Download PDF
Methods Inf Med 2007; 46(03): 332-343
DOI: 10.1160/ME5001
paper
Schattauer GmbH

Towards Semantic Interoperability for Electronic Health Records

Domain Knowledge Governance for openEHR Archetypes
S. Garde
1   Central Queensland University, Health Informatics Research Group, Faculty of Business and Informatics, Melbourne, Victoria, and Rockhampton, Queensland, Australia
,
P. Knaup
2   University of Heidelberg, Department of Medical Informatics, Heidelberg, Germany
,
E. J. S. Hovenga
1   Central Queensland University, Health Informatics Research Group, Faculty of Business and Informatics, Melbourne, Victoria, and Rockhampton, Queensland, Australia
,
S. Heard
1   Central Queensland University, Health Informatics Research Group, Faculty of Business and Informatics, Melbourne, Victoria, and Rockhampton, Queensland, Australia
3   Ocean Informatics, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
20 January 2018 (online)

    Permissions and Reprints

Summary

Objectives: In the field of open electronic health records (EHRs), openEHR as an archetype-based approach is being increasingly recognised. It is the objective of this paper to shortly describe this approach, and to analyse how openEHR archetypes impact on health professionals and semantic interoperability.

Methods: Analysis of current approaches to EHR systems, terminology and standards developments. In addition to literature reviews, we organised face-to-face and additional telephone interviews and tele-conferences with members of relevant organisations and committees.

Results: The openEHR archetypes approach enables syntactic interoperability and semantic interpretability – both important prerequisites for semantic interoperability. Archetypes enable the formal definition of clinical content by clinicians. To enable comprehensive semantic interoperability, the development and maintenance of archetypes needs to be coordinated internationally and across health professions. Domain knowledge governance comprises a set of processes that enable the creation, development, organisation, sharing, dissemination, use and continuous maintenance of archetypes. It needs to be supported by information technology.

Conclusions: To enable EHRs, semantic interoperability is essential. The openEHR archetypes approach enables syntactic interoperability and semantic interpretability. However, without coordinated archetype development and maintenance, ‘rank growth’ of archetypes would jeopardize semantic interoperability. We therefore believe that openEHR archetypes and domain knowledge governance together create the knowledge environment required to adopt EHRs.

Keywords

Electronic health records - semantic interoperability - openEHR archetypes - domain knowledge governance - computerized medical record systems
 

