openEHR in China 2019-06

openEHR in China
2019-06
Prof. Xudong Lu / Zhejiang University
Management Board Member of openEHR Foundation
General-Secretary of China Medical Software Association

China Medical Software Association／中国医疗器械行业协会医用软件分会
Early Researches of openEHR in China
l 2009, Jiye An（ZJU PhD Thesis），《Research on
Healthcare Information Framework and Information
Model》
l 2010, Zhihong Yao，Lei Liu ，《Introduction of
openEHR and its difference with CDA and DICOM》
l 2012, Bin Li ，《Research on the Integration of
SNOMED CT and OpenEHR》
l 2013, Zhihong Yao ，《Modelling Personal Health
Record Based on openEHR》

• 2015.08 , Xudong introduced a Case Study of openEHR-based
CDR in Shangxi Dayi Hospital at Medinfo2015 in Brazil
• 2016.04 ， Prof. Huilong Duan was assigned ambassador of
openEHR China
“First-Contact”with openEHR Community

openEHR TC of CMSA
Started from 2016.04
Goal: Promoting openEHR Modeling and Implementation in China
Activities：Seminars/workshops, Tutorials, Forums/conferences,
Website Development，Modeling collaboration……
openEHR TC
Modeling
WG1
Modeling
WG2
Modeling
WG3
……
Secretariat

openEHR Workshops
• 2016.04, Shanghai, 1st openEHR workshop
• 2016.11, Wuhan, 2nd openEHR workshop
• 2017.08, Hangzhou, 3rd openEHR workshop
• 2018.10, Shenzhen, 4th openEHR workshop
1-2 times/yearly, now we are having 5th openEHR workshop

1-2 times/yearly, we will have 3rd openEHR tutorial tomorrow
• 2018.05, Hanzhgou, 1st openEHR Tutorial, over 30 trainees from 6
companies/institutes
• 2018.10, Shenzhen, 2st openEHR Tutorial,
openEHR Tutorial

• 2018.07, Guiyang, openEHR speech at CHIMA2018
• 2018.07, Heihe, openEHR speech at CODATA2018
• 2019.04, Chengdu, openEHR speech at 15th International Oral
Medicine Medical Academic Conference
• 2019.05, Shanghai, openEHR-based RDR at CMEF2019
openEHR in conferences recently

openEHR China Website
www.openEHR.org.cn open to Chinese around 2016.08

openEHR International Connection
Prof. Xudong Lu has been elected as openEHR Management Board Member in 2018

Clinical Modelling
in China

HMC – Healthcare Modelling Collaborations
http://openehr.org.cn/hmc/
A platform maintained by ZJU to support modeling collaborations

openEHR Ecosystem
CKM
SYS-A
Templates
HMC
SYS-B
Templates
SYS-C
Templates
Domain
Experts
Building the sharable
archetypes
End Users
Defining the templates and
building the applications
Developers
Building the enabling systems
International
Library of
information Models

China Medical Software Association / 中国医疗器械行业协会医用软件分会
HMC Management
Experts
User:
Vendors
User：
Researchers
Published
Proposal
Public
Domain
ACS
Domain
Obstetrics
Domain
Oral
Domain
Submit
update
Subdomain
Subdomain
Subdomain

Relationship Between HMC and CKM
Archetype
Library
Archetype
Library
International
domestic
China clinicians
International
clinicians

China Medical Software Association / 中国医疗器械行业协会医用软件分会
HMC Modeling Results
909 9archetypes
ACS
Oral Medicine
Liver Cancer
Stroke
Heart Failure
AD Invervention
Liver Translation
EMR
Lung Cancer
sub-domains
435 transferred from CKM and
translated to Chinese
476 are new archetypes created
according to requirements

openEHR-based persistence solution
openEHR
Archetypes/
templates
Reference
model
Archetype&
Template
Domain
Experts
ARM
Schema
Rules
+
Database Schema
• Wang, L., Min, L., Wang, R., Lu, X., & Duan, H. (2015). Archetype relational mapping-a practical
openEHR persistence solution. BMC Medical Informatics and Decision Making, 15(1), 88.

