EHR Archetypes

Background

EHR Archetypes are a formal, rigorous and standardised (interoperable) specification for an agreed consensus or best practice representation of a clinical data structure within an electronic health record.

The strength of the approach taken internationally on the communication (sharing) or electronic health record information has been the development of a rigorous generic representation suitable for all kinds of entries. Provided that the communications architecture is common to both a sending and a receiving information system, any health record extract will contain all of the structure and names required for it to be interpreted faithfully on receipt even if its organisation and the nature of the clinical content have not been "agreed" in advance.

ISO/EN 13606 is a forthcoming EHR Communications standard that defines such a generic information model. A richer EHR model has been published by the openEHR Foundation, which draws on over fifteen years of international research on the EHR.

However the scalable sharing of health records, and their meaningful analysis across distributed sites, also requires that a consistent approach is used for the naming and organisation of EHR hierarchies, so that requesting processes can precisely specify the desired parts of an EHR within a request, and anticipate the kinds of data structures that will be provided in response. EHR Archetypes are a standardised way of specifying these clinical data hierarchies and the kinds of data values that may or must be included.

EHR Archetypes originate from over ten years of research and clinical demonstrators in Europe and Australia; much of this work has in recent years been consolidated within the openEHR Foundation. ISO/EN 13606 Part 2 incorporates the openEHR archetype approach as a standard information model, and an exchange representation, for the communication of EHR Archetypes.

One notable challenge in designing libraries of Archetypes to meet broad areas of clinical practice, for example to cover the complete clinical information needs of a speciality or professional discipline, is to ensure that Archetypes are evidence based or meet de facto established clinical needs. Given that many Archetypes may be needed to cover a given domain, it is also important for them to be mutually consistent and bind to terminology systems in appropriate and consistent ways. This is necessary in order to minimise the diversity of ways in which a given kind of EHR data might be represented. This consistency is needed by clinical applications, decision support and other analytic software that need to retrieve or filter EHR data, or assist users with selective navigation through a large EHR or across populations of EHRs.

EHR Archetypes themselves therefore need to be quality assured, since they will direct the ways in which clinical data is captured, processed and communicated. EuroRec is partnering the openEHR Foundation in developing governance practices for archetype development and the quality criteria and editorial policies by which certified libraries of EHR Archetypes can be recognised. In the future EuroRec will reference the organisations and EHR Archetype repositories whose governance and editorial policies have met EuroRec standards, and whose Archetypes are therefore considered to be of good quality.

Further information on EHR Archetypes may be found on the openEHR web site, at: https://www.openehr.org/