openEHR Clinical modelling workshop
Silje Ljosland Bakke a, Ian McNicoll b,c, Hildegard Franke d
a Nasjonal IKT HF,
b openEHR Foundation,
c CHIME UCL,
d freshEHR Clinical Informatics Ltd.
Abstract. openEHR is an open specification for the a health information model required , architected to underpin an open digital care record platform. A key feature in of the openEHR architecture is to enable the direct , collaborative involvement of clinicians in the design, review, curation and governance of open source clinical content definitions ‘archetypes’, which are made freely available under an open-source licence. This workshop will discuss the implications basis of this evolutionary novel approach to shared clinical content development based on international, national and vendor-level experience as a means of maximizing benefit within a highly dynamic, culturally-mediated complex system.
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, examine some examples of real-world openEHR modelling projects and conclude with a ‘live’ modelling exercise involving workshop participants
Keywords. openEHR, archetype, clinical content, interoperability, platform, open source
1. Introduction
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The complexity of healthcare processes and data continues to present a significant challenge to international, national organisations and to healthcare systems implementers as they try to apply the levels of digitisation that have been transformative in countless other sectors from finance to leisure and most recently to taxi hire.
The ‘apps revolution’ in health has seen an explosion of disconnected and siloed mobile apps, if anything worsening the challenge of delivering ‘connected health’, and the international e-health market is largely contracting into the hands of the shrinking number of large health IT vendors able to cope with the complexity of health data implementation and ever-expanding clinical and legislative demands.
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Decades of top-down international standards developments have, in general, had limited impact, and while newer
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, developer-focused technologies1 hold promise for interfacing between systems, they
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are not architected to support a new ‘open platform’ approach capable of delivering complex clinical data requirements for large-scale patient record systems.
openEHR2, an open-source specification for a health information model, draws heavily from distributed open source development methodology in attempting to maximise the implementation of high-quality clinical content models, whilst supporting the competing need to reflect local requirements and innovation.
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openEHR is both ‘cathedral and bazaar’ in Raymond’s4 terms. A carefully controlled and slowly developing core ‘cathedral’ information model underpins technical implementation but is designed to consume arbitrary clinical concept models designed and developed by a set of collaborating clinical communities operating rather more as ‘bazaar’, as a means of maximizing value within the highly complex and diverse domain of healthcare documentation.
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It defines the architecture needed both to develop computable clinical content models3 and the requirements of back-end systems to consume and use those models directly without re-engineering.
openEHR content development anticipates evolutionary development4, with speciation and ‘forking’ of assets. It
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understands that local, national
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5 and international6 perspectives to have to be supported, and that
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short-term imperatives will
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trump longer-term aspirations
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7.
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Despite such challenges, steady progress is being made in the delivery of high-quality, open-source and freely available content models, largely due to considerable voluntary commitment from the openEHR community with
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openEHR vendor support.
2. Workshop
2.1. Workshop
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Speakers
- Silje Ljosland Bakke, RN BSN, Nasjonal IKT HF, Bergen, Norway
- Ian McNicoll, MSc, MbChB, openEHR, CHIME UCL, London, UK
- Hildegard Franke, BA (Psych), MBA, freshEHR Clinical Informatics Ltd., Kettering, UK
2.2. Workshop structure
Three short presentations will be followed by a practical modelling session.
2.3. Introduction to openEHR and openEHR clinical modelling
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(Ian McNicoll)
openEHR is an open-source specification for a clinical information model with a specific aim of enabling the direct design input and quality assurance of detailed clinical models via the use of 'archetypes' and 'templates' These models can be consumed immediately in openEHR-compliant systems and used to define persistence and querying schema without any need for re-engineering but are also used as part of national and international standardisation efforts to help define the detailed clinical content of interfaces and messages.
The openEHR clinical modelling approach, and associated tooling, has evolved with experience but remains true to it's its open-source philosophy, with a focus on collaborative and distributed governance.
