openEHR in China, 2018

openEHR in China
2018-07
Prof. Xudong Lu
Zhejiang University

China Medical Software Association／中国医疗器械行业协会医用软件分会
Personal Introduction
l Professor of Medical Informatics, Zhejiang University China
l Associate Director of Biomedical Information Technology
Institute of ZJU
l Visiting Research Professor, Technical University of
Eindhoven, the Netherlands
l General Secretary of Chinese Medical Software Association
l Co-ambassdor of openEHR China
l Medical Informatics, clinical decision
support system, big data analytics in
medicine
Job Titles：
Research Focus：
Contact：
l Email: lvxd@zju.edu.cn
l homepage:
http://mypage.zju.edu.cn/en/0003440

Early Publications of openEHR in China
l 2009, Jiye An（ZJU PhD Thesis），《Research on
Healthcare Information Framework and Information
Model》
l 2010, Zhihong Yao，Lei Liu ，《Introduction of
openEHR and its difference with CDA and DICOM》
l 2012, Bin Li ，《Research on the Integration of
SNOMED CT and OpenEHR》
l 2013, Zhihong Yao ，《Modelling Personal Health
Record Based on openEHR》

Case Study of openEHR-based CDR
l The study has been funded by Chinese National
“863” Program, initiated in 2012
l The CDR has been implemented in Shangxi Dayi
hospital since 2014
Shangxi Dayi Hospital with 2600 beds

• 2015.08 , Xudong introduced China's openEHR Case Study at
Medinfo2015 in Brazil
• 2016.04 ， Prof. Huilong Duan was assigned ambassador of
openEHR China, while Xudong supported him as co-
ambassador
“First-Contact”with openEHR Community

openEHR TC of CMSA
Started from 2016.04
Goal: Promoting openEHR Modeling and Implementation in China
Activities：Seminars/workshops, Tutorials, Forums/conferences,
Website Development，Modeling collaboration……
openEHR TC
Oral Medicine
Modeling WG
Physical
Examination
Modleing WG
EMR
Modeling WG
……
Secretariat

openEHR Workshops
• 2016.04, Shanghai, 1st openEHR Technical Seminar
• 2016.11, Wuhan, 2nd openEHR Technical Seminar
• 2017.08, Hangzhou, 3rd openEHR Technical Seminar
1-2 times/yearly，4th workshop will be held in Shenzhen in 2018.10

2018.05, Hangzhou, 1st openEHR Tutorial
• 2 days program including introduction, modeling, and technical
implementation
• Over 30 students from 6 companies/institutes
openEHR Tutorials

• 2016.04, Shanghai , Heather ‘s speech at CMEF2016 Forum
• 2017.01, Hangzhou, Xudong ‘s speech at OMAHA2016 Forum
• 2017.08, Hangzhou, Xudong‘s speeches at Medinfo2017
• 2018.07, Guiyang, Xudong‘s speech at CHIMA2018
• 2018.07, Heihe, Xudong‘s speech at CODATA2018
openEHR in forums/conferences

openEHR China Website
www.openEHR.org.cn open to Chinese around 2016.08

openEHR International Communication
Publish the Chinese events in www.openEHR.org ，plan to open English Events
Reporting page in www.openEHR.org.cn

openEHR Technology WeChat Group
• Started from 2018.05, for the purpose of discussing openEHR related technologies
• So far 102 members from over 40 companies or institutes joined in
Screenshot of 7.20 Screenshot of 7.27 Screenshot of member list

Active Enterprise & institutions
ü PROSPECT-WELLNESS(Beijing)
ü Yixian technology (Beijing)
ü INFINITT China(Shanghai)
ü ZTE-ICT(Guangdong)
ü Suhai technology(Jiangsu)
ü JoyRun Medical(Zhejiang)
ü Ming zhihui technology (Zhejiang)
ü Vico Software(Zhejiang)
ü …
ü Zhejiang University
ü Academy of Military Sciences PLA China
ü PLA General Hospital & Hainan branch
ü ShanXi Dayi Hospital
ü General Hospital of Ningxia medical University
ü Wuhan General Hospital
of Guangzhou Military
ü Wuzhou Hospital of Traditional Chinese
Medicine
Eight+ companies
Seven+ institutions

