openehr the reference model thomas beale sam heard

openEHR The Reference Model

Thomas Beale

Sam Heard

© Ocean Informatics 2008

What openEHRprovides

openEHR Semantic architecture

1:N

Templates

1:N

Reference Model

Archetypes

1:N

Terminologyinterface

Messages

Querying

Screen Forms

1:N

Reports

Data conversionschemas Terminologies

Sn

omed

CT

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 thedata are


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.dataarchetyped attribute in

if relevant

context.start_time data.origin context.end_time

generally= instant event

audit.time


Time in openEHR

radiologist - assess imagesdata entry

commitimaging reportradiology

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_ENTRYdischargetime = ...

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



Template OM



Entry types based on process

This process is cyclic & repetitiveClinicians don’t always document every step

investigator

Investigatoragents


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

paperf()

observations

ev a lua tion

inter ve ntions

clinical investigator system

patientsystem

observations

e va lua tion

clinical investigator system

in te rv e nti ons

go al s

b) control system metaphor

a) problem-solving metaphor

-

+

administrative context

administrative context

goa ls

o bse rva tio ns)(d e sired

patientsystemobservations)

(desired


Entry types based on process

This process is cyclic & repetitiveClinicians don’t always document every step

investigator

Investigatoragents


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)admin

information

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



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_time time_specification uri 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


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



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


Contrib12/4/2003

Contrib15/4/2003

Contrib20/4/2003

Contrib22/4/2003

Versioning

FamilyHistory

Currentmedications

ProblemList

CarePlan

Contact12/4/2003

Test Results15/4/2003

Contact20/4/2003

ProblemList ++

CurrentMeds ΔΔ

CarePlan Δ

Correction22/4/2003

Current Version


User A System User B

Conflicts & Merging – One System

v1

commitv2

v1bv1a

commit?

v2a

merge

v3commit


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, globalversion identificationscheme


Distributed conflicts

Sys A

v1

v2a

Sys C

v1

This can only happen:1. where no master designated2. no update-before-commit3. patient presents in both

placesi.e. ad hoc situation, e.g. patientsick while on holiday

Solution:One of the systems will be thePatient’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 the reference model thomas beale sam heard

Documents

ocean informatics

openehr slide

entry slide

admin slide

versioning slide

paper slide

versioned slide

representation slide