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Sundvall, Erik
Publications (10 of 21) Show all publications
Sundvall, E., Wei-Kleiner, F., Freire, S. M. & Lambrix, P. (2017). Querying archetype-based Electronic Health Records using Hadoop and Dewey encoding of openEHR models. In: Rebecca Randell, Ronald Cornet, Colin McCowan, Niels Peek, Philip J. Scott (Ed.), Rebecca Randell; Ronald Cornet; Colin McCowan; Niels Peek; Philip J. Scott (Ed.), Informatics for Health: Connected Citizen-Led Wellness and Population Health. Paper presented at Informatics for Health 2017, Manchester, UK, April 2017 (pp. 406-410). Amsterdam, The Netherlands: IOS Press
Open this publication in new window or tab >>Querying archetype-based Electronic Health Records using Hadoop and Dewey encoding of openEHR models
2017 (English)In: Informatics for Health: Connected Citizen-Led Wellness and Population Health / [ed] Rebecca Randell; Ronald Cornet; Colin McCowan; Niels Peek; Philip J. Scott, Amsterdam, The Netherlands: IOS Press, 2017, p. 406-410Conference paper, Published paper (Refereed)
Abstract [en]

Archetype-based Electronic Health Record (EHR) systems using generic reference models from e.g. openEHR, ISO 13606 or CIMI should be easy to update and reconfigure with new types (or versions) of data models or entries, ideally with very limited programming or manual database tweaking. Exploratory research (e.g. epidemiology) leading to ad-hoc querying on a population-wide scale can be a challenge in such environments. This publication describes implementation and test of an archetype-aware Dewey encoding optimization that can be used to produce such systems in environments supporting relational operations, e.g. RDBMs and distributed map-reduce frameworks like Hadoop. Initial testing was done using a nine-node 2.2 GHz quad-core Hadoop cluster querying a dataset consisting of targeted extracts from 4+ million real patient EHRs, query results with sub-minute response time were obtained.

Place, publisher, year, edition, pages
Amsterdam, The Netherlands: IOS Press, 2017
Series
Studies in Health Technology and Informatics, ISSN 0926-9630 ; 235
Keywords
medical record systems, computerzied; database management systems; Dewey encoding; Archetypes; open EHR; Hadoop; Epidemiology; XML
National Category
Computer Sciences Other Medical Engineering
Identifiers
urn:nbn:se:liu:diva-136902 (URN)10.3233/978-1-61499-753-5-406 (DOI)28423824 (PubMedID)978-1-61499-752-8 (ISBN)978-1-61499-753-5 (ISBN)
Conference
Informatics for Health 2017, Manchester, UK, April 2017
Funder
Swedish e‐Science Research Center
Available from: 2017-04-28 Created: 2017-04-28 Last updated: 2019-07-03Bibliographically approved
Hägglund, M., Karlsson, M. G., Klein, G., Koch, S., Lindgren, H., Nyström, M., . . . Sundvall, E. (2017). Världsbäst på eHälsa kräver internationellt samarbete. Svenska dagbladet
Open this publication in new window or tab >>Världsbäst på eHälsa kräver internationellt samarbete
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2017 (Swedish)In: Svenska dagbladet, ISSN 1101-2412Article in journal, News item (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Det är glädjande att myndigheter nu äntligen tittar mer på internationellt delade detaljerade dokumentationsmodeller för innehåll i journaler. Vi hoppas att de ger tillräckligt kraftfulla och tydliga budskap så att de upphandlande vårdgivarna också ser vikten av detta. Om vi ska bli världsbäst på eHälsa krävs internationellt samarbete, skriver flera forskare i medicinsk informatik.

