openehr the reference model thomas beale sam heard
TRANSCRIPT
openEHR The Reference Model
Thomas Beale
Sam Heard
© Ocean Informatics 2008
What openEHRprovides
openEHR Semantic architecture
1:N
Templates
1:N
Reference Model
Archetypes
1:N
Terminologyinterface
Messages
Querying
Screen Forms
1:N
Reports
Data conversionschemas Terminologies
Sn
omed
CT
ICD
x
ICP
C
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Specification Map
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
Archetype Query Language Terminology Subset Syntax
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Reference Model – Class model overview
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The reference model – Structure of one EHR
All versioned
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Structure of one Composition
ENTRYs – where thedata are
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Context Model in openEHR
data values
temporal structure
clinical statement
healthcare event
spatial structure
EHR
ENTRIES
organise by: SECTIONS
organise by: FOLDERs
COMPOSITION
Recording EnvironmentHealthcare Events
commit to EHR(Contribution)
recorded in (1:1)
recorded in (1:N)
data-entry session
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Time in openEHR
Real-world activities
observation
sample/collection time
measurement/reporting time
healthcare event
data entry
OBSERVATION.COMPOSITION. VERSION.openEHRrecord
COMPOSITION.
commit
time-lag recorded in
OBSERVATION.dataarchetyped attribute in
if relevant
context.start_time data.origin context.end_time
generally= instant event
audit.time
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Time in openEHR
radiologist - assess imagesdata entry
commitimaging reportradiology
OBSERVATION.data.origin
COMPOSITION.context.start_time
COMPOSITION.context.end_time
VERSION.audit.time
openEHRrecord
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Time in openEHR
commitvitalnurse obs.
OBSERVATION.data.origin
VERSION.audit.time
(hospital) signs commitvital
OBSERVATION.data.origin
VERSION.audit.time
signs commitvital
OBSERVATION.data.origin
VERSION.audit.time
signs0100 0500 0900
ADMIN_ENTRYmove to wardtime = ...
ADMIN_ENTRYdischargetime = ...
openEHRrecord
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Security Features
Separation
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Entries – the clinical information
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Entry types
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
Archetype Query Language Terminology Subset Syntax
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Entry types based on process
This process is cyclic & repetitiveClinicians don’t always document every step
investigator
Investigatoragents
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History of Solutions
GeHR Australia – early version of Entry types based on information categories in philosophy + problem-solving
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History of Solutions – Danish G-EPJ
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History of Solutions - Samba
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History of Solutions – Act-based
Includes RICHE HL7v3 RIM Many others
Problems Everything is an act – good for tracking business
process steps, but not natural to physicians Hard to model typical clinical recordings
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Our approach – ‘Clinical Investigator’
Based on clinical process
MedInfo 2007
paperf()
observations
ev a lua tion
inter ve ntions
clinical investigator system
patientsystem
observations
e va lua tion
clinical investigator system
in te rv e nti ons
go al s
b) control system metaphor
a) problem-solving metaphor
-
+
administrative context
administrative context
goa ls
o bse rva tio ns)(d e sired
patientsystemobservations)
(desired
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Entry types based on process
This process is cyclic & repetitiveClinicians don’t always document every step
investigator
Investigatoragents
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Leading to an Ontology
observation/ intervention
recordedinformation
history opinion
assessment
careinformation
admininformation
proposal
diagnosis risk recommendation goal
intervention
scenario prognosis
instruction
xxx
xxx = observation-related
= intervention-related
observation action
cognitive/temporal categories
categories
analytical categories
investigationrequestrequest
OBSERVATION ACTION
EVALUATION INSTRUCTION
ADMIN_ENTRY
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(with a speculative part for Admin)admin
information
admission
scheduling
reservation
appointment
completion transfer
discharge referral
commence
task event patient event
ment
emergencycare
birth death
status update
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Specification Map
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
Archetype Query Language Terminology Subset Syntax
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RM data types & structures
terminology
support
definitions measurement identification
text
data_types
basic
quantity
assumed typesInteger
BooleanString
Real CharacterInterval<T>
Set<T>
List<T>
inbuilt
date_time time_specification uri multimedia
history
data_structures
item_structure
representation
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data_structures
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data_structures.item_structure
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item_structure.representation
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data_structures.history
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History – Basic Structure
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History - Variations
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History – Storing Device Data Efficiently
14,400 x 1 second samples from device
5 x Events in openEHR History
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Math Functions
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Glucose Tolerance Test
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Versioning
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Specification Map
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
Archetype Query Language Terminology Subset Syntax
© Ocean Informatics 2008
Basis of versioning
(similarly to CVS, Subversion etc…) We use the Composition as the unit of
change (like a file in Subversion) Folder structure also versioned We use the Contribution as the unit of
committal (like a change-set) Pre-commit check ensures that the current
state of Compositions & Folder structure unchanged since check-out
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Contrib12/4/2003
Contrib15/4/2003
Contrib20/4/2003
Contrib22/4/2003
Versioning
FamilyHistory
Currentmedications
ProblemList
CarePlan
Contact12/4/2003
Test Results15/4/2003
Contact20/4/2003
ProblemList ++
CurrentMeds ΔΔ
CarePlan Δ
Correction22/4/2003
Current Version
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User A System User B
Conflicts & Merging – One System
v1
commitv2
v1bv1a
commit?
v2a
merge
v3commit
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Sys B
Synchronisation Problems
Sys A
v1
v2
v3
Sys C
v1
v1
v1
Do we have the latest?
Are we getting Duplicates?
Solutions:• designated master
repository from which to update
• reliable, globalversion identificationscheme
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Distributed conflicts
Sys A
v1
v2a
Sys C
v1
This can only happen:1. where no master designated2. no update-before-commit3. patient presents in both
placesi.e. ad hoc situation, e.g. patientsick while on holiday
Solution:One of the systems will be thePatient’s ‘home’ system
v2c
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Why is the openEHR RM useful?
Because it was developed with clinical input OGTT example
It provides a solid ontological basis for the next levels: Archetypes Templates GUI, messages etc