Typical System Implementations
in China

1st Case– CLEVER CDR by ZJU
• Archetype/
Template Editor
• Archetype –
relational
mapping
• AQL-based
Data Access
Interfaces
• Archetype
driven UI
configuration
Developed by ZJU

CLEVER CDR – Upper Applications
病原体抗生素耐药性变化趋势图
Clinical Decision SupportTimeline view
Clinical Research Support

CLEVER CDR – Implemented in different scenarios
City Level
Wuzhou Chinese
Medicine Hospital
Research
Collaboration
Anzhen Hospital
Ningxia General
Hospital Group （33
hospitals）
Cardiovascular Registry
Provincial Level
Shangxi Dayi Hospital
（2600 beds）
301 Hospital
National Level
301 hospital

CLEVER CDR – Used in National Projects
• 《Research on Bigdata standardization & technology in
Precision Medicine》，2016-2020
• 《Clinical & imaging Bigdata platform for Coronary Heart
Diseases 》，2016-2020
• 《Clinical & Omics Database for Major Diseases and Rare
Diseases in China》，2017-2020

2nd Case – PHIP by ZTE-ICTApplicationsUsers
Citizens
Health
Admin
Medical
staff
Business
partners
Telemedicine Regional PACS Regional LISRegional HIS Decision Making Health Card
RegionalHealthInformationPlatform
Hospitals Platform IntegrationPrimary Health Centers Health Insurance
Data
Source
Data Sharing EHR EMR LIS PACS
Database Population
Databse
EMR EHR BI Data
Comprehensive
Management
Medical
Service
Public
Health
Medical
Insurance
Drug
System
Medical
resource …
Public Health
Regional HIS Regional PACS Regional LIS
Maternal&Ch
ild
Sub-systems
Medical
Knowledge
Health Card
Mobile App
Authority
Security
Quality
Management
Terminology
Library
Standard
Management
Health Portal
Information Exchange & Sharing Platform
Health Assessment
Center
EMPI
HL7
CDA
Registration
• Population Health Information Platform （PHIP）based on openEHR
• Developed by ZTE-ICT

PHIP – Installations in China
Shenzhen
PHIP, Primary Healthcare, Telemedicine,
AIO,H8, Health Management Platform
PHIP, AIO, Mobile Healthcare, H8
National health and family planning commission
International cooperation division
（Residents mobile health management、China-Africa cooperation center） Beijing Bureau of traditional
Chinese medicine
（TCM Healthcare provided for the aged）
PHIP, AIO, Mobile Healthcare, FDA
Shanxi All-in-One Health Terminal
Shaanxi All-in-one Health Terminal
PHIP, AIO, Mobile Healthcare, Telemedicine
Shi Jiazhuang E-health&Network Hospital
First Hospital Cooperation case, build Shi Jiazhuang Chest Hospital Telemedicine
Center, Family Doctor Service and Remote Clinics etc franchise rights
Suzhou E-Health
Grade-A hospital of second
class license obtained
Nantong E-Health
Shenzhen Luohu
Family Doctor Project

PHIP – Interconnect Test by MOH
门诊摘要住院摘要会诊记录
产后访视服务
糖尿病患者随访服务
预防接种报告服务
转诊（院）记录个人基本健康信息登记儿童健康体检
高血压患者随访服务
产前随访服务
成人健康体检服务
新生儿家庭访视
成人健康体检 2型糖尿病随访服务预防接种报告
产后访视
产后访视
病历概要
检查报告治疗记录
急诊留观病历麻醉记录
门(急)诊病历检验报告
西药处方
手术护理记录
入院记录
入院评估
中药处方一般手术记录一般护理记录
住院病案首页
住院病程记录会诊记录
住院病程记录抢救记录
住院病案首页中医住院病案首页病历出院小结
住院病程记录术前小结
2016卫生信息共享文档标准&2016电子病历共享文档标准
Standard Documents defined by NHC
公共卫
生服务
原型
OPENEHR CORE DB
EMR
Archetypes
（96）
Public Health
Archetypes
（152）
Interconnect Assess

