What is open EHR Today?data.nczisk.sk/old/nczisk/ZI/stvrtok/2_ThomasBealeopenEHR2007.pdf · 1 open EHR a knowledge-enabled health computing platform Thomas Beale 2007 Bratislava,

1

openEHR a knowledge-enabled

health computing platform

Thomas Beale

2007

Bratislava, Slovakia

© Ocean Informatics 2007

Introductions

Thomas Beale

� Chief Technology Officer Ocean Informatics (Aus, UK)

� Senior Researcher, Centre for Health Informatics, UCL (UK)

� Chair ARB openEHR Foundation

� 5 years’ int’l standards work

� 20 years’ in software engineering

� 13 years working with clinical people


What is openEHR Today?


Good European Health Record:

requirements and EHR architecture1992

2004

Synapses:FHR and Clinical Object Dictionary

SynEx: middleware component architecture

Medicate: remote asthma monitoring and alerts

6WINIT: wireless IPv6

EHCR SupA:

revised requirements and architecture Good Electronic Health Record

mNET: wireless demonstrator

GPGC projects

(1) EHR kernel services(2) legacy data transformation

(3) diabetes extraction and merge

Formal Archetype approach

Release 1

Feb 2006

Release 1.0.1

15 Apr 2007


The openEHR Foundation

� Non-profit organisation based at University College, London (UCL)

� Established by UCL and Ocean nformatics

in 2000 to own the IP

� 800+ Members from 71 countries

� All specifications & schemas publicly available

� Software open source (GPL, LGPL, MPL)


openEHR Deliverables

Application Development

Platform

Health Integration

Platform

Knowledge Management

Platform

Queries

EQL

Template

s

TOM

Archetypes

AOM ADL

Reference Model

(data types, …secure EHR)

Health InformationPlatform

2


ActivitiesopenEHR Board

Technical

Architecture Review Board

ProjectGroup

ProjectGroup

ProjectGroup

Clinical

Clinical Review Board

ProjectGroup

ProjectGroup

ProjectGroup

ComputableSingle-sourcedomain contentand process models

Computing architecturespecification &implementations


History of openEHR

Sep 2001 Specification development starts

Feb 2003 Formal Change Request system� …196 CRs…initial schemas, implementations

10 Feb 2006 Release 1.0� …51 CRs…heavy testing…

� Implementation in Java, C#, XML-schema…

15 Apr 2007 Release 1.0.1� Stabilised; 4 Archetype parsers; 5+

implementations emerging, some commercial

ADL spec � CEN EN13606-2 � ISO


What is openEHR for?


Challenges in e-Health Today

Semantic interoperability: how do computers know what our 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?


Semantic Interoperability

An e-health environment needs to establish common meaning of data everywhere

It’s no use knowing what the meaning is in

one place; it must be known from data capture to all uses, and all the plumbing in

between…

We need end-to-end semantic coherence

Meaning = structure + context + semantics


Middleware &Business Logic

Persistence

ApplicationLogic

User i/f

… within systems…

3


…and the distributed environment

LSP London

LSP NW&WM

LSP Southern

LSP NE LSP Eastern

Spine

•Record location•Record update•Cache•Authorisation


LSP London

LSP NW&WM

LSP Southern

LSP NE LSP Eastern

Royal Marsden

Whittington

Lawson Practice

Hospitals

General practice

Mental health

Shared EHR

…at various levels…


…as well as across functions….

GP

local hospital large

hospital

pathlab

imaginglab

nursing

socialworkers

home

aged care

specialistCare Pathways

Decision Support

KnowledgeDiscovery


Patient-centric View – what happens

ORDERcelebrex

ORDERCor bypass

ORDERACE inhib

GP

Specialist

Hospital

ACTIONstart

ACTIONstartPatient

ACTION↓↓↓↓ dose

ACTIONschedule

ACTIONperform

ADMINadmission

ADMINdischarge

ACTIONsuspend

ACTION∆∆∆∆ freq

ACTIONresume


Patient-centric View – what we need

ORDERCelebrex

(GP)

ORDERCor bypass(specialist)

ORDERACE inhib

(GP)

ACTIONStart

(patient)

ACTIONStart

(patient)

ACTION↓↓↓↓ dose(GP)

ACTIONSchedule

(specialist)

ACTIONPerform

(hospital)

ADMINAdmission(hospital)

ADMINDischarge(hospital)

ACTIONSuspend(hospital)

ACTION∆∆∆∆ freq(GP)

ACTIONResume

(GP)


Change and Complexity

� Snomed-ct has 500,000 concepts & 1,000,000 relationships….and is under continual heavy revision

