openEHR as the Health Computing Platform

for the EHR

Dr Hugh Leslie

Acknowledgement:

Thomas Beale

What is an Electronic Health

1.2

Its NOT the applicationIts the

INFORMATION

The EHR Architecture

• Semantic interoperability: how do di!erent pieces of software know what the data mean?

• Patient-centric view: how to build a patient-centric longitudinal EHR across enterprises?– For decision support, Care pathways,

Medical research

• Continual change and complexity:how to build systems that keep up with reality?

Problems that an EHR architecture needs to address

Structure of the semantic interoperability problem

Four levels of organisation of information sharing same semantics:

• The cognitive user interface – flexible approach to data capture and viewing

• The data capture sets for each step – process-oriented, may be ad hoc

• Standardised semantics of the data points in data capture sets

• Standardised data representation, enabling interoperability

+ Standardised querying capability

+ Standardised interface to terminology for inferencing

In other words….

• It is not just about what is ‘on the wire’ between two systems….

• A message-based approach to semantic interoperability will be largely deficient in the semantics of data capture, definition, re-use and querying.

1.6

Navigating the Health Informatics Jungle

HL7 version 2.X

HL7 version 3

Clinical Document Architecture (CDA)

ASTM E2369-05 (CCR)

CEN 13606

openEHR

ArchetypesTemplatesRIM

RMIMDMIM

HSSP

ISO

TC 215

ISO/TS 18308:2004

CCOW

DICOM

CDISC

IHE

pro

files

SNOMED CT

LOINC

ICD9/10

GALEN

Google PHR

GEHR

HIPAA

XML

XSLT

XFORMS

SOAWeb Services

openEHR as the Health Computing Platform

• openEHR is engineered as an EHR architecture not a messaging solution.

• openEHR is engineered for semantic interoperability

• openEHR is engineered to provide a solution for the logical record architecture

• openEHR is engineered to work and is not just an academic exercise

The cognitiveUser interface:

Different ways of Presenting & Capturing the

Same information

Information Level 1 & 2

Logical data-sets: Achieved by templates

That re-use and Organise underlyingStandardised data

Points according to use

Information Level 2 & 3Logical data sets:

Templates – using only Selected items from aNumber of archetypes

Standardised models ofThe data:

Achieved by archetypesOrganised by topic, Independent of use

Information Level 3 & 4

Standardised clinicalmodels of the data:

Archetypes – all basedOn same reference model

Standardised technical representation of the data:

The reference model – Enables interoperability

Queries based on archetypes - Archetype Query Language

SELECT

" o/data[at0001]/events[at0002]/time, o/data[at0001]/events[at0002]/data[at0003]/items

[at0013.1]/value

FROM

" Ehr[uid=@EhrUid] CONTAINS Composition c

[openEHR-EHR-COMPOSITION.encounter.v1] CONTAINS Observation o[openEHR-EHR-OBSERVATION.laboratory-lipids.v1]

The result…

• Semantic coherence in the application stack (all layers of software know what the data mean)

• A high level of re-use of artefacts – define once, reuse many times

• A single, stable reference model for sharing clinical and related information

• A standardised query language for writing portable queries

• A standardised, re-usable way of connecting to terminology

The openEHR artefact

Reference Model

Archetypes

Templates

Semantic Queries

Terminology

Mappings/ Subsets

Code Skeletons

Data Sets

UI Forms

XML Schema

s

HTML Displa

y

Messages

openEHR + Terminology

• Terminologies such as SNOMED CT don’t solve the interoperability problem

• Archetypes and Templates work well with Terminologies

• Terminologies important for capturing concepts that need to be queried or shared - subsets

• Place of terminology is for inferencing and connecting concepts in an ontology of reality

Health Information Platform

Application Development

Platform

Health Integration Platform

Knowledge Management

Platform

openEHR Health Information

Queries

AQL

Templat

es

TOM

Archetypes

AOM ADL

Reference Model

Data Retrieval

Data Entry & validation

Data Viewing

Support (Identifiers, Terminology Access)

Data Structures

Data Types

Security Common AOM

openEHR Archetype profile

Template OM

Composition

EHRDemographi

cIntegratio

n

EHR Extract

CDAr2CEN13606

Core

Patterns

Domain

RM

openEHR Reference Model

1.16

Virtual EHRTerminology

ServiceDemographic

ServiceEHR Service

Archetype Service

Archetype Query Language Terminology Subset Syntax

The reference model – structure of one EHR

Contributi

onContributi

onContributi

onContributi

onContributi

on

EHR Access

EHR AccessEHR Access

EHR Access

EHR AccessEHR Status

EHR AccessEHR AccessDirectory

EHR EHR_ID

EHR AccessEHR Access

Composition

s

EHR AccessEHR Access

Composition

s

EHR AccessEHR Access

Composition

s

ALL Versioned

Structure of one CompositionVersioned Composition

Composition

Section

Section

Observation

Instruction

Action

Observation

Observation

Observation

History

Event

Event

Item_list

Cluster

Cluster

Element

Element

Element

Entries -where the Data are

Elements are the leaf nodes which contain things like Text, Coded Text, Quantity, Boolean, Ordinal etc

Security Features

Contributi

onContributi

onContributi

onContributi

onContributi

on

EHR Access

EHR AccessEHR Access

EHR Access

EHR AccessEHR Status

EHR AccessEHR AccessDirectory

EHR EHR_ID

EHR AccessEHR Access

Composition

s

EHR AccessEHR Access

Composition

s

EHR AccessEHR Access

Composition

s

EHR Access

EHR AccessParties

EHR Access

EHR AccessParties

Demographics

= Digital Signature = Commit Audit

Separation

Distributed versioning

v3 v2v1

EHR

Centre 1

EHR

System B

(cache)

EHR

System A

(cache)

EHR

System C

(cache)

v3 v2v1

Logical EHR

v3 v2v1

v3 v2v1

EHR

Centre 2

v3 v2v1

1.21

openEHRRepository

ClinicalArchetypes

HL7v2

HL7v2

(archetype

d)CDAr2

(text)CDAr2

(structured)

13606Extract

openEHR

Extract

CDAr2

(generated)

XML

PDF

13606Extract

openEHR

Extract

A Universal EHR

1.22

Software demonstration:• Archetype Editor• Template Designer• GUI development with templates• Data persistence and retrieval• Archetype query language examples• Terminology subsets