Trusted personal health record access architecture
• Challenges：
• Medical institutions do not share patient data for safety reasons
• Medical information is fragmented and cannot effectively provide health services
Build PHR EMPI data structure
according to openEHR
• 姚俊明,邢丹,李庆玲. 基于区块链的个人健康记录分布式框架研究[J].医学信息学杂
志,2019,40(3):31-35,43. DOI:10.3969/j.issn.1673-6036.2019.03.005.

Discovering clinical information models online
• To discover clinical information models from an open repository online
Archetype Features Clinical Resources Network
A1
A2
A3
Suggest edges
Concept| Concept | Probability
medication order | medication
order | 0.2872
medication order | dosage| 0.2331
medication order | therapeutic
direction | 0.2219
……
address | address | 0.5257
address | healthcare provider
address | 0.2056
……
healthcare provider address |
0.1922
address | 0.1008
……
……
Information element layer
Archetype layer
Concept
subnetwork
……
……C1’
A1 A2 A3
C2’ C3’
C1 C2 C3
T1 T2 T3 T4 T5
• Yang, Lin, Xiaoshuo Huang, and Jiao Li. "Discovering Clinical Information Models Online
to Promote Interoperability of Electronic Health Records: A Feasibility Study of
OpenEHR." Journal of medical Internet research 21.5 (2019): e13504.

openEHR Related research conducted by ZJU
• Lingtong Min, Qi Tian, Xudong Lu, Huilong Duan. Modeling EHR with
the openEHR approach: an exploratory study in China. BMC Med Inform
Decis Mak. 2018; 18: 75.
• Min L, Tian Q, Lu X, et al. An openEHR based approach to improve the
semantic interoperability of clinical data registry[J]. BMC medical
informatics and decision making, 2018, 18(1): 15.
• Medinfo 2019 posters
• Extending CQL with openEHR to express clinical quality indicators
• Representing rules for clinical data quality assessment based on
openEHR Guideline Definition Language
• Using openEHR’s Guideline Definition Language for representing
Percutaneous Coronary Intervention Patient Safety Rules in a
Dynamic Checklist System

Active Enterprise & institutions
ü United Care Technologies(Beijing)
ü ZTE-ICT(Shenzhen)
ü Suhai technology(Suzhou)
ü Zhuojian Technology（Hangzhou）
ü Ternal Health(Shanghai)
ü INFINITT China(Shanghai)
ü Ming zhihui technology (Zhejiang)
ü Vico Software(Zhejiang)
ü Choice Technology（Hangzhou）
ü …
ü China Stroke Data Center
ü Zhejiang University
ü Academy of Military Sciences PLA China
ü PLA General Hospital & Hainan branch
ü ShanXi Dayi Hospital
ü General Hospital of Ningxia medical University
ü Wuhan General Hospital of Guangzhou Military
ü Wuzhou Hospital of Traditional Chinese
Medicine
22 companies 47 institutions

1st Case– CLEVER CDR by ZJU
• Archetype/
Template Editor
• Archetype –
relational
mapping
• AQL-based
Data Access
Interfaces
• Archetype
driven UI
configuration
Developed by ZJU

CLEVER CDR – Upper Applications
病原体抗生素耐药性变化趋势图
Clinical Decision SupportTimeline view
Clinical Research Support

CLEVER CDR – Implemented in different scenarios
City Level
Wuzhou Chinese
Medicine Hospital
Research
Collaboration
Anzhen Hospital
Ningxia General
Hospital Group （33
hospitals）
Cardiovascular Registry
Provincial Level
Shangxi Dayi Hospital
（2600 beds）
301 Hospital
National Level
301 hospital

