The ORCHID project Dr Ian Gaywood, NUH Dr Ira Pande, NUH Professor John Chelsom, City University...
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Transcript of The ORCHID project Dr Ian Gaywood, NUH Dr Ira Pande, NUH Professor John Chelsom, City University...
The ORCHID project
Dr Ian Gaywood, NUH
Dr Ira Pande, NUH
Professor John Chelsom, City University London
So much information……so little use
Clinical care generates enormous amounts of information which is difficult to use when caring for the individual and impossible to use for any secondary purpose
The origins of ORCHID
• Better organised information has the potential to provide an enormously valuable resource but must be achieved without additional onerous burden at the clinical coalface
• The greatest impediment to extended uses of clinical records, including research, is not lack of data. It is lack of useable data
• It should be possible to organise data in ways which allow any plausible question to be answered
Stratified medicine
• Treatment decisions in all but the simplest conditions increasingly rely on knowledge of the patient’s disease phenotype in several domains
• Current methods of gathering and organising data don’t place information in its correct context
• The relationships among pieces of information are at least as important as the information itself.
• It is no longer enough to simply ‘name the beast’
What clinicians want ….
• A way of organising data which:
– Identifies patient phenotypes to any degree of detail
– Produces untainted cohorts
– Is multidisciplinary
– Can include or exclude individual disease characteristics
– Can include or exclude treatment details
– Records and assesses outcomes
– Can be searched in real time
– Maps to existing coding systems
The ORCHID information model
• The two central tools of ORCHID are hierarchies and core data sets
• Together they provide a rich data architecture which can be applied to all data sets across all specialties
• ORCHID hierarchies cross-map to existing coding systems but overcame many of their limitations
• ORCHID hierarchies can be rapidly amended to reflect changes in knowledge and understanding without compromising the value of existing data
• Existing data sets can be embedded in ORCHID hierarchies and will inherit the richness of those structures
An ORCHID hierarchy
Rheumatoid arthritis
Rheumatoid arthritis - seropositive
Rheumatoid arthritis - seronegative
Rheumatoid arthritis - NOS
Inflammatory arthritis
Autoimmune disease
Bespoke cohort
SLE, PBC etc
Psoriatic arthropathy Other conditions
of interest
An ORCHID hierarchy
Core data sets
• ORCHID hierarchies place individual diseases, events etc in their
correct relationships with other entities
• They do not capture the finer details of complex diseases which
say something about subtype, severity, prognosis, treatment
choices
• Core data sets capture these data items in a searchable form and
provide a very detailed patient phenotype
• Can be either static or dynamic
An ORCHID Core Data Set
ICD-10 and patient phenotyping
• Requires separate codes for each manifestation
• Contains misclassifications
– Adult Still’s disease as type of rheumatoid arthritis
• Contains detailed codes of no clinical value
– M05.631 Rheumatoid arthritis of right wrist with involvement of other organs and systems
• Does not reflect recent developments
SNOMED and patient phenotyping
• SNOMED contains almost all of the codes required to capture diagnostic data to the required level
• But…. It also contains a very large number of redundant codes, duplications and non-existent entities
• Coding detailed phenotypes requires the use of multiple codes – usually one code for each disease manifestation
• Clinicians should agree a subset of SNOMED with careful moderation of additions and amendments
Implemented using Open Health Informatics principles
• Open standards
• Open source software
• Open systems interfaces
• Open development processes
Builds upon work in the Open Health Informatics research programme at City University
Maximises the potential for reuse and wider roll out
Implementation
ORCHID Architecture
• Standards based
• Ontology driven
• Clinician led
Information Architecture
Information Architecture
OntologyOntology
OWL (XML)
ISO 13606HL7 CDA
OWL (XML)
ISO 13606HL7 CDA
Information Model
Information Model
Clinical Coding
Clinical Data Sets
Clinical Coding
Clinical Data Sets
OWL (XML)
SNOMED CTICD-10LOINCdm+d
OWL (XML)
SNOMED CTICD-10LOINCdm+d
Art
efac
tIm
plem
ents
Sta
ndar
dsSystem
Configuration
System Configuration
Messages
Forms
Views
Messages
Forms
Views
HL7 v2/v3HL7 CDA
SNOMED CTXFormsXHTML
HL7 v2/v3HL7 CDA
SNOMED CTXFormsXHTML
Clinical System
Clinical System
Electronic Health Records
Electronic Health Records
XML
HL7 CDA
SNOMED CT
ISO 13606
XML
HL7 CDA
SNOMED CT
ISO 13606
ORCHID Platform
• Open source
• Standards based
• Enterprise Java
• No compiled code
IntegrationInterfaces
Access Control
OrbeonMVC Framework
eXist Native XML Database
Tom
cat
Ap
plic
atio
n S
erve
r/F
ram
ewor
k
Mirt
hIn
tegr
atio
n/M
ess
agin
g E
ngin
e
Application Logic
OrbeonXForms
ProtégéOntology Services
JFreeChartVisualisation
User Interfaces Service Interfaces
RESTful Web ServicesWeb Browser
Deployment of ORCHID
• A web based application with a common look and feel across specialties but specialty and disease specific forms and summaries
• Linked to Trust information systems for automatic download of demographics, laboratory data….
• Custom search engine allowing any finding within the ORCHID ontology to be used as a search term
• Can be deployed in modular form with all modules moderated for consistency allowing easy combining of modules and sharing of data among modules
• Moderated updates to take account of new knowledge, terminologies and classifications
Uses of ORCHID
• Routine clinical care• Automated HES / SUS reporting• Feasibility testing – research ideas, trial design• Phenotype pattern analysis• Registry data including possibility of cross-registry data
sharing• Generation of combined primary and secondary care data
sets