OpenEHR archetypes in detail

Hildegard Franke Dr Ian McNicoll

openEHR Archetypes in detail

Archetype Dictionary Definition

http://www.dictionary.com/browse/archetype

http://www.oxforddictionaries.com/definition/english/archetype

http://dictionary.cambridge.org/dictionary/english/archetype

openEHR Archetypes IComputable models of discrete clinical concepts

Familiar components of a health record

Blood pressure, Body weight, Symptom

Medication order, Family history

Prostate cancer histopathology result

‘Maximal dataset’ philosophy Capture as many clinical perspectives as possible

Universal use case

openEHR Archetypes IIcan be designed for specific local use case

particular data entry screen

local message

most useful when designed to be shared and reused

“What do WE mean by pulse rate”

Potential for a SINGLE, SHARED

MODEL of clinical content

Blood Pressure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.130

Archetypes are based on RM ‘classes’

Folders

Compositions

Sections

Entries

Clusters

Elements

Electronic health record for one person

High level organisation of the EHR,e.g. by episode or by specialty

Set of entries comprising a clinical care session or document, e.g. encounter, result

Clinical headings reflecting workflow or consultation process

Clinical statements about observations, evaluations, instructions, actions

Entry subcomponents, e.g. device details or inspired oxygen information

Leaf nodes of name-value pair and datatype, e.g. body weight = 60kg (Quantity)

Generic RM ClassesEHR

FOLDER (optional)

COMPOSITIONCOMPOSITION

SECTION (optional)

ENTRYELEMENT

ELEMENT

ENTRYELEMENT

ELEMENT

ENTRYELEMENT

ELEMENT

CLUSTER

ELEMENT

SECTION (optional)

Archetypes: recipes for clinical contentCOMPOSITIONCOMPOSITION (Encounter)

SECTION (Vital signs)

OBSERVN. (BP)ELEMENT (Systolic)

ELEMENT (Diastolic)

OBSERVN. (Pulse)ELEMENT (Rate)

ELEMENT (Comment)

COMPOSITIONVenison Wellington

Fillings

Mushroom Duxelles100g Wild Mushrooms

25g Butter

Herb Pancakes

PastryPuff Pastry

ingredients

SECTION (Allergies)

EVAL (Adverse Reaction)ELEMENT (Substance)

ELEMENT (Status)

ELEMENT (Category)

CompositionSection

Element

100g Plain Flour

MeatVenison

1 kg Venison Loin

Archetypes: recipes for clinical contentCOMPOSITIONCOMPOSITION (Encounter)

SECTION (Vital signs)

OBSERVN. (BP)ELEMENT (Systolic)

ELEMENT (Diastolic)

OBSERVN. (Pulse)ELEMENT (Rate)

ELEMENT (Comment)

COMPOSITIONVenison Wellington

Fillings

Mushroom Duxelles100g Wild Mushrooms

25g Butter

Herb Pancakes

PastryPuff Pastry

ingredients

SECTION (Allergies)

EVAL (Adverse Reaction)ELEMENT (Substance)

ELEMENT (Status)

ELEMENT (Category)

CompositionSection

Element

100g Plain Flour

MeatVenison

1 kg Venison Loin

Archetype namingConcept name: the human name of the clinical concept

‘Blood pressure’, ’Report’

ArchetypeID: the technical name used by tooling and CDRs

‘openEHR-EHR-OBSERVATION.blood_pressure.v1’

‘openEHR-EHR-COMPOSITION.report.v1’

Naming examples

Allow modeller to leave a gap

‘plug in’ another archetype

Allows complex ideas to be built up by mixing different combinations of archetypes

SLOT RulesDefined in Reference Model

COMPOSITIONS

SECTIONS, ENTRIES, CLUSTERS (in context only)

SECTIONS

other SECTIONS, ENTRIES

ENTRIES

CLUSTERS, ELEMENTS

i.e. ENTRIES cannot be nested

Report, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09].

Available from: http://openehr.org/ckm/#showArchetype_1013.1.677

Laboratory test, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available

from: http://openehr.org/ckm/#showArchetype_1013.1.2191

SLOT ConstraintsDetermine which archetypes can fill the slot

Good practice

Keep slot options ‘open’

Use the slot constraint to define common slot fills

Only occasionally ‘lock down’ the slot to specific archetypes

Slot constraint examples

Blood Pressure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-21]. Available from: http://

www.openehr.org/ckm/#showArchetype_1013.1.130

COMPOSITION archetypes‘Top level document’ container for all clinical data

All clinical data saved inside a Composition

Represent generic document types in clinical system

Encounter, Report, Lab Report

Problem List, Discharge Summary, End of Life Care plan

Simple

Do not define detailed content.

