Dealing with the Archetypes Development Process for a Regional EHR System

Summary

Objective: This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process.

Methods: This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process.

Results: The main steps of the archetype modelling process were identified and described, and 20 archetypes were created.

Lessons learned:

– The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;

– The initial focus on the archetype structural organization aspects was important;

– The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;

– Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;

– Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;

– The use of worksheets facilitated the modelling process by health professionals;

– It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team.

Conclusion: The archetypes (referencing terminology, domain tables and term lists) provided a favorable condition for the use of a controlled vocabulary between the central repository and the EMR systems and, probably, will increase the chances of preserving the semantics from the knowledge domain. Finally, the reference model from the ISO 13606 norm, along with the archetypes, proved sufficient to meet the specificities for the creation of an EHR system for basic healthcare in a Brazilian state.

Keywords

Health information systems - electronic health record - archetype modelling - two-level modelling - archetypes - ISO 13606; openEHR

• References

• 1 Beale T, Heard S. Archetype Definition Language 1.4: rev. 1.4.1 [Internet]. London: The OpenEHR Foundation, 2007. Available from: http://www.openehr.org/svn/specification/TRUNK/publishing/architecture/am/adl1.4.pdf.
• 2 International Organization For Standardization.. ISO 13606–1:2008: Health informatics, Electronic health record communication, Part 1: Reference model, 2008 [Internet]. Available from: http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=40784.
• 3 Kalra D. Electronic Health Record Standards. IMIA Yearbook of Medical Informatics, 2006; 1: 136-139.
• 4 Kalra D. Barriers, Approaches and research priorities for semantic interoperability in support of clinical care delivery. 2007 Available from: < http://www.semantichealth.org/DELIVERABLES/SemanticHealth_D4_1_final.pdf >.
• 5 Garde S P Knaup, Hovenga EJS, Heard S. Towards semantic interoperability for electronic health records: domain knowledge governance for openEHR archetypes. Methods Inf Med 2007; 46 (03) 332-312.
• 6 Santos MR. Sistema de registro eletrônico de saúde baseado na norma ISO 13606: aplicações na Secretaria de Estado de Saúde de Minas Gerais [Thesis]. Information Sciences Departament: Universidade Federal de Minas Gerais, 2011.
• 7 Newell A. The knowledge level [Internet]. AI Magazine. Summer 1982 18. (1).
• 8 Gruber TR. A translation approach to portable ontology specifications. Knowledge Acquisition 1993; 5 (02) 199-220.
• 9 Guarino N. Formal Ontology, Conceptual analysis and knowledge representation. Int J Human-Computer Studies 1995; 43 (05) 625-640.
• 10 Guarino N, Giaretta P. Ontologies and knowledge bases: towards a terminological clarification. In: Mars, NJI. Towards very large knowledge bases: knowledge building and knowledge sharing. Amsterdam:: IOS Press,; 1995. p. 25-32.
• 11 Jonhnson SB. Model formulation: generic data modelling for clinical repositories. J Am Med Inform Assoc 1996; 3: 328-339.
• 12 Chandrasekaran B, Josephson R, Benjamins VR. Ontology of tasks and methods. Proceedings of the International Joint conference on artificial intelligence 1999; 16: 31-43.
• 13 Kalra D. The Synapses project. Proceedings of the Current Perspectives in healthcare computing conference;. 1997 Harrogate, England:: BJHC,; 1997 p. 405-406.
• 14 Grimson J, Grimson W, Berry D, Stephens G, Felton E, Kalra D. et al. A CORBA –Based integration of distributed electronic healthcare records using the Synapses approach. IEEE Trans Inf Technol Biomed 1998; 2 (03) 124-115.
• 15 Bird L, Goodchild A, Tun Z. Experiences with a two-level modelling approach to electronic health records. J Res Prac Inf Tech 2003; 35 (02) 121-118.
• 16 OpenEHR [Internet]. OpenEHR future-proof and flexible; 2010. Available from: < http://www.openehr.org/about/origins.html >.
• 17 Michelsen L, Pedersen SS, Tilma HB, Andersen SK. Comparing different approaches to two-level modeling [Internet]. Stud. Health Tech. Inform. Amsterdam, 2005. Available from: < http://iospress.meta-press.com/index/1hm0l4hd611u9dey.pdf >.
• 18 Beale T, Heard S. Archetype definitions and principles: rev. 1.0 [Internet]. London: The OpenEHR Foundation, 2007. Available from: < http://www.openehr.org/svn/specification/TRUNK/publishing/architecture/am/archetype_principles.pdf >.
• 19 Beale T, Heard S. Architecture overview: rev. 1.1 [Internet]. London: The OpenEHR Foundation, 2007. Available from: < http://www.openehr.org/svn/specification/TRUNK/publishing/architecture/over-view.pdf >.
• 20 Hovenga EJS, Garde S, Carr T, Hullin CM. Innovative approaches and processes for capturing expert aged care knowledge for multiple purposes. Electronic Journal of Health Informatics. 2007 2. (1).
• 21 Leslie H, Heard S. Archetypes 101. Health Informatics Society of Australia Ltd.; 2006
• 22 Buck J, Garde S, Kohl CD, Knaup P. Towards a comprehensive electronic patient record to support an innovative individual care concept for premature infants using the openEHR approach. Int J Med Inf 2009; 78 (08) 521-511.
• 23 Santos MR, Bax MP, Kalra D. Building a logical EHR architecture based on ISO 13606 standard and Semantic Web Technologies. Proceedings of the World congress on medical and health informatics 13; 2010; South África,: 2010
• 24 Kalra D. Clinical foundations and information architecture for the implementation of a federated health record service [Thesis]. University College London,. London,: 2002
• 25 Moner D, Maldonado JA, Bosca D, Fernández JT. et al. Archetype-based semantic integration and standardization of clinical data. Proceedings of the EMBS IEEE Annual International Conference; 2006. 28 New York:: IEEE.;
• 26 Atalag K. Archetype based domain modelling for health information systems [Thesis]. Department of Information Systems, The Graduate School of Informatics, Middle East Technical University, 2007
• 27 Munoz A, Somolinos R, Pascual M, Fragua JÁ. et al. Proof-of-concept design and development of an EN13606-based electronic health care record service. J Am Med Inform Assoc 2007; 14 (01) 118-129.
• 28 Wollersheim D, Sari A, Rahayu W. Archetype-based electronic health records: a literature review and evaluation of their applicability to health data interoperability and access. HIM J. 2009 38. (2).
• 29 Conde AM. Towards best practice in the archetype development process [Dissertation]. Trinity College of Dublin, 2010