Leslie Heather
Atomica Informatics, Fitzroy, Australia.
openEHR International, Clinical Models Program, London, United Kingdom.
J Med Internet Res. 2020 Nov 2;22(11):e23361. doi: 10.2196/23361.
Despite electronic health records being in existence for over 50 years, our ability to exchange health data remains frustratingly limited. Commonly used clinical content standards, and the information models that underpin them, are primarily related to health data exchange, and so are usually document- or message-focused. In contrast, over the past 12 years, the Clinical Models program at openEHR International has gradually established a governed, coordinated, and coherent ecosystem of clinical information models, known as openEHR archetypes. Each archetype is designed as a maximal data set for a universal use-case, intended for reuse across various health data sets, known as openEHR templates. To date, only anecdotal evidence has been available to indicate if the hypothesis of archetype reuse across templates is feasible and scalable. As a response to the COVID-19 pandemic, between February and July 2020, 7 openEHR templates were independently created to represent COVID-19-related data sets for symptom screening, confirmed infection reporting, clinical decision support, and research. Each of the templates prioritized reuse of existing use-case agnostic archetypes found in openEHR International's online Clinical Knowledge Manager tool as much as possible. This study is the first opportunity to investigate archetype reuse within a range of diverse, multilingual openEHR templates.
This study aims to investigate the use and reuse of openEHR archetypes across the 7 openEHR templates as an initial investigation about the reuse of information models across data sets used for a variety of clinical purposes.
Analysis of both the number of occurrences of archetypes and patterns of occurrence within 7 discrete templates was carried out at the archetype or clinical concept level.
Across all 7 templates collectively, 203 instances of 58 unique archetypes were used. The most frequently used archetype occurred 24 times across 4 of the 7 templates. Total data points per template ranged from 40 to 179. Archetype instances per template ranged from 10 to 62. Unique archetype occurrences ranged from 10 to 28. Existing archetype reuse of use-case agnostic archetypes ranged from 40% to 90%. Total reuse of use-case agnostic archetypes ranged from 40% to 100%.
Investigation of the amount of archetype reuse across the 7 openEHR templates in this initial study has demonstrated significant reuse of archetypes, even across unanticipated, novel modeling challenges and multilingual deployments. While the trigger for the development of each of these templates was the COVID-19 pandemic, the templates represented a variety of types of data sets: symptom screening, infection report, clinical decision support for diagnosis and treatment, and secondary use or research. The findings support the openEHR hypothesis that it is possible to create a shared, public library of standards-based, vendor-neutral clinical information models that can be reused across a diverse range of health data sets.
尽管电子健康记录已经存在了50多年，但我们交换健康数据的能力仍然极其有限。常用的临床内容标准及其支撑的信息模型主要与健康数据交换相关，因此通常以文档或消息为重点。相比之下，在过去12年里，国际开放电子健康记录组织（openEHR International）的临床模型项目逐渐建立了一个规范、协调且连贯的临床信息模型生态系统，即开放电子健康记录原型（openEHR archetypes）。每个原型被设计为一个通用用例的最大数据集，旨在跨各种健康数据集重复使用，这些数据集被称为开放电子健康记录模板（openEHR templates）。迄今为止，仅有轶事证据表明跨模板重复使用原型的假设是否可行及可扩展。作为对新冠疫情的应对措施，在2020年2月至7月期间，独立创建了7个开放电子健康记录模板，用于表示与新冠相关的数据集，以进行症状筛查、确诊感染报告、临床决策支持和研究。每个模板都尽可能优先重复使用在国际开放电子健康记录组织的在线临床知识管理工具中找到的现有通用用例原型。本研究是首次有机会在一系列多样的、多语言的开放电子健康记录模板中调查原型的重复使用情况。
本研究旨在调查7个开放电子健康记录模板中开放电子健康记录原型的使用和重复使用情况，作为对跨用于各种临床目的的数据集的信息模型重复使用的初步调查。
在原型或临床概念层面，对7个离散模板中原型的出现次数和出现模式进行分析。
在所有7个模板中，共使用了58个独特原型的203个实例。最常用的原型在7个模板中的4个中出现了24次。每个模板的数据点总数从40到179不等。每个模板的原型实例数从10到62不等。独特原型的出现次数从10到28不等。通用用例原型的现有原型重复使用率从40%到90%不等。通用用例原型的总重复使用率从40%到100%不等。
在这项初步研究中，对7个开放电子健康记录模板中原型重复使用量的调查表明，即使面对意外的、新颖的建模挑战和多语言部署，原型也有大量重复使用。虽然这些模板的开发触发因素是新冠疫情，但这些模板代表了各种类型的数据集：症状筛查、感染报告、诊断和治疗的临床决策支持以及二次使用或研究。这些发现支持了开放电子健康记录的假设，即有可能创建一个基于标准的、供应商中立的临床信息模型共享公共库，该库可在各种健康数据集中重复使用。
