FHIR - Fast Healthcare Interoperability Resources is getting adoption at tremendous speed and hence enabling scope for successful nationwide interoperability while also being easy to get started and implement. OpenEHR also solves the interoperability challenge as one of its features. While FHIR adoption and ecosystem is maturing in India, interoperability problem may be best tackled with it.
Combining OpenEHR with FHIR and clinical terminologies (eg. LOINC, SNOMED CT) is a possibility to build more powerful electronic medical records because of the Archetypes in OpenEHR.
"Archetypes define the possible clinical content, representing a model that originates from actual clinical practice. Archetypes have a governance boundary around them, essentially representing a clinical sign off that can be used to support the idea of a clinical data standard. One or more archetypes can then be used in a template that represents a specific clinical use case. A simple example could be the development of a Body Mass Index (BMI) app. In order to achieve this, we need three principle archetypes to capture height, weight and the BMI itself. The benefit of using these standard archetypes is that they can also be inserted into other templates that require the same clinical data. And when that data is stored in a common way, it can be queried and reused, reducing the burden of repeated data entry." 1
"Reuse of data - A key attribute of any clinical data repository is its ability to facilitate reuse for additional clinical requirements and for audit and reporting purposes. The Archetype Query Language exists to support this. AQL provides a means of performing queries on the CDR for individual or multiple records at either the patient or archetype level, maintaining data provenance and exporting for more advanced analysis where needed."1
While clinical terminologies help in analysing data, AQL provides another dimension of data analysis i.e. at patient/archetype level in much easier way.
fig 1 - example archetype
Conclusion -
Design choice of :
- using FHIR for Interoperability (across the globe).
- using OpenEHR Archetypes for data storage (writing to database and reusing in templates)
- AQL on CDR and clinical terminologies for more powerful analytics.
fig 2 - FHIR + OpenEHR
references -
1- https://echalliance.com/what-is-openehr-and-why-is-it-important/
fig - https://ckm.openehr.org/ckm/archetypes/1013.1.3574/mindmap
fig - https://www.youtube.com/watch?v=biEXVRzjWmw&t=841s&ab_channel=openEHR