1. 1 A Standards-based Approach to Development of Clinical Registries - NZ Gestational Diabetes Registry Pilot Dr. Koray Atalag MD, PhD, FACHI (National Institute for Health Innovation) Aleksandar Zivaljevic, PhD candidate (Univ. Of Auckland) Dr. Carl Eagleton MBChB, FRACP (Counties Manukau District Health Board) Karen Pickering (Diabetes Projects Trust)

2. Aims of the Registry  100% successful screening of women for type 2 diabetes (T2DM) within 3 months after a pregnancy with GDM  Annual screening of all women for new onset T2DM  Early warning to healthcare providers (GPs, Maori/Pacific Health, others) about GDM history in subsequent pregnancies

3. GDM Registry Pathway Entry Referral from primary care with a diagnosis of GDM Education Attendance at Group Session Registry information supplied Consent Attendance at DiP Clinic Consent obtained and entry into the registry Postpartum 6 week OGTT request or 3 month HbA1c GP & Patient advised of results Annual Annual HbA1c with copy to primary care GP & Patient advised of results Next time Positive pregnancy test detected in Testsafe Requesting healthcare provider advised of Diabetes history by the Registry Registry Directed

4. 4 GDM Registry Development Used OceanEHR Framework –Academic license from Ocean Informatics –Simplifies persistence and querying plus more! –Supports openEHR Demographic IM –Supports AQL Extended MultiPrac App (Source provided on academic license) –MVC Application (VS 2010 w/ SQL Server) –Handles user management, basic admin etc. –Supports reference sets, provider/organisation etc. 4

5. 5 The Dataset

6. 6 openEHR Template

7. 7 Automatic code generation – C# Class

8. Further Development Model-View-Controller (MVC) –Model  openEHR > C# –View  written in html / forms –Controller  written bindings and business rules Front-end (Javascript / Angular JS) Back-end: OceanEHR & MultiPrac Extended Demographics –Added patient’s GP, LMC and Obstetrician –Added Provider organisation 8

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11. Interventions Search due tests Automatic annual screening Send SMS to patients & providers for due tests 11

12. Evidence: Software Maintainability using openEHR 12 Atalag K, Yang HY, Tempero E, Warren JR. Evaluation of software maintainability with openEHR – a comparison of architectures. International Journal of Medical Informatics. 2014 Nov;83(11):849–59. VB6 / Access Same Function & GUI

13. Conclusions Using an openEHR framework makes implementation a heck of a lot easier! Demographics model is challenging Identifiers can be confusing Getting data out is difficult –Unit of openEHR committal is Compositions –Need Extract model to come to life There’s really no real incentive to use standards We need scientific evidence that proposed benefits are realised 13