I have a project that I’m working on. We’re creating a CPOE for medication, and we’re not sure which information model we should use to store our content. I’m more familiar with FHIR, but I’m also a fan of openEHR. I have heard from the openEHR community for quite some time that they encourage developers to store data in the openEHR model.
So, to do this project, I decided to analyze which one to choose. Here are the processes I did for this work.
- I used Archetype Designer to create a template and include the Medication Order archetype.
- I filled in almost all SLOTs with pertinent archetypes. I haven’t filled in those who didn’t specify any archetypes in the “Include” part of the SLOT (I don’t know what it calls). Other ones are not much related to the medication order (such as the minor detail of the administration device).
- I exported it as an Excel file and re-format it to be more similar to FHIR.
- I filled in some descriptions or comments from the CKM and studied each element to learn the meaning.
- I duplicated it to another sheet and mapping with FHIR. I exclude SLOT and CLUSTER elements because their main goal is structuring (I think the way they work is quite similar to complex and backbone elements in FHIR).
And here is the result
Disclaimer: I’m not an expert in openEHR or FHIR, especially openEHR. I might understand the meaning of some elements wrong, or I could incorrectly map. But I have tried my best. I would love any feedback.Read more: Mapping Medication Order Between openEHR And FHIR
In overall, there are 138 data elements in openEHR medication order after the exclusion of SLOTs/CLUSTERs. From these elements, I could map FHIR elements into 97 elements. That is around 70% of all elements. There are 41 elements that I couldn’t find FHIR elements to map (shown as None in the spreadsheet).
However, several things to note here.
- There are many elements that I would say it’s not fully equivalent in the meaning. But it might be OK to use those FHIR elements.
- I mapped many elements as many-to-one, i.e., several openEHR elements share the same FHIR element. I would say that this can be implied that openEHR’s overall granularity is a bit more than FHIR. For example, in the body structure archetype/resource. The openEHR use 3 elements to fine-tune the location (Laterality, Aspect, Anatomical line), but FHIR uses only
BodyStructure.locationQualifierfor all three meanings.
- In my opinion, most elements that I can’t find FHIR resources (to map) seem to be not much important and not be used much. I would say even though we build our system based on the FHIR information model, we would not need many extensions.
- I haven’t tried mapping in the opposite direction. I think there might be some elements that exist in FHIR but don’t exist in openEHR as well. I saw the ePrescription (FHIR) template in the CKM. I think it’s an excellent example of mapping in this direction, but it’s pretty outdated now.
I still can’t find my own conclusion about which information model to use in our project. But if I had to choose today, maybe I would prefer FHIR, just because I’m more familiar with it, and it seems good enough to capture essential data. And in my context, the hospital still uses paper prescriptions. I don’t think we can implement a system with comprehensive data capturing capability anyway.