openEHR in the Clinical Process space

When one speaks to working clinicians about what they want from IT and informatics, they generally say: support for ‘process’. This may mean a variety of things, but there are core challenges that most agree on, such as supporting teamwork, hand-overs, ensuring continuity of care across referrals and discharges, and proper up-to-date shared medication lists.

The openEHR specifications have historically supported one aspect of clinical process: orders and actions, via the INSTRUCTION and ACTION types in the Reference Model, which enables the execution of orders, such as medication administration, to be tracked through time. The archetyping approach enables care journey steps to be associated with the states in the Instruction State Machine, so that the Actions performed for any Instruction can be queried in a standard way – e.g. by searching for ‘active’ + ‘suspended’ Instructions based on the medication order archetype, we see what medications the patient is currently on.

But of course this does not go nearly far enough. Two other more recent additions to openEHR expand the support for clinical process. The first is Guideline Definition Language (GDL), an extension of ADL archetypes designed to enable the expression of when/then rules over archetyped data. The practical utility of this is to enable clinical guidelines such as for stroke risk (CHADVASC2) to be operationalised within clinical applications working on typical EMR data, as done by Cambio in Sweden.

GDL’s development is led by Rong Chen of Cambio, and is now entering a new iteration with GDL2 and new tools. Progress can be followed here and on the CDS-apps site.

A recent addition to the openEHR specifications, Task Planning, addresses clinical process in a much more comprehensive way, by providing support for:

  • detailed plans of Actions to perform, e.g. single medication administrations in chemotherapy, rather than just the prescription;
  • context switching and forking between multiple performers in a team;
  • explicit allocation and de-allocation of performers to Tasks, enabling shift changes to be managed;
  • conditional Decision nodes to be mixed with Task nodes in Task Plans;
  • numerous kinds of events, including timing, patient state change and user actions to trigger of block Tasks,

and much more. Version 1.0.0 of the specification has been released, and will be first implemented in Moscow City, using an implementation by Marand.

This blog provides a place for users of Task Planning, GDL, and process-related aspects of the original specifications to share experience both on the development side and the user side.

 

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