openEHR

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openEHR is an open standard specification 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 primary focus of openEHR is NOT the exchange of data between EHR-systems; this is the primary focus of Message standards such as ISO13606 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 methodologyfor specification of content.

The openEHR specifications include information and service models for the EHR, demographics, clinical workflow, archetypes, and are designed to be the basis of a medico-legally sound, distributed, versioned EHR infrastructure.

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[edit] Two level modelling with archetypes

The key innovation in the openEHR framework is to leave all specification of clinical information out of the information model but, most importantly, providing 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 records there are a number of existing information models with difficult to manage overlaps in their scope, such as between HL7 V3 and SNOMED CT. The openEHR model is a further model, with attendant harmonisation challenges unless used in isolation.

Of course all health records will be different, but the core information in the openEHR framework always complies to archetypes. How can this work? Archetypes must express clinical information in a way that is as reusable as possible. To get to the point where information is suitably presented for clinical care it always involves a number of archetypes. These 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[1]. Archetypes are used in openEHR to model clinical concepts such as "blood pressure" or "medical prescription".

[edit] 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 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.

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