

service

{core

Common{patterns

{domain

{ }Integration


Template OM



Basis of versioning

(similarly to CVS, Subversion etc…)

We use the Composition as the unit of

change (like a file in Subversion)

Folder structure also versioned

We use the Contribution as the unit of

committal (like a change-set)

Pre-commit check ensures that the current

state of Compositions & Folder structure

unchanged since check-out


Contrib 12/4/2003

Contrib 15/4/2003

Contrib 20/4/2003

Contrib 22/4/2003

Versioning

Family

History

Current

medications

Problem

List

Care

Plan

Contact

12/4/2003

Test Results

15/4/2003

Contact

20/4/2003

Problem

List ++

Current

Meds ΔΔ

Care

Plan Δ

Correction

22/4/2003

Current Version


User A System User B

Conflicts & Merging – One System

v1

commit v2

v1b

v1a commit?

v2a v3 commit


Sys B

Synchronisation Problems

Sys A

v1

v2

v3

Sys C

v1

v1

v1

Do we have

the latest?

Are we getting

Duplicates?

Solutions:

• designated master

repository from which

to update

• reliable, global

version identification

scheme


Distributed conflicts

Sys A

v1

v2a

Sys C

v1

This can only happen:

1. where no master designated

2. no update-before-commit

3. patient presents in both

places

i.e. ad hoc situation, e.g. patient

sick while on holiday

Solution:

One of the systems will be the

Patient’s ‘home’ system

v2c


Why is the openEHR RM useful?

Because it was developed with clinical input

OGTT example

It provides a solid ontological basis for the next

levels:

Archetypes

Templates

GUI, messages etc

openEHR: a healthcare computing platform for the future · Composition open EHR Archetype Profile Template OM Archetype Query Language Terminology Subset Syntax ... control system

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