Report, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2015-10-11]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.677

SECTION archetypesSub-divide complex compositions

No ‘semantic’ meaning

Meaning carried in ENTRY archetypes names inside SECTIONS

Very few pre-defined SECTION archetypes

Vital signs, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://

openehr.org/ckm/#showArchetype_1013.1.278

Ad hoc heading, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available

ENTRY archetypesCarry key clinical content payload

Carry clinical meaning

Carry sufficient clinical context

‘Clinical statement’ Blood pressure, Diagnosis

Lab test, ECG, Procedures

Must use one of the ENTRY sub-types

‘Clinical decision making process’

ENTRY sub-type featuresProviderSubject Data History

Event Protocol State Activities Pathway

OBSERVATIONS Yes Yes Yes Yes Yes

EVALUATIONS Yes Yes Yes

INSTRUCTIONS Yes Yes Yes Yes

ACTIONS Yes Yes Yes Yes

ADMIN_ENTRY Yes Yes

ENTRY: Provider/Subject/Participation

Provider of care

Optional where provider <> composer

Subject of care

Optional where subject <> patient

Participation

Optional where other individuals involved, e.g. MDT

ADMIN_ENTRY Yes Yes

ENTRY: Data

The data of primary clinical interest

Sometimes nested within another feature

inside INSTRUCTION ‘activities’

inside OBSERVATION ‘events’

ADMIN_ENTRY Yes Yes

ENTRY: History/Event featureAll data inside event

Allows complex, repeated ‘events’ to be captured efficiently

Multiple pulse readings

Apgar scores at different times

Support averages, max , min etc

ADMIN_ENTRY Yes Yes

ENTRY: ’Protocol’ featureSecondary information about the method or circumstances of data collection

Observations

Device/ methodology e.g. Cuff size

Evaluations/Instructions

Links to guidance or criteria

Instructions / Actions

Workflow identifiers

ADMIN_ENTRY Yes Yes

ENTRY: ’State’ featureState of patient with possible impact on interpretation

Exercise level

Fasting state

Anxiety

Stress

Other confounding factors

ENTRY: ’State’ featureState of patient with possible impact on interpretation

Exercise level

Fasting state

Anxiety

Stress

Other confounding factors

ADMIN_ENTRY Yes Yes

ENTRY: ’Activities’ feature

Allows for multiple ‘chained’ sub-instructions

All data embedded within Activities

ADMIN_ENTRY Yes Yes

ENTRY: ’Pathway’ featureRecording workflow status

Procedure

Planned, Scheduled, Commenced

Completed

Postponed, Suspended

Cancelled, Aborted

OBSERVATION archetypesGathering of evidence

Measurable / observable data

Patient history, physical examination

Lab tests, imaging

Scores and scales

Laboratory test, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited:

2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.2191

Apgar score, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.172

Blood Pressure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available

http://www.openehr.org/releases/RM/latest/docs/data_structures/diagrams/history_ogtt.png

EVALUATION archetypesOutcomes of a clinical assessment or decision

Clinically interpreted findings “I think the problem is …”

I think there is a risk of …

The treatment goal is …’

Diagnosis, synthesis

Genetic risk, Risk of Adverse reaction

CPR Decision

Problem/Diagnosis, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from:

http://openehr.org/ckm/#showArchetype_1013.1.169

CPR decision, Draft Archetype [Internet]. UK Clinical Models, UK Clinical Models Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://clinicalmodels.org.uk/ckm/

#showArchetype_1051.32.205

INSTRUCTION archetypesOrders that arise from clinical assessment

Initiation of workflow process “I will order some blood tests”

“I would like you to start this medication”

“I would like to refer you to a specialist”

Lab test request, referral

Medication order

Nursing task

Service request, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.614

ACTION archetypes

Activities that result from an Instruction “Lab test performed”

“Medication prescribed, administered”

“Procedure performed"

“Lab test tracking”

“Medication supply”

Procedure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.204

Admin entry - for non-clinical data

No special RM attributes other than subject, provider

No special features

Inpatient admission, Draft Archetype [Internet]. UK Clinical Models, UK Clinical Models Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://clinicalmodels.org.uk/ckm/#showArchetype_1051.32.291

CLUSTER archetypesOnly inside ENTRY archetypes or COMPOSITION context

Re-usable sub-components which do not amount to a ‘clinical statement’

Device details

Symptom

Fragment of physical examination

Daily timing, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited:

2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.2245

Inspired oxygen, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from:

http://openehr.org/ckm/#showArchetype_1013.1.393

ELEMENT archetypes

Single datapoint only

Allows re-use in other archetypes

No current use case

SpecialisationAllows new child archetype to be defined

‘Inherits’ all of the content of the parent e.g. Lab_test_panel => Blood Lipid test panel

Add new elements, clusters

Rename nodes

Add coded lists

Common aspects of both parent and child archetypes remain compatible

LocalisationSpecialisation can be helpful for adding / adapting an international archetype for local use

Adding new nodes

Renaming existing nodes

Does impose overheads

filling slots with local cluster archetypes often easier to maintain

Localisation by slot-filling examples

Datatypes: ‘Demonstration'

Demonstration, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2015-10-11]. Available from: http://openehr.org/

ckm/#showArchetype_1013.1.1385

Datatypes I

Datatypes II

Datatypes III

Datatypes IV

Datatypes V

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