Managing archetypes for sustainable and semantically interoperable electronic health records

Background: With the release of openEHR Version 1.0 a common Electronic Health Records (EHR) architecture has been defined to pursue the aim of semantic interoperability of Electronic Health Records. Archetypes as clinical content models play a key role in this approach, but their development and maintenance needs to be managed by Knowledge Governance in order to avoid incompatibilities. Objectives: To analyse the functional requirements for supporting Domain Knowledge Governance with Information Technology (like authoring or updating archetypes) and present a prototype implementation. Methods: Requirements analysis using the Unified Modeling Language (UML) and incremental prototyping. A series of archetype workshops were also conducted. Results: For a web-based Archetype Repository, a total of four top-level use cases and 23 refining use cases for 5 different actors were found to be essential. A prototype implementing some of these use cases has been developed and an example process for the coordinated development of archetypes defined.Discussion: We believe that Domain Knowledge Governance is necessary independent of the actual approach and methodology chosen for EHR systems. Appropriate information technology is required to support a clear process for authoring archetypes.Conclusion: High-quality archetypes with high-quality clinical content are the key to semantic interoperability of clinical systems. Domain Knowledge Governance is the key to high quality archetypes. A comprehensive Archetype Repository will render comprehensive Domain Knowledge Governance feasible and efficient.