It does not make any real sense to make archetypes literally based on CEN 13606

Archetypes have a very important requirement: to be targetted
to an informatoin model which acts as a "base ontology". In openEHR we
use the openEHR reference model fr this purpose. This is what allows you
to write an archetype for somehting like "Apgar result", which needs to
use concepts like OBSERVATION (with properties data, state and
protocol), HISTORY (with properties events, origin), EVENT (property
data), and varous data structure types, like TREE, LIST, TABLE and SINGLE.

EN 13606 is not designed directly to support archetyping; it is designed
as a lowest-common denominator EHR data interoperability model, with
support for transmitting archetyped information.

This is not the same as providing sufficient ontological definitoins to
support the building or use of archetypes. If you were to use EN13606
literally for archetypes, you could only use ENTRY, CLUSTER and ELEMENT;
you will see that trying to define most clinical concepts with such a
weak ontology will be annoying difficult, error-prone, and ultimately
will not engage clinical professionals.

So openEHR currently offers at least part of a base ontology for
building archetypes, with concepts of sufficient strength to make
higher-level clinical concepts easily expressible. In the near future,
we intend to propose the creation of an agreed "base level ontology"
reference model, expressed in UML, for use by everybody for buiulding
archetypes. We will include the core of the openEHR reference model for
this (from COMPOSITION down); but we want other organisations to think
about what they need to see in this. There are other reference models
such as the Danish G-EPJ which have clean concepts which may need to be
in this base ontology; also ENV 13940 (continuity of care) models need
to be analysed for possible contributions. We will propose this base
ontology at the next CEN working group meeting. I believe people will
agree in principle.

A data mapping is also being defined between openEHR (and later, the
common base ontology) and EN13606. This wll enable 13606 to fulfull its
purpose, which is to move  data faithfully between EHR sites, including
data which has been archetyped in those sites.

But please don’t try to directly archteype 13606 information structures
– you will be going down he wrong route!

– thomas beale (Posted in discussion list)

211 thoughts on “It does not make any real sense to make archetypes literally based on CEN 13606”

  1. Jose Alberto Maldonado wrote:

    > Hello,
    > We have just read the message bellow and honestly we do not understand
    > anything now. We supposed that EN13606-1 reference model could be used as
    > reference model for developing archetypes.
    > You can read in prEN13606-2 (last version February 2005), section
    > 1.3. Communicating archetypes: “It is
    > the intention of both CEN and HL7 that HL7 Templates and EN13606
    > archetypes be interoperable”.

    well, this has been stated for a long time, but there is little evidence
    of it happening. A recent post from the HL7 templates list indicates the
    current state of play…in short they using something called MIF to do
    “templates”, which are approximately the same as archetypes. But it is
    complicated in HL7 because there are two ways to create any model of a
    clinical concept: using a template (presuming they finish defining what
    they think a template is) and using an RMIM – a message model.

    CEN doesn’t need archetypes based on its own model, although not
    everyone in the working realises this yet. However, I had a recent
    discussion with Dr Gunnar Klein (chair of TC/251) and he now understands
    the reason why basing archetypes literally on EN13606 does not make a
    lot of sense. The documents you mention are indeed somewhat confusing as
    currenly worded and have to be changed; I will be recommending changes
    at the next CEN meeting.

    > One question arises are these EN13606
    > archetypes different from OPENEHR archetypes?.
    > Could you show some examples of clinical concepts that can not be
    > expressed as archetypes derived from EN13606-1 reference model?.

    Sure….practically every archetype we have built. Have a look at the
    archetypes either using the adl-workbench or jsut on the web – see
    Consider the apgar archetype at
    – you will see it references classes OBSERVATION, HISTORY, EVENT, and
    LIST, and particular attributes, e.g. OBSERVATION has data, state and
    protocol (see e.g. blood pressure for example use of these). You can’t
    write any of this using the CEN model because it just doesn’t have any
    of the classes I just mentioned. Instead, you can only write ENTRY,
    CLUSTER and ELEMENT, which is too limited.

    CEN is designed to carry data that has already been archetyped, not to
    be a model on which archetypes are based.