Place, publisher, year, edition, pages
Stockholm, Sweden: Svenska Dagbladet AB & Co., 2017
National Category
Other Engineering and Technologies not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-141173 (URN)
Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2017-10-04Bibliographically approved
Sundvall, E., Siivonen, D. & Örman, H. (2016). Approaches to learning openEHR: a qualitative survey, observations, and suggestions. In: Daniel Karlsson, Andrius Budrionis, Ann Bygholm, Mariann Fossum, Conceicao Granja, Gunnar Hartvigsen, Ole Hejlesen, Maria Hägglund, Monika Alise Johansen, Carl E Moe, Luis Marco-Ruiz, Vivian Vimarlund, Kassaye Y Yigzaw (Ed.), Proceedings from the 14th Scandinavian Conference on Health Informatics 2016: Gothenburg, Sweden, April 6-7 2016. Paper presented at The 14th Scandinavian Conference on Health Informatics 2016, Gothenburg, Sweden, April 6-7 2016 (pp. 29-36). Linköping: Linköping University Electronic Press, 122
Open this publication in new window or tab >>Approaches to learning openEHR: a qualitative survey, observations, and suggestions
2016 (English)In: Proceedings from the 14th Scandinavian Conference on Health Informatics 2016: Gothenburg, Sweden, April 6-7 2016 / [ed] Daniel Karlsson, Andrius Budrionis, Ann Bygholm, Mariann Fossum, Conceicao Granja, Gunnar Hartvigsen, Ole Hejlesen, Maria Hägglund, Monika Alise Johansen, Carl E Moe, Luis Marco-Ruiz, Vivian Vimarlund, Kassaye Y Yigzaw, Linköping: Linköping University Electronic Press, 2016, Vol. 122, p. 29-36Conference paper, Published paper (Refereed)
Abstract [en]

Approaches such as ISO 13606 and openEHR aim to address data reusability by defining clinical data structures called archetypes and templates, based on a reference model. A problem with these approaches is that parts of them currently are rather difficult to learn. It can be hard to imagine what an archetype-based clinical system combined with modern terminology systems will look like and what consequences different modeling choices have, without seeing and experimenting with an operational system. This paper reports findings from a survey among openEHR learners and educators combined with observations of related openEHR mailing list discussions. The paper ends with an opinion piece, where we discuss potentially fruitful ways to learn, explore, and extend archetype-based EHR systems using visualization and examples.The findings highlight potential stumble blocks and solutions and should be of interest for both educators and self-learners.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016
Series
Linköping Electronic Conference Proceedings, ISSN 1650-3686, E-ISSN 1650-3740 ; 122
Keywords
Electronic Health Records; Software; Learning; Standards
National Category
Information Systems
Identifiers
urn:nbn:se:liu:diva-87701 (URN)9789176857762 (ISBN)
Conference
The 14th Scandinavian Conference on Health Informatics 2016, Gothenburg, Sweden, April 6-7 2016
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2018-02-05Bibliographically approved
Freire, S. M., Teodoro, D., Wei-Kleiner, F., Sundvall, E., Karlsson, D. & Lambrix, P. (2016). Comparing the Performance of NoSQL Approaches for Managing Archetype-Based Electronic Health Record Data. PLoS ONE, 11(3), Article ID e0150069.
Open this publication in new window or tab >>Comparing the Performance of NoSQL Approaches for Managing Archetype-Based Electronic Health Record Data
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0150069Article in journal (Refereed) Published
Abstract [en]

This study provides an experimental performance evaluation on population-based queries of NoSQL databases storing archetype-based Electronic Health Record (EHR) data. There are few published studies regarding the performance of persistence mechanisms for systems that use multilevel modelling approaches, especially when the focus is on population-based queries. A healthcare dataset with 4.2 million records stored in a relational database (MySQL) was used to generate XML and JSON documents based on the openEHR reference model. Six datasets with different sizes were created from these documents and imported into three single machine XML databases (BaseX, eXistdb and Berkeley DB XML) and into a distributed NoSQL database system based on the MapReduce approach, Couchbase, deployed in different cluster configurations of 1, 2, 4, 8 and 12 machines. Population-based queries were submitted to those databases and to the original relational database. Database size and query response times are presented. The XML databases were considerably slower and required much more space than Couchbase. Overall, Couchbase had better response times than MySQL, especially for larger datasets. However, Couchbase requires indexing for each differently formulated query and the indexing time increases with the size of the datasets. The performances of the clusters with 2, 4, 8 and 12 nodes were not better than the single node cluster in relation to the query response time, but the indexing time was reduced proportionally to the number of nodes. The tested XML databases had acceptable performance for openEHR-based data in some querying use cases and small datasets, but were generally much slower than Couchbase. Couchbase also outperformed the response times of the relational database, but required more disk space and had a much longer indexing time. Systems like Couchbase are thus interesting research targets for scalable storage and querying of archetype-based EHR data when population-based use cases are of interest.