2nd Case – PHIP by ZTE-ICTApplicationsUsers
Citizens
Health
Admin
Medical
staff
Business
partners
Telemedicine Regional PACS Regional LISRegional HIS Decision Making Health Card
RegionalHealthInformationPlatform
Hospitals Platform IntegrationPrimary Health Centers Health Insurance
Data
Source
Data Sharing EHR EMR LIS PACS
Database Population
Databse
EMR EHR BI Data
Comprehensive
Management
Medical
Service
Public
Health
Medical
Insurance
Drug
System
Medical
resource
…
Public Health
Regional HIS Regional PACS Regional LIS
Maternal&Ch
ild
Sub-systems
Medical
Knowledge
Health Card
Mobile App
Authority
Security
Quality
Management
Terminology
Library
Standard
Management
Health Portal
Information Exchange & Sharing Platform
Health Assessment
Center
EMPI
HL7
CDA
Registration
• Population Health Information Platform （PHIP）based on openEHR
• Developed by ZTE-ICT

PHIP – Installations in China
Shenzhen
PHIP, Primary Healthcare, Telemedicine,
AIO,H8, Health Management Platform
PHIP, AIO, Mobile Healthcare, H8
National health and family planning commission
International cooperation division
（Residents mobile health management、China-Africa cooperation center） Beijing Bureau of traditional
Chinese medicine
（TCM Healthcare provided for the aged）
PHIP, AIO, Mobile Healthcare, FDA
Shanxi All-in-One Health Terminal
Shaanxi All-in-one Health Terminal
PHIP, AIO, Mobile Healthcare, Telemedicine
Shi Jiazhuang E-health&Network Hospital
First Hospital Cooperation case, build Shi Jiazhuang Chest Hospital Telemedicine
Center, Family Doctor Service and Remote Clinics etc franchise rights
Suzhou E-Health
Grade-A hospital of second
class license obtained
Nantong E-Health
Shenzhen Luohu
Family Doctor Project

PHIP – Interconnect Test by MOH
门诊摘要住院摘要会诊记录
产后访视服务
糖尿病患者随访服务
预防接种报告服务
转诊（院）记录个人基本健康信息登记儿童健康体检
高血压患者随访服务
产前随访服务
成人健康体检服务
新生儿家庭访视
成人健康体检 2型糖尿病随访服务预防接种报告
产后访视
产后访视
病历概要
检查报告治疗记录
急诊留观病历麻醉记录
门(急)诊病历检验报告
西药处方
手术护理记录
入院记录
入院评估
中药处方一般手术记录一般护理记录
住院病案首页
住院病程记录会诊记录
住院病程记录抢救记录
住院病案首页中医住院病案首页病历出院小结
住院病程记录术前小结
2016卫生信息共享文档标准&2016电子病历共享文档标准
Standard Documents defined by NHC
公共卫
生服务
原型
OPENEHR CORE DB
EMR
Archetypes
（96）
Public Health
Archetypes
（152）
Interconnect Assess

Funded by National Project, covering 16 big hospitals in 13 provinces.
Targeting for 100,000 clinical and imaging data of coronary heart diseases
3rd Case – Coronary Heart Registry
大连
医科
大学
附属
院
大附属
一院四院
Beijing huairou hopital
Renji hospital, shanghai
Jinan military general hospital
Sir run run shaw hospital
zhejiang university
School of medicine
The second affiliated hospital
of zhejiang university school
of medicine
Shanghai chest hospital
Ruijin hospital,shanghai
The first affiliated hospital of
xinjiang medical university
West china hosppital,
sichuan unieversity
The first affiliated hopstial Of
dalian medical university
The first affiliated hosptal of
zhengzhou university
Tongji medical college of
hust tongji medical
The first affiliated hospital，
sun yat-sen University
Qilu hospital of
Shandong Unversity
Chinese PLA general hospital
Beijing Anzhen hospital

CHR – System Concept Design
US MRA ECG
Meication Lab EMR
Datasets from
system in hospital
…
…
CRF designed by
clinicians
Mid-term
Follow-up
Baseline
Adverse Events Final Follow-up
Coronary
Heart Registry
based on
openEHR
Data QC
Data Verify
数据集成
CRF Entry
Data
Processing
Integartion
… extraction
• openEHR is used for modeling both from clinicians and existing databases
• The data extraction is facilitated through linking to openEHR-based CDR

