openEHR: a healthcare computing platform for the future · Composition open EHR Archetype Profile...
Transcript of openEHR: a healthcare computing platform for the future · Composition open EHR Archetype Profile...
© Ocean Informatics 2008
What openEHR
provides
openEHR Semantic architecture
1:N
Templates
1:N
Reference Model
Archetypes
1:N
Terminology
interface
Messages
Querying
Screen Forms
1:N
Reports
Data conversion
schemas Terminologies
Snom
ed C
T
ICD
x
ICP
C
© Ocean Informatics 2008
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
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
© Ocean Informatics 2008
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.data
archetyped attribute in
if relevant
context.start_time data.origin context.end_time
generally
= instant event
audit.time
© Ocean Informatics 2008
Time in openEHR
radiologist - assess images
data entry
commitimaging report
radiology
OBSERVATION.data.origin
COMPOSITION.context.start_time
COMPOSITION.context.end_time
VERSION.audit.time
openEHRrecord
© Ocean Informatics 2008
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_ENTRY
dischargetime = ...
openEHRrecord
© Ocean Informatics 2008
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
© Ocean Informatics 2008
Entry types based on process
This process is cyclic & repetitive
Clinicians don’t always document every step
investigator
Investigator
agents
© Ocean Informatics 2008
History of Solutions
GeHR Australia – early version of Entry types
based on information categories in
philosophy + problem-solving
© Ocean Informatics 2008
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
© Ocean Informatics 2008
Our approach – ‘Clinical Investigator’
Based on
clinical
process
MedInfo 2007
paper f()
observations
evaluation
interventions
clinical investigator system
patientsystem
observations
evaluation
clinical investigator system
interventions
goals
b) control system metaphor
a) problem-solving metaphor
-
+
administrative context
administrative context
goals
observations)(desired
patientsystemobservations)
(desired
© Ocean Informatics 2008
Entry types based on process
This process is cyclic & repetitive
Clinicians don’t always document every step
investigator
Investigator
agents
© Ocean Informatics 2008
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
© Ocean Informatics 2008
(with a speculative part for Admin)
admininformation
admission
scheduling
reservation
appointment
completion transfer
discharge referral
commence
task event patient event
ment
emergencycare
birth death
status update
© Ocean Informatics 2008
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
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_timetime_
specificationuri multimedia
history
data_structures
item_structure
representation
© Ocean Informatics 2008
History – Storing Device Data
Efficiently
14,400 x 1 second
samples from device
5 x Events in
openEHR History
© Ocean Informatics 2008
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
© Ocean Informatics 2008
Contrib 12/4/2003
Contrib 15/4/2003
Contrib 20/4/2003
Contrib 22/4/2003
Versioning
Family
History
Current
medications
Problem
List
Care
Plan
Contact
12/4/2003
Test Results
15/4/2003
Contact
20/4/2003
Problem
List ++
Current
Meds ΔΔ
Care
Plan Δ
Correction
22/4/2003
Current Version
© Ocean Informatics 2008
User A System User B
Conflicts & Merging – One System
v1
commit v2
v1b
v1a commit?
v2a v3 commit
© Ocean Informatics 2008
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, global
version identification
scheme
© Ocean Informatics 2008
Distributed conflicts
Sys A
v1
v2a
Sys C
v1
This can only happen:
1. where no master designated
2. no update-before-commit
3. patient presents in both
places
i.e. ad hoc situation, e.g. patient
sick while on holiday
Solution:
One of the systems will be the
Patient’s ‘home’ system
v2c