1. Standardised and Flexible Health Data Management with an Archetype Driven EHR System (EHRflex) Anton Brass 1, David Moner 2, Claudia Hildebrand 1, Montserrat Robles 2 1 Helmholtz Zentrum München, Germany 2 Universidad Politécnica de Valencia, Spain

2. Content Dual model and CEN EN13606 The EHRflex system Operational Template Model System by example Conclusion and future work 2EHRflex

3. Dual model and CEN EN13606 The Dual Model approach is a methodology for building Information Systems based on the separation of information and knowledge. –Information – statements about specific entities Eg. Blood pressure measurement: 120/80, patient was sitting –Knowledge – statements which apply to all entities of a class Eg. Blood pressure is composed by Systolic and Diastolic measurements in mmHg, possible positions are: Lying, Sitting and Standing. A dual model system can thus incorporate knowledge from a specific domain and evolve seamlessly. EHRflex3

4. Dual model and CEN EN13606 ISO/CEN EN13606 is an international standard for the semantic interoperability of electronic health records. –Based on a dual model approach. Reference model (information model) –Provides the generic structures or building blocks to build an EHR. Archetype model (knowledge model) –Constrains the reference model building blocks in order to define high-level semantic concept definitions. EHRflex4

5. Dual model and CEN EN13606 An archetype… –Defines the specific structure for data. –Defines other data constraints such as cardinalities, existence, occurrences, default values… –Binds data structures to terminologies. –Is a shareable definition of knowledge. –Can be defined by domain specialists (health professionals). –Can be used to generate user interfaces. EHRflex5

6. Archetype “Blood pressure” Created with LinkEHR Archetype Editor: www.linkehr.com 6EHRflex

7. The EHRflex system EHRflex: An archetype-based EHR system. Main goals: –Definition and implementation of a generic model for user interaction and visualization of health data. –Clear and self-explanatory screen forms. –Empower clinicians to design their own content. –Introduce the dual model and archetypes into the daily practice. EHRflex7

8. The EHRflex system The problem How can we represent an EN13606 ENTRY? –Or an OpenEHR INSTRUCTION? –Or a HL7 CDA PROCEDURE? In essence they all represent the same “business concept” –They should be represented in the same way. –They must be transformed into usable graphic interfaces. –And they should incorporate specific user needs or preferences (templates). EHRflex8

9. The EHRflex system The solution Operational Template Model (OTM) –A generic model for representing graphical user interfaces. –Independent of a particular reference model. –Also holds and transmits the associated health data instances. EHRflex9 Medical Data Reference Model Archetype Model OTMListData 1Data 2Data 3

10. Operational Template Model The OTM is an object oriented model which includes: –Generic data structures: StructureObject, List, Alternative. –Generic data types: FieldList, Boolean, Integer, Real, CodedText, SimpleText. Classes and data types from any reference model can be mapped and transformed into an OTM instance and vice versa. EHRflex10

11. Operational Template Model Step 1: transform archetypes into an OTM instance. EHRflex11 Archetype Parser

12. Operational Template Model Step 2: transform the OTM into a form to be filled with data. EHRflex12 Data 1 List1 Data 2 Data 5

13. Operational Template Model Step 3: transform the OTM into an XML of any reference model. EHRflex13 XML Data

14. 14EHRflex System by example http://www.ehrflex.eu

15. 15 System by example Google Health medication EHRflex

16. System by example Google Health medication 16EHRflex

17. Conclusions Clinicians can define and use their own clinical concepts through archetypes. Graphical representations are usable despite the generic reference models. Data can be stored as standard XML documents. EHRflex is generic and can be used with any standard. EHRflex17

18. Future work Support of additional archetype properties: –Alternatives, multiple languages, use of terminologies… Support of templates for specific uses or domains. Support for other reference models such as OpenEHR, CCR and HL7 CDA. EHRflex18

19. Thank you for your attention! Standardised and Flexible Health Data Management with an Archetype Driven EHR System (EHRflex) David Moner damoca@upv.es EHRflex19