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OpenEHR The Reference Model Thomas Beale Sam Heard.

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Presentation on theme: "OpenEHR The Reference Model Thomas Beale Sam Heard."— Presentation transcript:

1 openEHR The Reference Model Thomas Beale Sam Heard

2 © 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 Snomed CT ICDx ICPC

3 © Ocean Informatics 2008 Specification Map Archetype Query LanguageTerminology Subset Syntax

4 © Ocean Informatics 2008 Reference Model – Class model overview

5 © Ocean Informatics 2008 The reference model – Structure of one EHR All versioned

6 © Ocean Informatics 2008 Structure of one Composition ENTRYs – where the data are

7 © Ocean Informatics 2008 Context Model in openEHR

8 © Ocean Informatics 2008 Time in openEHR

9 © Ocean Informatics 2008 Time in openEHR

10 © Ocean Informatics 2008 Time in openEHR

11 © Ocean Informatics 2008 Security Features Separation

12 © Ocean Informatics 2008 Entries – the clinical information

13 © Ocean Informatics 2008 Entry types Archetype Query LanguageTerminology Subset Syntax

14 © Ocean Informatics 2008 Entry types based on process This process is cyclic & repetitive Clinicians don’t always document every step investigator Investigator agents

15 © Ocean Informatics 2008 History of Solutions GeHR Australia – early version of Entry types based on information categories in philosophy + problem-solving

16 © Ocean Informatics 2008 History of Solutions – Danish G-EPJ

17 © Ocean Informatics 2008 History of Solutions - Samba

18 © 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

19 © Ocean Informatics 2008 Our approach – ‘Clinical Investigator’ Based on clinical process MedInfo 2007 paper

20 © Ocean Informatics 2008 Entry types based on process This process is cyclic & repetitive Clinicians don’t always document every step investigator Investigator agents

21 © Ocean Informatics 2008 Leading to an Ontology OBSERVATION ACTION EVALUATION INSTRUCTION ADMIN_ENTRY

22 © Ocean Informatics 2008 (with a speculative part for Admin)

23 © Ocean Informatics 2008

24 Specification Map Archetype Query LanguageTerminology Subset Syntax

25 © Ocean Informatics 2008 RM data types & structures

26 © Ocean Informatics 2008 data_structures

27 © Ocean Informatics 2008 data_structures.item_structure

28 © Ocean Informatics 2008 item_structure.representation

29 © Ocean Informatics 2008 data_structures.history

30 © Ocean Informatics 2008 History – Basic Structure

31 © Ocean Informatics 2008 History - Variations

32 © Ocean Informatics 2008 History – Storing Device Data Efficiently 14,400 x 1 second samples from device 5 x Events in openEHR History

33 © Ocean Informatics 2008 Math Functions

34 © Ocean Informatics 2008 Glucose Tolerance Test

35 © Ocean Informatics 2008 Versioning

36 © Ocean Informatics 2008 Specification Map Archetype Query LanguageTerminology Subset Syntax

37 © 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

38 © 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

39 © Ocean Informatics 2008 User ASystemUser B Conflicts & Merging – One System v1 commit v2 v1b v1a commit? v2a merge v3 commit

40 © Ocean Informatics 2008 Sys B Synchronisation Problems Sys A v1 v2 v3 Sys C v1 Do we have the latest? Are we getting Duplicates? Solutions: designated master repository from which to update reliable, global version identification scheme

41 © 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

42 © Ocean Informatics 2008 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


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