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HISI Conference – 18th November 2010 Towards use of OpenEHR Archetypes to support views of Cystic Fibrosis Review Records Derek Corrigan Overview • Problems specific to developing clinical systems • OpenEHR – a potential solution? • A methodology for developing OpenEHR systems • Application of methodology to a clinical case •Conclusions about OpenEHR experience Clinical Systems -The Software Design Perspective Developing clinical systems is difficult! • Clinical knowledge is broad and changes quickly • Software developers are not domain specialists • Clinical knowledge is embedded in software • Cluttered, static and inflexible views of data Clinical Systems - The Clinicians Perspective The Clinical guidelines : Increasingly demanding multi-disciplinary care teams for best practice This requires flexible and dynamic views of data to cater for all each team member as well as the overall team. Incompatible with previous limitations OpenEHR – A Silver Bullet? Specific implementation of 2 level information modelling employed using concepts of archetypes and templates. Courtesy of OpenEHR Foundation Cystic Fibrosis – A Case Study Why Cystic Fibrosis? Was kindly given access to CF registry documentation Very relevant to Ireland – highest incidence in world Best practices demands multi-disciplinary team care relating to a number of discreet clinical areas By implication requires dynamic views of CF patient data to support different team member requirements Could I satisfy team data view requirements using OpenEHR archetypes and templates and provide a “how-to” guide for others? Literature Review Based Design Methodology 1 Identify the key information sources for the domain 2 Determine all individual clinical items in the domain 3 Merge related individual clinical items to single archetype clinical concepts 4 Map the derived clinical concepts to existing archetypes 5 Data model new clinical concepts e.g. Using mindmaps 6 Model new archetypes for clinical concepts that are not already available 7 Create templates to group and constrain related archetypes that represent the contents of locally used form or document data. 8 Publish newly created archetypes to the OpenEHR Clinical Knowledge Manager Cystic Fibrosis Registry Update Process Flow Person with CF Patient Consent Form Step 1 Clinician Submits CF Patient Details Or an Updated Annual Assessment Cystic Fibrosis Registry Registration and Diagnosis Form Cystic Fibrosis Registry Annual Assessment Form Cystic Fibrosis Registry Staff Enter Submitted Patient Data Data Updated in Database And available via Web Database Schema Document Cystic Fibrosis Periodic Review Step 1 Covers a number of clinical areas including physical functions, nutrition, physiotherapy, medication CF Registry DB Schema Step 1 Clinical Concept Description Patient Demographic Details Patient demographic details Hospital Demographic Details Hospital demographic Spirometry Measurement A clinical observation of a single complete set of readings to be captured and interpreted as a single spirometry lung function test. Weight A clinical observation of the recorded weight at a point in time for a patient. Height A clinical observation of the recorded height at a point in time for a patient. Body Mass Index A clinical observation of the recorded body mass index at a point in time for a patient. Centile Weight A clinical observation of the recorded centile weight at a point in time for a patient. Biochemistry Result List A clinical observation of a list of the results of multiple biochemistry tests recorded for a particular patient Medication List A clinical instruction of the current list of medications that a patient is currently using. Physiotherapy Regimen A clinical evaluation and record of the physiotherapy regimen that a patient is currently undergoing Nutrition Regimen A clinical evaluation and record of the nutrition regimen that a patient is currently undergoing Steps 2 and 3 OpenEHR Clinical Knowledge Manager (CKM) – Search for archetypes Step 4 Spirometry Archetype Design Key OpenEHR Goal Should be clinically complete and reusable Step 5 Spirometry Archetype Design V2 Step 5 Archetype Editor Step 6 Develop Templates (Views) Step 7 Step 7 Publish Archetypes to CKM Step 8 Spirometry archetype submitted to OpenEHR Aspects incorporated into new archetype they were working on To be published on CKM and currently being used in system in paediatric hospital system in Slovenia OpenEHR - Conclusions OpenEHR worked well – descriptive enough from a data perspective – too flexible though? Will clinicians use this? Jury still out Design patterns for archetypes could help OpenEHR CKM is a very powerful tool to locate and reuse existing archetypes quickly Global OpenEHR community - archetype features developed in Ireland being used in application in Slovenia Publication of archetypes to CKM, and governance needs to be streamlined – most still in draft form If not done, localised archetypes will be used – defeats the aim of supporting reuse of archetypes Questions ?