openehr: a healthcare computing platform for the future · ehr extract virtual ehr archetype om...
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Thomas Beale CTO, Ocean Informatics
Copyright 2012 Ocean Informatics
Forum 2013 Tromsø
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Copyright 2012 Ocean Informatics
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Why can’t existing systems keep up with changing requirements?
Why do we REPLACE clinical information systems every few years?
Why are clinical users usually left out of system design?
Copyright 2012 Ocean Informatics
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Most current (clinical) information systems are not adaptive
Their capabilities diverge continually from needs
Copyright 2012 Ocean Informatics
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Cost of new system O(€10 - 200m) Costs of retraining Costs of data migration ◦ Cost of data loss ◦ Cost of data migration errors
Copyright 2012 Ocean Informatics
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Docs create secret departmental Access DBs Other ‘peripheral’ systems added to
compensate Free-text soaks up more content User frustration
Copyright 2012 Ocean Informatics
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System doesn’t do what they want Users develop ‘workarounds’
Copyright 2012 Ocean Informatics
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Why is there no decision support industry in health?
Why do computerised clinical guidelines remain a largely academic activity?
Copyright 2012 Ocean Informatics
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No standard way to talk to the EHR No standard way to query the EHR
Copyright 2012 Ocean Informatics
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500 clinical guidelines Average of 5 queries each, some complex ◦ e.g. find any BP over 160 not related to exercise
Average of 8h professional work to design & validate a query
500 x 5 x 8h = 20,000h = 8 person years OK if we do it once... Not OK if we do it for each vendor product And that’s assuming standard EHR data!
Copyright 2012 Ocean Informatics
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A semantic architecture designed to flexibly standardise: ◦ Data, Content structures, Terminology use, APIs
Content developed by clinicians Build adaptive systems – software not
dependent on content models Make querying based on content, not physical
databases
Copyright 2013 Ocean Informatics
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A Services-oriented Architecture (SOA) designed to standardise how applications talk to systems ◦ APIs
And how systems talk to each other ◦ EHR Extracts ◦ Generated message schemas ◦ Generated document schemas
Copyright 2013 Ocean Informatics
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Data Structures
Data Types
DemographicEHR
Security
EHR Extract
virtual EHR
Archetype OM
Support (identifiers, terminology acce ss)
AM
RM
SMEHR
servicearchetype
servicedemographic
serviceterminology
service
{core
Common{patterns
{domain{ }Integration
Composition openEHR Archetype Profile
Template OM
Concrete: GUI, messages, documents
Use-case specific data sets - Templates
Data Representation and sharing - Reference Model
Theme-based models of content – Archetypes (library of content definitions)
Querying
Terminology Interface
Discharge summary UI form
Discharge summary content model
HbA1C, phys. exam, meds list, vital signs etc
Observation, Quantity, coded text etc
Copyright 2013 Ocean Informatics
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The cognitive User interface: Different ways of Presenting & Capturing the Same information
Logical data-sets: Achieved by templates That re-use and Organise underlying Standardised data Points according to Business process event
Copyright 2012 Ocean Informatics
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Logical data sets: Templates – using Selected items from a Number of archetypes
Standardised models of The data: Achieved by archetypes Organised by topic, Independent of use
Copyright 2012 Ocean Informatics
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Standardised clinical models of the data: Archetypes – all based On same reference model
Data Structures
Data Types
DemographicEHR
Security
EHR Extract
virtual EHR
Archetype OM
Support (identifiers, terminology acce ss)
AM
RM
SMEHR
servicearchetype
servicedemographic
serviceterminology
service
{core
Common{patterns
{domain{ }Integration
Composition openEHR Archetype Profile
Template OM
Standardised technical representation of the data: The reference model – Enables interoperability
Copyright 2012 Ocean Informatics
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They have a form-builder
Possibly a library of ‘elements’
Data Structures
Data Types
DemographicEHR
Security
EHR Extract
virtual EHR
Archetype OM
Support (identifiers, terminology acce ss)
AM
RM
SMEHR
servicearchetype
servicedemographic
serviceterminology
service
{core
Common{patterns
{domain{ }Integration
Composition openEHR Archetype Profile
Template OM And a proprietary database
And only SQL, against The proprietary database
Copyright 2012 Ocean Informatics
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Copyright 2012 Ocean Informatics
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Copyright 2012 Ocean Informatics
Terminology
Reference Model
Bindings
Ref Sets
Archetypes Templates
Queries
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Copyright 2012 Ocean Informatics
Terminology
Reference Model
Bindings
Ref Sets
Archetypes Templates
Queries
Operational Template
Java API
C# API
XSD
Forms
Message Def
Document Def
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We generate ‘normal’ downstream artefacts ◦ XSDs, facade classes, HTML, GUI XML
These can be used by typical developers
The data they create can always be converted
back to canonical form
Copyright 2012 Ocean Informatics
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your CKM
remote CKM
Reusable archetypes
sets
Terminology
ref
Template Operational
Template
TDS (XSD)
TDO (C#)
HTML
etc
Downstream artefacts
Tran
sfor
m E
ngin
e
Archetypes
re-used
changed
new
changed
Related documentation
Dissemination
TDS
Release set International clinical modelling... It could be you!
