Page Comparison

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• Theoretical approaches
  o 1968: Weed's POMR defined a problem/SOAP model of clinical information ref #Weed1968
  o 1978: Elstein described a hypothetico-deductive model of clinical reasoning (mainly diagnosis) ref #Elstein1978
  o 1992: Rector, Nowlan and Kay described an approach in which EHR information included (paraphrasing) 'what can be said, thought and done for the patient' ref #Rector1991
  o 1994: GEHR (Good European Health Record) an EU-funded project that developed requirements for an EHR and an information model ref #Ingram1995
  o 2003: Tange et al proposed a synthesis of the POMR, Elstein and 'conversation for action;' theory ref #Tange2003
• Practical approaches:
  o 1998- : the Danish G-EPJ ('EPJ' = 'EHR'), which described a cycle very similar to the one used in openEHR ref #Bruun2005
  o 2001-3: the Australian GeHR (Good electronic Health Record) project, an approach that introduced formal 'archetypes' ref #Beale2000
  o 2005- : the Swedish Samba project distinguished 3 kinds of interlinked process: clinical, management and communication ref #Areblad2005
• Act-based approaches:
  o 1992: RICHE consortium devised a method of representing health information in terms of acts carried out in the care delivery process ref #Riche1992
  o 1993- : The HL7v3 RIM (reference information model) is a current approach that attempts to represent health information as acts. ref #hl7org
• Medical terminologies: all medical terminologies with any structure whatever are ontologies of some kind, whether they think they are or not, including:
  o MeSH
  o ICDx
  o Read codes
  o SNOMED CT
  o LOINC
  o and many others

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• The NCBO (National Centre for Biomedical Ontology) OCI - the ontology of clinical investigation home page; visual schematic;
• The OBO - Open Biomedical Ontologies home page; the OBO Foundry (where the actual ontologies are); most of these appear to be 'ontologies of reality', although the following ones seem to be about information:
  o Ontology for biomedical investigations (OBI)
  o Evidence codes
• The Basic Formal Ontology (BFO) home page (an ontology of reality), incorporating:
  o SNAP, an ontology of substantial entities, tropes (their qualities and functions) and spatial regions
  o SPAN, an ontology of process, temporal and spatio-temporal regions
  o The paper "Biodynamic Ontology: Applying BFO in the Biomedical Domain" by Grenon, Smith and Goldberg is a good introduction to BFO in the biomedical domain. ref #Grenon2004

What parts of openEHR have Ontological Relevance?

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The openEHR Reference Model defines many classes, but the part of the model of most ontological interest is the 'Entry' part, which is formally specified in the openEHR EHR Information Model; it can also be seen online as detailed UML. A summarised UML form of the Entry types in openEHR is illustrated below.

The openEHR Entry model has an ontological design which is described in a forthcoming MedInfo 2007 paper (in-press copies are available on request). We can summarise the approach with the following three diagrams. The first is a model of process (shown in two ways); the second shows a cycle of information creation due to the process, and the last shows the information ontology developed in openEHR for recorded clinical information.|

The explanation of the ontology behind the openEHR Entry model is in a forthcoming paper by Beale and Heard ref. The following 3 diagrams show in a summarised way the ontological underpinning of the openEHR Entry model the way it is today. The first is a model of process, the second a model of information creation due to this process, and the third an ontology of information.

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To be continued

References

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, K. Kuhn et al. (Eds), IOS Publishing 2007.