Can OpenEHR, ISO 13606 and HL7 FHIR work together? An agnostic perspective for the selection and application of EHR standards from Spain

Pedrera-Jiménez, Miguel; standards, Spanish Expert Group on EHR; Kalra, D; Beale, Thomas; Carrero, Adolfo Muñoz; Balazote, Pablo Serrano

doi:10.36227/techrxiv.19746484

Cited by 7 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, by modeling ontologies of other standards and mapping them to local variables, we may, for example, carry out transformations between EN/ISO 13606, OpenEHR [ 21 ], Fast Healthcare Interoperability Resources (FHIR) [ 22 ], OMOP CDM, and Informatics for Integrating Biology and the Bedside (i2b2) [ 23 ] with the minimum use of resources and without the need for changes in the database structure. Health information standards such as EN/ISO 13606 and OpenEHR allow the modeling and formalization of clinical knowledge through their RMs and archetypes [ 24 ], and ontologies are precisely a tool for carrying out such tasks. This is what makes them ideal in the context of an implementation of a dual-model strategy, allowing the representation of concepts in the health domain, its standardization, and the storage of instantiated patient data.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, other standard-agnostic approaches have been reported in the literature. The ongoing INFOBANCO project of the Madrid Region [ 32 ] seeks to create a platform for the management, persistence, exchange, and reuse of health data focused on applying each health information standard for the purpose it was intended to, offering multiple interoperability and exploitation services suited for specific use cases [ 24 ]. Furthermore, the 3-pillar strategy of the Swiss Personalized Health Network [ 33 ] pursues a semantically interoperable clinical data landscape based on a multidimensional encoding of concepts, an RDF-based storage and transport of the instances of these concepts and a conversion of RDF to any target data model.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An Ontology-Based Approach for Consolidating Patient Data Standardized With European Norm/International Organization for Standardization 13606 (EN/ISO 13606) Into Joint Observational Medical Outcomes Partnership (OMOP) Repositories: Description of a Methodology

Frid¹,

Duran²,

Cucó³

et al. 2023

JMIR Med Inform

Self Cite

View full text Add to dashboard Cite

Background To discover new knowledge from data, they must be correct and in a consistent format. OntoCR, a clinical repository developed at Hospital Clínic de Barcelona, uses ontologies to represent clinical knowledge and map locally defined variables to health information standards and common data models. Objective The aim of the study is to design and implement a scalable methodology based on the dual-model paradigm and the use of ontologies to consolidate clinical data from different organizations in a standardized repository for research purposes without loss of meaning. Methods First, the relevant clinical variables are defined, and the corresponding European Norm/International Organization for Standardization (EN/ISO) 13606 archetypes are created. Data sources are then identified, and an extract, transform, and load process is carried out. Once the final data set is obtained, the data are transformed to create EN/ISO 13606–normalized electronic health record (EHR) extracts. Afterward, ontologies that represent archetyped concepts and map them to EN/ISO 13606 and Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) standards are created and uploaded to OntoCR. Data stored in the extracts are inserted into its corresponding place in the ontology, thus obtaining instantiated patient data in the ontology-based repository. Finally, data can be extracted via SPARQL queries as OMOP CDM–compliant tables. Results Using this methodology, EN/ISO 13606–standardized archetypes that allow for the reuse of clinical information were created, and the knowledge representation of our clinical repository by modeling and mapping ontologies was extended. Furthermore, EN/ISO 13606–compliant EHR extracts of patients (6803), episodes (13,938), diagnosis (190,878), administered medication (222,225), cumulative drug dose (222,225), prescribed medication (351,247), movements between units (47,817), clinical observations (6,736,745), laboratory observations (3,392,873), limitation of life-sustaining treatment (1,298), and procedures (19,861) were created. Since the creation of the application that inserts data from extracts into the ontologies is not yet finished, the queries were tested and the methodology was validated by importing data from a random subset of patients into the ontologies using a locally developed Protégé plugin (“OntoLoad”). In total, 10 OMOP CDM–compliant tables (“Condition_occurrence,” 864 records; “Death,” 110; “Device_exposure,” 56; “Drug_exposure,” 5609; “Measurement,” 2091; “Observation,” 195; “Observation_period,” 897; “Person,” 922; “Visit_detail,” 772; and “Visit_occurrence,” 971) were successfully created and populated. Conclusions This study proposes a methodology for standardizing clinical data, thus allowing its reuse without any changes in the meaning of the modeled concepts. Although this paper focuses on health research, our methodology suggests that the data be initially standardized per EN/ISO 13606 to obtain EHR extracts with a high level of granularity that can be used for any purpose. Ontologies constitute a valuable approach for knowledge representation and standardization of health information in a standard-agnostic manner. With the proposed methodology, institutions can go from local raw data to standardized, semantically interoperable EN/ISO 13606 and OMOP repositories.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An Ontology-Based Approach for Consolidating Patient Data Standardized With European Norm/International Organization for Standardization 13606 (EN/ISO 13606) Into Joint Observational Medical Outcomes Partnership (OMOP) Repositories: Description of a Methodology

