Development and Implementation of an openEHR Archetype for

HIV/AIDS Diagnosis

Carla Esteves

, Nuno Rocha

, Emanuel Catumbela

1,2

, Tiago Silva-Costa

1,2

, Gustavo Bacelar-Silva

1,2

and Alberto Freitas

1,2

CIDES – Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto,

Porto, Portugal

CINTESIS – Center for Research in Health Technologies and Information Systems, Porto, Portugal

Keywords: Archetypes Systems, Electronic Health Record, Health Informatics Standards, Health Information,

openEHR, HIV, AIDS.

Abstract: One of the biggest challenges in maintaining Electronic Health Record (EHR) systems is the necessity to

keep clinical knowledge up-to-date with the scientific evidence. Recently the standard modeling based on

archetypes, proposed by the openEHR Foundation has proved effective in creating flexibly and semantically

interoperable medical records. This paper describes the process of specifying and modeling an archetype for

the diagnosis of HIV/AIDS in a hospital information system designated by SaveCare.

1 INTRODUCTION

Healthcare needs a well-coordinated and

collaborative approach that is not fully achieved

with existing systems, as well as the traditional

models of development, due to the high complexity

of health data and the dynamism of clinical

knowledge, thus the need to develop Electronic

Health Records (EHR) Systems.(Garde et al., 2007).

The models of clinical information, including

different models and EHR variants (Electronic

Medical Records (EMR), Electronic Patient Record

(EPR), Clinical Patient Record (CPR)), do not

currently have a theoretical strong enough base to

ensure interoperability and computability (Beale and

Heard, 2007d). Given the difficulty of

communication between systems, several groups

organized themselves in order to standardize the

development of interoperable EHR, so that the

information could be securely transmitted and

properly interpreted between different information

systems. Significant contributions were made by

producing specifications as the openEHR.

A openEHR

The openEHR Foundation goal of the openEHR

standard is to enable semantic interoperability of

EHRs, allowing improved access to information on

health (Leslie, 2007). The technical specifications

openEHR define the design patterns, reference

model and archetypes, these being continually

evolving. This standard is becoming internationally

known as the most complete architecture standard

for information representation of an EHR (Kalra,

2006).

The architecture of openEHR is basically

founded on the ontological separation of the

technical level (information model) and the domain

level (clinical content model). The information

model is characterized by being stable, the content

of its basic elements remains unchanged during the

lifetime of the information system. On the other

hand, the domain level is susceptible to changes to

represent the evolving clinical knowledge, being

represented by archetypes. The separation in two

levels allows future modifications in information

systems, without requiring changes to the software

code since the construction of the information

system is based on the information model, resulting

in a greater interoperability (Beale and Heard,

2007a); (Leslie, 2007). In an information system

based on openEHR, IT professionals develop and

modify the information model, while health

professionals build and modify the clinical content

model / knowledge (Beale and Heard, 2007c).

390

Esteves C., Rocha N., Catumbela E., Silva-Costa T., Bacelar-Silva G. and Freitas A..

Development and Implementation of an openEHR Archetype for HIV/AIDS Diagnosis.

DOI: 10.5220/0004294403900393

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2013), pages 390-393

ISBN: 978-989-8565-37-2

 2013 SCITEPRESS (Science and Technology Publications, Lda.)

The openEHR model is object-oriented and

incorporates data types to represent very robust

healthcare information. These are described as a

formal and reusable model of a concept. Thus, if a

term is represented by a prototype this concept can

be reused in the various scenarios (Beale and Heard,

2007b).

Different archetypes can be grouped into a

template. A template is typically used to define a

clinical record, or a form to be filled out, and can

determine the archetypes that will be used,

occurrences that must exist for each archetype, and

which elements within an archetype will be used,

among other definitions. From a template, it is

possible to infer an interface that allows creating a

data entry application that collects information from

the concepts and definitions contained in the various

archetypes (Beale and Heard, 2008).

B VCIntegrator

VCIntegrator is the latest version of a system that is

based on premises of a patient-centered EHR and

allows, in an automated manner, the integration of

various previously existing information systems

relevant clinical information. It allows adding

diversified medical records, as well as showing this

information in a centralized way to the health

professional. VCIntegrator allows quick access to

various clinical records without requiring the change

of application, thereby allowing a horizontal view of

the patient’s process in the hospital.

This framework is recently being modified to

work and integrate archetype based templates in its

forms, so the link between the clinic side of the

patient data collection may be closer to the technical

side.

2 AIM AND MOTIVATION

The department of Health Information and Decision

Sciences (CIDES) as been adopting the openEHR

reference model, so headed to a new paradigm

which will address the problem of lack of

standardization of health records and little

integration and interoperability between systems.

This is still an early stage and SaveCare system

(System for AIDS Virtual Evaluation) aims to

become the first fully-implemented CIDES system

in openEHR, however, at this early stage, will only

set the standard variables of a model of diagnosis of

HIV/AIDS.

