Archetypes and FHIR by Koray Atalag
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Archetypes and FHIR by Koray Atalag

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Some thoughts on the intersection between OpenEHR archetypes and FHIR presented at the HL7 New Zealand FHIR seminar

Some thoughts on the intersection between OpenEHR archetypes and FHIR presented at the HL7 New Zealand FHIR seminar

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Archetypes and FHIR by Koray Atalag Archetypes and FHIR by Koray Atalag Presentation Transcript

  • Information Models & FHIR It’s all about content! Koray Atalag MD, PhD, FACHI k.atalag@auckland.ac.nz Vice Chair HL7 New Zealand Chair openEHR New Zealand openEHR Localisation Program Leader Member HISO
  • Programmes of research in • Health informatics & technology • Clinical trials • Cardiovascular disease • Addictions • Nutrition & physical activity Research services Teaching • PG Diploma in Health Informatics • MSc & PhD
  • (Clinical) Information Models Myths and Facts • They are NOT reference information models; – as in HL7 v3 RIM, openEHR/ISO13606 or FHIR resource ontology! • They are pure representations of health information • They may employ a number of formats and methods; inc. – Mindmaps, pdf, UML, XML/XSD, Archetypes, FHIR resources and even OO language implementations • For max semantic interoperability & computability:  formal reference information model – but can be very generic! • Latest buzzword: Detailed Clinical Models (DCM)
  • What’s in the name? Terminology: Labels/codes attached to atomic concepts (mostly without explicit context) – Diabetes Mellitus, ear ache, left hip, CT scan etc. Some have hierarchy (ICD) & relationships (SNOMED) Boundary Problem  Terminology binding Information Model: structure and semantics of concrete clinical concepts w/ context – Blood pressure measurement, lab test result, discharge summary, adverse reaction, prescription etc.
  • The Hard Way: Coronary arteriosclerosis Structural disorder of heart Heart disease Cardiac finding Cardiovascular finding Finding by site Clinical finding SNOMED CT Concept Mediastinal finding Finding of region of thorax Finding of trunk structure Finding of body region Viscus structure finding Disorder of mediastinum Disorder of thorax Disorder of trunk Disorder by body site Disease Disorder of body system Disorder of body cavity Disorder of cardiovascular system Disorder of coronary artery Coronary artery finding Arterial finding Blood vessel finding General finding of soft tissue Disorder of soft tissue of thoracic cavity Disorder of soft tissue of body cavity Disorder of soft tissue Disorder of artery Vascular disorder Arteriosclerotic vascular disease Soft tissue lesion Degenerative disorder
  • Structure with terminology: SNOMED Inconsistencies due to different post-coordination of concepts In a vasculitis physical examination: “Vascular exams: Carotid Right/Tender” 247348008 | tenderness (finding) | : 363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | : 24028007 | Right (qualifier value) | _____________________________________________________________________________ 301390006 | tenderness of cardiovascular structure | : 363698007 | finding site | = 69105007 | Carotid artery structure (body structure) |: 272741003 | laterality | = 24028007 | Right (qualifier value) | _______________________________________________________________________________ 309655006 | On examination-artery (finding) | : 69105007 | Carotid artery structure (body structure) | : 24028007 | Right (qualifier) |: 247348008 | tenderness | _______________________________________________________________________________ 401050002 | Carotid artery finding (finding) | : 363698007 | finding site | = 69105007 | Carotid artery structure (body structure) | : 272741003 | laterality | = 24028007 | Right (qualifier value) | : 247348008 | tenderness |
  • Problem/Diagnosis Archetype (Nehta)
  • Archetype terminology binding
  •  Open specs, tools and content for representing health information & building EHR – Based on 18+ years of international implementation experience including Good European Health Record Project – Origin of ISO/CEN 13606 EHR standard  Not-for-profit organisation - established in 2001 www.openEHR.org  “Inside Systems” vs HIE  Separation of clinical and technical worlds • Big international community
  • & Archetypes • FHIR resources and Archetypes are closely related – should avoid reinvention at all costs! • Archetype  FHIR resource conversion is expected to be seamless – Archetypes are maximal datasets; as opposed to – FHIR resources include most commonly used items (e.g. 80%) with an option to extend as needed (e.g. 20%) • An opportunity exists for FHIR to leverage openEHR content, tooling and expertise
  • FHIR: Adverse Reaction Resource
  • ADR Archetype (from CKM tool)
  • Getting closer…
  • HISO 10040 Interoperability Reference Architecture 10040.1 R-CDRs XDS 10040.2 CCR SNOMED CT openEHR 10040.3 CDA Acknowledge Alastair Kenworthy
  • What is a Content Model? • IT IS A REFERENCE LIBRARY – of validated information models for health information exchange (and more!) • Consists of maximal datasets (as opposed to minimal) – normalised using a standard EHR record organisation (openEHR) – Expressed as reusable and computable models – Archetypes • Top level organisation follows CCR • Only relevant items bound to SNOMED, ICD, LOINC etc. • Further detail provided by: – Existing relevant sources (CCDA, Nehta, epSoS, HL7 FHIR etc.) – Extensions (of above) and new Archetypes (NZ specific) • Each HIE content (CDA/FHIR/v2) will include one or more models and formally conform
  • Usage of the Content Model
  • Exploiting Content Model for Secondary Use Single Content Model CDA FHIR HL7 v2/3 EHR Extract UML XSD/XMI PDF Mindmap PAYLOAD System A Data Source A Map To Content Model System B Data Source B Native openEHR Repository Secondary Use Map To Content Model Automated Transforms No Mapping
  • Questions? k.atalag@auckland.ac.nz