Funded by National Project, covering 16 big hospitals in 13 provinces.
Targeting for 100,000 clinical and imaging data of coronary heart diseases
3rd Case – Coronary Heart Registry
大连
医科
大学
附属
院
大附属
一院四院
Beijing huairou hopital
Renji hospital, shanghai
Jinan military general hospital
Sir run run shaw hospital
zhejiang university
School of medicine
The second affiliated hospital
of zhejiang university school
of medicine
Shanghai chest hospital
Ruijin hospital,shanghai
The first affiliated hospital of
xinjiang medical university
West china hosppital,
sichuan unieversity
The first affiliated hopstial Of
dalian medical university
The first affiliated hosptal of
zhengzhou university
Tongji medical college of
hust tongji medical
The first affiliated hospital，
sun yat-sen University
Qilu hospital of
Shandong Unversity
Chinese PLA general hospital
Beijing Anzhen hospital

CHR – System Concept Design
US MRA ECG
Meication Lab EMR
Datasets from
system in hospital
…
…
CRF designed by
clinicians
Mid-term
Follow-up
Baseline
Adverse Events Final Follow-up
Coronary
Heart Registry
based on
openEHR
Data QC
Data Verify
数据集成
CRF Entry
Data
Processing
Integartion
… extraction
• openEHR is used for modeling both from clinicians and existing databases
• The data extraction is facilitated through linking to openEHR-based CDR

CHR – International Collaboration
All of New Zealand
Acute Coronary Syndrome – Quality Improvement
(Registry)
急性冠脉综合征
风险预测
Ø Research on the benefit of improving
interoperability through openEHR
Ø Data Analytics such as Disease Risk
Predication Models on dual Registries to
compare the results between two countries,

4th Case – EHR.care by PROSPECTWELLNESS
l Open Care Solution to provide rapid development for healthcare
enterprise information platform, which is powered by openEHR-
based EHR.care
l Use case 1(implemented in 2017.12): Building information platform
for High-end Health Management Corporations covering four cities
in China,
l Use case 2(On-going):
Building information
platform for Private
Hospital Alliance
Corporation，
integrating all the
heterogeneous
systems.

Clinical Modelling
in China

HMC – Healthcare Modelling Collaborations
http://openehr.org.cn/hmc/
A platform maintained by ZJU to support modeling collaborations

openEHR Ecosystem
CKM
SYS-A
Templates
HMC
SYS-B
Templates
SYS-C
Templates
Domain
Experts
Building the sharable
archetypes
End Users
Defining the templates and
building the applications
Developers
Building the enabling systems
International
Library of
information Models

Archetype Library In HMC
61
17
0
20
40
60
80
Archetype localization
new alter
CKM
83%
Localization
17%
Distribution of Archetype
CKM
localization
CKM
12%
Localization
88%
Chinese version Archetypes
CKM
393
10 72
78

Relationship Between HMC and CKM
Archetype
Library
Archetype
Library
International
domestic
China clinicians
International
clinicians

Modeling Working Groups in openEHR TC
l Oral Medicine Modeling Working Group（ In progress ）
l Physical Examination Modeling Working Group （ In progress ）
l EMR Modeling Working Group （ proposing）
l Cardiovascular Working Group （ proposing）
l Obstetrics and Gynecology Working Group （ proposing）
l Public Health Working Group （ proposing）
l Radiology Working Group （ proposing）
l Genomics Working Group （ proposing）

Discussions

Relationship with messaging standards
• CDA is used as the referenced framework for
MOH standards in China
• Relationship with HL7v2, HL7v3, CDA and FHIR
(point to point messaging)
• openEHR is models for maximum dataset which can
be used as knowledge base for messaging standards
(minmum datasets)
Messaging
openEHRopenEHR

Relationship with other models
Ø Relationship with other popular models like OHDSI
CDM
• Multi-layered vs. single-layered
• Modeling all clinical events vs. modeling for
certain purposes like cohort study
Ø The researches of mapping different models are
planned to prove the interoperability between
openEHR and other models

Ideas of promoting openEHR in China
Ø “Bottom-up” method
• Promoting the use of openEHR in products and
projects to show the real-life successful stories
• Emphasis on open modeling collaboration since it
can show the advantages of openEHR
Ø “Top-down” method
• Continue discussing with corresponding departments
in NHC to find the opportunities to link to national
standards
Combining two methods to achieve goal

What we can do next ?
• Improve openEHR Education
• Improve International collaboration
• Develop local standards based on openEHR
• Open sourcing more openEHR tools
• openEHR Certifications

Thanks !

openEHR in China, 2018

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