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Modeling EHR with the openEHR approach: an exploratory study in China

Abstract Background The openEHR approach can improve the interoperability of electronic health record (EHR) through two-level modeling. Developing archetypes for the complete EHR dataset is essential for implementing a large-scale interoperable EHR system with the openEHR approach. Although the open... Full description

Main Author: Lingtong Min
Contributors: Qi Tian
Xudong Lu
Huilong Duan
Contained in: BMC Medical Informatics and Decision Making (01.08.2018)
Journal Title: BMC Medical Informatics and Decision Making
Fulltext access: Fulltext access (direct link - free access) 10.1186/s12911-018-0650-6
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Links: Additional Link (dx.doi.org)
Additional Link (doaj.org)
Additional Link (link.springer.com)
Fulltext access (doaj.org)
ISSN: 1472-6947
DOI: 10.1186/s12911-018-0650-6
Language: English
Physical Description: Online-Ressource
ID (e.g. DOI, URN): 10.1186/s12911-018-0650-6
PPN (Catalogue-ID): DOAJ033531536
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Internes Format
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520 |a Abstract Background The openEHR approach can improve the interoperability of electronic health record (EHR) through two-level modeling. Developing archetypes for the complete EHR dataset is essential for implementing a large-scale interoperable EHR system with the openEHR approach. Although the openEHR approach has been applied in different domains, the feasibility of archetyping a complete EHR dataset in a hospital has not been reported in academic literature, especially in a country where using openEHR is still in its infancy stage, like China. This paper presents a case study of modeling an EHR in China aiming to investigate the feasibility and challenges of archetyping a complete EHR dataset with the openEHR approach. Methods We proposed an archetype modeling method including an iterative process of collecting requirements, normalizing data elements, organizing concepts, searching corresponding archetypes, editing archetypes and reviewing archetypes. Two representative EHR systems from Chinese vendors and the existing Chinese EHR standards have been used as resources to identify the requirements of EHR in China, and a case study of modeling EHR in China has been conducted. Based on the models developed in this case study, we have implemented a clinical data repository (CDR) to verify the feasibility of modeling EHR with archetypes. Results Sixty four archetypes were developed to represent all requirements of a complete EHR dataset. 59 (91%) archetypes could be found in Clinical Knowledge Manager (CKM), of which 35 could be reused directly without change, and 23 required further development including two revisions, two new versions, 18 extensions and one specialization. Meanwhile, 6 (9%) archetypes were newly developed. The legacy data of the EHR system in hospitals could be integrated into the CDR developed with these archetypes successfully. Conclusions The existing archetypes in CKM can faithfully represent most of the EHR requirements in China except customizations for local hospital management. This case study verified the feasibility of modeling EHR with the openEHR approach and identified the fact that the challenges such as localization, tool support, and an agile publishing process still exist for a broader application of the openEHR approach. 
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