� ICD10 has 75,000 conditions… and ICD11 is on the way…

� There are no standards for questions on most hospital forms

� There are 500 common lab tests, many changing, new ones emerging

� Hospital business processes changing…

4


Information complexity: timing

…to a maximum of 4 times

per day

Maximum per time period

…not less than every 8 hoursMaximum interval

…every 4-6 hours,

…2-3 times per day

every time period range

…2 per day

…6 per week

n per time period

…three times per dayn times per time period

…every 4 hoursevery time period

ExamplesDose frequency



…via a syringe driver

over 4 hours

Time period

Dose duration

06:00, 12:00, 20:00Specific times of day

…take after breakfast

and lunch

Morning and/or lunch and/or

evening

ExamplesTime specific



…on days 5-10 after

menstruation begins

Duration n time period

before/after event

…3 days before traveln time period before/after

event

…after meals

…before lying down…after each loose stool

…after each nappy change

After/Before event

ExamplesEvent related



…Take every 2 hours for 5

doses

n doses

…for 5 daysn time period/s

…stat, repeat in 14 daysNow and then repeat after

n time period/s

1-7 January 2005Date/time to date/time

ExamplesTreatment duration



…Apply daily until day 21 of

menstrual cycle

Finish event

…Start 3 days before travelStart event

…if pulse is greater than 80

…until bleeding stops

If condition is true

ExamplesTriggers/Outcomes


Survey of algorithms for solution

Analyse Computing Requirements

10 years passes

Everything has changed

Retire DIE

AcademicIT

20 years passes30 years passes40 years passes

Analyse Clinical Requirements

Academicmedicine

1000s of good ideas

10 years passes

Go back to doing medicine and wait…

Academicengineering

100s of good ideas

Analyse System Requirements

Build some thing with–ve feedback or DSP in it

Use in sexy white goods

5



Invent requirements

GOVT Spend billions €

New govt elected

forever

Amnesia

SmartGOVT

Copy other GOVT Save 50 €

Apply typical business methods



StandardsOrgs

Meet 4 times a year

Drink a LOT of coffee

Generate some paper

…for 15 years…

BigVENDOR

Build nice Radiology System

Market as generic e-Health Solution

Make $millions DIE RICHRetire


Some hope…

HealthInformatics

…for 20 years…

New kinds of system

Innovations for complexity & knowledge management

Ontologicalbasis for computing

Cross-disciplinary Meta-analysis of problem space

PhilosophersOntologistsTerminologistsGuidelines expertsWorkflow expertsEHR expertsSoftware engineersTechnology expertsClinical professionals


openEHR Health Computing Platform

Integrated Care

Pathway MgtDecisionSupport

KnowledgeDiscovery

Health Information Platform


Platform

Health Integration

Platform


Platform


openEHR Health Information Platform

Health Information Platform


Platform

Health Integration

Platform


Platform

Queries

EQL

Template

s

TOM

Archetypes

AOM ADL

Reference Model

Data Retrieval

Data Entry & validation

Data Viewing


Key Innovations

“Two-level Modelling” – separation of models of information into 2 layers:

� Hard-coded information model (domain-invariant)

� Archetypes (domain-specific)

� Software is only built from the first layer

Scientific process model of basic information

Distributed Semantics

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The Reference Model

Queries

EQL

Template

s

TOM

Archetypes

AOM ADL

Reference Model


Reference Model

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

EN13606

?

CDA Rel 2


Structure of one EHR

All versioned


Structure of one Composition

ENTRYs –where thedata are


Analytical Paradigm for clinical recording

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 ΣΣΣΣ


Entry types based on process

Actions

Published evidence

base

Personal

knowledge base Evaluation

- assessment

- opinion- goals

2

Observations

Patient

system

Instructions

Investigator

agents

Investigator

system

4

3

1

measurable or observable

clinically interpreted

findings

Define intervention

recording clinical

activities

7


Ontology of Entry data


Sowa’s Top-level categories

OBSERVATIONACTIONEVALUATIONINSTRUCTION


Core clinical Entry semantics


Standard state machine


Security Features

Separation


Distributed versioning

v3 v2v1

EHR

Centre 1

EHR

System A

(cache)

EHR

System A

(cache)

EHR

System C

(cache)

v3 v2v1

Logical EHR

v3 v2v1

v3 v2v1

EHR

Centre 2

v3 v2v1

8


Archetypes

Queries

EQL

Template

s

TOM

Archetypes

AOM ADL

Reference Model


Principle

The components of the Reference Model are like LEGO brick specifications

Archetypes = instructions/designs constraining the use of LEGO pieces to create meaningful

structures

Archetype A Archetype B

Information model

Instances


Language (ADL)


© Ocean Informatics 2007 © Ocean Informatics 2007

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Queries

Template

s

TOM

Archetypes

AOM ADL

Reference Model

Queries

EQL


Queries from Archetypes

openEHREHR

Archetype-pathBased Queries


EHR Query Language (EQL)

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]


Archetype-based Queries

We can now write portable queries in terms of semantic elements rather than only in

terms of underlying information model

Queries can be built by domain users, not IT people

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Templates

Archetypes

AOM ADL

Reference Model

Queries

EQL

Template

s

TOM


Antenatal visitDiabetic checkup

Archetypes and Templates

Weight

Archetypes

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


Archetypes are semantic single-source models

Xpath-compliantpaths – basis ofquerying

Control datastructure andterminology use

Used to generateGUI screens

Single placefor domainagreement oncontent

Templates canbe used to generatemessage definitions

Generate data-manipulationcode skeletons


The openEHR EHR

openEHREHR

openEHRExtract

ArchetypesTemplates

Queries

Comprehensive Entry modelLINKingDistributed VersioningState model of Instruction & ActionsArchetype-based QueryingFormal Terminology integrationopenPGP digital signing

Virtual EHRweb service


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

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Conclusions

� Methodology of 2-level modelling works; 3 years experience; now in use in NHS

� Archetypes and templates provide control

over data entry, persistence, querying and terminology binding

� For the first time, clinical professionals can

substantially define the semantics of their own information systems: archetypes,

templates and queries


Questions

www.openEHR.org

Release 1.0.1 – 15 April 2007

www.OceanInformatics.biz

Documents

What is open EHR Today?data.nczisk.sk/old/nczisk/ZI/stvrtok/2_ThomasBealeopenEHR2007.pdf · 1 open EHR a knowledge-enabled health computing platform Thomas Beale 2007 Bratislava,