The ORCHID project
Dr Ian Gaywood, NUH
Dr Ira Pande, NUH
Professor John Chelsom, City University London
So much information……so little use
Clinical care generates enormous amounts of information which is
difficult to use when caring for the individual and impossible to use for
any secondary purpose
The origins of ORCHID
• Better organised information has the potential to provide an
enormously valuable resource but must be achieved without
additional onerous burden at the clinical coalface
• The greatest impediment to extended uses of clinical records,
including research, is not lack of data. It is lack of useable data
• It should be possible to organise data in ways which allow any
plausible question to be answered
Stratified medicine
• Treatment decisions in all but the simplest conditions increasingly
rely on knowledge of the patient’s disease phenotype in several
domains
• Current methods of gathering and organising data don’t place
information in its correct context
• The relationships among pieces of information are at least as
important as the information itself.
• It is no longer enough to simply ‘name the beast’
What clinicians want ….
• A way of organising data which:
– Identifies patient phenotypes to any degree of detail
– Produces untainted cohorts
– Is multidisciplinary
– Can include or exclude individual disease characteristics
– Can include or exclude treatment details
– Records and assesses outcomes
– Can be searched in real time
– Maps to existing coding systems
The ORCHID information model
• The two central tools of ORCHID are hierarchies and core
data sets
• Together they provide a rich data architecture which can be
applied to all data sets across all specialties
• ORCHID hierarchies cross-map to existing coding systems
but overcame many of their limitations
• ORCHID hierarchies can be rapidly amended to reflect
changes in knowledge and understanding without
compromising the value of existing data
• Existing data sets can be embedded in ORCHID hierarchies
and will inherit the richness of those structures
An ORCHID hierarchy
Autoimmune
disease
Inflammatory
arthritis
Bespoke cohort
SLE, PBC etc
Rheumatoid
arthritis
Rheumatoid
arthritis seropositive
Rheumatoid
arthritis seronegative
Rheumatoid
arthritis - NOS
Psoriatic
Other conditions
arthropathy of interest
An ORCHID hierarchy
Core data sets
• ORCHID hierarchies place individual diseases, events etc in their
correct relationships with other entities
• They do not capture the finer details of complex diseases which
say something about subtype, severity, prognosis, treatment
choices
• Core data sets capture these data items in a searchable form and
provide a very detailed patient phenotype
• Can be either static or dynamic
An ORCHID Core Data Set
ICD-10 and patient phenotyping
• Requires separate codes for each manifestation
• Contains misclassifications
– Adult Still’s disease as type of rheumatoid arthritis
• Contains detailed codes of no clinical value
– M05.631 Rheumatoid arthritis of right wrist with involvement of
other organs and systems
• Does not reflect recent developments
SNOMED and patient phenotyping
• SNOMED contains almost all of the codes required to capture
diagnostic data to the required level
• But…. It also contains a very large number of redundant codes,
duplications and non-existent entities
• Coding detailed phenotypes requires the use of multiple codes –
usually one code for each disease manifestation
• Clinicians should agree a subset of SNOMED with careful
moderation of additions and amendments
Implementation



Implemented using Open Health Informatics
principles
•
Open standards
•
Open source software
•
Open systems interfaces
•
Open development processes
Builds upon work in the Open Health Informatics
research programme at City University
Maximises the potential for reuse and wider roll out
•
Ontology driven
•
Clinician led
Implements
Standards based
Information
Information
Architecture
Architecture
Ontology
Ontology
OWL
OWL(XML)
(XML)
Standards
•
Artefact
ORCHID Architecture
ISO
ISO13606
13606
HL7
HL7CDA
CDA
Information
Information
Model
Model
System
System
Configuration
Configuration
Clinical
Clinical
Coding
Coding
Messages
Messages
Clinical
Clinical
Data
DataSets
Sets
OWL
OWL(XML)
(XML)
SNOMED
SNOMEDCT
CT
ICD-10
ICD-10
LOINC
LOINC
dm+d
dm+d
Forms
Forms
Clinical
Clinical
System
System
Electronic
Electronic
Health
HealthRecords
Records
Views
Views
HL7
HL7v2/v3
v2/v3
HL7
CDA
HL7 CDA
SNOMED
SNOMEDCT
CT
XForms
XForms
XHTML
XHTML
PDF
PDF
XML
XML
HL7
HL7CDA
CDA
SNOMED
SNOMEDCT
CT
ISO
ISO13606
13606
ORCHID Platform
•
Open source
•
Standards based
•
Enterprise Java
•
No compiled code
Integration
Interfaces
User Interfaces
Service Interfaces
Web Browser
RESTful Web Services
Access Control
Orbeon
JFreeChart
XForms
Visualisation
Protégé
Ontology
Services
eXist
Native XML Database
Tomcat
Application Logic
Application Server/Framework
Mirth
Integration/
Messaging Engine
Orbeon
MVC Framework
Deployment of ORCHID
• A web based application with a common look and feel across
specialties but specialty and disease specific forms and
summaries
• Linked to Trust information systems for automatic download of
demographics, laboratory data….
• Custom search engine allowing any finding within the ORCHID
ontology to be used as a search term
• Can be deployed in modular form with all modules moderated for
consistency allowing easy combining of modules and sharing of
data among modules
• Moderated updates to take account of new knowledge,
terminologies and classifications
Uses of ORCHID
•
•
•
•
•
Routine clinical care
Automated HES / SUS reporting
Feasibility testing – research ideas, trial design
Phenotype pattern analysis
Registry data including possibility of cross-registry data
sharing
• Generation of combined primary and secondary care data
sets