An OpenEHR repository based on a native XML database

OpenEHR is an open standard specification that describes the management, storage, retrieval and exchange of data in Electronic Health Record (EHR). Despite its growing importance in the field, the lack of open source solutions is hindering a larger visibility. In this paper we present an openEHR-based repository supported by a native XML database, which allows to store and query OpenEHR records through the DB service layer and a set of REST web services. The obtained results highlight the efficiency of this API and show that it can be used as a persistence component in any OpenEHR solution

An Investigation of Semantic Links to Archetypes in an External Clinical Terminology through the Construction of Terminological Shadows

The two-level model based specifications for electronic health record communication EHRcom (ISO 13606) and openEHR both support the embedding of terminological references in Archetypes. This terminological binding can be created manually by a health terminology expert during Archetype design, and the binding is assessed during Archetype evaluation. There has also been some recent work on using lexical queries to generate term sets to represent concepts in Archetypes. This work created an information construct which we call a Terminological Shadow that links Archetype nodes to sets of candidate concepts from a terminology system. The coding scheme used for this work is SNOMED-CT. The proposed Shadows can be used to facilitate the mapping between an Archetype information model and terminological systems. A framework, which also acts as an analysis tool, has been created to construct Shadows from Archetypes. The work also demonstrates how the framework can be used to evaluate different searching algorithms by comparing the search results to the existing bound SNOMED codes

Design and Implementation of an Archetype Based Interoperable Knowledge Eco-system for Data Buoys

This paper describes the ongoing work of the authors in translating two-level system design techniques used in Health Informatics to the Earth Systems Science domain. Health informaticians have developed a sophisticated two-level systems design approach for electronic health documentation over many years, and with the use of archetypes, have shown how knowledge interoperability among heterogeneous systems can be achieved. Translating two-level modelling techniques to a new domain is a complex task. A proof-of-concept archetype enabled data buoy eco-system is presented. The concept of operational templates-as-a service is proposed. Design recommendations and implementation experiences of re-working the proposed architecture to run on ultra-resource constrained data buoy platforms using templates-as-service are described

Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

<p>Abstract</p> <p>Background</p> <p>The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture.</p> <p>Methods</p> <p>Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms.</p> <p>Results</p> <p>The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it.</p> <p>Conclusions</p> <p>Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete communication architecture to simulate the exchange of TISS data between systems according to the openEHR approach still needs to be designed and implemented.</p

LinkEHR-Ed: A multi-reference model archetype editor based on formal semantics

Purpose To develop a powerful archetype editing framework capable of handling multiple reference models and oriented towards the semantic description and standardization of legacy data. Methods The main prerequisite for implementing tools providing enhanced support for archetypes is the clear specification of archetype semantics. We propose a formalization of the definition section of archetypes based on types over tree-structured data. It covers the specialization of archetypes, the relationship between reference models and archetypes and conformance of data instances to archetypes. Results LinkEHR-Ed, a visual archetype editor based on the former formalization with advanced processing capabilities that supports multiple reference models, the editing and semantic validation of archetypes, the specification of mappings to data sources, and the automatic generation of data transformation scripts, is developed. Conclusions LinkEHR-Ed is a useful tool for building, processing and validating archetypes based on any reference model.This work was supported in part by the Spanish Ministry of Education and Science under grant TS12007-66S7S-C02; by the Generalitat Valenciana under grant APOSTD/2007/055 and by the program PAID-06-07 de la Universidad Politecnica de Valencia.Maldonado Segura, JA.; Moner Cano, D.; Boscá Tomás, D.; Fernandez Breis, JT.; Angulo Fernández, C.; Robles Viejo, M. (2009). LinkEHR-Ed: A multi-reference model archetype editor based on formal semantics. International Journal of Medical Informatics. 78(8):559-570. https://doi.org/10.1016/j.ijmedinf.2009.03.006S55957078

Towards a Digital Earth: Using Archetypes to Enable Knowledge Interoperability within Geo-Observational Sensor Systems Design

Earth System Science (ESS) observational data are often inadequately semantically enriched by geo-observational information systems in order to capture the true meaning of the associated data sets. Data models underpinning these information systems are often too rigid in their data representation to allow for the ever-changing and evolving nature of ESS domain concepts. This impoverished approach to observational data representation reduces the ability of multi-disciplinary practitioners to share information in a computable way. Object oriented techniques typically employed to model data in a complex domain (with evolving domain concepts) can unnecessarily exclude domain specialists from the design process, invariably leading to a mismatch between the needs of the domain specialists, and how the concepts are modelled. In many cases, an over simplification of the domain concept is captured by the computer scientist. This paper proposes that two-level modelling methodologies developed by Health Informaticians to tackle similar problems of specific domain use-case knowledge modelling can be re-used within ESS Informatics. A proposed methodology to re-use two-level modelling within geo-observational sensor systems is described. We show how the Open Geospatial Consortium’s (OGC) Observations & Measurements (O&M) standard can act as a pragmatic solution for a stable reference-model (necessary for two-level modelling), and upon which more volatile domain specific concepts can be defined and managed using archetypes. A use-case is presented, followed by a worked example showing the implementation methodology and considerations leading to an O&M based, two-level modelling design approach, to realise semantically rich and interoperable Earth System Science based geo-observational sensor systems

