LinkEHR: A Platform for the Normalization of Legacy Clinical Data Based on Archetypes

LinkEHR: A Platform for the Normalization of Legacy Clinical Data Based on Archetypes

José Alberto Maldonado (Instituto ITACA, Universitat Politècnica de València, Spain), Diego Boscá (Instituto ITACA, Universitat Politècnica de València, Spain), David Moner (Instituto ITACA, Universitat Politècnica de València, Spain) and Montserrat Robles (Instituto ITACA, Universitat Politècnica de València, Spain)
DOI: 10.4018/978-1-4666-3000-0.ch003


Normalization of data is a prerequisite to achieve semantic interoperability in any domain. This is even more important in the healthcare sector due to the special sensitivity of medical data: data exchange must be done in a meaningful way, avoiding any possibility of misunderstanding or misinterpretation. In this chapter, we present the LinkEHR system for clinical data standardization and exchange. The LinkEHR platform provides tools that simplify meaningful sharing of electronic health records between different systems and organizations. Key contributions of LinkEHR are the development of a powerful medical concept, expressed in the form of archetypes, editing framework based on formal semantics capable of handling multiple electronic health record architectures, the definition of high-level non-procedural mappings to describe the relationship between archetype and legacy clinical data and the semi-automatic generation of XQuery scripts that transform legacy data into XML documents compliant with the underlying electronic health record data architecture and at the same time satisfy the constraints imposed by the archetype.
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2. Dual Model Ehr Architectures

During the last decade different organizations have been working on the definition of an EHR architecture for the faithful communication of health data. The Technical Committee 251 (health informatics) of the European Committee for Standardization (CEN/TC251) completed in 2007 a European Standard for the communication of the EHR called EN13606 whose part 1 (reference model) (International Organization for Standardization, 2008a) became an ISO standard in February 2008. One of the main contributions of CEN/ISO 13606 is the utilization of an EHR architecture based on the dual model methodology (Beale, 2002) for the description of the structure and semantics of health data. The dual model methodology distinguishes a reference model and archetypes. In a broad sense, a reference model is an abstract representation of the entities and relationships of a domain which is designed to provide a basis for the development of more concrete models and implementations. The reference model is represented by a stable and small object oriented model that models the generic and stable properties of health record information. The generality of the reference model is complemented by the particularity of archetypes. Archetypes are detailed and domain-specific definitions of clinical concepts (Apgar score, discharge report, primary care EHR, etc.) in the form of structured and constrained combinations of the entities of the reference model. Their principal purpose is to provide a powerful, reusable and interoperable way of managing the creation, description, validation and query of EHRs. From a data point of view, archetypes are a means for providing semantics to data instances that conform to some reference model by assuring that data obey a particular structure and satisfy a set of constraints. The semantic description of domain concepts is achieved by linking the data structures and content to knowledge resources such as terminologies and ontologies (Maldonado et al., 2009).

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