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The European EHR standard: Archetypes and Templates explained


Do you want to learn more on new developments in semantic interoperability?
Do you want to learn about archetypes that will be essential for semantic interoperability?

Semantic Interoperability: The ability for two computer systems to exchange data, use those data enabling the users to cooperate.

European EHR standard (EN13606): A full European standard (an ISO standard soon) to be used for standardised communication between and inside EHR-systems.
Systems that have the EN13606 fully implemented inside (persistence based on Reference Model of EN13606) let healthcare providers define what they have to document, exchange, archive and re-use in EHR-systems. Those EHR-systems no longer store information in a proprietary way. Database conversions are no longer needed.

Features of EHR-systems that use EN13606 and its implementable openEHR specification

Figure 1: EHR-system with Proprietary database

Figure 2: EHR-system with European standard inside

EHR-systems no longer have proprietary databases. All components in an EHR-system exchange information using the 13606 Information Bus. There is an absolute separation between the healthcare knowledge domain and the ICT knowledge domain. Using standard derived tools healthcare defines what it has to document, exchange, archive and re-use.
Exchange using message formats like Edifact and HL7v2 and v3 are supported.
Implementation times are reduced to minutes in stead of years in order to be able to adapt to and support new work processes. Innovation is facilitated.

Archetype: An artefact, produced by healthcare providers using tools based on the European EHR-standard, that defines what can documented in healthcare about a specific topic. An archetype is the maximal data set. Each element in an Archetype can be labelled with any number of relevant codes from several coding systems and thereby document mappings between those codes in a context.

Template: An artefact, subset of one or more archetypes, produced by healthcare providers using tools based on the European EHR-standard that define in a specific place at a specific time what one or more healthcare providers want to document, exchange, archive and re-use. Templates have a more limited data set. They consist of a structure (chapters, paragraphs, etc) and are filled with relevant pruned down Archetypes expressing only what is defined as needed in that context.

Clinical Archetypes: Four different types of archetypes have been defined in order to faithfully document healthcare:

  • Observation archetype: artefact documenting a patient's specific health status finding, using the human faculties of sight, hearing, feeling, smelling and tasting or devices, e.g. the blood pressure.
  • Evaluation archetype: artefact expressing an opinion on an aspect of patient's health condition, e.g. an archetype "diagnosis" with as value "hypertension"
  • Instruction archetype: artefact documenting an order, either diagnostic (to perform more observations) or care providing (therapeutic, medicinal,.), e.g. order an X-Ray or an order to administer a medicinal product.
  • Action archetype: artefact documenting the care processes, possibly subsequently to an order, e.g. a knee punction or an appendicectomy or a psychotherapeutic session.

How to learn more about it and there availability?

Link to find and inspect archetypes
The link is to the Clinical Knowledge Manager (a product by Ocean Informatics).
Archetypes can be displayed in several ways: HTML, Mind Map, technical ADL, XML.
http://www.openehr.org/knowledge/
Please use following login: user name: Member.eurorec, password: qrec4h. Once you are logged in, you will find an introduction to the Clinical Knowledge Manager.

Inspect an existing archetype or do you want to produce one yourself?
It is possible to download the archetype to your own system and use it in an Archetype Editor provided by openEHR.
(Download via: http://www.openehr.org/download/software.html)

Warning: Many of these Archetypes are not interoperable. They were designed for particular and specific purposes. A Quality Assurance and Certification process started at least partially based on new methods for Archetype Design Already published. Archetypes that are in use can be used to produce QA and Certifies Archetype Libraries.

Role of EuroRec: One of the services is to host, in the near future, quality assured archetypes that can be used by health IT-systems for semantic interoperability.

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Archetypes

White paper: Archetype paradigm: an ICT revolution is needed (.pdf)