This document discusses the progress of openEHR in China. It outlines important events in openEHR research in China since 2009. It also describes clinical modeling collaborations in China using the Healthcare Modeling Collaborations platform, major projects using openEHR, industrial companies using openEHR, research institutes involved in openEHR, and recent research on a Computerized Interpretable Guideline Builder based on openEHR.

1. Prof. Xudong Lu
(lvxd@zju.edu.cn)
Zhejiang University, China
2022.07
openEHR Progress in China

2. Important Events of openEHR in China
l 2009, Earliest openEHR research in China ”Research on Healthcare
Information Framework and Information Model”
l 2013, First openEHR-based CDR implementation in Shanxi Dayi hospital
by Zhejiang University in China
l 2015.08 , “First Contact”with openEHR communities, Prof. Xudong Lu
introduced the CDR implementation at Medinfo2015 in Brazil
l 2016.04，Prof. Huilong Duan was assigned ambassador of openEHR
China, and openEHR TC of CMSA has been
l 2018.05, First openEHR tutorial was held in Hangzhou, and 1~2
tutorials/yr afterwards
l 2019.06, Stroke Working group has been initiated under the openEHR TC,
targeted for Stroke data modeling and implementation and 4 WGs so far
l 2020.07, Template of “COVID-19 Pneumonia Diagnosis and Treatment
(7th edition) “ has been contributed to CKM

3. HMC – Healthcare Modelling Collaborations
http://openehr.org.cn/hmc/
A platform maintained to support modeling collaborations in China
So far 136 users (97 in 2019.6) from 87 institutions/companies (67 in 2019.6)

4. HMC Modeling Results
692 12
archetypes
ACS
Oral Medicine
Liver Cancer
Stroke
Heart Failure
AD Invervention
Liver Translation
EMR
Lung Cancer
Public Health
Genomic Modeling
Covid-19 Modeling
sub-domains
441 transferred from CKM and
translated to Chinese
251 are new archetypes
created according to
requirements

5. Major Projects using openEHR in China
l 2016, National Coronary Heart Registry Project, covering 16 big
hospitals in 13 provinces. Targeting for 100,000 clinical and
imaging data of coronary heart diseases
l 2017, China National Clinical & Genomics Database for Major
and rare diseases, Totally 14 disease, covering more than 20 big
hospitals
l 2018, Military EHR Project, Collecting data from over 200
hospitals and 1400 clinics, and provide EHR data services for
improving management and medical services
l 2019, China Stroke Data Platform Project, Nearly 7 million
patients, covering 360 hospitals
l 2020, National Clinical & Imaging Database Project by
Radiology Branch of Chinese Medical Association，First focus will
be Chest CT pulmonary nodules database

6. Major Industrial companies
using openEHR in their products
ZICT (ZTE ICT Ltd.)
l Reginal Healthcare Platform based on openEHR
United Care Technologies Co. Ltd.
l Stroke Acute Care Information System
Shuzhou Suhai Technology Co. Ltd.
l image CDR based on openEHR
Hangzhou JOYRUN Medical Software and Technology Co. Ltd.
l CLEVER CDR, driven by ZJU technologies
PROSPECT WELLNESS Co. Ltd.
l Health IT Open hpaPaaS, using openEHR for clinical data
repository

7. Regional Healthcare Platform 2019
Longhua District, Shenzhen Municipality
Regional Healthcare Platform 2017
Wuzhou City, Guangxi Province
Regional Healthcare Platform 2021
Wanzhou District, Chongqing Municipality
Regional Healthcare Platform 2020
Harbin City, Heilongjiang Province
• Connected to 110 tertiary, secondary,
primary hospitals and 14 specialized business
systems, such as public health service system,
blood bank information system, infectious
disease surveillance system
• Collected more than 1.3 billion data record
• Include population data, personal health
record, electronic medical record, and master
patient index
• Connected to 3 tertiary hospitals, 72 primary hospitals
and 3 specialized business systems, such as public
health service system, health surveillance system,
disease control system
• Collected more than 1.5 billion data record
Connected to 28 tertiary, secondary, primary
hospitals
Collected more than 700 million data record
National Regional Interoperability Certification
Progress of openEHR-based
Regional Healthcare Platform by ZTEICT

