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Hildegard Franke Dr Ian McNicoll
openEHR Archetypes in detail
Archetype Dictionary Definition
http://www.dictionary.com/browse/archetype
http://www.oxforddictionaries.com/definition/english/archetype
http://dictionary.cambridge.org/dictionary/english/archetype
openEHR Archetypes IComputable models of discrete clinical concepts
Familiar components of a health record
Blood pressure, Body weight, Symptom
Medication order, Family history
Prostate cancer histopathology result
‘Maximal dataset’ philosophy Capture as many clinical perspectives as possible
Universal use case
openEHR Archetypes IIcan be designed for specific local use case
particular data entry screen
local message
most useful when designed to be shared and reused
“What do WE mean by pulse rate”
Potential for a SINGLE, SHARED
MODEL of clinical content
Blood Pressure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.130
Archetypes are based on RM ‘classes’
EHR
Folders
Compositions
Sections
Entries
Clusters
Elements
Electronic health record for one person
High level organisation of the EHR,e.g. by episode or by specialty
Set of entries comprising a clinical care session or document, e.g. encounter, result
Clinical headings reflecting workflow or consultation process
Clinical statements about observations, evaluations, instructions, actions
Entry subcomponents, e.g. device details or inspired oxygen information
Leaf nodes of name-value pair and datatype, e.g. body weight = 60kg (Quantity)
Generic RM ClassesEHR
FOLDER (optional)
COMPOSITIONCOMPOSITION
SECTION (optional)
ENTRYELEMENT
ELEMENT
ENTRYELEMENT
ELEMENT
ENTRYELEMENT
ELEMENT
ELEMENT
ELEMENT
CLUSTER
ELEMENT
SECTION (optional)
Archetypes: recipes for clinical contentCOMPOSITIONCOMPOSITION (Encounter)
SECTION (Vital signs)
OBSERVN. (BP)ELEMENT (Systolic)
ELEMENT (Diastolic)
OBSERVN. (Pulse)ELEMENT (Rate)
ELEMENT (Comment)
COMPOSITIONVenison Wellington
Fillings
Mushroom Duxelles100g Wild Mushrooms
25g Butter
Herb Pancakes
PastryPuff Pastry
ingredients
SECTION (Allergies)
EVAL (Adverse Reaction)ELEMENT (Substance)
ELEMENT (Status)
ELEMENT (Category)
CompositionSection
Entry
Element
100g Plain Flour
1 egg
MeatVenison
1 kg Venison Loin
Archetypes: recipes for clinical contentCOMPOSITIONCOMPOSITION (Encounter)
SECTION (Vital signs)
OBSERVN. (BP)ELEMENT (Systolic)
ELEMENT (Diastolic)
OBSERVN. (Pulse)ELEMENT (Rate)
ELEMENT (Comment)
COMPOSITIONVenison Wellington
Fillings
Mushroom Duxelles100g Wild Mushrooms
25g Butter
Herb Pancakes
PastryPuff Pastry
ingredients
SECTION (Allergies)
EVAL (Adverse Reaction)ELEMENT (Substance)
ELEMENT (Status)
ELEMENT (Category)
CompositionSection
Entry
Element
100g Plain Flour
1 egg
MeatVenison
1 kg Venison Loin
Archetype namingConcept name: the human name of the clinical concept
‘Blood pressure’, ’Report’
ArchetypeID: the technical name used by tooling and CDRs
‘openEHR-EHR-OBSERVATION.blood_pressure.v1’
‘openEHR-EHR-COMPOSITION.report.v1’
Naming examples
Naming examples
Naming examples
SLOTS
Allow modeller to leave a gap
‘plug in’ another archetype
Allows complex ideas to be built up by mixing different combinations of archetypes
SLOT RulesDefined in Reference Model
COMPOSITIONS
SECTIONS, ENTRIES, CLUSTERS (in context only)
SECTIONS
other SECTIONS, ENTRIES
ENTRIES
CLUSTERS, ELEMENTS
i.e. ENTRIES cannot be nested
Report, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09].
Available from: http://openehr.org/ckm/#showArchetype_1013.1.677
Laboratory test, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available
from: http://openehr.org/ckm/#showArchetype_1013.1.2191
SLOT ConstraintsDetermine which archetypes can fill the slot
Good practice
Keep slot options ‘open’
Use the slot constraint to define common slot fills
Only occasionally ‘lock down’ the slot to specific archetypes
Slot constraint examples
Blood Pressure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-21]. Available from: http://
www.openehr.org/ckm/#showArchetype_1013.1.130
COMPOSITION archetypes‘Top level document’ container for all clinical data
All clinical data saved inside a Composition
Represent generic document types in clinical system
Encounter, Report, Lab Report
Problem List, Discharge Summary, End of Life Care plan
Simple
Do not define detailed content.
