Koray Atalag National Institute for Health Innovation University of Auckland (Wednesday, Interoperability Workshop)

1. Exchange Content Model
(ECM)
Getting there...
Koray Atalag, MD, PhD, FACHI
k.atalag@nihi.auckland.ac.nz
koray.atalag@openehrfoundation.org

3. What is ECM?
• IT IS A REFERENCE LIBRARY - for consistent HIE Payload (CDA)
• Superset of all clinical dataset definitions
– normalised using a standard EHR record organisation (aka DCM)
– Expressed as reusable and computable models – Archetypes
• Top level organisation follows CCR*
• Further detail provided by:
– Existing relevant sources (CCDA, Nehta, epSoS, FHIR etc.)
– Extensions and new Archetypes (NZ specific)
• Each HIE payload (CDA) will correspond to a subset (and conform)
What’s the value proposition of ECM? Why not just build CDAs?
* kind of – CCDA may be more appropriate

5. ECM > Payload

6. Creating Payload
?

7. Archetypes
• The way to go for defining clinical content
 CIMI (led by S. Huff @ Intermountain & Mayo)
 In many nat’l programmes (eg. Sweden, Slovenia, Australia, Brazil,
Scotland)
• Smallest indivisible units of clinical information with clinical context
• Brings together building blocks from Reference Model (eg. record
organisation, data structures, types)
• Puts constraints on them:
– Structural constraints (List, table, tree, clusters)
– What labels can be used
– What data types can be used
– What values are allowed for these data types
– How many times a data item can exist?
– Whether a particular data item is mandatory
– Whether a selection is involved from a number of items/values

8. Logical building blocks of EHR
EHR
Folders
Compositions
Sections
Entries
Clusters
Elements
Data values

9. BP Measurement Archetype

10. Extending ECM
• Addition of new models
• Making existing models more specific
– powerful Archetype specialisation mechanism:
– Lab result > HbA1C result, Lipid profiles etc.
Problem First level specialisation
Text or Coded Term Diagnosis Second level specialisation
Clinical description
Date of onset Coded Term Diabetes
Date of resolution + diagnosis
No of occurrences Grading +
Diagnostic criteria Diagnostic criteria
Stage  Fasting > 6.1
 GTT 2hr > 11.1
 Random > 11.1

11. Value Proposition
• Content is ‘clinician’s stuff’ – not techy; yet most existing standards are
meaningless for clinicians and vice versa for techies
– Archetypes in ‘clinical’ space – easily understood & authored by them
• Single source of truth for entire sector
– One agreed way of expressing clinical concepts – as opposed to
multiple ways of doing it with HL7 CDA (CCDA is a good first step)
• Archetypes can be transformed into numerous formats – including CDA
• Archetypes are ‘maximal datasets’
– Much easier to agree on
• Scope not limited to HIE but whole EHR; workflow supported
• ECM principle invest in information fulfilled completely
– future proof content today for tomorrow’s implementation technology
(e.g. FHIR etc., distributed workflows etc.)