Managing archetypes for sustainable and semantically interoperable electronic health records

Sebastian Garde
http://www.healthinformatics.cqu.edu.au
Health Informatics Research Group, Central Queensland University; ACACI Austin Health
Australia

Since 2007, Sebastian is a Research Fellow for Health Informatics at Central Queensland University. Before that, from 2004-07, he was a Postdoctoral Research Fellow for Health Informatics at Central Queensland University. He has a strong interest in electronic Health Records and in cooperation with Ocean Informatics, he has developed the openEHR Archetype Finder (http://www.dualitysystems.com.au/archetypefinder). In 2005, Sebastian was co-convenor of a series of workshops on archetype development for clinicians in Brisbane, Melbourne and Sydney. He has also contributed to the development of a prototype User Interface Generator for the openEHR-initiative based on archetypes. He was lead researcher for the Australian Skill Needs Analysis of Health Informatics Professionals which lead to the development of a Health Informatics Educational Framework to provide guidance with regard to ‘good’ Health Informatics education while acknowledging the diversity of different roles in Health Informatics and the diversity of ways that lead to Health Informatics and the diversity of education within the Health Informatics discipline. He was also responsible for the research-part of a pilot study for the adoption of a simulated integrated health care information system for educational purposes. As part of his academic role he also supervises several PhD students in the field of Electronic Health Records and works together with researchers in Germany to foster the design, development and introduction of shared electronic patient records and make patient data available for multiple purposes (e.g. patient care, administrative purposes, and research). Before migrating to Australia, Sebastian conducted his PhD research at the University of Heidelberg, Germany, in the field of Health Information Systems which he completed in 2004. In 2001, Sebastian received a degree in Medical Informatics (Dipl.-Inform. Med., graduate program) from the University of Heidelberg, Germany. From 2001 until 2004, while carrying out his PhD research, he was employed by the Department of Medical Informatics of the Heidelberg University Medical Centre in Germany as a scientific employee. Sebastian worked in several projects in Health Informatics, for example as project manager for a nationwide electronic health record and integrated therapy planning system for paediatric oncology in Germany. Sebastian also worked on an ongoing Germany-wide project, developing and introducing a web-based teaching and case-based-learning system for medical education (CAMPUS, http://campus.fh-heilbronn.de). This system is closely integrated into the new Curriculum Medicinale of the University of Heidelberg, Germany, as well as other German and European universities. Further contributions to the field of health Informatics include the remodelling of legacy systems in health care, as well as the adequate representation of clinical knowledge for routine, research and education and the integration of application systems in hospital information systems using standards like HL7. Sebastian co-supervised diploma and study theses of the graduate program Medical Informatics, University of Heidelberg, was member of the educational committee of the graduate program Medical Informatics and the post-graduate program Information Management in Medicine. Sebastian was Managing Editor of the Yearbook of Medical Informatics of the International Medical Informatics Association, and managed the clinical knowledge server of the Heidelberg University Medical Centre. He is reviewer for several international papers and conferences. In 2007, Sebastian was appointed Fellow of the Australian College of Health Informatics (ACHI).

Evelyn JS Hovenga
http://www.healthinformatics.cqu.edu.au
Health Informatics Research Group, Central Queensland University
Australia