CHR – International Collaboration
All of New Zealand
Acute Coronary Syndrome – Quality Improvement
(Registry)
急性冠脉综合征
风险预测
Ø Research on the benefit of improving
interoperability through openEHR
Ø Data Analytics such as Disease Risk
Predication Models on dual Registries to
compare the results between two countries,

4th Case – Chinese Army EHR-S
l Switching technical framework to openEHR since 2018, by Academy
of Military Sciences PLA China and ZJU
l Collecting data from over 200 hospitals and 1400 clinics, and provide
EHR data services for improving management and medical services

5th Case - China Stroke Data Center
• Nearly 7 million patients, covering 360 hospitals
• openEHR data standardization is on-going and the implementation
has been planned

6th Case – image CDR by Suhai Co. Ltd.
- Compliance with ACR
RADs, RSNA SR template,
DICOM SR & RadLex
- Fast Reporting
Templates by openEHR
- Image Labeling
- Deep Learning
- Segmentation &
Analysis
- Data archive
- Search & Statistics
- Study Management
Radiology Structured
Reporting System
影像结构化报告系统
Radiology AIaaS
System (AI Lab)
影像AI研究支持系统
Radiology Research
System
影像科研管理系统
openEHR image-
CDR
基于openEHR影像数据平台
影像医生诊断辅助、高效发表高质量研究成果、创新探索的工作平台

• Scope:
1. Accumulate 10000+ liver transplant studies
2. 50000+ structured EMR+Followup data including Labelled
images
3. To support research and clinical CDS
• Current Research:
1. openEHR modelling for Liver Transplant
2. Liver transplant Ultrasound Hemodynamics CDSS
#Grant by Tianjin Government in 2018
as Key Science Project
1600beds, the No.1 Liver Transplant
Center in Asia
Liver Transplant Ultrasound image-CDR
Dental image-CDR
200+Chair & 200beds, one of the best
dental hospitals in China.
• Scope:
1. Oral & Maxillofacial image structure reporting system
2. CBCT and Panoramic image labelling of children dental caries
3. Dental big data repository including labelled images
1. openEHR modelling for Oral and Maxillofacial Image
2. Children dental caries evaluation
• Scope:
1. Radiology structure reporting system
2. MDCT, DR image labelling of Chest Image
3. Radiology big data repository including labelled images
1. openEHR modelling for Chest (Lung, Cardiac) Radiology
2. Five decease CDSS of Chest DR by Deep Learning
3. Lung RADs for Lung Cancer Score classification
Installations of iCDR
Radiology image-CDR

7th Case – EHR.care by PROSPECTWELLNESS
l Open Care Solution to provide rapid development for healthcare
enterprise information platform, which is powered by openEHR-
based EHR.care
l Use case 1(implemented in 2017.12): Building information platform
for High-end Health Management Corporations covering four cities
in China,
l Use case 2(On-going):
Building information
platform for Private
Hospital Alliance
Corporation，
integrating all the
heterogeneous
systems.

openEHR Industrial Alliance
openEHR产业化联盟

Requirements & Motivations
Ø Enforce the Strength of openEHR in the domain
Ø Localization of Archetypes／Templates
Ø Linkage with the standardization efforts of MOH
Ø Training and Educations
Ø International Communication
Ø Collaborations both in technology and in market

Proposal for COIA
Ø China openEHR Industrial Alliance – COIA
• Non-profit Organization
CMSA／
openEHR TC
COIA
Management
Board
Industrial
Members
Individual
Members
Modeling／Specification／
Development WGs

What COIA can do for members ?
• Development and Maintenance of openEHR.org.cn
• Development and Maintenance of openEHR.org.cn/hmc
• openEHR Specification Translation and Development
• openEHR localization and Modeling services
• Standardization and linkage with other standardizing efforts
• Connection with openEHR Foundation
• Training and Workshops
• openEHR Certification
• ……

openEHR国际：www.openEHR.org
openEHR中国：www.openEHR.org.cn
openEHR模型库： www.openEHR.org/ckm
openEHR中国模型库： www.openEHR.org.cn/hmc
openEHR技术交流微信群
Welcome to join in openEHR community

openEHR in China 2019-06

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openEHR in China 2019-06