National clinical modelling... It could be you!
Standard templates modelling... Government / clinical / DIPS?
Vendor/solution implementation... E.g. DIPS
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Copyright 2012 Ocean Informatics
Deployed system consumes new content definitions ... forever
Forms and messages formally based on content models
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Copyright 2012 Ocean Informatics
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You only put data in once... You get it out a hundred times, in a dozen
different ways
huge economic value in the data
querying matters...
Copyright 2012 Ocean Informatics
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Portable query mentioning ‘data/consulting doctor/last name’
Vs SQL query based on physical schema or view table – each DB is different!
Relational database
Object database
OQL query based on physical object storage model
Archetype +
Terminology
Copyright 2012 Ocean Informatics
Query based on content models
Query based on storage model
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Copyright 2012 Ocean Informatics
Not to be confused with: Logical / Physical levels of relational modelling... These are ALL models of storage
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It means the need for a query interpreter to process portable queries, performing any necessary conversions between the logical information model form and the physical storage form
Copyright 2012 Ocean Informatics
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SQL query based on physical schema + object in-memory data access
Relational database
Physical
Portable query based on content model
Archetypes +
Terminology Logical
Copyright 2012 Ocean Informatics
Query Interpreter
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Currently, there are ~no portable queries in health, nor in most other industries
Preventing any meaningful business analytics or decision support industry
Why? Because BI, CDS etc queries are complex and expensive to design. Having to replicate the work for each site database and/or vendor proprietary database is not economically feasible
Copyright 2012 Ocean Informatics
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It should not matter if the patient BP was captured in a GP visit, via a nurse form used in a hospital, or at home – a longitudinal query for BPs should return all the results
Copyright 2012 Ocean Informatics
BP = 120/80
HIS ED screen GP app
BP = 170/108
Specialist app
BP = 140/95
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Copyright 2012 Ocean Informatics
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Get the number of patients with diabetes who have HbA1c results greater than 7.0 in last 12 months.
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Copyright 2012 Ocean Informatics
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Copyright 2012 Ocean Informatics
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SELECT COUNT(e/ehr_id) FROM EHR e
CONTAINS (COMPOSITION probs [openEHR-EHR-COMPOSITION.problem_list.v1]
CONTAINS EVALUATION dx [openEHR-EHR-EVALUATION.problem-diagnosis.v1] AND COMPOSITION lab_rpt [openEHR-EHR-COMPOSITION.report.v1]
CONTAINS OBSERVATION hba1c [openEHR-EHR-OBSERVATION.lab_test-hba1c.v1]) WHERE
dx/data/items[at0002.1]/value/defining_code/code_string matches {terminology:SNOMEDCT?refset_id=1234567} AND lab_rpt /context/other_context/items[at0006]/items[at0013]/value > current-date() - P1Y AND hba1c /data/events[at0002]/data/items[at0013.1]/value/numerator > 7
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This query is based solely on the information model and the content models....
No knowledge of the physical persistence, which can differ across vendors and even single vendor in different locations.
Copyright 2012 Ocean Informatics
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Copyright 2012 Ocean Informatics
Did you hear the one about a Russian, a Brazilian and a cat
who walk into a bar... Zzz
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Copyright 2012 Ocean Informatics
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Copyright 2012 Ocean Informatics
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A standard logical information model, describing basic data types and structural relations ◦ On which quality software can be based
Ability to build trustworthy, open content models
Reliable, known use of terminology Language in which to write portable queries
Copyright 2012 Ocean Informatics
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There is growing acceptance of standardised content-modelling in health using archetypes ◦ CIMI taskforce, led by Dr Stan Huff (Intermountain) ◦ openEHR.org archetypes ◦ Other national programmes ◦ New OMG Archetype Modelling Language (AML) RfP ◦ VA’s Model-driven Health Tools (MDHT) now
moving to incorporate archetype semantics
Copyright 2012 Ocean Informatics
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Australia New Zealand UK now starting to use archetypes again Moscow health
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DIPS will be formally involved in openEHR Foundation as a vendor
Norwegian clinical modelling is already happening ◦ Get involved in international effort ◦ Share your models ◦ Some leadership probably needed going forward
Various academic efforts
The future is very exciting
Copyright 2013 Ocean Informatics