Evelyn Hovenga's research and teaching interests include electronic health records, work study in the health services, performance measurement, health service management, nursing resource usage, casemix plus health and nursing outcomes in conjunction with health and nursing informatics, terminology, decision support. Evelyn's PhD research was in casemix, and hospital nursing resource usage and costs. The resultant patient classification/nursing workload measurement system was adopted by more than 100 Australian hospitals between 1984 and 2004. Evelyn is a foundation member of the Standards Australia IT/14 health informatics committee and serves on two technical sub-committees and represents this committee as a member of the National Health Data Standards Committee. She initiated and collaboratively directed an international effort to develop a new ISO standard for the integration of a reference terminology model for nursing. Compliance with this standard ensures that a clinical information system is able to accommodate nursing concepts. This work was supported by the IMIA Nursing Informatics group and the International Council of Nurses. Evelyn contributes to many standards development projects overseen by Standards Australia International (SAI) IT/14, IT/14/9 and IT/14/2 committees. Many of these projects contribute to standards work items undertaken by health informatics committees from the European standards organization (CEN TC251), the International Organisation of Standards (ISO/TC215) and HL7. Evelyn was elected to represent IT/14 as a member of the national Health Data Standards Committee (HDSC) whose work focuses primarily on the maintenance, revision and development of the National Health Data Dictionary now also used as the repository of data standards to support electronic health records development in Australia . The HDSC also has responsibility for overseeing the work of the Classifications and Terminology Working Group. Evelyn is a founding member of the open EHR Clinical Review Board responsible for Archetype Governance and a development process framework promoting Archetype standardisation. Evelyn participated in the Australian Health Information Council's workforce capacity building sub-group and contributed to the development of the National Statement outlining a vision for the health informatics capacity of the workforce and detailing priorities of action in the areas of leadership, education and research. Similarly, Evelyn was a key contributor to the development of a white paper, a Roadmap for Nursing Informatics in Australia, commissioned by the Australian Government Department of Health and Ageing. Evelyn chairs the Medinfo 2007 Organising Committee managing the 12th World Congress on medical informatics hosted by HISA under the auspices of IMIA, to be held in Brisbane , August 2007. Evelyn is Founding Editor-in-Chief of eJHI – the electronic Journal of Health Informatics (http://www.ejhi.net). She has served as an editorial team member for the International Journal of Medical Informatics for several years, and reviews papers for a number of other journals. Evelyn is Fellow and Past President of the Australian College of Health Informatics, Fellow of the Australian College of Health Service Executives, Fellow of the Royal College of Nursing Australia, Fellow of the Australian Computer Society, and Chair of its Health Informatics Committee, past Vice-President (Working and Special Interest Groups) of the International Medical Informatics Association (IMIA). She was appointed as an expert advisor to the European Commission funded Nightingale project from 1998-2002, has been an invited speaker to many international conferences and meetings, reviewer of many conference papers, and member of numerous scientific program committees.

Jana Gränz
http://www.healthinformatics.cqu.edu.au
Health Informatics Research Group, Central Queensland University; University of Applied Sciences Ulm, Germany
Australia

Shahla Foozonkhah
http://www.healthinformatics.cqu.edu.au
Health Informatics Research Group, Central Queensland University; Tabriz Medical Sciences University, Tabriz, Iran
Australia

Sam Heard
http://www.oceaninformatics.com
Health Informatics Research Group, Central Queensland University; Ocean Informatics
Australia

Dr. Sam Heard (MBBS, MRCGP, FRACGP, FACHI) is a general practitioner and has been a Senior Lecturer in General Practice, first with London University and until 2002 with Flinders University. He developed a GP clinical system in London in the mid 80's, which is still in use and was a co-author of the original Good European Health Record Project funded by the European Commission. He has worked with Thomas Beale closely since then and their collaboration has formed the hub of the Australian contribution to openEHR. Sam has written and presented widely on electronic health records and was the principal author of the background document for the Australian EHR Taskforce. He has been the lead on all the GPCG funded GEHR projects and has developed the clinical approach to the groundbreaking archetypes. He was co-chair of the EHR Technical Committee of HL7 International until 2005 (now on the board of HL7 Australia) and remains Chair of the Standards Australia EHR working group. He also has a strong educational background in primary care and has just completed a 3 year term as the Chair of the National Education Committee of the Royal Australian College of General Practitioners. Sam is an Adjunct Professor at Central Queensland University

Managing archetypes for sustainable and semantically interoperable electronic health records

Sebastian Garde, Evelyn JS Hovenga, Jana Gränz, Shahla Foozonkhah, Sam Heard

Abstract

Background: With the release of openEHR Version 1.0 a common Electronic Health Records (EHR) architecture has been defined to pursue the aim of semantic interoperability of Electronic Health Records. Archetypes as clinical content models play a key role in this approach, but their development and maintenance needs to be managed by Knowledge Governance in order to avoid incompatibilities. Objectives: To analyse the functional requirements for supporting Domain Knowledge Governance with Information Technology (like authoring or updating archetypes) and present a prototype implementation. Methods: Requirements analysis using the Unified Modeling Language (UML) and incremental prototyping. A series of archetype workshops were also conducted. Results: For a web-based Archetype Repository, a total of four top-level use cases and 23 refining use cases for 5 different actors were found to be essential. A prototype implementing some of these use cases has been developed and an example process for the coordinated development of archetypes defined. Discussion: We believe that Domain Knowledge Governance is necessary independent of the actual approach and methodology chosen for EHR systems. Appropriate information technology is required to support a clear process for authoring archetypes. Conclusion: High-quality archetypes with high-quality clinical content are the key to semantic interoperability of clinical systems. Domain Knowledge Governance is the key to high quality archetypes. A comprehensive Archetype Repository will render comprehensive Domain Knowledge Governance feasible and efficient.

Keywords

Electronic Health Records; openEHR; Archetypes, semantic interoperability; Computerized Medical Record Systems

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This work is licensed under a Creative Commons Attribution 3.0 License.

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