Can openEHR archetypes be used in a national context? The Danish - PowerPoint PPT Presentation

Can openEHR archetypes be used in a national context? The Danish archetype Proof-of-Concept project . Knut Bernstein MEDIQ kb@mediq.dk Ida Tvede Jan Petersen, Kirsten Bredegaard Sarajevo, 1. September 2009

About the organisations  Digital Health  Danish Government, Danish Regions, Municipalities  To implement the National Strategy for Digitalisation of the Health (2008-2012)  MEDIQ  Independent consultants in health informatics  Advice to ministries, regions, hospitals, municipalities in DK and Europe MEDIQ

Disposition  The challenge  Semantic interoperability  The project  Is archetypes a part of the solution?  Regional track  Develop archetypes  Vendor track  Implement archetypes  Conclusions MEDIQ

The ambition: Use and re-use of data  Business goals  High quality of service, patient safety  Cost efficient  Support for  Clinical decisions, planning and documentation  Administration and management  Information exchange; sharing of data  National/regional EHR  National/regional registries  Secondary use of data  Clinical research, clinical quality development  Health and performance monitoring  Semantic interoperability MEDIQ

Danish implementations EHR, admin, LAB… Many systems exist Clinical National – infra- Patient semantic structure Registry interoperability is a challenge Continuity The clinical of care Danish infrastructure in DK Health SNOMED is not yet decided! Portal CT But there are candidates… Technical e-Record infra- & medi- structure cation MEDIQ

Clinical infrastructure Interoperable EHR systems Process Terminology Clinical Model System content SNOMED CT Archetypes Proces Terminologi openEHR? Sundheds- Model System fagligt CEN 13606? Indhold HL7 V3? MEDIQ

Purposes of the project  Get knowledge on archetype methods and experience on techniques  Can archetypes improve  representation of clinical content specifications  sharing clinical content specifications between different IT-systems  Can archetypes be used when  entering data in the systems  sharing data between systems MEDIQ

Project design Tools Data Entry EHR Use-case Archetypes Clinical content OpenEHR Archetypes Data exchange MEDIQ

Clinical process and Information types MEDIQ The open EHR EHR Information Model Editors:{T Beale, S Heard}1, {D Kalra, D Lloyd}2, Revision: 5.0

Regional track MEDIQ

Modelling from OpenEHR  OBSERVATION – obstetric examination  Could be represented  9 OpenEHR archetypes  1 new archetype  One area with terminology differences  Imposing constraints on the maximum dataset using the template  Binding to SNOMED CT  The result is complex MEDIQ

Obstetric ex. Abdominal examination Ex. of uterus Palpation Ex. of fetus Abdominal ex. Vaginal explor. Vaginal exploration Ex. of cervix Excretion Ex. of fetus Abdominal ex. Vaginal explor. Contractions MEDIQ Heart activity Composition Cluster Entry

Modelling from use-cases  OBSERVATION – obstetric examination  Could be represented with archetypes  Support for structuring  Ambiguities resolved  The result is easy to overview  Use-case specific (minimum dataset)  Few reusable elements MEDIQ

Vendor track  Tieto: KMS  Logica: COSMIC  Siemens: Melior  CSC: Clinical Suite  Systematic : Columna  IBM-Acure: NOTAT  MyClinic: MyClinic MEDIQ

Import via configuration module ADL, XML MEDIQ

Import and use of archetype  Import of ADL or XML straight forward  Useful for import of rich data specifications  More than archetypes are needed: process descriptions, business logic user interface  Using archetypes  OBSERVATIONS are particularly useful, can (usually) be integrated with other data  EVALUATION, INSTRUCTION, ACTION does not always fit well with internal models

Conclusion: Modelling  The clinical content specifications improve on archetype modelling and become  computable  expressed in a standardised language  Sharable  OpenEHR archetypes can be used for representing Danish clinical content (probably)  Archetypes can provide consistency across a clinical content library MEDIQ

Conclusion: Use of archetypes  Danish vendors can handle archetypes via ADL and XML  OBSERVATIONS can be imported in Danish systems  even they are using different modes  Supports interoperability of the exchanged data  Constraints should be defined nationally  Suggestion: Use archetypes for reporting of data to central databases MEDIQ

Conclusion: Challenges  Decision on level of interoperability needed  what data, what granularity, which parties  Development  Guidelines for terminology, AT building blocks  Resources for development  Implementation  Access to archetypes  National template library  Migration of systems  Governance  Versioning, distribution, central/local development MEDIQ

Archetypes in a clinical infrastructure Systems Archetypes Quality databases Archetypes National patient DB Patient summary MEDIQ

Archetypes are not that easy to implement When you have pulled your hear long enough… the problem is solved

Contact point Knut Bernstein MEDIQ kb@mediq.dk www.mediq.dk MEDIQ