openehr usage

Clinical (archive)
1

Dear All

I have just subscribed to this service. I wondered if you could help.

I am trying to introduce the usage of these archetypes to the people I work with within the NHS. I usually work with the clinical / technical community to develop information standards for clinical and la systems.

The problem has often been that there is confusion on developing standards and how to actually ensure these are standards … with commissioning standards, there is usually a requirement to reference these to the NHS data dictionary but with clinical record standards, there is usually no where to go. I have just come across the openEHR clinical knowledge manager and can see that there is a central point for archetypes, terms & their relevant headings.

Can I check if:

  1. the archetypes posted on the clinical knowledge manager site are actually being used and have been tested?
  2. whether the archetypes, templates and terms posted on the site can just be adopted for use within clinical settings?
  3. whether anyone knows whether the STarLiMs and LiMs systems used for laboratory systems support openEHR standards?
  4. whether adoption of these archetypes prove that one has conformed to the required standard for clinical usage

Many thanks.

Kindest regards

Eunice

2

Hi Eunice.

Basically clinical standards development throughout the world is a mess and we in the UK are no better or worse at this kind of work than anyone else, so do not expect any easy answers. Thos of us involved in openEHR developments think that the archetype/template approach is the best solution available but it is still not easy. You are quite correct that traditional Data dictionary based standards development is of very little value. Scotland put a lot of effort into this approach with very limited benefit, in spite of a a well-funded and supported program.

Can I check if:

  1. the archetypes posted on the clinical knowledge manager site are actually being used and have been tested?

This is difficult to know with accuracy as we currently do not ask archetype downloaders how/if they are using the archetypes in production systems but I have recently been involved in a paediatric hospital project almost wholly based archetypes and the Ocean openEHR database, 70% of which were derived from the international CKM.

“Tested” is an interesting concept, which does not really apply in this context. Most of the CKM archetypes are still in draft but a few have been formally published. There is a lot of interest in quality assuring archetypes but it turns out to be quite tricky to define, without resoritng to a kind of tick-box approach which is not a terribly good measure of actual quality.

  1. whether the archetypes, templates and terms posted on the site can just be adopted for use within clinical settings?

Yes

  1. whether anyone knows whether the STarLiMs and LiMs systems used for laboratory systems support openEHR standards?

Unlikely. The vast majority of labs use HL7v2 messages or an older standard called EDIFACT. In the hospital system I mentioned above we import HL7v2 messages from labs, devices and radiology into openEHR archetypes and templates.

  1. whether adoption of these archetypes prove that one has conformed to the required standard for clinical usage

Again this is a difficult question, since there really is no such thing as a ‘standard for clinical usage’. An archetype is an attempt to describe a fairly simple clinical idea which allows us to exchange clinical data in a coherent manner. A lot more has to be done in addition to fully define a ‘clinical standard’ - which terminologies and termsets to use, what are the data definitions e.g definition of diabetes or Hypertension.

Sorry if some of the replies seem at bit vague!! Feel free to press more on some of the wobbly answers.

If you are coming to this subject fairly fresh it will seem horribly over-complex. If you have not discovered it already, my colleague Heather Leslie has a great blog at Archetypical http://omowizard.wordpress.com/ which covers some of these topics in more depth.

I would be very interested to know more about your interest in the NHS context. I am a former Scottish GP and am pretty actively involved in UK informatics via the BCS primary healthcare specialist group.

Many thanks.

Kindest regards

Eunice

Dr Ian McNicoll
office +44 (0)1536 414 994
+44 (0)2032 392 970
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

3

Hi Ian

Many thanks for your email. They have been very useful.

Thanks Ian.

Kinest regards

Eunice

4

“Tested” is an interesting concept, which does not really apply in this context. Most of the CKM archetypes are still in draft but a few have been formally published. There is a lot of interest in quality assuring archetypes but it turns out to be quite tricky to define, without resoritng to a kind of tick-box approach which is not a terribly good measure of actual quality.

what can be tested is ‘templates’, i.e. actual concrete data sets, made up from data elements defined in archetypes.

  1. whether the archetypes, templates and terms posted on the site can just be adopted for use within clinical settings?

Yes

  1. whether anyone knows whether the STarLiMs and LiMs systems used for laboratory systems support openEHR standards?

Unlikely. The vast majority of labs use HL7v2 messages or an older standard called EDIFACT. In the hospital system I mentioned above we import HL7v2 messages from labs, devices and radiology into openEHR archetypes and templates.

this is true. However, in the future there is no reason not to use openEHR-based messages, because:

  • an openEHR message definition is generated from archetypes & templates, not hand-made
  • it improves the semantic expressiveness of the data, and
  • if the target system looks like openEHR or 13606, the need for transformation is either removed or greatly reduced.
    but… things change slowly in the LIS world.
  1. whether adoption of these archetypes prove that one has conformed to the required standard for clinical usage

Again this is a difficult question, since there really is no such thing as a ‘standard for clinical usage’. An archetype is an attempt to describe a fairly simple clinical idea which allows us to exchange clinical data in a coherent manner. A lot more has to be done in addition to fully define a ‘clinical standard’ - which terminologies and termsets to use, what are the data definitions e.g definition of diabetes or Hypertension.

the real test of any kind of technical conformance is whether the data created based on templates (themselves based on archetypes) are queryable by AQL queries based on the same archetypes. if so, it means that the modelling tools, software etc are all working properly.

Whether the clinical usage model implied by a template matches one that has been defined as some target can only be known if the latter itself is expressed in some testable/formal way.

regards

  • thomas beale
(attachments)

OceanInformaticsl.JPG