Place, publisher, year, edition, pages
Public Library Science, 2016
National Category
Computer Sciences
Identifiers
urn:nbn:se:liu:diva-125961 (URN)10.1371/journal.pone.0150069 (DOI)000371992300032 ()26958859 (PubMedID)
Funder
Swedish e‐Science Research Center
Note

Funding agencies: Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES Foundation - Brazil) [4055/11]; Conselho Brasileiro de Desenvolvimento Cientifico e Tecnologico (CNPq) [150916/2013-2]

Available from: 2016-03-09 Created: 2016-03-09 Last updated: 2018-03-22
Nyström, M., Örman, H., Lind, L., Sundvall, E., Shahsavar, N. & Karlsson, D. (2016). Det krävs en riktad satsning på e-hälsa. Dagens medicin (18), pp. 22
Open this publication in new window or tab >>Det krävs en riktad satsning på e-hälsa
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2016 (Swedish)In: Dagens medicin, ISSN 1104-7488, no 18, p. 22-Article in journal, News item (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Stockholm: , 2016
Keywords
e-hälsa, vision, forskning
National Category
Other Computer and Information Science
Identifiers
urn:nbn:se:liu:diva-127704 (URN)
Available from: 2016-05-09 Created: 2016-05-09 Last updated: 2018-01-10
Hojen, A., Sundvall, E. & Goeg, K. (2014). Methods and applications for visualization of SNOMED CT concept sets. Applied Clinical Informatics, 5(1), 127-152
Open this publication in new window or tab >>Methods and applications for visualization of SNOMED CT concept sets
2014 (English)In: Applied Clinical Informatics, ISSN 1869-0327, Vol. 5, no 1, p. 127-152Article in journal (Refereed) Published
Abstract [en]

Inconsistent use of SNOMED CT concepts may reduce comparability of information in health information systems. Terminology implementation should be approached by common strategies for navigating and selecting proper concepts. This study aims to explore ways of illustrating common pathways and ancestors of particular sets of concepts, to support consistent use of SNOMED CT and also assess potential applications for such visualizations. The open source prototype presented is an interactive web-based re-implementation of the terminology visualization tool TermViz that provides an overview of concepts and their hierarchical relations. It provides terminological features such as interactively rearranging graphs, fetching more concept nodes, highlighting least common parents and shared pathways in merged graphs etc. Four teams of three to four people used the prototype to complete a terminology mapping task and then, in focus group interviews, discussed the user experience and potential future tool usage. Potential purposes discussed included SNOMED CT search and training, consistent selection of concepts and content management. The evaluation indicated that the tool may be useful in many contexts especially if integrated with existing systems, and that the graph layout needs further tuning and development.

Place, publisher, year, edition, pages
Schattauer, 2014
Keywords
Clinical terminology; Implementation; SNOMED CT; Information Visualization; knowledge representation
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-105766 (URN)10.4338/ACI-2013-09-RA-0071 (DOI)000332018700009 ()
Available from: 2014-04-04 Created: 2014-04-04 Last updated: 2017-12-05
Sundvall, E., Nyström, M., Karlsson, D., Eneling, M., Chen, R. & Örman, H. (2013). Applying representational state transfer (REST) architecture to archetype-based electronic health record systems. BMC Medical Informatics and Decision Making, 13(57)
Open this publication in new window or tab >>Applying representational state transfer (REST) architecture to archetype-based electronic health record systems
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2013 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 13, no 57Article in journal (Refereed) Published
Abstract [en]

Background

The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content.

The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored.

Results

The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored.

A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping.

Conclusions

Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications.

Place, publisher, year, edition, pages
BioMed Central, 2013
National Category
Information Systems
Identifiers
urn:nbn:se:liu:diva-87696 (URN)10.1186/1472-6947-13-57 (DOI)000320998000001 ()
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2018-01-11
Sundvall, E. (2013). Scalability and Semantic Sustainability in Electronic Health Record Systems. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Scalability and Semantic Sustainability in Electronic Health Record Systems
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This work is a small contribution to the greater goal of making software systems used in healthcare more useful and sustainable. To come closer to that goal, health record data will need to be more computable and easier to exchange between systems.

