Templates and Archetypes GF.fm - HL7

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It is important to recognise that organisational models will have slots that can be filledby further organisational archetypes or archetypes.These organisational ‘archetypes’ will describe the ‘organisers’ in openEHR and the‘sections’ in HL7 CDA. While the names of these headings do not alter the semanticsof the information structures held within them they do imply some knowledge - andmay be derived from the meaning of the term used to label them.Constraint during data captureA further level of artefact is required in EHR systems - one which specifies the use ofthe ‘organisational’ and ‘primary’ archetypes within a document or other record constuct.This will be as specific as is required by a group of users and may be sharedwidely or not at all. These specifications have a firm foundation in specific environmentsand user preferences. The role of these specifications (which are called ‘templates’in openEHR to differentiate them from archetypes) describe how the entries inthe record are organised and specify what optional elements in the entries will be populatedand what values and default values apply.While these may well be registered for reuse, they will arise from consideration of bestpractice, specific demands for quality care, decision support systems and applicationrequirements.Consider an openEHR template for recording an antenatal care contact.Figure 4: openEHR antenatal template exampleHistorySymptomsConcernsPhysical examOrganisationalBlood pressureOntologicalmodelsFetal heart ratemodelsPalpation of abdomenAssessmentPlanThe openEHR ‘template’ or constraint specification will show which organisationalmodels are used, in which order, and which ‘primary’ archetypes these will contain. Itwill also set appropriate default values in the primary archetypes if required anddescribe, in the case of the antenatal examination, how the palpation ‘archetype’ isspecialised to enable the position of the fetus in the uterus to be described. 1The new use of ‘Primary’ and ‘Organisational’ archetypes and templatesIn summary, I propose that the term ‘template’ is used in HL7 and openEHR todescribe a constraint specification for a message, a document or a fragment of this -always in terms of primary and organisational archetypes - and in addition in HL71. It is worth noting that the openEHR approach would allow a generic ‘palpation’ archetype to be specialisedfor use in pregnancy only - and perhaps called ‘palpation of the pregnant abdomen’.
RMIM classes and CMETs. The term archetype is used to describe concepts that arerecorded in the EHR which can be usefully linked to an ontology.Table 1: Naming considerationsNameDescriptionCurrentopenEHRCurrentCDACurrentHL7messagesPrimaryarchetypeOrganisationalarchetypesTemplatesDiscrete whole conceptsrecorded in EHRRepresent concepts usedto organise EHR andmay constrain the containedprimary archetypesConstraint specificationsexpressed in termsof organisational archetypesand primary archetypesEntryarchetypesOrganiserarchetypesEntry templatesand RMIMclasses andCMETsSectiontemplatesTemplates ? ?RMIMclasses andCMETs?During detailed discussion, the terms templates, organisational archetypes and primaryarchetypes should be used. The HL7 and openEHR communities would need to agreethat:• The semantics of the HL7 may reside partly in the RIM, partly in the RMIM(and CMETs) and partly in the primary archetypes. Matching the semanticswith the openEHR archetype may prove difficult in the message world - butshould be easier in the somewhat aligned CDA world.• The semantics of the openEHR archetypes reside in the archetype alone -which is linked to an ontology.• The need to register primary and organisational archetypes is absolute - howmany are required for use with the CDA is not clear as the power of the semanticsexpressed in the current version 2 RMIM has not been tested. openEHR islikely to require a few hundred to achieve reasonable interoperability.• The primary archetypes are at the level of the ‘ENTRIES’ in the CDA RMIMand the openEHR reference model - providing an opportunity for covergentwork.For the HL7 community, organisational archetypes will apply to CDA SECTIONS, andsome messages. Primary archetypes will apply to CDA ENTRIES where the model isrequired for semantic interoperability and the full semantic is not provided by theRMIM. In openEHR, ‘organisational’ archetypes will apply to ORGANISERS and ‘primary’archetypes will apply to openEHR ENTRIES.The ‘templates’ with the weakest links to the knowledge base and the strongest link toquality and practice - will apply to predominantly to HL7 CDA documents, openEHR
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Templates and Archetypes GF.fm - HL7

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