Generification by Translation: Designing Generic Systems in Context of the Local

While the mechanisms of generification during implementation and use of large-scale systems are well known, this paper extends and analyzes the notion into the design phase of generic systems and provides insight into the associated socio-technical key mechanisms at play. The paper draws on the information infrastructure literature, and emphasizes how generic systems’ designs always face infrastructural challenges and opportunities in the development process. The paper illustrates how a vendor solved the infrastructural challenges by (to a large degree) lending on local practice, translating perspectives, and carefully adjusting their design strategy over time. We argue that our findings have implications for practice because they underscore the malleability of the collaboration process between vendor and users. First, we suggest that designing a generic system calls for a flexible vendor willing to change and adjust the development strategy along with the evolving project. Second, to strengthen the user-developer collaboration, we highly recommend giving the user-participants, at the very early stage of a development project, a basic understanding of software design, and raising their skills in making precise contextual narratives. Third, we emphasize the importance of the project management’s engagement in recruiting clinical personnel and in making it possible for the clinicians to participate in the project. Empirically, the paper presents the initial stages of a large electronic patient record (EPR) development project that has been running from 2012 in the North Norwegian health region and is due to finish in 2016

Introducing end-user reconfiguration on clinical knowledge information systems

Tese de mestrado integrado. Engenharia Informática e Computação. Universidade do Porto. Faculdade de Engenharia. 201

Growing an information infrastructure for healthcare based on the development of large-scale Electronic Patient Records

The papers of this thesis are not available in Munin. Paper 1. Silsand, L., Ellingsen, G. (2014). Generification by Translation: Designing Generic Systems in Context of the Local. Available in: Journal of Association for Information Systems, vol. 15(4): 3. Paper 2. Christensen, B., Silsand, L., Wynn, R. and Ellingsen, G. (2014). The biography of participation. In Proceedings of the 13th Participatory Design Conference, 6-10 Oct. Windhoek, Namibia. ACM Digital Library. Paper 3. Silsand, L. and Ellingsen, G. (2016). Complex Decision-Making in Clinical Practice. In: Proceedings of the 19th ACM Conference on Computer-Supported Cooperative Work & Social Computing (CSCW '16). ACM Digital Library. ISBN: 978-1-4503-3592-8. Paper 4: Silsand, L., Ellingsen, G. (2017). Governance of openEHR-based information Infrastructures. (Manuscript). Paper 5. Silsand, L. (2017). The ‘Holy Grail’ of Interoperability of Health Information Systems: Challenges and Implications. Available in: Stigberg S., Karlsen J., Holone H., Linnes C. (eds) Nordic Contributions in IS Research. SCIS 2017. Lecture Notes in Business Information Processing, vol 294. Springer, Cham. This thesis provides empirical insights about socio-technical interdependencies affecting the making and scaling of an Information Infrastructure (II) for healthcare based on the development of large-scale Electronic Patient Records. The Ph.D. study is an interpretive case study, where the empirical data has been collected from 2012 to 2017. In most developed countries, the pressures from politicians and public in general for better IT solutions have grown enormously, not least within Electronic Patient Record (EPR) systems. Considerable attention has been given to the proposition that the exchange of health information is a critical component to reach the triple aim of (1) better patient experiences through quality and satisfaction; (2) better health outcomes of populations; and (3) reduction of per capita cost of health care. A promising strategy for dealing with the challenges of accessibility, efficiency, and effective sharing of clinical information to support the triple aim is an open health-computing platform approach, exemplified by the openEHR approach in the empirical case. An open platform approach for computing EPR systems addresses some vital differences from the traditional proprietary systems. Accordingly, the study has payed attention to the vital difference, and analyze the technology and open platform approach to understand the challenges and implications faced by the empirical process. There are two main messages coming out of this Ph.D. study. First, when choosing an open platform approach to establish a regional or national information infrastructure for healthcare, it is important to define it as a process, not a project. Because limiting the realization of a large-scale open platform based infrastructure to the strict timeline of a project may hamper infrastructure growth. Second, realizing an open platform based information infrastructure requires large structural and organizational changes, addressing the need for integrating policy design with infrastructure design