  • References

  • 1 International Organisation for Standardisation (ISO). 20514 Draft Technical Report: EHR Definition, Scope and Context.
    PubMedGoogle Scholar
  • 2 Ash JS, Bates DW. Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion. J Am Med Inform Assoc 2005; 12 (01) 8-12.
    PubMedGoogle Scholar
  • 3 Schloeffel P. openEHR archetypes: Putting the clinician back in the driver’s seat. HIC 2003 (Health Informatics Conference Australia). Sydney: 2003
    Google Scholar
  • 4 UK Royal College of Nursing. Nurses and NHS IT developments. 2005 http://www.rcn.org.uk/downloads/research/nurses-it-devs-survey.doc (Last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 5 Kuhn KA, Giuse DA. From hospital information systems to health information systems. Problems, challenges, perspectives. Methods Inf Med 2001; 40 (04) 275-87.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 van Bemmel JH, Musen MA. Handbook of Medical Informatics.. Heidelberg: Springer; 1997
  • 7 Brandner R, van der Haak M, Hartmann M, Haux R, Schmücker P. Electronic Signature for Medical Documents – Integration and Evaluation of a Public Key Infrastructure in Hospitals. Methods Inf Med 2002; 41 (04) 321-30.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Frankel A, Gandhi TK, Bates DW. Improving patient safety across a large integrated health care delivery system. Int J Qual Health Care 2003; 15 (Suppl. 01) i31-i40.
    CrossrefPubMedGoogle Scholar
  • 9 Classen DC, Kilbridge PM. The roles and responsibility of physicians to improve patient safety within health care delivery systems. Acad Med 2002; 77 (10) 963-72.
    CrossrefPubMedGoogle Scholar
  • 10 Fitzpatrick NK, Shah S, Walker N, Nourmand S, Tyrer PJ, Barnes TR, Higgitt A, Hemingway H. The determinants and effect of shared care on patient outcomes and psychiatric admissions – an inner city primary care cohort study. Soc Psychiatry Psychiatr Epidemiol 2004; 39 (02) 154-63.
    CrossrefPubMedGoogle Scholar
  • 11 Smith S, Bury G, O’Leary M, Shannon W, Tynan A, Staines A, Thompson C. The North Dublin randomized controlled trial of structured diabetes shared care. Fam Pract 2004; 21 (01) 39-45.
    CrossrefPubMedGoogle Scholar
  • 12 Harris MF, Priddin D, Ruscoe W, Infante FA, O’Toole BI. Quality of care provided by general practitioners using or not using Division-based diabetes registers. Med JAust 2002; 177 (05) 250-2.
    PubMedGoogle Scholar
  • 13 Ciardullo AX, Daghio MM, Brunetti M, Bevini M, Daya G, Feltri G, Novi D, Goldoni CA, Guerzoni A, Messori A, Magrini N. Audit of a shared-care program for persons with diabetes: baseline and 3 annual follow-ups. Acta Diabetol 2004; 41 (01) 9-13.
    CrossrefPubMedGoogle Scholar
  • 14 Kuperman GJ, Spurr C, Flammini S, Bates D, Glaser J. A clinical information systems strategy for alarge integrated delivery network. Proc Amia Symp. 2000: 438-42.
    PubMedGoogle Scholar
  • 15 Wan TT, Lin BY, Ma A. Integration mechanisms and hospital efficiency in integrated health care delivery systems. J Med Syst 2002; 26 (02) 127-43.
    CrossrefPubMedGoogle Scholar
  • 16 Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, Kittler AF, Goldszer RC, Fairchild DG, Sussman AJ, Kuperman GJ, Bates DW. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003; 114 (05) 397-403.
    CrossrefPubMedGoogle Scholar
  • 17 Safran C. The collaborative edge: patient empowerment for vulnerable populations. Int J Med Inf 2003; 69 2-3 185-90.
    CrossrefPubMedGoogle Scholar
  • 18 Garde S, Wolff AC, Kutscha U, Wetter T, Knaup P. CSI-ISC: Concepts for Smooth Integration of Health Care Information System Components into Established Processes of Patient Care. Methods Inf Med 2006; 45 (01) 10-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Ammenwerth E, Shaw NT. Bad health informatics can kill – is evaluation the answer?. Methods Inf Med 2005; 44 (01) 1-3.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Shabo A, Vortman P, Robson B. Who’s Afraid of Lifetime Electronic Medical Records. Proceedings of 1st Annual Conference on Mobile and Wireless Healthcare Applications. November 11-14 2001. Café Royal; London.:
    Google Scholar
  • 21 Cimino JJ. Terminologytools: state of the artand practical lessons. Methods Inf Med 2001; 40 (04) 298-306.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Mludek X, Knaup P, Garde S, Merzweiler A, Weber R, Wetter T. Formale Definition von Integritätsbedingungen für den Basisdatensatz der Pädiatrischen Onkologie (Formal Definition of Integrity Constraints for a Basic Data Set for Pediatric Oncology). Informatik, Biometrie und Epidemiologie in Medizin und Biologie 2002; 33 2-3 338.
