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HL7 CDA, Clinical Modelling
and openEHR Thomas Beale
NHS Scotland, February 2007
IntroductionsThomas Beale
Chief Technology Officer Ocean InformaticsSenior Researcher, Centre for Health Informatics, UCLChair ARB openEHR Foundation5 years’ int’l standards work20 years’ experience in software engineering12 years working with clinical people
© Ocean Informatics 2007
openEHR Health Computing Platform
© Ocean Informatics 2007
Integrated Care
Pathway MgtDecisionSupport
KnowledgeDiscovery
Health Information Platform
Application Development
Platform
Health Integration
Platform
Knowledge Management
Platform
openEHR Health Information Platform
Health Information Platform
Application Development
Platform
Health Integration
Platform
Knowledge Management
Platform
Queries
EQL
Templates
TOM
Archetypes
AOM ADL
Reference Model
(data types, …secure EHR)
Data Retrieval
Data Entry & validation
Data Viewing
© Ocean Informatics 2007
© Ocean Informatics 2007
Health Information Platform
Data Structures
Data Types
DemographicEHR
Security
EHR Extract
virtual EHR
Archetype OM
Support (identifiers, terminology access)
AM
RM
SM EHRservice
archetypeservice
demographicservice
terminologyservice
{core
Common{patterns
{domain }Integration
Composition openEHR Archetype Profile
Template OM
EN13606
?
CDA Rel 2
© Ocean Informatics 2007
Observation
SubstanceAdministration
Supply
Procedure
Encounter
Act
Organiser
ActReference
opinions
observations
instructions
actions
patient
investigatoragents
investigator
administrativeeventspublished
knowledgebase
personalexperience
Standard state machine
© Ocean Informatics 2007
ArchetypesThe components of the Reference Model are
like LEGO brick specificationsArchetypes = instructions/designs constraining
the use of LEGO pieces to create meaningful structures
Archetype A Archetype B
Information modelInstances
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Archetypes and Templates
Antenatal visitDiabetic checkup Archetypes
Weight
FH
HbA1c
BP
Issues
Assess
Tingling feetFeeling tired
76 kg
124/92
7.5%
Excellent control
66 kg
102/64 mmHg
142/min
NAD, see 4/52
Back pain
Template Template
© Ocean Informatics 2007
© Ocean Informatics 2007
Integrated Care Pathways
INSTRcelebrex
INSTRCor bypass
INSTRACE inhib
GP
Specialist
Hospital
ACTIONstart
ACTIONstartPatient
ACTION↓ dose
ACTIONschedule
ACTIONperform
ADMINadmission
ADMINdischarge
ACTIONsuspend
ACTION∆ freq
ACTIONresume
Reporting on Instructions
INSTRCelebrex
(GP)
INSTRHip repl.
(specialist)
INSTRACE inhib
(GP)
ACTIONStart
(patient)
ACTIONStart
(patient)
ACTION↓ dose(GP)
ACTIONSchedule
(specialist)
ACTIONPerform
(hospital)
ADMINAdmission(hospital)
ADMINDischarge(hospital)
ACTIONSuspend(hospital)
ACTION∆ freq(GP)
ACTIONResume
(GP)
© Ocean Informatics 2007
© Ocean Informatics 2007
The openEHR EHR
openEHREHR
openEHRExtract
ArchetypesTemplates
Queries
Comprehensive Entry modelLINKingDistributed VersioningState model of Instruction & ActionsArchetype-based QueryingFormal Terminology integrationopenPGP digital signing
Virtual EHRweb service
Queries from Archetypes
openEHREHR
Archetype-pathBased Queries
© Ocean Informatics 2007
QueriesSELECT
o/data[at0001]/events[at0002]/time,o/data[at0001]/events[at0002]/data[at0003]/items[at0013.1]/value
FROM
Ehr[uid=@EhrUid] CONTAINS Compositionc[openEHR-EHR-COMPOSITION.encounter.v1]CONTAINS Observation o[openEHR-EHR-OBSERVATION.laboratory-lipids.v1]
© Ocean Informatics 2007
© Ocean Informatics 2007
openEHR Application Development Platform
Health Information Platform
Application Development
Platform
Health Integration
Platform
Knowledge Management
Platform
Application Development
Platform
Query BuilderTemplateDesigner
openEHR EQL
Virtual EHR API
openEHR TemplateObject Model
openEHR VirtualEHR API
openEHR Knowledge Management Platform
Health Information Platform
Application Development
Platform
Health Integration
Platform
Knowledge Management
Platform
Knowledge Management
Platform
ArchetypeEditor
TerminologySubsetting tool
ArchetypeRepository
openEHR ADL(CEN, ISO)
openEHR OWLArchetype Ontology
TerminologySubsettingLanguage
© Ocean Informatics 2007
© Ocean Informatics 2007
openEHR Health Integration Platform
Health Information Platform
Application Development
Platform
Health Integration
Platform
Knowledge Management
Platform
Health Integration
Platform
© Ocean Informatics 2007
A Universal EHR
openEHREHR
HL7v2 msg
HL7v2 (archetyped)
openEHRExtract
CDAr2(text)
CDAr2(struct)
13606Extract
CDAr2(copied)
CDAr2(generated)
13606Extract
openEHRExtract
IntegrationArchetypes
ClinicalArchetypes
ClinicalArchetypes
ClinicalArchetypes
mappings
© Ocean Informatics 2007
Conclusions
openEHR is a fully integrated, knowledge-enabled platform, EN13606-capableCan accommodate textual and structural CDA documentsArchetypes and templates provide control over data entry, querying and terminology binding
© Ocean Informatics 2007
Figure – © 2006 Koray Atalag
© Ocean Informatics 2007
Questions
http://www.openEHR.org
Release 1.0.1 – March 2007
© Ocean Informatics 2007
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