OpenEHR a primer

1. openEHR a primer Thomas Beale Utrecht 2007

2. 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

3. What is openEHR Today?

5. 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)

6. openEHR Deliverables

7. Activities

8. 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

9. What is openEHR for?

10. 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?

11. 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

13. �and the distributed environment Shared EHR = openEHR Semantic interoperability Federated viewing is not a shared EHR Data transformation Data integration (linking) Versions, update, accountability (tracability) Heterogeneous login/security models Heterogeneous query models PerformanceShared EHR = openEHR Semantic interoperability Federated viewing is not a shared EHR Data transformation Data integration (linking) Versions, update, accountability (tracability) Heterogeneous login/security models Heterogeneous query models Performance

14. �at various levels� Shared EHR = openEHR Semantic interoperability Federated viewing is not a shared EHR Data transformation Data integration (linking) Versions, update, accountability (tracability) Heterogeneous login/security models Heterogeneous query models PerformanceShared EHR = openEHR Semantic interoperability Federated viewing is not a shared EHR Data transformation Data integration (linking) Versions, update, accountability (tracability) Heterogeneous login/security models Heterogeneous query models Performance

15. �as well as across functions�.

16. Patient-centric View � what happens

17. Patient-centric View � what we need

18. 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�

19. Information complexity: timing If you think about the seemingly simple concept of communicating the timing of a medication, it readily becomes apparent that it is more complex than most expect�If you think about the seemingly simple concept of communicating the timing of a medication, it readily becomes apparent that it is more complex than most expect�

20. Information complexity: timing

21. Information complexity: timing

22. Information complexity: timing

23. Information complexity: timing �and therefore it has not been easy to express and share this information accurately and reproducibly. However Archetypes are designed to do this. �and therefore it has not been easy to express and share this information accurately and reproducibly. However Archetypes are designed to do this.

24. openEHR Health Computing Platform

25. openEHR Health Information Platform

26. 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

27. The Reference Model

28. Reference Model

29. Structure of one EHR

30. Structure of one Composition

31. Analytical Paradigm for clinical recording

32. Entry types based on process There are three categories of archetypes � each corresponding to classes in the reference model - that are useful to understand when starting out. Thematic archetypes of Compositions � which correspond to commonly used clinical documents, such as �antenatal visit� or �care plan�. Organisational archetypes of Sections � these are effectively used to assist with human navigation within EHRs and correspond to document headings, for example �antenatal examination� or �summary�. Descriptive archetypes of Entries � these are the most common and are fundamental building blocks of EHRs. There are four types of Entry archetypes: Observations � recording measurable or observable data e.g. blood pressure, symptoms or weight; Evaluations � recording clinically interpreted findings e.g. adverse event or assessment of risk; Instructions � recording the initiation of a workflow process, such as a medication order or referral; Actions � recording clinical activities e.g. procedure or medication administration. Actions complement the instruction and can record the ensuing state of the instruction, such as �completed� or �cancelled�.There are three categories of archetypes � each corresponding to classes in the reference model - that are useful to understand when starting out. Thematic archetypes of Compositions � which correspond to commonly used clinical documents, such as �antenatal visit� or �care plan�. Organisational archetypes of Sections � these are effectively used to assist with human navigation within EHRs and correspond to document headings, for example �antenatal examination� or �summary�. Descriptive archetypes of Entries � these are the most common and are fundamental building blocks of EHRs. There are four types of Entry archetypes: Observations � recording measurable or observable data e.g. blood pressure, symptoms or weight; Evaluations � recording clinically interpreted findings e.g. adverse event or assessment of risk; Instructions � recording the initiation of a workflow process, such as a medication order or referral; Actions � recording clinical activities e.g. procedure or medication administration. Actions complement the instruction and can record the ensuing state of the instruction, such as �completed� or �cancelled�.

33. Ontology of Entry data

34. Core clinical Entry semantics

35. Standard state machine

36. Security Features

37. Distributed versioning

38. Archetypes

39. 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

40. Language (ADL)

46. Queries

47. Queries from Archetypes

48. 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]

49. 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

50. Templates

51. Archetypes and Templates

53. Archetypes are semantic single-source models

54. The openEHR EHR

55. A Universal EHR

56. 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

57. Questions