    > thanks in advance

    ——————————- HL7 templates list post —————–

    Lloyd McKenzie wrote:

    Hi John,

    The internal format of all HL7 v3 content is MIF. It is used for persistence, exhange, as well as for definition of what’s possible. The MIF also acts as a UML profile expressing what pieces of UML HL7 permits and what stereotypes we require.

    The MIF requires that all ‘custom’ constraints be expressed as OCL, though alternate formal (e.g. Schematron) or free text representations are also supported. (Obviously we’re coming up short on OCL representations at present.)

    Thus, to a certain extent, the statement of UML + OCL is accurate. We just need to make clear that the UML being referred to is the MIF LIM stereotype.

    Also, the format for registration should be MIF XML to allow for easy validation and checking against other models (e.g. RIM, datatypesn etc.)
    —–Original Message—–
    Date: Thu, 3 Mar 2005 11:01:17,,
    Subject: Re: Comments on draft document

    As an ‘outside’ observer to all of these discussions there seems to be a core issue of disagreement and one
    which I share. That is, WHAT is the ITS and what is the ‘official’ HL7V3 representation of a model – I don’t
    care if it a RIM, D-MIM or Any-MIM, template, CMET. Some contends it’s the MIF and others contend it’s UML
    (maybe with OCL) and the MIF is an interchange for the model (it’s name suggests it is a interchange
    format NOT the model itself)!

    The other problem that seems to crop up is the resistance to use any previously defined mechanism to
    describe the logic or mathematical constraints on the model itself. When OCL is mentioned it’s ‘tossed’ as
    an ITS rather than being viewed as an existing ‘language’ to define constraints. Same thing with OWL or
    ADL. I can’t see why we can’t separate the notion of using these ‘existing languages or formalisms’ to help
    define our constraints? (*) Just because we choose to use one of these languages for definitions doesn’t IMPLY
    that the specific artifact has to be rendered or, for that matter, even stored in that format; it is used as a means
    to convey the concept in a more precise language. We could choose to use formal logic languages, assuming
    that these wouldn’t be viewed as ‘ITS’es , e.g. relational algebra or regular expressions, etc. if it could precisely
    define the constraints and remove the issue of these being ‘ITS’-ish. However, at some point there has to be a formalism
    for defining the constraints on model elements (templates or any other V3 element) and that can either be a
    human language or a mathematical/logic language, or an existing constraints language. To me this all goes back
    to the discussion of HL7 V3’s model as a ‘pure’ UML metamodel — something we seem to have lost along the
    way — because the MIF appears to [try to] be the V3 ‘metamodel’. [To me this is analogous to saying the XMI is
    the model and UML is not.]

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  73. Khi có b?ng h?u ho?c c?ng s? ??n nhà ch?i ,
    chúng ta có kh? n?ng ch? bi?n nh?ng món ngon ?ãi khách nào có kh? n?ng v?a th? hi?n s?
    tôn tr?ng và thân m?t nh?t. Hãy cùng theo dõi m?t s? h??ng
    d?n d??i ?ây ?? có kh? n?ng D? b? cho menu ?ón khách thêm ph?n phong phú và sang tr?ng h?n.

    7 món ngon ?ãi khách b?n có kh? n?ng làm
    Ti?p ?ãi khách v?i món gà rang mu?i
    V?i th?t gà chúng ta có xác xu?t ch? bi?n theo nhi?u cách khách nhau nh?:
    lu?c , xào , rán , n?u súp , n?u canh… Tuy nhiên ?? ??i thay kh?u v? và
    cách th??ng th?c m?i cho nh?ng ng??i khách quý c?a mình hãy
    cùng h?c cách làm món gà rang mu?i.

    Món ngon ?ãi khách – gà rang mu?i
    Món ngon ?ãi khách – gà rang mu?i So v?i nhi?u món gà khác thì gà rang mu?i có
    th? làm chín trong th?i gian ng?n và v?t li?u chính c?ng nh? ph?
    gia không thèm lan tràn th?ng d?. C? th? nh? sau:

    1/ 2 ho?c 1 con th?t gà ta tùy vào s? l??ng ng??i ?n.
    S? 4 cây.
    Lá chanh.
    1 qu? tr?ng gà.
    B?t n?ng.
    Cách th?c hi?n:

    Th?t gà làm s?ch , sau th?i gian ?y nêm vào
    các gia v? tiêu , ?t , d?u ?n , m? chính , lòng ?? tr?ng gà và 1 thìa cà phê
    n??c n?m. ??p th?t trong vòng 15 phút.