Frid¹,

Duran²,

Cucó³

et al. 2023

JMIR Med Inform

Self Cite

View full text Add to dashboard Cite

show abstract

“…Likewise, the INFOBANCO project of the Madrid Region in Spain [ 28 ] aims to create a platform for the management, persistence, exchange, and reuse of health data, contemplating 2 types of outputs: interoperability (HL7 FHIR, EN/ISO 13606, Clinical Data Interchange Standards Consortium [CDISC] [ 29 ]) and persistence (OpenEHR, i2b2, Observational Medical Outcomes Partnership Common Data Model [OMOP CDM]). It uses a standard-agnostic design that seeks to apply each health information standard for the purpose it was intended to, offering multiple interoperability and exploitation services suited for specific use cases [ 12 ]. However, these projects focus on the creation of interoperable platforms for different purposes, but they do not include a strategy for integrating information coming from mobile apps.…”

Section: Discussionmentioning

confidence: 99%

“…This framework enables medical apps to be written once and run unmodified across different health care IT systems and has proven to be an effective approach for interoperability. FHIR offers operational mechanisms for data exchange, but unlike EN/ISO 13606, it lacks the capacity to build new concepts based on specific requirements [ 12 ], which limits its flexibility to adapt to new scenarios.…”

Section: Discussionmentioning

confidence: 99%

“…EN/ISO 13606’s advantages over FHIR in terms of modeling and formalization of clinical knowledge, as well as flexibility in the creation of new concepts, suggest it could play a role in the communication of EHR extracts with mobile apps, despite the limited existing evidence. This could be particularly useful in complex scenarios of health data exchange between nodes [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Successful Integration of EN/ISO 13606–Standardized Extracts From a Patient Mobile App Into an Electronic Health Record: Description of a Methodology

