Collage of Applied Medical Sciences

Department of Health Information Management and Technology

ELECTRONIC HEALTH RECORDS (EHR)

CHAPTER 4: Open EHR
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

-STUDENTS RESOURCES:
- John Wiley & Sons, PART 4: OpenEHR, Chapter (18)
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

Open EHR

▪ Open EHR is an open standard specification in health informatics that

describes the management and storage, retrieval and exchange of
health data in electronic health records (EHRs). In openEHR, all
health data for a person is stored in a "one lifetime", vendor-
independent, person-centred EHR. The open EHR specifications
include an EHR Extract specification but are otherwise not primarily
concerned with the exchange of data between EHR-systems as this is
the focus of other standards such as EN 13606 and HL7.

▪ An open standard is a standard that is openly accessible and usable

by anyone

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Open EHR
- University College of London (UCL) and Ocean Informatics from
Australia established the open EHR Foundation in 2000.
- It is a not-for profit organization, which provides EHR
specifications, open source implementation of these specifications,
and development of clinically constrained specifications called
Archetypes.
- OpenEHR uses XML for communication. All architecture diagrams
in specifications are represented by using UML unified modelling
language.
- A reference implementation of open EHR is available under
open source licenses.

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Department of Health Information Management and Technology

OPEN EHR FRAME WORK

- The framework of open EHR is based on a two-level modeling
approach for separating clinical concepts from the EHR
information model.
- The first level is technical in nature and involves specification
development and implementation to obtain a stable Reference
Model.
- The second level is clinical in nature and involves domain
specialists for development of ontology and archetypes based
on domain constraints, called the Archetype Model.

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OPENEHR FRAME WORK

Separation between the technical and clinical concepts helps to

reduce the complexity in building and maintaining a knowledge-
driven EHR system over a period.
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Department of Health Information Management and Technology

OPEN EHR FRAME WORK

OpenEHR uses the following:
1. Reference Model, which represents a collection of information
models including generic data types and data structures.
• A central part of the open EHR specifications is the set of
information models, known in openEHR as 'reference
models'. The models constitute the base information models
for openEHR systems, and define the invariant semantics of
the Electronic Health Record (EHR), EHR Extract, and
Demographics model, as well as supporting data types, data
structures, identifiers and useful design patterns.

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▪ Archetype Model, which defines the types of constraints that

can be placed on generic data types and data structures to
form Archetypes.

▪ Archetypes provides a place to formally define re-usable data point

and data group definitions, i.e. content items that will be re-used in
numerous contexts. Typical examples include "systemic arterial blood
pressure measurement" and "serum sodium".

▪ (Archetypes are models of clinical content, and they have many

beneficial properties. They are interoperable, both between
settings and through time. They are more amenable to change
than conventional paradigms, and their design is congruent with
clinical practice.)

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The framework of EHR

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▪ The second kind of artefact is known in openEHR as a

"template", and is used to logically represent a use case-
specific data-set, such as the data items making up a patient
discharge summary, or a radiology report.

▪ A template is constructed by referencing relevant items from a

number of archetypes. A template might only require one or two
data points or groups from each archetype

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Department of Health Information Management and Technology

OPENEHR CLINICAL PROCESS MODEL

Clinical information is classified depending on the clinical

workflow followed during patient care.
- It includes the patient and the care provider (Investigator /
Investigator Agents) as two participating entities.
- This model follows the SOAP concept (Subjective-Objective-
Assessment-Plan) and is called the Clinical Investigator Model.

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OPENEHR CLINICAL PROCESS MODEL

The major types of clinical information generated in this process

includes:

1. Observations (such as measurements and tests)

2. Opinions (such as diagnosis)
3. Instructions (such as advices and medications)
4. Actions (such as procedures)

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OPENEHR CLINICAL PROCESS MODEL

- The entire process is controlled through Administrative Events.

