Stand openEHR, Archetypen & Templates

Dr. Sebastian Garde

ByMedConnectProjekttreffen

Neuherberg, 4.11.09

© Ocean Informatics 2009

Was ist openEHR?

Spezifikationen für eine logische EHR Architektur

Trennt zwischen klinischen und technischen Belangen

openEHR Foundation: non-profit Organisation, gegr. 2001

http://www.openehr.org

CEN/ISO 13606

© Ocean Informatics 2009

United StatesUnited States

SwedenSwedenSwedenSweden

DenmarkDenmark

NetherlandsNetherlandsKazakhstanKazakhstan

CanadaCanada

United StatesUnited States

BrazilBrazil

SingaporeSingapore

NEHTANEHTA

Where is Where is openopenEHR being used?EHR being used?

National ProgramsNational ProgramsVendors incl open sourceVendors incl open source

AustraliaAustralia

AcademicAcademic

ChileChile NZNZ

JapanJapan

South AfricaSouth AfricaAustraliaAustralia

NZNZChileChile

SwedenSwedenUKUK

BrazilBrazil

SloveniaSloveniaSloveniaSloveniaSpainSpain

PolandPolandUnited KingdomUnited Kingdom

© Ocean Informatics 2009

Microsoft Connected Health Framework Architecture and

Design Blueprint• Includes references to the role and use of

openEHR for the first time.

• Represents a vendor-agnostic set of best practices and approach based on Services Oriented Architecture (SOA), for architecting e-Health solutions for health information networks ranging from within health organizations to across multiple government agencies.

© Ocean Informatics 2009

Microsoft Connected Health Framework

Growing academic interest around the world

© Ocean Informatics 2009

Sintero Project• £1.1m Wellcome Trust• openEHR as the basis of the core

clinical repository• CDA → openEHR• Aim: semantically aggregating data from

multiple sources, and making it amenable to research querying and inferencing. → Longitudinal patient histories to be reconstructed from heterogeneous systems, which can the be mined for outcomes studies and patient risks.

• CKM archetypes

Clinical Knowledge Manager

http://www.openehr.org/knowledge

Collaboration: IHTSDO & openEHR

• September 15, 2009• IHTSDO and openEHR begin

Collaborative Work Programme• Explore how clinical terminologies and

archetype-based record structures can best be aligned to support electronic health records.

• How best to support those who wish to use openEHR archetypes and SNOMED CT terminology together within current and future systems to support data capture, complex queries, clinical decision support and reporting.

Japan: 8th Medical Open Source Software Seminar (MOSS8) in

Tokyo, Oct 31 2009• Organized by: Medical Open Source Software Council

in Japan• Program

– 3) The openEHR project• a) Introduction of the openEHR project

(Sadahiko KANO, Waseda University)• b) openEHR.jp activity (Shinji

KOBAYASHI, Ehime University)– 4) Application of openEHR system to

Tuberculosis program in Cambodian public health sector, （ Waseda university, Saran Kong ）

– 5) openEHR as a new approach to electronic health record system in Cambodia maternity care program (Waseda university, Hok Kakada)

– 6) Ruby implementation of ADL parser (Akimichi Tatsukawa, Narimasu Kousei hospital)

– ...

OSHIP gets CLIPS decision support engine

• The Open Source Health Information Platform (OSHIP) has integrated the “gold standard” forward chaining inference engine CLIPS in order to support complex decision support requirements.

• Based on the Python reference implementation of the openEHR specifications

– adding proven open source components to provide a web services based development base for any type of healthcare application.

Sweden

• Sveriges Kommuner ock Landsting (Swedish Association of Local Authorities and Regions)

• Adoption of openEHR 2009. The Swedish government has decided on the use of ISO 13606 as a base standard for national health data communication. openEHR will be used to define clinical models, terminology integration, and to implement 13606 in some contexts.

Sweden

• Swedish eHealth approach: will focus on EN13606 & openEHR for semantic interoperability & standardization of clinical data (Sep 30, 2009)

• Sweden promoting openEHR and ISO 13606 at a national presentation: 40 people from 11 countries came

• CKM instance• OceanEHR EHR test lab• OTS – Ocean terminology service• Currently “producing” archetypes &

templates

Australia

• NeHTA (National e-Health Transition Authority)– Clinical data groups based on openEHR

methodology. Investigation of transformation from openEHR to CDA in progress.

• Queensland Health– An openEHR-based repository has been running

at Qld Health for about 3 years, managing discharge summaries.

