Developing a Real Archetype-Based EPR for Heart Failure Patient Management

Objectives: To test the ontology approach for knowledge representation in developing a working distributed electronic patient record (EPR) for heart failure patient’s care process management by starting from the archetype-based openEHR architecture. In this paper, our work in developing a domain conceptualization for real laboratory test results is presented as well as our software solution for the archetype management into a preexistent working EPR system that has been developed in the e-Heart Failure project funded by the Autonomous Province of Trento (Northern Italy) and started in May 2002. Methods: On the examination of a significant extract of the laboratory test reports we started from, out concept descriptions customized to domain specifications are explained. As regards implementation, archetypes were represented using eXtended Markup Language (XML) format whereas components for their management were developed with Microsoft COM+ technology. The whole structure of our EPR is described. Results: All the laboratory test results used in the heart failure care process have been represented in archetypes and then integrated into the Web-based EPR system. At present this EPR has been using and evaluating in the district of Trento by the health care professionals involved in the heart failure patient management. Conclusions: Archetype approach seems to work. As we have tested, archetypes allow to model and manage clinical information in a flexible and powerful way so that it is possible the rapid integration of new medical knowledge with no changes in software architecture