    PubMedGoogle Scholar
  • 23 Xu Y, Sauquet D, Degoulet P, Jaulent MC. Component-based mediation services for the integration of medical applications. Artif Intell Med 2003; 27 (03) 283-304.
    CrossrefPubMedGoogle Scholar
  • 24 Goodchild A, Gibson K, Anderson L, Bird L. The Brisbane Southside Health Connect Trial: Preliminary Results.. Health Informatics Conference (HIC). Brisbane: 2004
    Google Scholar
  • 25 W3C. OWL Web Ontology Language Over-view–W3C Recommendation 10 February 2004. 2004 http://www.w3.org/TR/owl-features/ (Last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 26 Knublauch H, Fergerson RW, Noy NF, Musen MA. The Protégé OWL Plugin: An Open Development Environment for Semantic Web Applications. Third International Semantic Web Conference – ISWC. 2004
    PubMedGoogle Scholar
  • 27 Rector AL. Terminology and concept representation languages: where are we?. Artif Intell Med 1999; 15 (01) 1-4.
    CrossrefPubMedGoogle Scholar
  • 28 Beale T. Archetypes: Constraint-based Domain Models for Future-proof Information Systems. OOPSLA 2002 workshop on behavioural semantics. 2002
    PubMedGoogle Scholar
  • 29 Veltman KH. Syntactic and Semantic Interoperability: New Approaches to Knowledge and the Semantic Web. The New Review of Information Networking 2001; 07: 159-84.
    PubMedGoogle Scholar
  • 30 Institute of Electrical and Electronics Engineers (IEEE). IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries.. New York, NY: 1990
  • 31 Sheth AP. Changing Focus on Interoperability in Information Systems: From System, Syntax, Structure to Semantics. Goodchild MF, Egenhofer MJ, Fegeas R, Kottman CA. Interoperating Geographic Information Systems.. Norwell, MA: Kluwer; 1999
    Google Scholar
  • 32 Elkin PL, Brown SH, Lincoln MJ, Hogarth M, Rector A. A formal representation for messages containing compositional expressions. Int J Med Inform 2003; 71: 89-102.
    CrossrefPubMedGoogle Scholar
  • 33 Health Level 7. HL7 EHR System Functional Model: A Major Development Towards Consensus on Electronic Health Record System Functionality – A White Paper 2004. http://www.hl7.org/ehr/downloads/dstu/EHR-SWhitePaper.zip (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 34 Min Z, Baofen D, Weeber M, van Ginneken AM. Mapping OpenSDE domain models to SNOMED CT. Applied to the domain of cardiovascular disease. Methods Inf Med 2006; 45 (01) 4-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Kalra D. Electronic Health Record Standards. In: Haux R, Kulikowski C, editors. IMIA Yearbook of Medical Informatics 2006. Methods Inf Med 2006; 45 (Suppl. 01) S136-44.
    PubMedGoogle Scholar
  • 36 CEN. ENV13606 Health informatics-Electronic health record communication. 1999
    PubMedGoogle Scholar
  • 37 CEN. ENV 13606–1 Health informatics – Electronic health record communication – Part 1 : Reference model. 1999
    PubMedGoogle Scholar
  • 38 ISO. Committee Draft (CD) 13606-1 Health informatics – Electronic health record communication – Part 1 : Reference model.
    PubMed
  • 39 International Organisation for Standardisation (ISO). ISO/TS 18308: Requirements for an Electronic Health Record Reference Architecture. 2004.
    PubMed
  • 40 Beale T. openEHR/ISO 18308 Conformance Statement. The openEHR Foundation. 2006 http://svn.openehr.org/specification/TRUNK/publishing/requirements/iso18308_conformance.pdf (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 41 International Organisation for Standardisation (ISO). ISO 8601, Data elements and interchange formats – Information interchange – Representation of dates and times. 1988.
    PubMed
  • 42 Jaspers MWM, Knaup P, Schmidt D. The Computerized Patient Record: Where Do We Stand? In: Haux R, Kulikowski C, editors. IMIA Yearbook of Medical Informatics 2006. Methods Inf Med 2006; 45 (Suppl. 01) S29-39.
    PubMedGoogle Scholar
  • 43 Garde S, Heard S, Hovenga E. Archetypes in Electronic Health Records: Making the case and showing the path for domain knowledge governance. Grain H, Wise M. HIC 2005:13th Australian Health Informatics Conference, Melbourne, 31.07.2005-02.08.2005, Brunswick East. Vic: Health Informatics Society of Australia; 2005
    Google Scholar
  • 44 Kumar A, Smith B, Pisanelli DM, Gangemi A, Stefanelli M. An Ontological Framework for the Implementation of Clinical Guidelines in Health Care Organisations. Pisanelli DM. Ontologies in Medicine.. Amsterdam: IOS Press; 2004
    Google Scholar
  • 45 Pisanelli DM, Gangemi A. If Ontology is the Solution, What is the Problem?. Pisanelli DM (ed). Ontologies in Medicine.. Amsterdam: IOS Press; 2004
    Google Scholar