SaveCare is a system that is based on

assumptions of an EHR patient-centered and allows,

in an automated way, the integration of relevant

clinical information from various previously existing

information systems (clinical process, exams). The

system consists of an electronic medical record of

internal medicine, more specifically for patients with

HIV/AIDS. The idea of building the diagnosis of

HIV/AIDS archetype arose from the need to find a

collection standard model fitted to the data obtained

during the diagnosis of the condition and the lack of

an archetype that fulfilled this purpose.

This article describes the process used in the

specification and modeling of a HIV/AIDS

diagnosis archetype, adjusted to the hospital/clinic

reality of Portugal and Angola, to be integrated into

the module VCSaveCare in VCIntegrator framework

developed by CIDES, which will be used in both

countries.

3 METHODS

The first activity was to search the database of the

openEHR Foundation, Clinical Knowledge Manager

(CKM), for the existing archetypes.

Thus, the Diagnosis archetype (openEHR-EHR-

EVALUATION.problem-diagnosis.v1) was used as

a starting point to design a new archetype to fulfill

our purpose. At this stage, we used open source tools

to edit archetypes and build a template: Ocean

Archetype Editor (Informatics, Latest Beta Release

2011a) and Ocean Template Designer (Informatics,

Latest Beta Release 2011b). With the support of

these tools, the archetype was translated and

specialized to reflect the Portuguese and Angolan

reality.

Once defined the archetype, a template was

created, in turn, exported to a file in CSV format,

and later was used in the openEHR VCIntegrator

compiler that transforms a openEHR template into a

Web form, automatically becoming available in the

clinical module VCSaveCare. The developed

prototype will be further subjected to CKM for

evaluation by experts. Also it was validated through

tests and the archetype was changed, instantiated

and validated accordingly. This cycle was repeated

until the template was considered appropriated.

4 RESULTS

The Evaluation archetype was designed specifically

for the collection of data related to the diagnosis of

DevelopmentandImplementationofanopenEHRArchetypeforHIV/AIDSDiagnosis

391

HIV/AIDS. It is based on several data collection

systems already implemented in Portugal and will

serve to collect data worldwide. Table 1 briefly

describes the purpose of the "Diagnosing

HIV/AIDS".

Table 1: Archetype diagnosis HIV/AIDS purpose.

Archetype: HIV/AIDS Diagnosis

Concept name HIV/AIDS Diagnosis

Concept

description

A diagnosis defined by a medical doctor,

which collects data related to HIV/AIDS

infection including stage of disease and

diagnostic criteria.

Purpose

Registration of medical diagnostics with

optional criteria of diagnosis and stage of

infection. Requires entry of coded diagnosis.

Use

Used for recording any current or past.

diagnosis of HIV/AIDS.

The archetype was designed using Archetype

Designer® application and then imported to

Template Designer® application, where a template

was built based on past archetypes (Diagnosis;

Anatomical Location; Address) increased by other

clinical information. Figure 1 shows the created

mindmap.

The main differences between the existing

Diagnosis archetype and the Diagnosis HIV/AIDS

reside in the fact that the etiologic agents are

associated with several variables, such as TypeHIV,

transmission mode, data of transmission partner and

more detailed information in case of pregnancy. In

turn, the variable TypeHIV is a cluster to which

archetype has been defined TypeHIV.

This consists of detailed tests of detection of

infection, the serotype information, contagion

(vertical, sexual or blood), country of residence on

the likely contagion, the country of residence of the

first symptoms, age and diagnosis, the diagnosis

state (confirmed, suspect, unconfirmed) and clinical

description. The probable date , date of last negative

test, the date of the first positive test, the date of first

observation, the first date as asymptomatic carrier,

the probable year of infection and viral load.

5 DISCUSSION

The incorporation of the Diagnosis HIV/AIDS

archetype in SaveCare system based on openEHR

model proved to be adequate even though it still was

in a draft format.

The archetype and template editing tools, freely

distributed, eased and sped up the work. Thus, one

Figure 1: Mindmap diagnosis HIV/AIDS.

HEALTHINF2013-InternationalConferenceonHealthInformatics

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Figure 2: Arquetype template result.

of the biggest challenges is in the construction of the

Graphical Interface that better reflects the

applications needs from the defined templates.

As the understanding of openEHR ontology

increases, the faster is the process of defining

archetypes and templates.

6 CONCLUSIONS

The use of the archetypes in the construction of

systems is still in its early stages. We believe that

modelling through archetypes allows the

construction of EHR systems that meet the

comprehensive needs of solution to develop, while

ensuring interoperability between systems. It is also

necessary to improve the freely distributed tools so

that they could hide the complexity of the model

from health professionals, facilitating the

construction of new archetypes and templates,

enabling the sharing of records. Therefore the

number of available archetypes could significantly

grow enabling international cooperation and

influencing the clinical healthcare of patients.

ACKNOWLEDGEMENTS

The authors would like to thank to the Department

of Health Information and Decision Sciences

(CIDES) in the Faculty of Medicine, University of

Porto.

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