Interoperability refers to getting systems to work together and semantics concerns the study of meanings. If Semantic interoperability is achieved then information entered in one information system is usable in other systems and reusable for many purposes. Scalability refers to the extent to which a system can gracefully grow by adding more resources. Sustainability refers more to how to best use available limited resources. Both aspects are important.

The main focus and aim of the thesis is to increase knowledge about how to support scalability and semantic sustainability. It reports explorations of how to apply aspects of the above to Electronic Health Record (EHR) systems, associated infrastructure, data structures, terminology systems, user interfaces and their mutual boundaries.

Using terminology systems is one way to improve computability and comparability of data. Modern complex ontologies and terminology systems can contain hundreds of thousands of concepts that can have many kinds of relationships to multiple other concepts. This makes visualization challenging. Many visualization approaches designed to show the local neighbourhood of a single concept node do not scale well to larger sets of nodes. The interactive TermViz approach described in this thesis, is designed to aid users to navigate and comprehend the context of several nodes simultaneously. Two applications are presented where TermViz aids management of the boundary between EHR data structures and the terminology system SNOMED CT.

The amount of available time from people skilled in health informatics is limited. Adequate methods and tools are required to develop, maintain and reuse health-IT solutions in a sustainable way. Multiple levels of modelling including a fixed reference model and another layer of flexible reusable ‘archetypes’ for domain specific data structures, is an approach with that aim used in openEHR and the ISO 13606 standard. This approach, including learning, implementing and managing it, is explored from different angles in this thesis. An architecture applying Representational State Transfer (REST) to archetype-based EHR systems, in order to address scalability, is presented. Combined with archetyping this architecture also aims at enabling a sustainable way of continuously evolving multi-vendor EHR solutions. An experimental open source implementation of it, aimed for learning and prototyping, is also presented.

Manually changing database structures used for storage every time new versions of archetypes and associated data structures are needed is likely not a sustainable activity. Thus storage systems that can handle change with minimal manual interventions are desirable. Initial explorations of performance and scalability in such systems are also reported

Graphical user interfaces focused on EHR navigation, time-perspectives and highlighting of EHR content are also presented – illustrating what can be done with computable health record data and the presented approaches.

Desirable aspects of semantic sustainability have been discussed, including: sustainable use of limited resources (such as available time of skilled people), and reduction of unnecessary risks. A semantic sustainability perspective should be inspired and informed by research in complex systems theory, and should also include striving to be highly aware of when and where technical debt is being built up. Semantic sustainability is a shared responsibility.

The combined results presented contribute to increasing knowledge about ways to support scalability and semantic sustainability in the context of electronic health record systems. Supporting tools, architectures and approaches are additional contributions.

Abstract [sv]

Syftet med denna avhandling är ytterst att göra informationssystem som används i hälso- och sjukvård, särskilt patientjournaler, mer användbara och lättarbetade. Om systemen vore lättare att utveckla och underhålla skulle fler resurser kunna läggas på att tillföra nya och mer användarvänliga funktioner.

Om journalsystem och datorprogram kan ”begripa” vad olika saker i journalen är och betyder så kan de vara till större hjälp, t.ex. genom att visa bättre patientöversikter och bidra med beslutsstöd. En del i att göra journalinnehållet begripligt och hanterbart för datorer är att använda sig av terminologisystem som t.ex. ICD-10 och SNOMED CT. En annan viktig del är datastrukturerna där man stoppar in text, mätvärden, koderna från terminologisystem etc. De flesta journalsystem har någon sorts mallar som datastrukturer. Projektet openEHR har tagit fram ett sätt att dela specifikationer av datastrukturer mellan olika journalsystem så att man lättare kan dela och återanvända dem och den journaldata som matats in i dem. Dessa specifikationer kallas ”arketyper” och arketyp-metoden beskrivs även i standarden ISO 13606.

Om två olika journalsystem använder samma datastruktur, t.ex. med hjälp av samma arketyper, så kan de utväxla patientdata mellan varandra (de uppnår s.k. semantisk interoperabilitet). Begreppet ”Semantic sustainability” definieras i avhandlingen som ett förhållningssätt som är bredare än semantisk interoperabilitet. Det syftar till att möjliggöra långsiktigt hållbar utveckling av semantik (betydelse) i journalsystem och genom att hantera risker och resurser förståndigt. Förhållningssättet baserar sig på forskning och erfarenheter från systemutveckling och hantering av komplexa system och är avsett att stödja beslutsfattare, och de som utvecklar och underhåller journalsystem, relaterade system och strukturer.

