Experiences from Ireland using archetype methodology for clinical ...

Archetype Research in Ireland(with a focus on records to supportbiomedical research)Damon BerryDublin Institute of Technology

Passing the baton (& EHR)Acute CarereferralCommunity InterventionsTeam (C.I.T.) Dublin NorthMater Hospital Two level model basedContinuing CareSt Marys Geriatric OPDreferralAssessmentToolDatabaseWeb applicationPrimary CareCommunity CareArea 6 and 7– PHN & DCTreferralPARTNERS TeamMs Lorraine McFeely, Ms Sue Paffrath (CIT)Ms Rosaleen Killalea(MMUH)Ms Mary Lee(DCT)Ms Anne McDonald, Ms Vicky Madden, Ms MaryKelly(Public Health Nursing)Ms Daragh Rodgers(St Marys)Ms Julianne Ballard, (Older person services)Mr Bevan Ritchie (Outreach CUH Temple St.)EHRland TeamDr Kathryn Hannah (Canadian Nursing Assoc.)Ms Janette Byrne (Patients Together)

Passing the baton: observations• The use of archetype editor was quite aheavy load for the members of the group• However, it brought user awareness of,– use of data types– coding, coded values, enumerations• Automatic user interface was generic– needs a lot of work to produce desired roundtrip experience for users

Use ofarchetypesandtemplatesIn CFproject

Archetypes for CF - observations• The ref model and archetype were foundto be sufficiently descriptive within thescope of this project.• This work underlined the dependenciesfrom template to archetype and archetypeto ref model.• High level of reuse – even with a relativelyimmature set of archetypes

Example 3: Archetypes forwound care (Gallagher – 2012)• MSc (HI) student who is an experiencedtissue viability nurse.• Recognised wound care documentationissues in Irish health system• Studied doc. practices “on the ground”• Researched best practice re documentation• Incorporated ideas based on this study intodraft archetype and submitted to CKM.

Example 4: Archetypes forbiobanks (Spaeth – ongoing)• Growth in biomedical research accompanied bya growth in Biobanks containing large number ofwell annotated biological specimens data storedin biobank information systems (BIMS)• High throughput automation has led to a hugeincrease in ‘omic’ information.• But Omic research hampered by fragmentationof associated health information

Archetypes for biobanks- research question• Is it practical to use openEHR to representa generic biomedical record that integratesclinical and research information in asingle EHR?

Archetypes for biobanks -observations• The main obstacle that has emerged is theway that SPECIMEN is in the backgroundof two-level EHR reference models.• But from a biomedical research point ogview specimen is an example of asecondary identity, a “subject ofinformation” rather than a “subject of care”• It is an example of a secondary identity.

2. Research on two levelmodels

Identity management andsecondary use

Patient and HCP: the two mainidentities in the record…PatientDoctorThese are the identities that EHR referencemodels focus on

… but for EHR reuse, others may berequiredCare IdentitiesPatientDoctorGeographical regionSecondaryuse identitiesBiological SampleResearcher

EHRcom (CEN13606)• Generic Fixed Demographics Model• Advantage– small enough to understand– Simple and efficient– identity information can easily be stored in the genericstructures• Problem– like other standards (GEHR, HL7) standardisedgeneric domain information structures, but no place toadd traits or new types of identity.

Demographics Package of CEN13606 RIMpreEN13606 Extract Reference Model v3FVDEMOGRAPHICS_PackageIDENTIFIED_ENTITY+extract_id: II+id: SETTELECOM+telecomAddress: URI+use: SETSOFTWARE_OR_DEVICE+desc: String[1]+manufacturerModelName: String[1]+code: CV[1]+version: String[0..1]IDENTIFIED_HEALTHCARE_PROFESSIONALowningOrganisationORGANISATION+code: CV[1]+desc: String[1]+name: String[1]+addraddrPERSONnameSUBJECT_OF_CARE_PERSON_IDENTIFICATION+administrativeGenderCode: CS+birthTime: TS+deceasedTime: TS+birthOrderNumber: Interger+role 0..*scopingOrganisation0..*POSTAL_ADDRESS0..*+postallCode: String+addressUse: SET+validTime: IVL0..*ENTITY_NAME+use: CV+validTime: IVLHEALTHCARE_PROFESSIONAL_ROLE+specialty: CV+id: SET+profession: CV+position_or_grade: CV0..*POSTAL_ADDRESS_PART+addressLine: String+addressLineType: CS+1..*ENTITY_NAME_PART+entityPartName: String+namePartType: CS+namePartQualifier: CS

Generalised Identity model(Chen ongoing):EntityidEntity = 10001idEntityDomain = 10001idEntityType = 10001idEntitLink =name = dmf_patstatus = Active:TraitidTrait = 1idEntity = 10001idTraitType= 12001simpleValue = 97CH87timeCreated = 2009-12-15 13:42:53TraitTypeidTraitType = 12001idEntityType = 10001name = hl7_PID_214.patient.iddescription = Patient Identifierof HL7 PID 2.14 profilesdataType = IIstatus = ActiveidTraitTypeSet = 120001:TraitTypeidTraitType = 12002idEntityType = 10001name = en13606.person.entity_name.usedescription = EN13606 Entity namedataType = CSstatus = ActiveidTraitTypeSet = 129001:TraitTypePartidTraitTypePart = 1idTraitTypeSet = 129001name = en13606.person.entity_name_part.entityPartNamedescription = (CEN 13606 RIM) The name part represented asa string.dataType = String

Generalised identity - Basic idea• Reference model stays fixed for parts ofdemographic model that are working forcare process.• Allow certain general demographicsclasses to be archetypes– e.g. to allow creation of “subjects ofinformation” for biomedical research

Archetypes and data quality

ISO EN 13606 – generic“bridge” between islands ofinformationEPR XTwo-level EHREPR Y

“loose” vs “constrained” recordsLoose definitionreference modelEntryelementConstrained definitionreference modelEntryelementDifferent definitionsBlood pressuresystolicdiastolicmeanorBlood pressuresystolicdiastolicpostureactivity+ Archetype rules(if blood pressure,1) must have systolic, diastolic, posture, activityelements2) posture must be one of {sitting, standing lying}3) activity must be one of ….Single definitionBlood pressuresystolicdiastolicposture {sitting, standing, …}activity {…}25

Data Quality• Data or information quality refers to the degreeto which data are suitable for a specificpurpose.• Data quality assessment is commonly applied toaggregated or shared data – which have variedlevels of completeness, timeliness, accuracy,consistency, accessibility…• the data quality of shared health information inan EHR should be of interest.• But also the quality of health information duringsecondary use - e.g. when merged with biobankdata