Administrative Events generate administrative data such as
demographics, discharge, referrals, and so on.
- The four major types are further classified on temporal basis,
observation/interventional basis, and analytical basis to obtain
more specific types for recorded clinical information.
- The classification obtained in this manner is known as Clinical
Investigator Record(CIR) ontology.

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OPENEHR CLINICAL PROCESS MODEL

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EHR software architecture

▪ Software architecture is the foundation of the EHR system. It

comprises functionality, reliability, usability, efficiency, maintainability
and portability. A stable, well thought-out architecture yields more
intuitive usability, greater scalability, and a more secure and flexible
operating environment. On the other hand, a faulty architecture
increases the odds of failed implementations when the time comes to
add on additional systems or apps, resulting in a poor customer
experience. In some cases, it can lead to entire system replacements,
sometimes within just a few years of implementation.

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Why does EHR software architecture matter?

▪ To stay abreast of changing regulations and information

technology advancements, behavioral health organizations will
be required to implement a number of technologies to remain
competitive in the marketplace over the next decade.

▪ Your EHR is the foundation for these new technologies—the

single source of truth for behavioral health information—and
has direct implications on clinicians’ point-of-care decision-
making.

▪ Choosing the right architecture ensures scalability of your entire

system, while preserving your ability to provide exceptional
behavioral health outcomes.

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OPENEHR ARCHITECTURE

- OpenEHR architecture specification includes Reference Model

(RM), Archetype Model (AM), and Services Model (SM).
- Dependency between components is from the bottom to top.
- All three models use core components from RM.
- All data types and data structures in openEHR adhere to the
standard specifications given by CEN/ISO 13606 for particular
structures.

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OPENEHR ARCHITECTURE

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OPENEHR ARCHITECTURE

Data types defined in the Data Types Information Model include:

1. Text for representing plain text, coded text, and paragraphs.
2. Quantity for representing ordinal values, measured amount with
units.
3. Date/times.
4. Encapsulated data type for multimedia and data for analyzing.
5. Basic type for Boolean and state variable.
6. URI (uniform resource identifier) types for referring to objects on
the Internet.

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OPENEHR ARCHITECTURE
- The Data Structure Information Model: includes Single, List,
Table, and Tree as generic data structures. Explicit data
structures are available for representing time series structure
and are useful for collecting time-interval data.
- The Support Information Model: includes components for
definitions, identification, terminology, and measurement. All
other models can use these identifiers for data processing.

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OPENEHR ARCHITECTURE
- The integration process: includes the development of openEHR
template (in the form of XSD) that provides mapping between
message/artifact (clinical content of legacy system data) from
legacy system and an openEHR archetype. The legacy
message/artifact is converted into openEHR archetype through
custom convertor using the openEHR template.
- Such openEHR templates are called Integration Archetypes.

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OPENEHR ARCHITECTURE

- The Archetype Model: contains the models required for describing

archetypes, templates, and their use. The Archetype Definition Language
(ADL) is used for describing the rules for building archetypes.
- The Service Model (SM) describes the services provided around an EHR
system.They include:
1. Virtual EHR API (Application Programming interface).
2. EHR Service.
3. Archetype Service.
4. Terminology Service.
5. Demographic Service.

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Conclusion

▪ openEHR is compliant and interoperable with other standards.

Hence, an EHR system should be able to interoperate with it.
The clinical process model of openEHR can be referred to while
developing an EHR model in the healthcare system due to its
relevance with real-world workflow in clinical environment for
treating a patient. openEHR specifications for structure of
coded terms and for interfacing with coding systems are
adaptable for implementing EHR systems that can support
multiple coding systems.

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Conclusion

▪ The two-level modeling approach of openEHR by using

archetypes brings stability in the EHR model. This provides
flexibility in incorporating emerging clinical concepts. This
design approach is generic and can be applied in any domain
that uses IT. The openEHR clinical process model can be the
basis for designing a workflow-oriented EHR model.

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THANK YOU
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