Openehr
Encyclopedia
openEHR is an open standard
specification in health informatics
that describes the management and storage, retrieval and exchange of health data in electronic health records (EHRs). In openEHR, all health data for a person is stored in a "one lifetime", vendor-independent, person-centred EHR. The openEHR specification is not concerned with the exchange of data between EHR-systems as this is the primary focus of other standards such as EN 13606
and HL7.
The openEHR specifications are maintained by the openEHR Foundation, a not for profit foundation supporting the open research, development, and implementation of openEHR EHRs. The openEHR specifications are based on a combination of 15 years of European and Australian research and development into EHRs and new paradigms, including what has become known as the archetype methodology for specification of content.
The openEHR specifications include information and service models for the EHR, demographics, clinical workflow and archetype
s. They are designed to be the basis of a medico-legally sound, distributed, versioned EHR infrastructure.
but, most importantly, to provide a powerful means of expressing what clinicians and patients report that they need to record so that the information can be understood and processed wherever there is a need. Clinical information models are specified in a formal way ensuring the specifications, known as 'archetypes
', are computable. The set of openEHR archetypes need to be quality managed to conform to a number of axioms such as being mutually exclusive. The archetypes can be managed independently from software implementations and infrastructure, in the hands of clinician groups to ensure they meet the real needs on the ground. Archetypes are designed to allow the specification of clinical knowledge to evolve and develop over time. Challenges in implementation of information designs expressed in openEHR centre on the extent to which actual system constraints are in harmony with the information design.
In the field of Electronic health record
s there are a number of existing information models with overlaps in their scope which are difficult to manage, such as between HL7 V3 and SNOMED CT
. The openEHR approach faces harmonisation challenges unless used in isolation.
While individual health records may be vastly different in content, the core information in openEHR data instances always complies to archetypes. The way this works is by creating archetypes which express clinical information in a way that is highly reusable, even universal in some cases. To get to the point where information is suitably presented for clinical care it always involves a number of archetypes. These combinations of archetypes are called 'templates'; aggregations of archetypes which may also be refined for use in a particular situation. Templates may be used to specify forms, documents or even messages.
The openEHR approach uses the CEN- and ISO-standardised "archetype definition language" (expressed in ADL syntax or its XML equivalent) to build archetypes; these are reusable, formal models of domain concepts. Archetypes are used in openEHR to model clinical concepts such as "blood pressure
" or "medical prescription
".
The prospect of gaining agreement on design and on forms of governance at the international level remains speculative, with influences ranging from the diverse medico-legal environments to cultural variations, to technical variations such as the extent to which a reference clinical terminology
is to be integral.
The openEHR Framework is consistent with the new Electronic Health Record Communication Standard (EN 13606
). It is being used in parts of the UK NHS Connecting for Health Programme and has been selected as the basis for the national program in Sweden. It is also under evaluation in a number of countries including Denmark, Slovakia, Chile and Brazil. It is beginning to be utilised in commercial systems throughout the world.
Open standard
An open standard is a standard that is publicly available and has various rights to use associated with it, and may also have various properties of how it was designed . There is no single definition and interpretations vary with usage....
specification in health informatics
Health informatics
.Health informatics is a discipline at the intersection of information science, computer science, and health care...
that describes the management and storage, retrieval and exchange of health data in electronic health records (EHRs). In openEHR, all health data for a person is stored in a "one lifetime", vendor-independent, person-centred EHR. The openEHR specification is not concerned with the exchange of data between EHR-systems as this is the primary focus of other standards such as EN 13606
EN 13606
The overall goal of this Health informatics - Electronic Health Record Communication European Standard is to define a rigorous and stable information architecture for communicating part or all of the Electronic Health Record of a single subject of care...
and HL7.
The openEHR specifications are maintained by the openEHR Foundation, a not for profit foundation supporting the open research, development, and implementation of openEHR EHRs. The openEHR specifications are based on a combination of 15 years of European and Australian research and development into EHRs and new paradigms, including what has become known as the archetype methodology for specification of content.
The openEHR specifications include information and service models for the EHR, demographics, clinical workflow and archetype
Archetype (information science)
In the field of informatics, an archetype is a formal re-usable model of a domain concept. Traditionally, the term archetype is used in psychology to mean an idealized model of a person, personality or behaviour...
s. They are designed to be the basis of a medico-legally sound, distributed, versioned EHR infrastructure.
Two level modelling with archetypes
The key innovation in the openEHR framework is to leave all specification of clinical information out of the information modelInformation model
An information model in software engineering is a representation of concepts, relationships, constraints, rules, and operations to specify data semantics for a chosen domain of discourse...
but, most importantly, to provide a powerful means of expressing what clinicians and patients report that they need to record so that the information can be understood and processed wherever there is a need. Clinical information models are specified in a formal way ensuring the specifications, known as 'archetypes
Archetype (information science)
In the field of informatics, an archetype is a formal re-usable model of a domain concept. Traditionally, the term archetype is used in psychology to mean an idealized model of a person, personality or behaviour...
