Help needed: what's out there? medication list, allergies and adverse reactions

Koray Atalag k.atalag at
Mon Jun 3 22:17:06 EDT 2013

Hi Jussara, thanks.

And thanks others who have responded directly to me.
I’m really keen to hear from the many other people on these lists.
I think ideally we should have this kind of intelligence somewhere on the website, e.g. who’s using what  models etc.



From: openEHR-clinical [mailto:openehr-clinical-bounces at] On Behalf Of Jussara
Sent: Saturday, 1 June 2013 2:14 a.m.
To: For openEHR clinical discussions
Cc: Edgard Costa Oliveira; Ricardo Puttini; Beatriz deFariaLeao; For openEHR technical discussions; Lourdes Mattos Brasil; Rodrigo Queiroga; Gabriela Alves; For openEHR clinical discussions
Subject: Re: Help needed: what's out there? medication list, allergies and adverse reactions

Hi, Koray

Brazil has the same approach, you know, to usearchetypes to model and IHE profiles ( and CDA) to exchange documents,   but we don't have any prior work done,  using HL7 v2 or CDA  for exchanging clinical information.

We're beginning to specify the information model of the two first documents of Brazilian national EHR, using international and Nehta CKM archetypes as models for  creating the templates and from there to transform them into CDA, which will be the exchange format. those are the two first business cases of  the e health  platform : hospital discharge summary to primary care, which is intended to be a national standard and primary/ community care event summary, this one being designed acording  the requirements the primary care team has established.

We still have a discussion on how to transform a openEHR template into CDA, possibly we we're going to do per archetype. There's another parallel discussion, which is to use simply 13606 or even openEHR extracts instead, and to create special IHE profiles in Brazil ( Minas Gerais, as you know has deployed a EHR platform using 13606 as exchange format). We volunteered to work on the revision of 13606 at ISO, to harmonize the two reference and archetype object models, and CDA, so we could create implementation guides to tackle this, although there are some of us that think that Brazil has no hl7 legacy, so it would be a waste of  time and money to do this transformation. It has been a hot discussion among us, and I would wellcome any
comments or suggestions from the community regarding this.

Recently  we had  a discussion with Charles Parisot and Michael Nussbaum ( IHE) on it, Michael is the opinion Brazilian should propose new profiles. Marcelo Santos, who was the technical developer of Minas Gerais extracts is now working at GE research  and he is currently working  on a IHE openEHR profile, but still using CDA as  exchange format. He is contributing to the national documents as well, because he is a member of the architecture group of our health standards committee and is also one of the experts of the Brazilian  national eHealth strategy. I think he's the right person to talk in Brazil  on this issue.

Regarding to a national CKM, we're pursuing this for a while, you know. The state of Minas  Gerais will finally have  CKM service to manage their archetypes and we're trying to get a national instance soon. Sam was here discussing how to deploy a national instance of CKM with the Institute of Technology and Innovation of University of Brasilia, which was contracted to develop the National EHR platform, based on SOA architecture.  I'm working with them to  create the openehr operational templates for all use cases.  In the discharge summary we will use specializations of adverse reactions, medication list and allergies CKM Archetypes.  We will need a repository soon to create and manage our generated artifacts, therefore we are trying to get MOH as host of National CKM,  but are prone to join the Minas gerais one if MOH doesn't take over the role. As you know the maturity level, when it concerns to health informatics standards at the government IT department is very low, and we have some difficulties to convince them to invest in tools and methodologies to develop interoperable clinical information systems. It is one of our big challenges, and the Institute resolved to assume the job to develop the EHR,  bringing  together experts, acquiring and  training people in health informatics, being  openEHR  one of them. They  intend to  have interchange   with other national programs that use the same approach, in order to share experiences and maybe develop common projects, and NZ is a potential  source of knowledge to us.

Another big challenge  for  us are terminologies, to create the termsets in our templates,  then we don't have any clinical terminology in Brazil, not even  a medication terminology adequate to be used in clinical information systems. We submitted a special project to IHTSDO to begin the translation of SNOMED CT with procedures and medications.  Beatriz Leao wants to  use DM+D to do the mapping to our national terms, but I prefer to use Australian Medicine Terminology instead.  I'd like to know of all of you, which is the better choice. I read one NZ paper dedicated to that issue, but it dates back a couple of years already, so I'd really appreciate to learn from your experience.

We're definitely going mainstream, I'm very proud to be part of  this community.


Jussara Rötzsch
openEHR Foundation

Enviado via iPad

Em May 30, 2013, às 8:16 PM, Koray Atalag <k.atalag at<mailto:k.atalag at>> escreveu:
Hi All,

As you may already know New Zealand have decided to used openEHR Archetypes for modelling an Exchange Content Model<> for the purpose of standardising payload content during health information exchange (HIE). Of course there’s heaps of prior work done, mostly propriety dataset specifications we well as some v2 based constructs and now CDA templates. We also decided to go with CDA as the common payload between systems, preferably with a web-services based connectivity. So ideally the content model will be defined using Archetypes that will then be templated for specific use-cases (e.g. eReferrals) and finally create final CDA payload (as much automatically as we can). And then the propagation of any changes needed in that exchange will be from the Content Model to CDA – so these will remain linked. However initially we need to run the cycle backwards: I’ve been tasked by the government to review existing CDA templates and former standards and build part of the content model for medication list, allergies and adverse reactions by harmonising with what’s standing out there as good/reusable examples. Of course first place to look at is openEHR and NEHTA CKM but I know a great deal of stuff is also out there. I’m hoping that once we get the essentials done we can resume the normal lifecycle.

I’d really appreciate if you could share if there’s any relevant work that you think might worth looking at. I’m particularly interested in other national CKM’s. Many thanks in advance.



Koray Atalag, MD, PhD, FACHI
Senior Research Fellow
School of Population Health, The University of Auckland
Private Bag 92019 Auckland 1142, New Zealand
Email: k.atalag at<mailto:k.atalag at> | Web:<>
Skype: atalagk  Mob: 021 02412096  DDI: +64 9 923 7199

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