Abstract
BackgroundExchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was 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.MethodsThe openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates.ResultsAutomated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats.ConclusionThe openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.
Highlights
Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge
We believe that even before this long term goal of EHR content exchange can be achieved there are several advantages of having clinical content models expressed as archetypes instead of completely proprietary formats: http://www.biomedcentral.com/1472-6947/9/33
The result of this study shows that clinical content models from an existing EHR product with a large installed base covering both primary care and specialist hospital care can be consistently represented as archetypes
Summary
Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. The two-level modelling paradigm using a standard reference model and archetypes [1] defining specific clinical content models has been developed by the openEHR foundation [2] and standardized by CEN and ISO in the EN/ISO 13606 standard series [3] This approach to standards and interoperability recognizes that there is a need and possibility for general agreement on the basic structure and structural elements of an EHR (the Reference Model). It acknowledges that there is a need for various clinical expert groups to agree on specific data sets for different purposes which must be easy to amend as new requirements emerge This can be achieved using the archetype structures which act as description of a building block of instantiated record information. Only limited experience has been reported on exchange of clinical information between different systems that are based on the new paradigm [4]
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