EHR Data Reuse through openehr Archetypes

(1)

EHR Data Reuse through

openEHR Archetypes

Rong Chen MD, PhD

Chief Medical Informatics Officer 2012.09.19

(2)

-2- 2012-10-02 © Cambio Healthcare Systems AB

Agenda

• Background introduction (3 min)

• Experience of extracting EHR data from regional EHR systems to national quality registers (10 min)

• Quality assurance, compliance checking & clinical decision support (15 min)

• Software demonstration (10 min) • Summary, Q&A (5 min)

(3)

Cambio Healthcare Systems

• Founded in 1993

– 300 staff across the globe – Private and Venture funded

• The leading provider of Regional EHR solutions in Scandinavia - presence in Sweden, Denmark, UK, others to follow • COSMIC is an international standard product • Close to 95 000 staff users when current

projects are fully implemented

• Our solutions are open, scalable and flexible based on industry standards

• Actively involved in academic research and

(4)

Cambio COSMIC

Compliant Open Solutions

(5)

(6)

Agenda

• Background introduction

• Experience of extracting EHR data from large scale

regional EHR systems to national quality registers

• Quality assurance, compliance checking & clinical decision support

• Software demonstration • Summary (Q&A)

(7)

Quality Registers Background

• About 80+ quality registers (QR) in Sweden

– National or regional ones

– Usually single condition based

• Common challenges/issues with QR data report

– (Aggregated) data sets do not exist in EHRs – Unsynchronized data structures among QRs – Mismatched terminology bindings

– Some QR are guideline based, some not – Multiple integrations, multiple data entries

(8)

(9)

Cosmic

RiksSvikt

(10)

Swedish National Heart Failure Quality Registry

Pilot Project (IFK2) Introduction

• Working towards a national semantic interoperability framework

– Single logic EHR architecture

– Shared clinical content library for reuse

• Two commercial EHR systems (Cambio COSMIC & Siemens Melior) and one QR hosting organization

• openEHR archetypes/templates as machine-readable specification with bindings to SNOMED CT

(11)

(12)

IFK2 Results - Archetypes

• Total 21 archetypes • 7 international archetypes – openEHR-EHR-OBSERVATION.blood_pressure.v2 – openEHR-EHR-OBSERVATION.body_weight.v2 – openEHR-EHR-OBSERVATION.ecg_12_lead_standard_recording.v1 – openEHR-EHR-OBSERVATION.heart_rate.v2 – openEHR-EHR-OBSERVATION.height.v2 – openEHR-EHR-OBSERVATION.lab_test.v1 – openEHR-EHR-OBSERVATION.waist_hip.v2

• Expected generally reusable

– openEHR-EHR-OBSERVATION.eq_5d.v2

– openEHR-EHR-OBSERVATION.heart_failure_stage.v2

• Some expected to be reusable in QR reports

– openEHR-EHR-EVALUATION.review_of_conditions.v1 – openEHR-EHR-EVALUATION.review_of_procedures.v1

(13)

(14)

IFK2 Results Summary

• openEHR archetypes/templates proven to be capable of communicating EHR Data to QR

– Reuse of existing EHR archetypes for QR report purpose – Validation rules for data values and structures

– SNOMED CT bindings seem useful to synchronize QR terminologies

• Remaining issues

– Lack of ways to express validation rules on incorrect combinations – Highly aggregated view of QR template vs detailed EHR data

• Mismatch between QR requirements and EHR archetypes • Auto-prefill of EHR Data in QR templates very hard

(15)

Agenda

• Background introduction (5 min)

• Clinical Decision Support, Quality assurance &

compliance checking (15 min)

(16)

A L Rector PD Johnson S Tu C Wroe and J Rogers (2001) Interface of inference models with concept and medical record models. in S Quaglini, P Barahona and S Andreassen (eds) Proc Artificial Intelligence in Medicine Europe (AIME-2001 ) Springer:314-323

openEHR Archetype

SNOMED CT ???

(17)

CDS Strategy

• openEHR Archetypes as semantic building blocks

– Reuse existing archetypes

– High quality clinical information, language independence..

• Reference Terminology, ontology as concept models in

different domains

– SNOMED CT, FMA, ..

• Rule-based CDS

– Industry strength rule engine, standard rule language features

(18)

Guide Definition Language (GDL)

• A sub-language of dADL, driven by an object model • The object model consists of

– Header: Id, concept, language, description, translation – Archetype binding

– Guide definition, pre-condition and list of rules – Each rule has when and then expressions

– Term definition for language-dependent labels

Extensive reuse of existing openEHR specifications Aiming to release through openEHR

(19)

Guide Definition Language (GDL)

(20)

Clinical Decision Support Workbench

(GDL implementation)

• A tool to import, export and author clinical rules • A rule engine to execute

the rules

• Linked to COSMIC (EHR) Intelligence for verification, simulation and compliance checking

• An extension of Cambio

COSMIC (EHR)

2. Model new or find

existing clinical rules using evidence based

guidelines

3. Analyze EHR data in CDS workbench

4. Confirm the clinical gaps and find areas for

improvements 5. Deploy Runtime

CDSS inside COSMIC (EHR)

1. Identify or monitor the clinical problems

(21)

Case Study

: Antithrombotic Management in Atrial Fibrillation

• 20% of strokes caused by atrial fibrillation

• Evidence-based European guideline on management of atrial

fibrillation, European Heart Journal (2010) 31, 2369–2429

(22)

(23)

(24)

(25)

(26)

Does Result from CDS Workbench Match the

Result from the Quality Register ?

keep in mind

• Coverage of patient groups, data sets size

• Multiple data entry or not

• Linkage to Clinical Decision Support

(27)

Warfarin Treatment

AURICULA QR, 1 yr (AF Unit Patients)

10% 20% 30% 40% 50% 60% 70% 80% 90% 84% 16%

(28)

Warfarin Treatment

CDS Workbench/EHR, 1 yr (whole region)

0% 10% 20% 30% 40% 50% 60% 70% 80% Ja (2025) Nej (6105) 25% 75%

(29)

CHADS

2, AURICULA QR

(30)

Compliance Checking Results Divided per

CHA

₂

DS

₂

VASc score by CDS Workbench

(31)

Reason for not having Warfarin Treatment,

AURICULA

43% 18% 13% 4% 22% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

(32)

Some Thoughts

• Instead of extraction data from EHR for various reuse, reuse of EHR data on-site with EHR extension like CDS Workbench?

• With shared common clinical models like openEHR archetypes, possible to reuse EHR data for multiple purpose without re-entries?

• With open source GDL specification and OS reference implementation, possible to share rules for data reuse, e.g. quality indicators, decision support & quality

(33)

Agenda

• Background introduction (3 min)

• Clinical Decision Support, quality assurance & compliance checking (15 min)

(34)

Summary

• openEHR archetype provides common definition of

clinical information models that could facilitate reuse of EHR data for various purposes

• Guide Definition Language (GDL)

– Built on archetypes and standard rule language for increased interoperability and able to share guides

– open specification and standardized through openEHR

– Reference GDL Editor to be release as Open Source Software – May facilitate further EHR data reuse

(35)

Questions & feedback?

[email protected]

SNOMED CT Implementation Showcase 2012, Stockholm

FRIDAY 26th_{October, 13:30 to 14:15}

Clinical Decision Support Using openEHR Archetypes and SNOMED CT