2.4. International and national perspectives: managing international clinical modelling collaboration and governing national clinical model standardisation (Silje Ljosland Bakke)
The collaborative and largely voluntary development of a library of open source clinical content models ‘archetypes’ is one of the core programs of openEHR. The clinical program is built on clinical informatics leadership and clinical assurance/review from using web-based tools and broad, democratized clinical input. We will give a a background to the chosen approach and highlight the practical implications, touching on both successes and challenges.
Norway's situation is unusual in that it has both an active community of openEHR vendors, a national clinical modelling program, and an aspiration to reuse international models where possible. This leads to both opportunities and challenges, especially related to combining national and international governance, and doing modelling as fast as implementers require. We will present methods, experiences and progress.
2.5. Managing the diversity of operational and research requirements in a real life project (Hildegard Franke)
NHS Genomics Medicine Centres in the UK face the diverse
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requirements of creating and managing a rich dataset
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for the
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primary purpose of
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creating standardised reports for research and population analysis of clinical phenotypic data. There is a desire to reduce the need for data entry by drawing on day-to-day operational data from a variety of sources.
We will present the methodology for managing and attempting to reconcile this diversity and report on progress to
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date working with one of the Genomics Medicine Centres.
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2.6. Practical modelling
The openEHR clinical modelling methodology has evolved over more than a decade, and has adopted several thought processes, methods and tools over the years. We will demonstrate the initial steps of modelling a
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commonly relatable clinical concept, where all workshop participants are encouraged to participate, and introduce questions and reflections from their experience.
3. Target audience
This session is directed at students, clinicians, clinical informaticians and system implementers who are interested in the clinical modelling methodologies used by the openEHR community, and how these are reflected in clinical requirements gathering/ clinical content development/governance at implementer, national and international levels.
4. Educational goals
Participants will gain a better understanding of the philosophical / methodological background to the openEHR approach and how this has been carried through to relate to real-world clinical modelling challenges and experience, with learning applicable to other related projects beyond those interested in a pure-openEHR approach.
5. References
[1] HL7 HL7 Fast Healthcare Interoperability Resources, https://www.hl7.org/fhir [Accessed December 8, 2016]
[2] openEHR openEHR Foundation, openEHR.org [Accessed December 8, 2016]
[3] Beale Beale T . Archetypes: Constraint-based Domain Models for Future-proof Information Systems. In: Baclawski K, Kilov H. (eds.) Eleventh OOPSLA Workshop on Behavioral Semantics: Serving the Customer (Seattle, Washington, USA, November 4, 2002). Boston, 2002.
[4] Raymond, Eric. "The cathedral and the bazaar." Knowledge, Technology & Policy 12, no. 3 (1999): 23-49.[5] Curto-Millet, Daniel Adrian Curto-Millet D A. To Be or To Become? An Enquiry into the Changing Nature of Requirements in Open Source Health IT. Diss. London School of Economics and Political Science, 2014.
[6] Leslie, Heather, Sam Heard, Sebastian Garde, and Ian McNicoll. Engaging clinicians in clinical content: herding cats or piece of cake?. In MIE, pp. 125-129. 2009.[7] Silje Ljosland Bakke5] Ljosland Bakke S, National governance of archetypes in Norway, In: Sarkar, I. N., Georgiou, A., & de Azevedo Marques, P. M. (Eds.). (2015).MEDINFO 2015: EHealth-enabled Health: Proceedings of the 15th World Congress on Health and Biomedical Informatics (Vol. 216). IOS Press.
[8] Sundvall, E. (2013). Scalability and Semantic Sustainability in Electronic Health Record Systems. http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A599752&dswid=-8106 [Accessed December 8, 2016][9] Christensen, 6] Leslie H, Heard S, Garde S, McNicoll I, Engaging Clinicians in Clinical Content: Herding Cats or Piece of Cake? Studies in health technology and informatics 150 (2009), 125-129.
[7] Christensen B., & Ellingsen , G. (2016). Evaluating Model-Driven Development for large-scale EHRs through the openEHR approach. International Journal of Medical Informatics, 89, 43-54.