    S? ??p d?p và c?t khúc , thái s?i.
    Cho mu?i , s? và lá chanh vào rang qua. Sau ?ó trút ra ??a ?? riêng.

    Th?t gà sau khi ??p chúng ta s? mang
    ra l?n ??u v?i b?t n?ng , r?i t? t? chiên lên , khi ph?n th?t th?n l?i hãy cho mu?i , s? và lá chanh
    ?ã rang s?n vào sóc ??u.
    Nh? v?y chúng ta có kh? n?ng mang món gà rang mu?i ra ti?t ?ãi khách r?i.

    Ti?p ?ãi khách v?i món ngon v?t om s?u
    N?u ai ?ã t?ng th??ng th?c v?t om s?u s?
    không th? quên ???c v? thanh chua
    c?a n??c lèo , cùng v?i ph?n th?t th?n béo.
    Ng??i dùng có th? th??ng th?c nhi?u mà không b? ng?y
    hay ngán. ??c bi?t V?t om s?u là m?t món ?n ngon r?t phù h?p cho
    vi?c ti?p ?ãi khách. ?? tr? bi?n ???c món ?n này chúng
    tôi c?n chu?n b? nh? sau:

    Món ngon ?ãi khách – V?t om s?u
    Món ngon ?ãi khách – V?t om s?u nguyên li?u c?n:

    1 con v?t.
    10 qu? s?u t??i.
    G?ng t??i.
    ?t , t?i , tiêu , rau ng? , mùi tàu.

    Cách th?c hi?n:

    V?t sau khi r?a v?i n??c hãy ngâm trong r??u tr?ng ?? kh? mùi hôi , sau th?i gian ?y ti?p ki?n r?a l?i v?i n??c s?ch.

    Thái th?t thành t?ng mi?ng v?a ?n , nêm các gia v? nh? mu?i , h?t tiêu , t?i b?m , ?t
    b?m , h?t nêm sau th?i gian ?y tr?n ??u và ??p trong 30 phút.

    S?u c?o s?ch v? cho vào n??c l?nh ngâm.
    Rau mùi và rau ng? làm s?ch thái khúc.
    Cho s? và t?i tao lên , sau ?ó cho th?t v?t ?ã ??p vào và ??o ??u tay.
    Khi th?t th?n l?i chúng ta s? cho n?a bát n??c chín vào.

    ti?p ki?n cho s?u vào , ??ng th?i v?n l?a nh? v?a.

    Nêm thêm gia v? ?? v?a mi?ng , sau ?ó cho
    mùi tàu và rau ng? vào t?t b?p.
    Tôm chiên khoai tây
    Tôm chiên khoai tây c?ng là m?t trong nhi?u món ngon ?ãi khách b?n có th? làm.
    Vì tôm r?t d? trang trí sang tr?ng l?i khá d?
    th?c hành trong th?i kì ng?n. ?? làm món này ?ã khách b?n c?n chu?n b? nh?ng nguyên li?u nh? sau:

    Món ngon ?ãi khách – Tôm chiên khoai tây
    Món ngon ?ãi khách – Tôm chiên khoai tây 10 con tôm
    2 c? khoai tây.
    B?t chiên xù
    Cách th?c hi?n:

    Tôm sau khi mua v? làm s?ch.
    Khoai tây bào thành s?i nh?.
    Qu?n khoai tây vào tôm , sau th?i gian ?y t?m vào b?t chiên.
    Cho tôm và khoai tây ?ã cu?n vào ch?o chiên giòn. Sau
    ?ó mang ra ?? ráo d?u.
    Món ?n này có th? làm trong th?i gian r?t nhanh.
    Vì th? b?n có nhi?u th?i kì ?? làm thêm m?t s? món ?n khác.
    ?? món ?n tr? thành h?p d?n , hãy bày
    trên ??a có ??ng rau xà lách và ?t
    hoa. Chú ý v?i món tôm chiên khoai tây chúng ta có kh? n?ng ?n cùng v?i t??ng ?t chinsu r?t tuy?t v?i.

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