  • 46 National E-Health Transition Authority (NEHTA). Review of Shared Electronic Health Record Standards – Version 1.0. 2006. http://www.nehta.gov.au/component/option,com_docman/task,doc_download/gid,68/Itemid,139/ (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 47 Hovenga E, Garde S, Heard S. Nursing Constraint Models for Electronic Health Records: a vision for domain knowledge governance. Int J Med Inf 2005; 74: 886-98.
    CrossrefPubMedGoogle Scholar
  • 48 CEN. Archetype Knowledge Framework – accepted as new work item. 2005
    PubMedGoogle Scholar
  • 49 National E-Health Transition Authority (NEHTA). Clinical Data Standards: Adverse Reaction and Alert Archetype Representations. Final Report. 2005 http://www.nehta.gov.au/component/option,com_docman/task,doc_download/gid,35/Itemid,139/ (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 50 Bird L, Goodchild A, Tun Z. Experiences with a Two-Level Modelling Approach to Electronic Health Records. Journal of Research and Practice in Information Technology. 2003 35. 02.
    PubMedGoogle Scholar
  • 51 Al-Ubaydli M. Open source medical records systems around the world. UK Health Informatics Today. 2006 49 (3-4).
    PubMedGoogle Scholar
  • 52 WHO. WHA58.28 – Resolution on eHealth. 58th World Health Assembly. 2005 http://www.who.int/gb/ebwha/pdf_files/WHA58/WHA58_28-en.pdf (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 53 Beuscart-Zéphir MC, Anceaux F, Crinquette V, Renard JM. Integrating user’s activitymodeling in the design and assessment of hospital electronic patient records: the example of anesthesia. Int J Med Inf 2001; 64 2-3 157-71.
    CrossrefPubMedGoogle Scholar
  • 54 Dolin RH, Alschuler L, Beebe C, Biron PV, Boyer SL, Essin D, Kimber E, Lincoln T, Mattison JE. The HL7 Clinical Document Architecture. J Am Med Inform Assoc 2001; 08 (06) 552-69.
    CrossrefPubMedGoogle Scholar
  • 55 Blobel B. Advanced and secure architectural EHR approaches. Int J Med Inform 2005; 75 3-4 185-90.
    PubMedGoogle Scholar
  • 56 Garde S. Developing and Managing Archetypes. NIA – HISA Nursing Informatics SIG Workshop: Capturing Health Knowledge: developing archetypes. July 1,2005 Brisbane: 2005
    Google Scholar
  • 57 Garde S, Hovenga E, Conrick M. Integratingnursing concepts into Electronic Health Records. Nursing Informatics Australia Conference: “Nurses make a difference: using information to make nurses’ contribution visible”.. Melbourne: December 4 2004
    Google Scholar
  • 58 Oemig F, Blobel B. Does HL7 Go towards an Architecture Standard? Stud Health Technol Inform. 2005; 116: 761-6.
    PubMedGoogle Scholar
  • 59 Heard S, Beale T, Freriks G, Mori AR, Pishev O. Templates and Archetypes: how do we know what we are talking about?. 2003 http://www.openehr.org/downloads/archetypes/templates_and_ archetypes.pdf (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 60 Heitmann KU, Schweiger R, Dudeck J. Discharge and referral data exchange using global standard-the SCIPHOX project in Germany. Int J Med Inform 2003; 70 2-3 195-203.
    CrossrefPubMedGoogle Scholar
  • 61 CEN/TC 251. EHRCOM prEN 13606-1. Health informatics – Electronic health record communication – Part 1 : Reference model.. 2005
    PubMedGoogle Scholar
  • 62 Despont-Gros C, Landau R, Rutschmann O, Simon J, Lovis C. The digital pen and paper. Evaluation and acceptance of anew data acquisition device in clinical settings. Methods Inf Med 2005; 44 (03) 359-68.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 63 van der Haak M, Wolff AC, Brandner R, Drings P, Wannenmacher M, Wetter T. Data security and protection in cross-institutional electronic patient records. Int J Med Inf 2003; 70 2-3 117-30.
    CrossrefPubMedGoogle Scholar
  • 64 Mulligan E, Rogers W, Braunack-Mayer A. Research within the Privacy Regulations: Problems and Solutions for Database Custodians. Electronic Journal of Health Informatics 2006; 01 (01) e7. http://ejhi.net/ojs/index.php/ejhi/article/view/e7 (last accessed: 08.08.2006).
    PubMedGoogle Scholar
  • 65 Hollerbach A, Brandner R, Bess A, Schmucker P, Bergh B. Electronically signed documents in health care – analysis and assessment of data formats and transformation. Methods Inf Med 2005; 44 (04) 520-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 66 Sax U, Schmidt S. Integration of genomic data in Electronic Health Records – opportunities and dilemmas. Methods Inf Med 2005; 44 (04) 546-50.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 67 Shabo A. A global socio-economic-medico-legal model for the sustainability of longitudinal electronic health records. Part 1. Methods Inf Med 2006; 45 (03) 240-5.
    Article in Thieme ConnectPubMedGoogle Scholar