archetypes and fhir by koray atalag
DESCRIPTION
Some thoughts on the intersection between OpenEHR archetypes and FHIR presented at the HL7 New Zealand FHIR seminarTRANSCRIPT
![Page 1: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/1.jpg)
Information Models & FHIR It’s all about content!
Koray Atalag MD, PhD, FACHI [email protected]
Vice Chair HL7 New Zealand
Chair openEHR New Zealand
openEHR Localisation Program Leader
Member HISO
![Page 2: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/2.jpg)
Programmes of research in
• Health informatics & technology
• Clinical trials
• Cardiovascular disease
• Addictions
• Nutrition & physical activity
Research services
Teaching
• PG Diploma in Health Informatics
• MSc & PhD
![Page 3: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/3.jpg)
(Clinical) Information Models Myths and Facts
• They are NOT reference information models; – as in HL7 v3 RIM, openEHR/ISO13606 or FHIR resource ontology!
• They are pure representations of health information
• They may employ a number of formats and methods; inc. – Mindmaps, pdf, UML, XML/XSD, Archetypes, FHIR resources and even
OO language implementations
• For max semantic interoperability & computability: formal reference information model – but can be very generic!
• Latest buzzword: Detailed Clinical Models (DCM)
![Page 4: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/4.jpg)
What’s in the name?
Terminology: Labels/codes attached to atomic concepts (mostly without explicit context)
– Diabetes Mellitus, ear ache, left hip, CT scan etc.
Some have hierarchy (ICD) & relationships (SNOMED)
Boundary Problem Terminology binding
Information Model: structure and semantics of concrete clinical concepts w/ context
– Blood pressure measurement, lab test result, discharge summary, adverse reaction, prescription etc.
![Page 5: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/5.jpg)
The Hard Way:
Coronary
arteriosclerosis
Structural
disorder of heart
Heart disease
Cardiac finding
Cardiovascular
finding
Finding by site
Clinical finding
SNOMED CT
Concept
Mediastinal
finding
Finding of region
of thorax
Finding of trunk
structure
Finding of body
region
Viscus structure
finding
Disorder of
mediastinum
Disorder of
thorax
Disorder of trunk
Disorder by
body site
Disease
Disorder of body
system
Disorder of body
cavity
Disorder of
cardiovascular
system
Disorder of
coronary artery
Coronary artery
finding
Arterial finding
Blood vessel
finding
General finding
of soft tissue
Disorder of soft
tissue of thoracic
cavity
Disorder of soft
tissue of body
cavity
Disorder of soft
tissue
Disorder of
artery
Vascular
disorder
Arteriosclerotic
vascular disease
Soft tissue
lesion
Degenerative
disorder
![Page 6: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/6.jpg)
Structure with terminology: SNOMED Inconsistencies due to different post-coordination of concepts
In a vasculitis physical examination: “Vascular exams: Carotid Right/Tender”
247348008 | tenderness (finding) | : 363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | : 24028007 | Right (qualifier value) |
_____________________________________________________________________________
301390006 | tenderness of cardiovascular structure | :
363698007 | finding site | = 69105007 | Carotid artery structure (body structure) |:
272741003 | laterality | = 24028007 | Right (qualifier value) |
_______________________________________________________________________________
309655006 | On examination-artery (finding) | :
69105007 | Carotid artery structure (body structure) | :
24028007 | Right (qualifier) |:
247348008 | tenderness |
_______________________________________________________________________________
401050002 | Carotid artery finding (finding) | :
363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | :
272741003 | laterality | = 24028007 | Right (qualifier value) | :
247348008 | tenderness |
![Page 7: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/7.jpg)
Problem/Diagnosis Archetype (Nehta)
![Page 8: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/8.jpg)
Archetype terminology binding
![Page 9: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/9.jpg)
Open specs, tools and content for representing health information & building EHR – Based on 18+ years of international implementation experience
including Good European Health Record Project
– Origin of ISO/CEN 13606 EHR standard
Not-for-profit organisation - established in 2001 www.openEHR.org
“Inside Systems” vs HIE
Separation of clinical and technical worlds
• Big international community
![Page 10: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/10.jpg)
& Archetypes
• FHIR resources and Archetypes are closely related – should avoid reinvention at all costs!
• Archetype FHIR resource conversion is expected to be seamless – Archetypes are maximal datasets; as opposed to
– FHIR resources include most commonly used items (e.g. 80%) with an option to extend as needed (e.g. 20%)
• An opportunity exists for FHIR to leverage openEHR content, tooling and expertise
![Page 11: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/11.jpg)
FHIR: Adverse Reaction Resource
![Page 12: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/12.jpg)
ADR Archetype (from CKM tool)
![Page 13: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/13.jpg)
Getting closer…
![Page 14: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/14.jpg)
HISO 10040 Interoperability Reference Architecture
10040.1 R-CDRs
XDS
10040.2 CCR
SNOMED CT openEHR
10040.3 CDA
Acknowledge Alastair Kenworthy
![Page 15: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/15.jpg)
![Page 16: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/16.jpg)
![Page 17: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/17.jpg)
What is a Content Model?
• IT IS A REFERENCE LIBRARY – of validated information models for health information exchange (and more!)
• Consists of maximal datasets (as opposed to minimal) – normalised using a standard EHR record organisation (openEHR) – Expressed as reusable and computable models – Archetypes
• Top level organisation follows CCR
• Only relevant items bound to SNOMED, ICD, LOINC etc.
• Further detail provided by: – Existing relevant sources (CCDA, Nehta, epSoS, HL7 FHIR etc.) – Extensions (of above) and new Archetypes (NZ specific)
• Each HIE content (CDA/FHIR/v2) will include one or more models and formally conform
![Page 18: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/18.jpg)
Usage of the Content Model
![Page 19: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/19.jpg)
Exploiting Content Model for Secondary Use
Single Content Model
CDA
FHIR
HL7 v2/3
EHR Extract
UML
XSD/XMI
Mindmap
PAYLOAD
System A
Data Source A
Map
To
Content
Model
System B
Data Source B
Native openEHR Repository
Secondary Use
Map
To
Content
Model
Automated Transforms
No Mapping
![Page 20: Archetypes and FHIR by Koray Atalag](https://reader033.vdocument.in/reader033/viewer/2022052504/554b7294b4c905030a8b5469/html5/thumbnails/20.jpg)
Questions? [email protected]