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'''''open''EHR''' is an [[open standard]] specification in [[health informatics]] that describes the management and storage, retrieval and exchange of health data in [[electronic health records]] (EHRs). In ''open''EHR, all health data for a person is stored in a "one lifetime", vendor-independent, person-centred EHR. The ''open''EHR specification is not concerned with the exchange of data between EHR-systems as this is the primary focus of other standards such as [[EN 13606]] and [[HL7]].

The ''open''EHR specifications are maintained by the '''''open''EHR Foundation''', a [[not for profit]] foundation supporting the open research, development, and implementation of openEHR EHRs. The ''open''EHR specifications are based on a combination of 15 years of European and Australian research and development into EHRs and new paradigms, including what has become known as the archetype methodology.

The ''open''EHR specifications include information and service models for the EHR, demographics, clinical workflow and [[archetype (information science)|archetype]]s. They are designed to be the basis of a medico-legally sound, distributed, versioned EHR infrastructure.

==Two level modelling with archetypes==
The key innovation in the ''open''EHR framework is to leave all specification of clinical information out of the [[information model]] but, most importantly, to provide a powerful means of expressing what clinicians and patients report that they need to record so that the information can be understood and processed wherever there is a need. Clinical information models are specified in a formal way ensuring the specifications, known as '[[Archetype (information science)|archetypes]]', are computable. The set of ''open''EHR archetypes need to be quality managed to conform to a number of axioms such as being mutually exclusive. The archetypes can be managed independently from software implementations and infrastructure, in the hands of clinician groups to ensure they meet the real needs on the ground. Archetypes are designed to allow the specification of clinical knowledge to evolve and develop over time. Challenges in implementation of information designs expressed in ''open''EHR centre on the extent to which actual system constraints are in harmony with the information design.

In the field of [[Electronic health record]]s there are a number of existing information models with overlaps in their scope which are difficult to manage, such as between [[HL7|HL7 V3]] and [[SNOMED CT]].  The ''open''EHR approach faces harmonisation challenges unless used in isolation.

While individual health records may be vastly different in content, the core information in ''open''EHR data instances always complies to archetypes. The way this works is by creating archetypes which express clinical information in a way that is highly reusable, even universal in some cases.{{citation needed|date=June 2010}} To get to the point where information is suitably presented for clinical care it always involves a number of archetypes. These combinations of archetypes are called 'templates'; aggregations of archetypes which may also be refined for use in a particular situation. Templates may be used to specify forms, documents or even messages.

The openEHR approach uses the CEN- and ISO-standardised "archetype definition language" (expressed in ADL syntax or its XML equivalent) to build archetypes; these are reusable, formal models of domain concepts. Archetypes are used in openEHR to model clinical concepts such as "[[blood pressure]]" or "[[medical prescription]]".

==International collaboration==
Following the openEHR approach, the use of shared and governed archetypes globally would ensure openEHR health data could be consistently manipulated and viewed, regardless of the technical, organisational and cultural context. This approach also means the actual data models used by any EHR are flexible, given that new archetypes may be defined to meet future needs of clinical record keeping. Recently work in Australia has demonstrated how archetypes and templates may be used to facilitate the use of legacy health record and message data in an openEHR health record system, and output standardised messages and CDA documents.

The prospect of gaining agreement on design and on forms of governance at the international level remains speculative, with influences ranging from the diverse medico-legal environments to cultural variations, to technical variations such as the extent to which a [[SNOMED CT|reference clinical terminology]] is to be integral.

The ''open''EHR Framework is consistent with the new Electronic Health Record Communication Standard ([[EN 13606]]).  It is being used in parts of the [[National Programme for IT|UK NHS Connecting for Health Programme]] and has been selected as the basis for the national program in Sweden. It is also under evaluation in a number of countries including Denmark, Slovakia, Chile and Brazil. It is beginning to be utilised in commercial systems throughout the world.

==Clinical Knowledge Manager==
One of the key features of openEHR is the development of structures and terminologies to represent health data. Due to the open nature of openEHR, these structures are publicly available to be used and implemented in health information systems. Commonly, community users share, discuss and approve these structures in a repository known as Clinical Knowledge Manager (CKM). The most known openEHR CKMs are presented below:

*[http://openehr.org/knowledge openEHR Clinical Knowledge Manager]
*[http://dcm.nehta.org.au/ckm/ NEHTA Clinical Knowledge Manager]
*[http://sllocean.karolinska.se/ckm/ Swedish openEHR Clinical Knowledge Manager]

==See also==
* [[Archetype (information science)]]
* [[European Institute for Health Records]]
* [[EN 13606|Electronic Health Record Communication]] ([[ISO]]/[[CEN]] EN 13606 - EHRcom)
* [[Health Level 7]]
* [[Health Informatics Service Architecture]] (HISA)
* [[HIPAA]]
* [[ProRec]]
* [[SNOMED CT]]

==External links==
*[http://www.openEHR.org openEHR Foundation website]
*[http://www.openehr.org/releases/1.0.2/roadmap.html openEHR specifications]