openEHR template development in Hangzhou, Zhejang University

1. § Mengyang Li
§ Ph.D. candidate, Zhejiang University,
China
§ Medical Informatics

2. Development of an openEHR Template for
COVID-19 Based on Clinical Guidelines

3. Ø The sudden outbreak of COVID-19 is a challenging
threat
Ø Guidelines were issued to deal with the epidemic
Ø Decision support tools is an efficient way to
transfer the knowledge of guidelines to clinical
practices
Ø The interoperability of disease-related data has
become an important issue.
Motivation

4. Ø Requirements
Ø Fast
Ø Rapidly updating knowledge for COVID-19
Ø OpenEHR can meet these demands very well.
Ø Open community
Ø provide the flexibility and scalability
Why openEHR?

5. An openEHR Template development approach
We used existing archetypes and knowledge from guidelines to develop the template.

6. Knowledge Sources
Ø The knowledge is limited at the beginning of outbreak
Ø the Guideline for Diagnosis and Treatment of COVID-19 released by the National
Health Commission of the China was adopted
The guideline can be divided into 13 sections:
(4) Clinical Characteristics
(5) Diagnostic Criteria
(6) Clinical Classifications
(7) Clinical Warning Signs for Severe and Critical Cases
(8) Differential Diagnosis
(9) Discovery and Reporting of Cases
(10) Treatment
(11) Criteria for Discharge and Notes After Discharge

7. Collect Data Items
Clinical
guidelines
Extract data
items separately
Review each other
Informaticist Informaticist
Medical specialist
Review & resolve conflicts
• Keep the inherent structure of the guideline
• Extract data items independently

8. Organize Domain Concepts
Merge data items with the
semantics
Regroup data items to same
domain concepts
Add knowledge from clinical
practices
Represent domain concepts into
MindMap
Map domain concepts to
openEHR models
Coagulopathy/blood coagulation disorder
(SCTID: 64779008)
Fever/difficulties in breathing -> symptoms
Operations can be treated as supplements

9. Development of openEHR Template
Search existing archetypes
Archetypes
are available?
Develop new archetypes
Reuse existing
archetypes
Develop openEHR template
• Terminology constraints
• Multilingual support
(Query+Manual) Reuse archetypes to
a large extent

10. Collaboration Development Online
openEHR Archetype Designer: https://tools.openehr.org/designer/#/
Communication & Discussion
Editing Editing

11. Review and Release of the Template
The template has been uploaded and shared in the project of the CKM.
https://ckm.openehr.org/ckm/templates/1013.26.291
Review focus:
Ø the representation of the domain knowledge
Ø reviewed from informatics, such as the data types
Review stages
• Internal review
• Outreach review

12. Results
Domain Concepts Archetypes found in CKM
Diagnosis&Treatment
of COVID-19
openEHR-EHR-COMPOSITION.encounter.v1
—— openEHR-EHR-SECTION.adhoc.v1
Age openEHR-EHR-OBSERVATION.age.v0
Symptom/sign screening questionnaire openEHR-EHR-OBSERVATION.symptom_sign_screening.v0
Condition/finding screening questionnaire openEHR-EHR-OBSERVATION.condition_screening.v0
Management/treatment screening questionnaire openEHR-EHR-OBSERVATION.management_screening.v0
Vital signs openEHR-EHR-OBSERVATION.body_temperature.v2
openEHR-EHR-OBSERVATION.respiration.v2
openEHR-EHR-OBSERVATION.pulse_oximetry.v1
Laboratory tests openEHR-EHR-OBSERVATION.laboratory_test_result.v1
openEHR-EHR-CLUSTER.specimen.v1
openEHR-EHR-CLUSTER.laboratory_test_analyte.v1
openEHR-EHR-CLUSTER.inspired_oxygen.v1
openEHR-EHR-OBSERVATION.pf_ratio.v0
Imaging tests openEHR-EHR-OBSERVATION.imaging_exam_result.v0
openEHR-EHR-CLUSTER.imaging_finding.v0
COVID-19 exposure assessment openEHR-EHR-OBSERVATION.exposure_assessment.v0
COVID-19 clinical assessment openEHR-EHR-EVALUATION.health_risk.v1
Risk of severe and critical disease openEHR-EHR-EVALUATION.health_risk.v1
Differential diagnoses openEHR-EHR-EVALUATION.differential_diagnoses.v0
Treatment openEHR-EHR-INSTRUCTION.therapeutic_activity_order.v0
Medication recommendation openEHR-EHR-INSTRUCTION.medication_order.v2
Discharge criteria openEHR-EHR-EVALUATION.health_risk.v1
COVID-19 diagnosis openEHR-EHR-EVALUATION.problem_diagnosis.v1
Other diagnosis openEHR-EHR-EVALUATION.problem_diagnosis.v1
Ø 203 data items
Ø 16 domain concepts
Ø All archetypes are available in CKM
Ø The template has been uploaded into CKM

13. Discussion: Facilitate the Interoperability
openEHR-based
CDR
Screening Data reports
Template
For openEHR-based CDR, the developed template can be used in screening/ Data reports.
The method facilitate the interoperability among different systems.
Domain Environment Technical development

14. Discussion: Flexible for Rapidly Changing Knowledge
2020-01-16, first edition was released
2020-01-16, second edition
2020-01-22, third edition
2020-01-27, 4th edition
2020-02-04, 5th edition
2020-02-18, 6th edition
2020-03-03, 7th edition

15. Discussion: less solutions based on openEHR
Ø A multi-level modelling framework, openEHR can improve the
current situation in the e-health domain.
Ø However, the implementations and adoption of the method is
relatively less
Ø Cooperation is needed among Healthcare IT vendors and
healthcare professionals.

16. Limitations of the research
1. The knowledge source used in this study is limited
Ø the Guideline for Diagnosis and Treatment of COVID-19 released by the
National Health Commission of the China
Ø Clinical management of COVID-19 released by WHO
Ø Coronavirus Disease 2019 (COVID-19) Treatment Guidelines by NIH
Ø others
2. Lack of reviews from frontline healthcare professionals
Ø most of the experienced medical professionals were prioritizing clinical care of
patients with COVID 19
Ø Clinicians in daily routines get stressed out

17. ØThis study proved that open and flexible openEHR methodology
can meet the requirements of rapidly updating knowledge like
COVID-19.
ØThe developed template in this study could be used to transfer
the experience and knowledge achieved from China to other
countries.
ØThe method for modeling COVID-19 can be used in other
diseases with some refinements.
Conclusion