Good Electronic Health Record

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Good Electronic Health Record
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Outline

• Introduction
• Gehr Object Model (GOM)
• Archetype
• System
• Detail
• GOM
• Archetype

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Why archetype?

• An EHR model to describe info structures for
  every possible clinical procedure or situation is
  unfeasible
• mainstream technology changes
• clinical norms changes
• ongoing medical research
• social and cultural environment

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Overview

• GOM provides concepts and primitives
• Archetypes are constraint definitions and define
  how to create clinically valid structures out of
  the GOM primitives

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GOM

• has five levels
• EHR
• transaction
• navigation
• content
• data

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EHR Level
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Transaction Navigation Levels

• A transaction consists of content items grouped
  using organizers
• Organizers are like headings or folders

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Content Level
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Data Level

• defines the data types
• plain text
• term expansions and codes
• hypertext links
• quantities
• absolute dates
• times
• durations
• digital images
• audiovisual data
• external data
• ....

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Outline

• Introduction
• Gehr Object Model (GOM)
• Archetype
• System
• Detail
• GOM
• Archetype

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Archetypes

• define valid GOM information structures for
  particular clinical concepts
• Archetypes are needed for
• Transaction types (How? and Why?)
  (DEFINITION_CONTENT)
• Navigational headings (ORGANIZER_ROOT)
• Clinical content types (EHR_CONTENT) (lab
  results, prescriptions)
• are expressed in XML-Schema

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Archetype example

• XML Schema version

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Outline

• Introduction
• Gehr Object Model (GOM)
• Archetype
• System
• Detail
• GOM
• Archetype

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System GEHR Kernel
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System in non-GEHR
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System - Archetype Translation

• GEHR allows the same clinical concept to have a
  number of different archetypes

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Outline

• Introduction
• Gehr Object Model (GOM)
• Archetype
• System
• Detail
• GOM
• Archetype

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DETAIL
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GEHR Object Model

• Four main clusters (groups of classes)
• Record
• Archetype
• Basic
• External
• UML is used
• line with arrow shows inheritance
• line with diamond shows possession

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(1) RECORD Cluster
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(1.1) EHR Cluster

• EHR is represented with EHR_BASE class
• EHR_BASE consists of four groups of
  VERSIONED_TRANSACTIONS
• subject_transaction
• demographic_entities
• persistent_clinical_transactions
• event_clinical_transactions

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Example
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(1.2) TRANSACTION Cluster

• The base class in this cluster is
  VERSIONED_TRANSACTION
• Each of them contains TRANSACTION classes (for
  the same concept)
• The transactions are GOMs primary content
  container

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TRANSACTION Class (not Cluster)

• The content of a TRANSACTION is provided in the
  EHR_CONTENT class (starting point in GOM for
  content of any kind)
• has two attributes
• content ? ORGANIZER_ROOT
• context ? DEFINITION_CONTENT

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(1.3) Clinical Content

• Three clusters contain classes which define the
  structural semantics of clinical content
• NAVIGATION
• CONTENT
• PROPOSITION

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Clinical Content
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(1.3.1) Navigation Cluster

• similar to folders in a file system in which
  content items can be found

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(1.3.2) Content Cluster

• Content is created under organizers and has two
  dimensions
• knowledge species
• structural form
• Knowledge species are modeled as subtypes of
  DEFINITION_CONTENT

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(1.3.2) Content Cluster

• DEFINITION_CONTENT knowledge without context
  (weight 85kg)
• PREDICATE_CONTENT abstract class, content about
  a subject
• OBSERVATION_CONTENT a posteriori observation
  about a subject
• SUBJECTIVE_CONTENT reported opinions about a
  subject
• INSTRUCTION_CONTENT commands to do something for
  a subject
• PROCESS_CONTENT models processes about a subject
• QUERY_CONTENT content type which contains the
  definition and results of query
• Each of these carry some contextual information
  such as, protocol (how something is done),
  date/time observed, recorder, provider,
  certainty.

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(1.3.3) Proposition Cluster

• Classes within this cluster define how data
  within XXX_CONTENT is represented
• root ? HIERARCHICAL_PROPOSITION
• non-leaf nodes ? HIERARCHICAL_GROUP
• leaf nodes ? HIERARCHICAL_VALUE
• H_GROUP and H_VALUE may have optionally context
  information (???)
• Each of the XXX_CONTENT classes has a
  propositionHIERARCHICAL_PROPOSITION attribute
  that links the content to the hierarchy

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(1.3.3) Proposition Cluster

• The data is hold in the DATA_VALUE Classes
• The form in the figure is a tree but other
  structures are also possible such as lists, 2D
  tables, 3D matrix, etc

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(1.4) Data Cluster

• Data types are defined in this cluster

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(2) Archetype Cluster

• Mainly on management of the Archetypes

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(3) Basic Cluster
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(4) External Cluster
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EXAMPLES
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OBSERVATION_CONTENT
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OBSERVATION_CONTENT
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OBSERVATION_CONTENT
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SUBJECTIVE_CONTENT
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INSTR_CONTENT
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INSTR_CONTENT
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Outline

• Introduction
• Gehr Object Model (GOM)
• Archetype
• System
• Detail
• Gehr Object Model (GOM)
• Archetype

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Archetype

• Needless to say, there are three types of
  archetype entity
• Archetype documents (the original entities being
  authored)
• Archetype objects (for run time use in the
  kernel)
• Archetype classes (which define the objects)

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Archetypes

• Two kinds of archetypes
• primitive (from GOM primitives)
• composite (from other archetypes)

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Archetype Management

• archetype domain a context in which archetypes
  are identified and issued
• Each domain needs to have an archetype naming
  authority ensuring unique archetype
  identification

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An example archetype domain hierarchy
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Archetype management

• Each domain maintain an archetype domain server
• HCFs download archetypes on request