', are computable. The set of openEHR archetypes need to be quality managed to conform to a number of axioms such as being mutually exclusive. The archetypes can be managed independently from software implementations and infrastructure, in the hands of clinician groups to ensure they meet the real needs on the ground. Archetypes are designed to allow the specification of clinical knowledge to evolve and develop over time. Challenges in implementation of information designs expressed in openEHR centre on the extent to which actual system constraints are in harmony with the information design.
In the field of Electronic health record
Electronic Health Record
An electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
s there are a number of existing information models with overlaps in their scope which are difficult to manage, such as between HL7 V3 and SNOMED CT
SNOMED CT
SNOMED CT , is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc...
. The openEHR approach faces harmonisation challenges unless used in isolation.
While individual health records may be vastly different in content, the core information in openEHR data instances always complies to archetypes. The way this works is by creating archetypes which express clinical information in a way that is highly reusable, even universal in some cases. To get to the point where information is suitably presented for clinical care it always involves a number of archetypes. These combinations of archetypes are called 'templates'; aggregations of archetypes which may also be refined for use in a particular situation. Templates may be used to specify forms, documents or even messages.
The openEHR approach uses the CEN- and ISO-standardised "archetype definition language" (expressed in ADL syntax or its XML equivalent) to build archetypes; these are reusable, formal models of domain concepts. Archetypes are used in openEHR to model clinical concepts such as "blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
" or "medical prescription
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
".
International collaboration
Following the openEHR approach, the use of shared and governed archetypes globally would ensure openEHR health data could be consistently manipulated and viewed, regardless of the technical, organisational and cultural context. This approach also means the actual data models used by any EHR are flexible, given that new archetypes may be defined to meet future needs of clinical record keeping. Recently work in Australia has demonstrated how archetypes and templates may be used to facilitate the use of legacy health record and message data in an openEHR health record system, and output standardised messages and CDA documents.The prospect of gaining agreement on design and on forms of governance at the international level remains speculative, with influences ranging from the diverse medico-legal environments to cultural variations, to technical variations such as the extent to which a reference clinical terminology
SNOMED CT
SNOMED CT , is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc...
is to be integral.
The openEHR Framework is consistent with the new Electronic Health Record Communication Standard (EN 13606
EN 13606
The overall goal of this Health informatics - Electronic Health Record Communication European Standard is to define a rigorous and stable information architecture for communicating part or all of the Electronic Health Record of a single subject of care...
). It is being used in parts of the UK NHS Connecting for Health Programme and has been selected as the basis for the national program in Sweden. It is also under evaluation in a number of countries including Denmark, Slovakia, Chile and Brazil. It is beginning to be utilised in commercial systems throughout the world.
Clinical Knowledge Manager
One of the key features of openEHR is the development of structures and terminologies to represent health data. Due to the open nature of openEHR, these structures are publicly available to be used and implemented in health information systems. Commonly, community users share, discuss and approve these structures in a repository known as Clinical Knowledge Manager (CKM). The most known openEHR CKMs are presented below:- openEHR Clinical Knowledge Manager
- NEHTA Clinical Knowledge Manager
- Swedish openEHR Clinical Knowledge Manager
See also
- Archetype (information science)Archetype (information science)In the field of informatics, an archetype is a formal re-usable model of a domain concept. Traditionally, the term archetype is used in psychology to mean an idealized model of a person, personality or behaviour...
- European Institute for Health RecordsEuropean Institute for Health RecordsThe European Institute for Health Records or EuroRec Institute is a non-profit organization founded in 2002 as part of the ProRec initiative. On 13 May 2003, the institute was established as a non-profit organization under French law. Current President of EuroRec is Prof. Georges De Moor...
- Electronic Health Record CommunicationEN 13606The overall goal of this Health informatics - Electronic Health Record Communication European Standard is to define a rigorous and stable information architecture for communicating part or all of the Electronic Health Record of a single subject of care...
(ISO/CENCENCEN may refer to:*Cen, or sen, is the currency of the fictional nation of Amestris of the anime/manga "Fullmetal Alchemist"As a three-letter acronym:* Cambridge Evening News, former name for the Cambridge News...
EN 13606 - EHRcom) - Health Level 7Health Level 7Health Level Seven , is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards...
- Health Informatics Service Architecture (HISA)
- HIPAA
- ProRecProRecThe ProRec initiative of 1996 is a network of national non-profit organisations . The initiative was a consequence of the conclusions of the Concerted Action MEDIREC regarding the reasons why Electronic Health Record systems were not used more widely in any of the European Union...
- SNOMED CTSNOMED CTSNOMED CT , is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc...