The contribution of Clinical Archetypes,
and the challenges, towards achieving
semantic interoperability for EHRs
Prof Dipak Kalra, Dr Archana Tapuria, Prof Georges de Moor
ARGOS Project meeting 15 March 2010, Barcelona
on behalf of The EuroRec Institute
This project is funded by the European Union
A pan-European Health Infostructure
Citizen in the
rapid bench to bed translation
Social care
Occupational health
School health
real-time knowledge directed care
Point of care
Clinical trials
explicit consent
Continuing care
(within the institution)
Data mining
implied consent
+/- consent
Long-term shared
care (regional national,
Public health
Health care
Clinical audit
Goals for EHR semantic
• Enable the safe, meaningful sharing and combining of
health record data between heterogeneous systems and
actors / care providers
Enable the integration and safe use of computerised
protocols, alerts and care pathways by EHR systems
Link EHR data to explanatory and educational materials
to support patient and family engagement and
professional development
Improve data quality to enable meaningful and reliable
use of longitudinal and heterogeneous data for public
health, research, health service management
The challenge of SIOP
•Many clinical systems can today achieve semantic
interoperability using data that has been captured within
their own applications, because the organisation and
meaning of the data can be dictated in advance by each
system designer
•Semantic interoperability is most needed when EHR
data are to be shared and combined from different
systems (or across modules within a large system)
Clinical meaning (data, information, knowledge)
must be capable of being represented consistently
in order to be shared and understood:
Semantic Equivalence
Representing meaning in EHRs
Generic reference models for representing clinical (EHR)
e.g. ISO/EN 13606 Part 1, HL7 CDA Release 2, the openEHR Reference
Clinical terminology systems
Agreed clinical data structure definitions
e.g. openEHR archetypes, ISO/EN 13606 Part 2, HL7 templates,
generic templates and data sets.
The problem with plugging terms into
a reference model
• Record structures and terminology systems have been
developed in relative isolation
with no co-operation on their mutual requirements or scope
resulting in overlapping coverage or clumsy fit
both often still fail to meet the needs of clinical practice!
With co-ordinated terminology and sophisticated EHR
there is a risk of introducing further inconsistency
making semantic equivalence harder to determine
What is a clinical archetype?
• a clinical archetype is an agreed, formal and
interoperable specification
• for representing a given clinical entity such as a clinical
observation, a finding, a plan or a treatment
• within an electronic health record
• invented and maintained by openEHR
• ratified by CEN and ISO: 13606 Part 2
• to be quality labelled by EuroRec
What value do archetypes add?
A user friendly means to capture and collate professional
consensus on how clinical data should be represented
A formal model of clinical domain concepts
e.g. “blood pressure”, “discharge summary”, “fundoscopy”
Specifies a context of use for clinical terms
Can be published and shared within a clinical
community, or globally
Can be imported by vendors into EHR system data
Defines a systematic EHR target for queries and for
decision support
openEHR Clinical Knowledge Manager
openEHR Clinical Knowledge Manager
openEHR Clinical Knowledge Manager
openEHR Clinical Knowledge Manager
Activities supporting the wide-scale
use of archetypes
• Growing communities to author, review and adopt
archetypes for different domains
Enriching the tools to support clinicians using archetypes
Improving the binding between archetypes and
co-ordinated terminologies, especially SNOMED-CT
Defining good practice for archetype authorship
Establishing quality, governance and certification
processes for archetypes and their repositories
EuroRec’s role in Archetype
quality labelling
• EuroRec is leading the European development of
archetype quality criteria, in areas such as:
clinical usage requirements
domain coverage
evidential basis
conformance to standards
modelling requirements
authorship, version management
access and licensing
endorsement, quality labelling, certification
archetype repository requirements
EuroRec will establish a formal certification process
EuroRec is actively involved in European semantic
interoperability research