Can openEHR archetypes be used in a national context? The Danish - - PowerPoint PPT Presentation

Can openEHR archetypes be used in a national context?

The Danish archetype Proof-of-Concept project.

Knut Bernstein MEDIQ kb@mediq.dk Ida Tvede Jan Petersen, Kirsten Bredegaard

Sarajevo, 1. September 2009

 Digital Health

 Danish Government, Danish Regions, Municipalities

 To implement the National Strategy for Digitalisation of the Health (2008-2012)

 MEDIQ

 Independent consultants in health informatics  Advice to ministries, regions, hospitals, municipalities in DK and Europe

About the organisations

MEDIQ

 The challenge

 Semantic interoperability

 The project

 Is archetypes a part of the solution?

 Regional track

 Develop archetypes

 Vendor track

 Implement archetypes

 Conclusions

Disposition

MEDIQ

The ambition: Use and re-use of data

 Business goals

 High quality of service, patient safety  Cost efficient

 Support for

 Clinical decisions, planning and documentation  Administration and management

 Information exchange; sharing of data

 National/regional EHR  National/regional registries

 Secondary use of data

 Clinical research, clinical quality development  Health and performance monitoring

Semantic interoperability

MEDIQ

Danish implementations

Continuity

• f care

EHR, admin, LAB… National Patient Registry Health Portal e-Record & medi- cation Technical infra- structure Danish SNOMED CT Clinical infra- structure

Many systems exist – semantic interoperability is a challenge

MEDIQ

The clinical infrastructure in DK is not yet decided! But there are candidates…

Clinical infrastructure

Process Model Terminology System Clinical content Terminologi System SNOMED CT

Sundheds- fagligt Indhold

Archetypes

Interoperable EHR systems

MEDIQ

Proces Model

• penEHR?

CEN 13606? HL7 V3?

 Get knowledge on archetype methods and experience on techniques  Can archetypes improve

 representation of clinical content specifications  sharing clinical content specifications between different IT-systems

 Can archetypes be used when

 entering data in the systems  sharing data between systems

Purposes of the project

MEDIQ

Project design

MEDIQ

EHR Clinical content Data Entry Data exchange Tools

OpenEHR Archetypes Use-case Archetypes

The openEHR EHR Information Model Editors:{T Beale, S Heard}1, {D Kalra, D Lloyd}2, Revision: 5.0

Clinical process and Information types

MEDIQ

Regional track

MEDIQ

 OBSERVATION – obstetric examination  Could be represented

 9 OpenEHR archetypes  1 new archetype  One area with terminology differences  Imposing constraints on the maximum dataset using the template  Binding to SNOMED CT

 The result is complex

Modelling from OpenEHR

MEDIQ

MEDIQ

Heart activity Obstetric ex. Contractions

• Ex. of fetus

Abdominal ex.

• Ex. of uterus

Palpation Vaginal explor.

Abdominal examination

• Ex. of cervix

Excretion

• Ex. of fetus

Abdominal ex. Vaginal explor.

Vaginal exploration

Entry Cluster Composition

 OBSERVATION – obstetric examination  Could be represented with archetypes

 Support for structuring  Ambiguities resolved  The result is easy to overview

 Use-case specific (minimum dataset)

 Few reusable elements

Modelling from use-cases

MEDIQ

 Tieto: KMS  Logica: COSMIC  Siemens: Melior  CSC: Clinical Suite  Systematic: Columna  IBM-Acure: NOTAT  MyClinic: MyClinic

Vendor track

MEDIQ

Import via configuration module

MEDIQ

ADL, XML

Import and use of archetype

 Import of ADL or XML straight forward

 Useful for import of rich data specifications  More than archetypes are needed: process descriptions, business logic user interface

 Using archetypes

 OBSERVATIONS are particularly useful, can (usually) be integrated with other data  EVALUATION, INSTRUCTION, ACTION does not always fit well with internal models

 The clinical content specifications improve

• n archetype modelling and become

 computable  expressed in a standardised language  Sharable

 OpenEHR archetypes can be used for representing Danish clinical content (probably)  Archetypes can provide consistency across a clinical content library

Conclusion: Modelling

MEDIQ

 Danish vendors can handle archetypes via ADL and XML  OBSERVATIONS can be imported in Danish systems

 even they are using different modes

 Supports interoperability of the exchanged data

 Constraints should be defined nationally

 Suggestion: Use archetypes for reporting of data to central databases

Conclusion: Use of archetypes

MEDIQ

 Decision on level of interoperability needed

 what data, what granularity, which parties

 Development

 Guidelines for terminology, AT building blocks  Resources for development

 Implementation

 Access to archetypes  National template library  Migration of systems

 Governance

 Versioning, distribution, central/local development

Conclusion: Challenges

MEDIQ

Archetypes in a clinical infrastructure

MEDIQ

Quality databases National patient DB Patient summary

Archetypes Archetypes Systems

When you have pulled your hear long enough…

Archetypes are not that easy to implement

the problem is solved

Contact point

Knut Bernstein MEDIQ

kb@mediq.dk www.mediq.dk

MEDIQ