För att datorsystem ska kunna växa vid ökad användning ,utan att hamna i återvändsgränder avseende prestanda, så bör vissa designprinciper för skalbarhet följas. Avhandlingen presenterar en systemarkitektur baserad på sådana principer och på arketyp-metoden. Denna arkitektur gör det möjligt att bygga system med delsystem från flera olika leverantörer. Skalbarheten i några lagringslösningar redovisas också.

Slutligen redovisas prototyper av gränssnitt för patientöversikter och journalläsning.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. p. 204
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1499
National Category
Information Systems Other Medical Sciences not elsewhere specified Other Computer and Information Science Human Computer Interaction
Identifiers
urn:nbn:se:liu:diva-87702 (URN)978-91-7519-699-2 (ISBN)
Public defence
2013-02-15, Berzeliussalen, Campus US, Universitetssjukhuset, Linköping, 09:15 (English)
Opponent
Supervisors
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2018-01-11Bibliographically approved
Freire, S. M., Sundvall, E., Karlsson, D. & Lambrix, P. (2012). Performance of XML Databases for Epidemiological Queries in Archetype-Based EHRs. In: Proceedings Scandinavian Conference on Health Informatics 2012: . Paper presented at Scandinavian Conference on Health Informatics 2012, October 2-3, Linköping, Sweden (pp. 51-57). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Performance of XML Databases for Epidemiological Queries in Archetype-Based EHRs
2012 (English)In: Proceedings Scandinavian Conference on Health Informatics 2012, Linköping: Linköping University Electronic Press, 2012, p. 51-57Conference paper, Published paper (Refereed)
Abstract [en]

There are very few published studies regarding the performance of persistence mechanisms for systems that use the openEHR multi level modelling approach. This paper addresses the performance and size of XML databases that store openEHR compliant documents. Database size and response times to epidemiological queries are described. An anonymized relational epidemiology database and associated epidemiological queries were used to generate openEHR XML documents that were stored and queried in four opensource XML databases. The XML databases were considerably slower and required much more space than the relational database. For population-wide epidemiological queries the response times scaled in order of magnitude at the same rate as the number of records (total database size) but were orders of magnitude slower than the original relational database. For individual focused clinical queries where patient ID was specified the response times were acceptable. This study suggests that the tested XML database configurations without further optimizations are not suitable as persistence mechanisms for openEHR-based systems in production if population-wide ad hoc querying is needed.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012
Series
Linköping Electronic Conference Proceedings, ISSN 1650-3686, E-ISSN 1650-3740 ; 70
Keywords
Medical Record Systems, Computerized; Database Management Systems, Archetypes, XML Databases, openEHR
National Category
Computer and Information Sciences
Identifiers
urn:nbn:se:liu:diva-84401 (URN)978-91-7519-758-6 (ISBN)
Conference
Scandinavian Conference on Health Informatics 2012, October 2-3, Linköping, Sweden
Available from: 2012-10-05 Created: 2012-10-05 Last updated: 2018-02-19Bibliographically approved
Chen, R., Klein, G. O., Sundvall, E., Karlsson, D. & Åhlfeldt, H. (2009). Archetype-based conversion of EHR content models: pilot experience with a regional EHR system. BMC Medical Informatics and Decision Making, 9(33)
Open this publication in new window or tab >>Archetype-based conversion of EHR content models: pilot experience with a regional EHR system
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2009 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no 33Article in journal (Refereed) Published
Abstract [en]

Background: Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. Methods: The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bidirectional conversion between openEHR archetypes and COSMIC templates. Results: Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. Conclusion: The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.

Place, publisher, year, edition, pages
BMC, 2009
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-19912 (URN)10.1186/1472-6947-9-33 (DOI)
Note
Original Publication: Rong Chen, Gunnar O Klein, Erik Sundvall, Daniel Karlsson and Hans Åhlfeldt, Archetype-based conversion of EHR content models: pilot experience with a regional EHR system, 2009, BMC MEDICAL INFORMATICS AND DECISION MAKING, (9), 33. http://dx.doi.org/10.1186/1472-6947-9-33 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-08-25 Created: 2009-08-14 Last updated: 2017-12-13Bibliographically approved
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