Frid¹,

Expósito²,

Grau-Corral³

et al. 2022

JMIR Med Inform

View full text Add to dashboard Cite

Background There is an increasing need to integrate patient-generated health data (PGHD) into health information systems (HISs). The use of health information standards based on the dual model allows the achievement of semantic interoperability among systems. Although there is evidence in the use of the Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR) framework for standardized communication between mobile apps and electronic health records (EHRs), the use of European Norm/International Organization for Standardization (EN/ISO) 13606 has not been explored yet, despite some advantages over FHIR in terms of modeling and formalization of clinical knowledge, as well as flexibility in the creation of new concepts. Objective This study aims to design and implement a methodology based on the dual-model paradigm to communicate clinical information between a patient mobile app (Xemio Research) and an institutional ontology-based clinical repository (OntoCR) without loss of meaning. Methods This paper is framed within Artificial intelligence Supporting CAncer Patients across Europe (ASCAPE), a project that aims to use artificial intelligence (AI)/machine learning (ML) mechanisms to support cancer patients’ health status and quality of life (QoL). First, the variables “side effect” and “daily steps” were defined and represented with EN/ISO 13606 archetypes. Next, ontologies that model archetyped concepts and map them to the standard were created and uploaded to OntoCR, where they were ready to receive instantiated patient data. Xemio Research used a conversion module in the ASCAPE Local Edge to transform data entered into the app to create EN/ISO 13606 extracts, which were sent to an Application Programming Interface (API) in OntoCR that maps each element in the normalized XML files to its corresponding location in the ontology. This way, instantiated data of patients are stored in the clinical repository. Results Between December 22, 2020, and April 4, 2022, 1100 extracts of 47 patients were successfully communicated (234/1100, 21.3%, extracts of side effects and 866/1100, 78.7%, extracts of daily activity). Furthermore, the creation of EN/ISO 13606–standardized archetypes allows the reuse of clinical information regarding daily activity and side effects, while with the creation of ontologies, we extended the knowledge representation of our clinical repository. Conclusions Health information interoperability is one of the requirements for continuity of health care. The dual model allows the separation of knowledge and information in HISs. EN/ISO 13606 was chosen for this project because of the operational mechanisms it offers for data exchange, as well as its flexibility for modeling knowledge and creating new concepts. To the best of our knowledge, this is the first experience reported in the literature of effective communication of EN/ISO 13606 EHR extracts between a patient mobile app and an institutional clinical repository using a scalable standard-agnostic methodology that can be applied to other projects, data sources, and institutions.

show abstract

Obtaining a multi-organization OMOP CDM repository from two heterogeneous EHR ecosystems: a flexible methodology based on Detailed Clinical Models

Pedrera-Jimenez,

Frid,

Garcia-Barrio

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background Standardized repositories of real-world data provide a mechanism for semantic convergence of data from different heterogeneous organizations for secondary use. However, it is common for these repositories to be populated from locally designed information systems, which generates inefficient processes that are not reusable in other organizations or projects. Objective Design and application of a methodology based on the Detailed Clinical Models (DCM) paradigm for allowing the flexible and harmonized implementation of a real world-data (RWD) repository from two technically and organizationally heterogeneous EHR ecosystems. Material and methods First, the DCM paradigm was used for the design of common information objects. Second, a set of clinical archetypes were implemented according to ISO 13606 standard. Third, an OMOP CDM muti-organization repository was implemented for COVID-19 research. Finally, the quality of the data obtained with the aforementioned process was evaluated. Results The main result was the proposal of a methodology for obtaining harmonized EHR-derived datasets using clinical archetypes as a convergence mechanism between local organization-dependent EHR designs. In addition, the application of this method also generated a set of reusable implementation results: (1) the catalog of clinical archetypes, (2) the definition of the transformation process from the archetypes to the OMOP CDM model, and (3) the EHR-derived dataset obtained. Conclusions The flexibility of the methodology made possible the adoption by two digitally mature tertiary hospitals, without altering the platforms already in place. Likewise, the method is agnostic to organizations, to persistence and exchange standards to be obtained, and to application health conditions. Therefore, it can be concluded that the implemented methodology constitutes an innovative and transferable solution to obtain RWD datasets in an efficient, flexible and reusable way.

show abstract

Can OpenEHR, ISO 13606 and HL7 FHIR work together? An agnostic perspective for the selection and application of EHR standards from Spain

Cited by 7 publications

References 14 publications

An Ontology-Based Approach for Consolidating Patient Data Standardized With European Norm/International Organization for Standardization 13606 (EN/ISO 13606) Into Joint Observational Medical Outcomes Partnership (OMOP) Repositories: Description of a Methodology

An Ontology-Based Approach for Consolidating Patient Data Standardized With European Norm/International Organization for Standardization 13606 (EN/ISO 13606) Into Joint Observational Medical Outcomes Partnership (OMOP) Repositories: Description of a Methodology

Successful Integration of EN/ISO 13606–Standardized Extracts From a Patient Mobile App Into an Electronic Health Record: Description of a Methodology

Obtaining a multi-organization OMOP CDM repository from two heterogeneous EHR ecosystems: a flexible methodology based on Detailed Clinical Models

Contact Info

Product

Resources

About