Appl Clin Inform 2017; 08(02): 660-679
DOI: 10.4338/ACI-2017-01-RA-0009
Research Article Special Topic Interoperability and EHR
Schattauer GmbH

Domain Modeling and Application Development of an Archetype- and XML-based EHRS

Practical Experiences and Lessons Learnt
Stefan Kropf*
1  Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University
2  Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University
Claire Chalopin*
1  Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University
Dirk Lindner
3  University Hospital, Department of Neurosurgery, Leipzig University
Kerstin Denecke
4  Institute for Medical Informatics, Bern University of Applied Sciences
› Author Affiliations
Funding This work was part of The Digital Patient Model Project (ICCAS), granted by the BMBF (03Z1LN11).
Further Information

Publication History

received: 14 January 2017

accepted: 20 April 2017

Publication Date:
21 December 2017 (online)


Background: Access to patient data within the hospital or between hospitals is still problematic since a variety of information systems is in use applying different vendor specific terminologies and underlying knowledge models. Beyond, the development of electronic health record systems (EHRSs) is time and resource consuming. Thus, there is a substantial need for a development strategy of standardized EHRSs. We are applying a reuse-oriented process model and demonstrate its feasibility and realization on a practical medical use case, which is an EHRS holding all relevant data arising in the context of treatment of tumors of the sella region. In this paper, we describe the development process and our practical experiences.

Methods: Requirements towards the development of the EHRS were collected by interviews with a neurosurgeon and patient data analysis. For modelling of patient data, we selected openEHR as standard and exploited the software tools provided by the openEHR foundation. The patient information model forms the core of the development process, which comprises the EHR generation and the implementation of an EHRS architecture. Moreover, a reuse-oriented process model from the business domain was adapted to the development of the EHRS.

Results: The reuse-oriented process model is a model for a suitable abstraction of both, modeling and development of an EHR centralized EHRS. The information modeling process resulted in 18 archetypes that were aggregated in a template and built the boilerplate of the model driven development. The EHRs and the EHRS were developed by openEHR and W3C standards, tightly supported by well-established XML techniques. The GUI of the final EHRS integrates and visualizes information from various examinations, medical reports, findings and laboratory test results.

Conclusion: We conclude that the development of a standardized overarching EHR and an EHRS is feasible using openEHR and W3C standards, enabling a high degree of semantic interoperability. The standardized representation visualizes data and can in this way support the decision process of clinicians.

Citation: Kropf S, Chalopin C, Lindner D, Denecke K. Domain modeling and application development of an archetype- and XML-based EHRS: Practical experiences and lessons learnt. Appl Clin Inform 2017; 8: 660–679

* Contributed equally

Human Subject Research Approval

The development was a proof of concept project. During development, the system was tested with randomized patient data. After finishing, we tested the system with anonymized real patient data. There was no person-identifying data included on any EHR at any time.