• Victoria Health, Department of Health Services– Various projects including the state cancer

registry are using or will use openEHR.• Cancer Council of Victoria (CCV)

– Scientific database integrating many proprietary databases, semantic querying

• SA HealthConnect• Stat Health, McCauley• RCPA – cancer pathology

UK• National Health Service (NHS),

Connecting for Health (CFH)• The NHS has developed and used

openEHR archetypes and templates as a formal way of capturing clinical content requirements. In a pilot in Q1&2 2007, around 220 archetypes and 40 templates were developed in the maternity and emergency department (ED) specialties. By end 2008, the number of archetypes was around 1000.

• Richard Kavanagh: Got my first idea for a #googlewave robot for use with #openEHR, just need to get a #sandpit account and learn #python. (the easy bit)

Singapore

• Ministry of Health• Adoption of openEHR 2009 for clinical

modelling, terminology.• CKM instance, ...

US

• US: College of Neurologists - content modelling

US: College of Rheumatologists - content modelling

• Histopathology models Cancer Institute

NZ

• Working to develop an openEHR based endoscopy reporting application with C# in .Net environment.

Netherlands

• TNO (national research agency)TNO is using openEHR archetypes and

templates in a diabetic management project. A number of companies are evaluating the approach with a view to implementation.

Denmark

• Connected Digital Health in Denmark• National proof-of-concept project.

• Various Danish regions

• Evaluation of archetype methodology in progress 2008/9

• Knut BERNSTEIN et al: Can openEHR Archetypes Be Used in a National Context? The Danish Archetype Proof-of-Concept Project http://www.hst.aau.dk/~ska/MIE2009/papers/MIE2009p0147.pdf

Brazil

• ISO Health Summit: ISO TC 215, Durham, NC

• Jussara Rötzsch, General Manager of Health Information Exchange and Standards at ANS (National Agency for Supplementary Health, Brazil

• presents the Brazilian approach to healthIT - Committed to openEHR Reference Model

• “The IHTSDO (SNOMED-CT) and the OpenEHR Foundation signed an agreement ! Shows the correctness of the project e-health of the Brazilian government”

Brasil

Ministry of Health / various govt agencies, Brazilian Agency for Supplementary Health, State University of Rio de Janeiro

Health Informatics companies are learning and developing archetype-based systems, as they reckon the value of archetypes for representing health knowledge. Also, some of the Brazilian Government Agencies intend to embody archetypes as part of their technological arsenal, as is the case of the Brazilian Supplementary Health Agency (ANS), responsible for regulating the Health Plan market. The Brazilian Agency for Supplementary Health (ANS) established a national standard to support the exchange of information among health providers and health care insurance companies. This standard, called (TISS in portuguese), was conceived as a traditional message exchange standard. This project aims at designing archetypes that could be used to carry all information represented in TISS. It also aims at implementing a prototype software that will use openEHR reference model to exchange TISS information. This proof of concept will show an alternative way of implementing TISS that could be more effective in dealing with the standard evolution.

Commercially

Sweden commercially / academic• Archetype-based conversion of EHR content models: pilot

experience with a regional EHR system• Study designed to investigate the feasibility of representing

EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format.

– Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved.

– Archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC

• “The openEHR RM and AM are expressive enough to represent the existing clinical content models [...] and legacy content models can automatically be converted to archetype format for sharing of knowledge.”

• “Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.”

Rong Chen, Gunnar Klein, Erik Sundvall, Daniel Karlsson, Hans Ahlfeldt, BMC Medical Informatics and Decision Making 2009, 9:33

© Ocean Informatics 2009

Uptake & interest in openEHR

Qld Health RepositorySA HealthConnectCancer Council of Victoria (CCV)DHS (Vic)Stat Health, McCauleyNEHTARCPA – cancer pathology

JP: openEHR siteISO Standards

SG: openEHR based content modelling

ZA: Two companies working to provide a national solution

BR: National private health coordination using openEHRCL: openEHR site

National program involving openEHR

SE: Cambio + National trial of openEHR

DK: National pilot

CfH: Clinical content modelling

CA: Pilot EHR project considering openEHR

Slovenia: Vendor / national interestUK: “Sintero” –

Wellcome-fundedresearch data repository

SCO: considering openEHR

NL: Vendor using full openEHR back-end

US: College of Rhematologists –

content modelling

US: College of Neurologists - content modelling

Other

• Ogi Pishev heading off to Moscow - invited by Microsoft to speak on openEHR and Ocean's activities

• Busy with openEHR technical & clinical modeling training for vendors - last week in eastern Europe, this week New Zealand

• eHealth Day at Java, Enterprise Architectures & SOA conference, Nov 11, Munich

Opereffa

• Opereffa - a reference application for openEHR - initial release

• openEHR REFerence Framework and Application

© Ocean Informatics 2009

CKM Benutzer

Wie viele Archetypen brauchen wir?~50 Archetypen für den Kern an klinischem Inhalt

~1500-2000 um den größten Teil einer EHR abbilden zu können

Benutzer pro Land

... ...

Templates in CKM