Abstract
BackgroundThe openEHR approach can improve the interoperability of electronic health record (EHR) through two-level modeling. Developing archetypes for the complete EHR dataset is essential for implementing a large-scale interoperable EHR system with the openEHR approach. Although the openEHR approach has been applied in different domains, the feasibility of archetyping a complete EHR dataset in a hospital has not been reported in academic literature, especially in a country where using openEHR is still in its infancy stage, like China. This paper presents a case study of modeling an EHR in China aiming to investigate the feasibility and challenges of archetyping a complete EHR dataset with the openEHR approach.MethodsWe proposed an archetype modeling method including an iterative process of collecting requirements, normalizing data elements, organizing concepts, searching corresponding archetypes, editing archetypes and reviewing archetypes. Two representative EHR systems from Chinese vendors and the existing Chinese EHR standards have been used as resources to identify the requirements of EHR in China, and a case study of modeling EHR in China has been conducted. Based on the models developed in this case study, we have implemented a clinical data repository (CDR) to verify the feasibility of modeling EHR with archetypes.ResultsSixty four archetypes were developed to represent all requirements of a complete EHR dataset. 59 (91%) archetypes could be found in Clinical Knowledge Manager (CKM), of which 35 could be reused directly without change, and 23 required further development including two revisions, two new versions, 18 extensions and one specialization. Meanwhile, 6 (9%) archetypes were newly developed. The legacy data of the EHR system in hospitals could be integrated into the CDR developed with these archetypes successfully.ConclusionsThe existing archetypes in CKM can faithfully represent most of the EHR requirements in China except customizations for local hospital management. This case study verified the feasibility of modeling EHR with the openEHR approach and identified the fact that the challenges such as localization, tool support, and an agile publishing process still exist for a broader application of the openEHR approach.
Highlights
The openEHR approach can improve the interoperability of electronic health record (EHR) through two-level modeling
Leslie, and Bakke et al introduced the principles and constraints of archetype modeling [30,31,32]; Madsen et al described the iterative process of archetype modeling [33] ; Buck, Spath, and Braun et al explained the detailed steps of converting existing information requirements into archeytpes [13, 18, 24]
The archetype modeling method a b c d. These EHR archetypes have been uploaded to the Healthcare Modeling Collaboration (HMC) [42] that has a governance model to facilitate other hospitals to reuse the same archetypes in China
Summary
The openEHR approach can improve the interoperability of electronic health record (EHR) through two-level modeling. Developing archetypes for the complete EHR dataset is essential for implementing a large-scale interoperable EHR system with the openEHR approach. This paper presents a case study of modeling an EHR in China aiming to investigate the feasibility and challenges of archetyping a complete EHR dataset with the openEHR approach. The openEHR divides models into two levels (two-level modeling): the archetype model (AM) and the reference model (RM) It enables the semantic interoperability and data sharing of EHRs, which differentiates. Archetypes are the formal and semantic artifacts that facilitate collecting, storing, retrieving, representing, communicating and analyzing clinical data, which can be modeled by clinical professionals and health informatics experts by constraining RM.
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