OpenEHR archetypes in electronic health records : the path to semantic interoperability?

A myriad of reasons ranging from physician concerns about workflow to broad environmental issues are still inhibiting the adoption of Electronic Health Record (EHR) systems [Ref. 1]. Some argue the most important reason why clinicians are reluctant to adopt clinical IT systems is a perceived lack of added value [Ref. 2] The UK Royal College of Nursing finds in a recent study that 93% of nurses believe that training for EHRs is very important, but over 50% received no training [Ref. 3]. Clinicians commonly feel that it is others who benefit from their keyboard labours – health system administrators, payors, and – hopefully – the patient [Ref. 2]. To really add value for the clinician it is still a necessity to develop best-of-breed systems (e.g. [Ref. 4]) commonly by circumventing existing systems with a strong administrative focus. Best-of-breed systems are at best awkwardly integrated, often maintained with minimum resources, and not interoperable with other systems. Further complicating this matter, health care is constantly changing in three ways (breadth, depth, complexity): new information, information in finer-grained detail, and new relationships are always being discovered or becoming relevant. Therefore, knowledge inherent in EHR systems will eventually become irrelevant or wrong. The openEHR archetype methodology (http://www.openEHR.org) is a possible solution to this dilemma as it claims to empower the clinician and ensure seamless integration and semantic interoperability. The aim of this paper is to shortly present the openEHR approach, analyse to what extend it empowers the clinician and what impact openEHR archetypes have on semantic interoperability.