8. Major Chinese Research Institutes using openEHR
Zhejiang University
l Leading openEHR China to promote openEHR
l Leading several national database projects
l Conducting Covid-19 CDSS project this year
Academy of Military Medial Science
l Leading Military EHR Project
l Leading several data project for disease research
l Deeply involved in China Stroke Data Platform Project
Chinese Academy of Medical Science
l Leading a project of computer Interpretable guideline
Platform based on openEHR and GDL since 2020

9. Recent Research
CIG-Builder: a Computerized Interpretable
Guideline Builder based on openEHR

10. The CIG Builder Collabration
Prof. Dr. Jiao Li
CAMS&PMC
Prof. Dr. Xudong Lu
ZJU
Dr. Shan Nan
HNU

11. Computer-interpretable Guidelines
Clinical
Guidelines
Computer Interpretable
Guidelines
Clinical Decision
Support Systems

12. Previous Work： openEHR EL Rule Editor
Using the experience gained from COVID-19 CIG and CDSS development, we have developed
an openEHR EL based rule editor and execution engine.

13. Practical Issue When Building a CIG
Flowchart vs. Rule
WHEN (D=1 OR D1=1) AND (A=0 AND B=0)
THEN Atherosclerosis Stroke=True

14. Our Goal
Design and develop an easy-to-use
openEHR-based graphical CIG
builder which support flowchart
oriented CIG editing.

15. CIG Building Workflow
Knowledge
Acquisition
Define openEHR information
model according to the
annotated guideline.
3.Define Information
Model
Guideline Annotate
2.Guideline Annotation
CIG Name, Meta Info, Authors
Name, etc.
1.Create a CIG
Draw flowcharts according to
the annotated guideline,
including logic flow and
expressions.
4.Draw Flowchart
Test CIG and export to
production systems.
5.CIG Export and
Deployment

16. Flowchart Design - BPMN
Start
End
Data Entry
Decision
Sub Process
Stage
Action
Compound
Explanation
Links
Use BPMN as the execution language.
Synchronize

17. Embedded Rule Development – openEHR EL
Archetype/Templates
Data Item
Operator
Value
WHEN Systolic BP has been measured
THEN …

18. General Workflow of CIG Builder
Create a CIG project Guideline Annotation Guideline Upload
Template Editing
Draw Flowchart
CIG Test and Export

19. Creating a CIG Project
A guideline
A flowchart

20. Create a New CIG
Create a blank flowchart Duplicate an existing flowchart
Enter Meta Info

21. Guideline Annotation
Annotate & Upload

22. Template Editing
We provide a general template for CIG. However, when a specific guideline needs extra data
item, expanding the template is enabled.

23. Flowchart Editing
Primitives
Flowchart
Attributes
of a node

24. Data Entry Node
For data items which are not available from EHRs.
A data form which bind with archetype/template data items.

25. Decision Node
Using openEHR EL expressions

26. Testing a CIG Step-by-step
Test Run Data Entry
Next Step
Inference Engine
Execution Path
Reference
to the
original
guideline Results

27. Guideline Export and Disseminate
Export
Industry Standard
Based Files
Import to a CDSS
Form
Rule
Data Model
Guideline

28. CIG-Builder Applications
Tumorboard decision support system
for lung cancer
Elderly people multi chronic diseases
management system
Emergency medicine priority dispatch decision support system
Our CIG-Builder has been used to develop 3 different types of CDSS

29. Ø openEHR has been promoted well in China, both for
research institutes, and for industrial companies
Ø Clinical Modeling collaboration has been organized using
HMC tools, but still need to enhance governance
Ø We proposed an approach to use BPMN and openEHR
EL, together with openEHT models to develop CIGBuilder,
which proves to be flexible and efficient to build CIG
Wrap up

30. Thanks!