The semantically interoperable Electronic Health Record is one of the most challenging research fields in health informatics. Reaching this objective, the use of EHR standards that formally describe health data structures cannot be waived. CEN EN13606 is one of the most promising approaches to solve this problem since it covers the technical needs for semantic interoperability and, at the same time, it incorporates a mechanism (archetype model) for clinical domain experts’ participation in building an EHR system. In this paper we present EHRflex, a generic system based on archetypes. It empowers the clinician and allows him to manage his own EHR system in a simple and generic way, assuring that the user works with underlying standardized data structures. They can be exchanged with other people and systems when needed. EHRflex introduces EHR standards into the clinical routine delivering a technical platform which works directly on archetype based data. Publication: Anton Brass, David Moner, Claudia Hildebrand, Montserrat Robles. "Standardized and flexible health data Management with an archetype driven EHR system (EHRflex)". Seamless care – Safe care: The Challenges of Interoperability and Patient Safety in Health Care. Proceedings of the EFMI Special Topic Conference, pp. 212-218. IOS Press BV, Amsterdam. ISBN: 978-1-60750-562-4, 2010.

1. Standardised and Flexible Health Data
Management with an Archetype Driven
EHR System (EHRflex)
Anton Brass1, David Moner2,
Claudia Hildebrand1, Montserrat Robles2
1 Helmholtz Zentrum München, Germany
2 Universidad Politécnica de Valencia, Spain

2. Content
• Dual model and CEN EN13606
• The EHRflex system
• Operational Template Model
• System by example
• Conclusion and future work
2EHRflex

3. Dual model and CEN EN13606
• The Dual Model approach is a methodology for building Information
Systems based on the separation of information and knowledge.
– Information – statements about specific entities
Eg. Blood pressure measurement: 120/80, patient was sitting
– Knowledge – statements which apply to all entities of a class
Eg. Blood pressure is composed by Systolic and Diastolic
measurements in mmHg, possible positions are: Lying, Sitting and
Standing.
• A dual model system can thus incorporate knowledge from a
specific domain and evolve seamlessly.
EHRflex 3

4. Dual model and CEN EN13606
• ISO/CEN EN13606 is an international standard for the
semantic interoperability of electronic health records.
– Based on a dual model approach.
• Reference model (information model)
– Provides the generic structures or building blocks to build
an EHR.
• Archetype model (knowledge model)
– Constrains the reference model building blocks in order to
define high-level semantic concept definitions.
EHRflex 4

5. Dual model and CEN EN13606
• An archetype…
– Defines the specific structure for data.
– Defines other data constraints such as cardinalities,
existence, occurrences, default values…
– Binds data structures to terminologies.
– Is a shareable definition of knowledge.
– Can be defined by domain specialists (health
professionals).
– Can be used to generate user interfaces.
EHRflex 5

6. Archetype “Blood pressure”
Created with
LinkEHR Archetype Editor:
www.linkehr.com
6EHRflex

7. The EHRflex system
• EHRflex: An archetype-based EHR system.
• Main goals:
– Definition and implementation of a generic model for
user interaction and visualization of health data.
– Clear and self-explanatory screen forms.
– Empower clinicians to design their own content.
– Introduce the dual model and archetypes into the
daily practice.
EHRflex 7

8. The EHRflex system
The problem
• How can we represent an EN13606 ENTRY?
– Or an OpenEHR INSTRUCTION?
– Or a HL7 CDA PROCEDURE?
• In essence they all represent the same “business
concept”
– They should be represented in the same way.
– They must be transformed into usable graphic interfaces.
– And they should incorporate specific user needs or
preferences (templates).
EHRflex 8

9. The EHRflex system
The solution
• Operational Template
Model (OTM)
– A generic model for
representing graphical user
interfaces.
– Independent of a particular
reference model.
– Also holds and transmits the
associated health data
instances.
EHRflex 9
Medical
Data
Reference
Model
Archetype
Model
OTM
List
Data 1 Data 2
Data 3

10. Operational Template Model
• The OTM is an object oriented model which
includes:
– Generic data structures:
• StructureObject, List, Alternative.
– Generic data types:
• FieldList, Boolean, Integer, Real, CodedText, SimpleText.
• Classes and data types from any reference model
can be mapped and transformed into an OTM
instance and vice versa.
EHRflex 10

11. Operational Template Model
• Step 1: transform archetypes into an OTM
instance.
EHRflex 11
Archetype
Parser

12. Operational Template Model
• Step 2: transform the OTM into a form to
be filled with data.
EHRflex 12
Data 1List1
Data 2
Data 5

13. Operational Template Model
• Step 3: transform the OTM into an XML of
any reference model.
EHRflex 13
XML Data

14. 14EHRflex
System by example
http://www.ehrflex.eu

15. 15
System by example
Google Health medication
EHRflex

16. System by example
Google Health medication
16EHRflex

17. Conclusions
• Clinicians can define and use their own
clinical concepts through archetypes.
• Graphical representations are usable despite
the generic reference models.
• Data can be stored as standard XML
documents.
• EHRflex is generic and can be used with any
standard.
EHRflex 17

18. Future work
• Support of additional archetype properties:
– Alternatives, multiple languages, use of
terminologies…
• Support of templates for specific uses or
domains.
• Support for other reference models such
as OpenEHR, CCR and HL7 CDA.
EHRflex 18

19. Thank you for your attention!
Standardised and Flexible Health Data
Management with an Archetype Driven
EHR System (EHRflex)
David Moner
damoca@upv.es
EHRflex 19