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The openEHR Developers' workshop

Shinji Kobayashia, Ian McNicollb,c, Xudong Lud, Christian Chevalleye

aThe EHR Research Unit, Kyoto University, Japan,

bopenEHR Foundation, c CHIME UCL

d Biomedical Engineering Department of Zhejiang University

eADOC Software

Abstract

The openEHR project is well-known for publishing and updating a set of open specifications to build maintainable and semantically interoperable (and even intraoperable) electronic health record systems that stay agile in a changing clinical reality. It is closely related to the family of ISO 13606 standards and to CIMI (now an HL7 WG). The detailed openEHR clinical models (archetypes and templates) are authored by global and regional clinical communities in an online environment where the authoring and review process gathers views and concensus from a breadth of clinical specialities. The openEHR archetypes are often used as a source of clinical requirements gathering also in non-archetype-based systems and interoperability standards.

This workshop will introduce and discuss openEHR based implementations and integrations primarily from developer and systems-engineering perspectives. In recent years several open source openEHR implementations have been published,  the approaches and technical features will also be described and discussed. Developers in an openEHR context nowadays thus have access to both a wealth of detailed clinical models and a wealth of published approaches to technical implementation using various persitence solutions, APIs and programming languages.

Keywords:

Electronic Health Records, openEHR, archetype, interoperability, intraoperability, open-source software, clinical standards

1. Introduction

Initially, we will provide an overview of the openEHR architecture and the clinical+technical usage contexts. This is followed by a number of presentations introducing various openEHR projects and related integrations. After the introduction and between each subtopic presentation there will be Q&A and open discussions with the workshop participants. 

Knowledge of the openEHR specification/technology and computer science is helpful to understand some details in the workshop, but not required for understanding the general concepts.

1.1 An openEHR architecture overview

The core technology of openEHR specification features a multi-level modeling system, often referred to as ‘archetype-based systems’. In this archetype-based technology, technical implementation is separated from the continuously updated detailed clinical modeling concerns in a way that makes it easier for implementers to maintain semantic intra- or interoperability. In this workshop introduction, we will overview:

  • The openEHR reference model (RM) and the Archetype Model (AM) and associated specification documentations etc.
  • Standardized approaches to clinical querying (AQL), REST-interfaces and Clinical Decision Support rules (GDL)
  • The mix of people, process and technology; how using archetypes, templates, AQL and GDL etc. a as a basis in EHR systems enables agility in adapting to changing clinical needs and reduces maintenance time. 
  • Options on the spectrum between semantic intraoperability and interoperability. (By intraoperability we here refer to the possibility to align internal clinical EHR datamodels across organizational boundaries and inside systems from different vendors - and thus easily share both data and share the workload of model authoring and maintenance.)

  • A quick overview of different existing (previously published/available/discussed) approaches to implementing openEHR; persistence solutions, APIs, programming languages, open source core reference implementations (in e.g. Java, C#, Ruby, Eiffel)

  • Comparing steps needed to implement archetype-based systems from scratch versus using/integrating existing openEHR based components and APIs
  • A quick overview of where in the world openEHR is used.

1.2. Examples of implementation and integration projects

See below for abstracts of short presentations

1.3. Discussion

Final open discussion, questions and answers

2. Examples of implementation and integration approaches

2.1. A review of FLOSS implementations of openEHR specifications(Shinji Kobayashi)

The openEHR project has been published EHR specifications and core library under open source software license. This artefacts are recognised as an ideal EHR specification and they became a basis of ISO 13606 standards. There are some EHR products that implemented openEHR specifications with faithful conformance and adopted to many organisations. Because the products have diversity on usage and implementation, fair evaluation for them are not applicable with standardised metrics.

In this session, we will review FLOSS implementations of openEHR for the developers' reference to implement openEHR specifications.

2.2. A CDR Implementation based on openEHR ARM persistence method(Xudong Lu)

One of the main obstacles to the wide adoption of openEHR in CDR implementation in hospital is that there is no practical persistence method described in the openEHR specifications. In this presentation, an archetype relational mapping (ARM) persistence method for CDR has been proposed, which was based on a set of rules designed for mapping the archetypes & templates to data tables of the relational database. The comparison between the generated ARM database, the conventional database of the hospital and the Node+Path database has been conducted, while the ARM database achieves better performance. The implemented CDR based on this method has been used in real clinical site for over two years. The current situation and the future plan of this effort will also be introduced.

2.3. EtherCIS: a pragmatic openEHR CDR(Christian Chevalley)

Many openEHR backend CDRs are based on various non mainstream technologies, from experimental to plain exotic. Although these works are important to lead the path to future production systems, with EtherCIS , we have resolutely decided to adhere to best- practice observed in current Data Center environments to ease its adoption. EtherCIS is an open source, multi-tiers application server based on a modern open source database engine: PostgreSQL. The presented approach may be of value for other openEHR implementations using, but not limited to, other well-known DB engines such as Oracle 12 or Intersystems Cache.

We will demonstrate some of the benefits of deploying an openEHR CDR using a mainstream database engine in real-life environments.  The aspects covered encompass: insertion in existing environment, leveraging from other users' experiences, development cycle: the beauty of OO SQL  (and some not so easy bits), security and privacy, operating concepts and adaptability to unforeseen business needs.  

3. Workshop speakers

  • Shinji Kobayashi, MD, PhD - Kyoto University, Japan
  • McNicoll, Ian, MSc, MBChB - UCL CHIME, openEHR, London, UK
  • Lu, Xudong,Professor of Medical Informatics in Biomedical Engineering Department of Zhejiang University, China.
  • Chevalley, Christian, Founder and Technical Director, ADOC Software,Thailand

4 Specific Educational Goals

The educational goal of this workshop is not only to learn openEHR technology, but implementation technology of standardized clinical models for semantic interoperability.

5 Expected Attendees

Expected attendees of this workshop are mainly developers who are interested in openEHR archetype technology, implementation of clinical models or open-source software projects in medical domain. The knowledge of the openEHR specification/technology is helpful to understand, but not required.

Because the workshop will present the state-of-the-art of implementation technologies in health care, attendees can learn the cutting edge of EHR system and software technology.




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