Report, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2015-10-11]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.677
SECTION archetypesSub-divide complex compositions
No ‘semantic’ meaning
Meaning carried in ENTRY archetypes names inside SECTIONS
Very few pre-defined SECTION archetypes
Vital signs, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://
openehr.org/ckm/#showArchetype_1013.1.278
Ad hoc heading, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available
from: http://openehr.org/ckm/#showArchetype_1013.1.631
ENTRY archetypesCarry key clinical content payload
Carry clinical meaning
Carry sufficient clinical context
‘Clinical statement’ Blood pressure, Diagnosis
Lab test, ECG, Procedures
Must use one of the ENTRY sub-types
‘Clinical decision making process’
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: Provider/Subject/Participation
Provider of care
Optional where provider <> composer
Subject of care
Optional where subject <> patient
Participation
Optional where other individuals involved, e.g. MDT
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: Data
The data of primary clinical interest
Sometimes nested within another feature
inside INSTRUCTION ‘activities’
inside OBSERVATION ‘events’
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: History/Event featureAll data inside event
Allows complex, repeated ‘events’ to be captured efficiently
Multiple pulse readings
Apgar scores at different times
Support averages, max , min etc
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: ’Protocol’ featureSecondary information about the method or circumstances of data collection
Observations
Device/ methodology e.g. Cuff size
Evaluations/Instructions
Links to guidance or criteria
Instructions / Actions
Workflow identifiers
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: ’State’ featureState of patient with possible impact on interpretation
Exercise level
Fasting state
Anxiety
Stress
Other confounding factors
ENTRY: ’State’ featureState of patient with possible impact on interpretation
Exercise level
Fasting state
Anxiety
Stress
Other confounding factors
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: ’Activities’ feature
Allows for multiple ‘chained’ sub-instructions
All data embedded within Activities
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY sub-type featuresProviderSubject Data History
Event Protocol State Activities Pathway
OBSERVATIONS Yes Yes Yes Yes Yes
EVALUATIONS Yes Yes Yes
INSTRUCTIONS Yes Yes Yes Yes
ACTIONS Yes Yes Yes Yes
ADMIN_ENTRY Yes Yes
ENTRY: ’Pathway’ featureRecording workflow status
Procedure
Planned, Scheduled, Commenced
Completed
Postponed, Suspended
Cancelled, Aborted
OBSERVATION archetypesGathering of evidence
Measurable / observable data
Patient history, physical examination
Lab tests, imaging
Scores and scales
Laboratory test, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited:
2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.2191
Apgar score, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.172
Blood Pressure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available
from: http://openehr.org/ckm/#showArchetype_1013.1.130
http://www.openehr.org/releases/RM/latest/docs/data_structures/diagrams/history_ogtt.png
EVALUATION archetypesOutcomes of a clinical assessment or decision
Clinically interpreted findings “I think the problem is …”
I think there is a risk of …
The treatment goal is …’
Diagnosis, synthesis
Genetic risk, Risk of Adverse reaction
CPR Decision
Problem/Diagnosis, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from:
http://openehr.org/ckm/#showArchetype_1013.1.169
CPR decision, Draft Archetype [Internet]. UK Clinical Models, UK Clinical Models Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://clinicalmodels.org.uk/ckm/
#showArchetype_1051.32.205
INSTRUCTION archetypesOrders that arise from clinical assessment
Initiation of workflow process “I will order some blood tests”
“I would like you to start this medication”
“I would like to refer you to a specialist”
Lab test request, referral
Medication order
Nursing task
Service request, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.614
ACTION archetypes
Activities that result from an Instruction “Lab test performed”
“Medication prescribed, administered”
“Procedure performed"
“Lab test tracking”
“Medication supply”
Procedure, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.204
Admin entry - for non-clinical data
No special RM attributes other than subject, provider
No special features
Inpatient admission, Draft Archetype [Internet]. UK Clinical Models, UK Clinical Models Clinical Knowledge Manager [cited: 2016-03-09]. Available from: http://clinicalmodels.org.uk/ckm/#showArchetype_1051.32.291
CLUSTER archetypesOnly inside ENTRY archetypes or COMPOSITION context
Re-usable sub-components which do not amount to a ‘clinical statement’
Device details
Symptom
Fragment of physical examination
Daily timing, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited:
2016-03-09]. Available from: http://openehr.org/ckm/#showArchetype_1013.1.2245
Inspired oxygen, Draft Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2016-03-09]. Available from:
http://openehr.org/ckm/#showArchetype_1013.1.393
ELEMENT archetypes
Single datapoint only
Allows re-use in other archetypes
No current use case
SpecialisationAllows new child archetype to be defined
‘Inherits’ all of the content of the parent e.g. Lab_test_panel => Blood Lipid test panel
Add new elements, clusters
Rename nodes
Add coded lists
Common aspects of both parent and child archetypes remain compatible
LocalisationSpecialisation can be helpful for adding / adapting an international archetype for local use
Adding new nodes
Renaming existing nodes
Does impose overheads
filling slots with local cluster archetypes often easier to maintain
Localisation by slot-filling examples
Datatypes: ‘Demonstration'
Demonstration, Published Archetype [Internet]. openEHR Foundation, openEHR Clinical Knowledge Manager [cited: 2015-10-11]. Available from: http://openehr.org/
ckm/#showArchetype_1013.1.1385
Datatypes I
Datatypes I
Datatypes I
Datatypes I
Datatypes I
Datatypes I
Datatypes II
Datatypes II
Datatypes II
Datatypes II
Datatypes II
Datatypes III
Datatypes III
Datatypes III
Datatypes III
Datatypes III
Datatypes IV
Datatypes IV
Datatypes IV
Datatypes IV
Datatypes V
Datatypes V
Datatypes V
Datatypes V