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Pablo Pazos Gutierrez^a, Koray Atalag^b, Luis Marco-Ruiz^c ... (please add your name here)

^a openEHR en español, Asociación Chilena de Informática en Salud, CaboLabs , ^bUniversity of Auckland and openEHR New Zealand...., ^cNorwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Norway (please add your affiliation here),...^d

Abstract and Objective

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Databases for Clinical Information Systems are difficult to design and implement, especially when the design involves the implementation of a formal specification or standard. The openEHR specifications offer a very

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expressve an generic model for clinical data structures, allowing semantic interoperability and compatibility with other standards like HL7 CDA, FHIR, and ASTM CCR. Software Developers

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find a great complexity in designing openEHR compliant databases since the specifications do not include any guidelines in that area. This tutorial will expose different requirements, design principles, technologies and techniques that can be used to tackle that problem

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Keywords:

EHR; Clinical Database Design; openEHR; Clinical Information Systems; EHR.

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• The main goal is to shorten the gap between the openEHR specifications and database design , implementation and populationand implementation for software developers.
• Secondary goals include: share experiences and lessons learned, enabling discussion about Clinical Database implementation (a topic that is not discussed or taught often enough), and spreading the use of standards at the database level on Clinical Information System development.

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• Clinical Database requirements that are derived from EHR/EMR requirements and Clinical Documentation standards requirements (ISO 18308, CEN/ISO 13606, openEHR, HL7 CDA, ASTM CCR)
• Review of the core concepts of the openEHR specification, focusing on the ones that will affect the Clinical Database Design (e.g. EHR, Folder, Composition, Section, Entry, DataStructure, ItemStructure and DataValue).
• Implementation methodologies, techniques, good practices and experiences for different types of databases (relational, document-oriented, key/value).
• Considerations about clinical data validation, storage, versioning, indexing and querying.Data Warehouse design with OpenEHR: extraction, transformation, load and reuse of clinical data

2. The workshop structure and arguments

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• Requirements
  • EHR purposes from ISO 18308 that guide to different uses of data in healthcare:
    • Transactional
    • Aggregated data
    • Charting
    • Reporting
    • Analysis
    • Research
    • Education
    • Medico-legal proof
  • Clinical records organization and main entities (based on EHRA from ISO 18308)
    • Concepts modeled by different standards like HL7, openEHR and CEN/ISO 13606.
    • Clinical information hierarchy
• openEHR Information Model core concepts, Archetypes and Operational Templates
  • Structure, content definition, ways of implementation at a database level.
  • Discussion about difficult areas of implementing openEHR-based clnical databases, opinions from developers.
    • The need of openEHR metadata in the database alongside with data.
• Implementation technologies
  • Different database models to fufill different kinds of requirement: relational, document-oriented, key/value.
  • Relational model techniques
    • Object-Relational Mapping
    • Schema auto-generation from archetypes
    • High level data indexing
    • Pros and cons of the relational model for clinical databases
  • General concepts about document-oriented approach, storing and querying for openEHR clinical documents.
    • XML and JSON databases.
    • openEHR in XML and JSON.
    • Querying mechanisms.
    • Pros and cons of the document-oriented approach for clinical databases.
  • General concepts about key/value approach, storing and querying for openEHR clinical data.
    • openEHR Archetype/Template paths and instance paths.
    • Pros and cons of the key/value approach.
• Clinical databases and information management summary:
  • Data validation
  • Data storage
  • Data versioning (an openEHR requirement, mentioned in ISO 18308, and supported by HL7 CDA documents)
  • Data indexing
  • Data querying
  OpenEHR Data Warehouses: Modeling, Extraction, Transformation and Load.
• Practical experience and conclusion.
  • Brief discussion about requirements, approaches and techniques.

Workshop speakers

• Pablo Pazos; openEHR en español, ACHISA, CaboLabs; Uruguay
• Koray Atalag, openEHR New Zealand, University of Auckland, New ZealandLuis Marco-Ruiz; Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Norway
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Resources

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