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A Standards-based Approach to Development of Clinical Registries -

NZ Gestational Diabetes Registry Pilot

Dr. Koray Atalag MD, PhD, FACHI (National Institute for Health Innovation)

Aleksandar Zivaljevic, PhD candidate (Univ. Of Auckland)

Dr. Carl Eagleton MBChB, FRACP (Counties Manukau District Health Board)

Karen Pickering (Diabetes Projects Trust)

Aims of the Registry

100% successful screening of women for type 2 diabetes (T2DM) within 3 months after a pregnancy with GDM

Annual screening of all women for new onset T2DM

Early warning to healthcare providers (GPs, Maori/Pacific Health, others) about GDM history in subsequent pregnancies

GDM Registry Pathway

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GDM Registry Development• Used OceanEHR Framework

– Academic license from Ocean Informatics– Simplifies persistence and querying plus more!– Supports openEHR Demographic IM– Supports AQL

• Extended MultiPrac App (Source provided on academic license)– MVC Application (VS 2010 w/ SQL Server)– Handles user management, basic admin etc.– Supports reference sets, provider/organisation

etc.4

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The Dataset

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Automatic code generation – C# Class

Further Development• Model-View-Controller (MVC)

– Model openEHR > C#– View written in html / forms– Controller written bindings and business

rules• Front-end (Javascript / Angular JS)• Back-end: OceanEHR & MultiPrac• Extended Demographics

– Added patient’s GP, LMC and Obstetrician– Added Provider organisation

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Interventions• Search due tests• Automatic annual screening• Send SMS to patients & providers for

due tests

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Evidence: Software Maintainability using openEHR

12Atalag K, Yang HY, Tempero E, Warren JR. Evaluation of software maintainability with openEHR – a comparison of architectures. International Journal of Medical Informatics. 2014 Nov;83(11):849–59.

VB6 / Access

Same Function & GUI

Conclusions• Using an openEHR framework makes

implementation a heck of a lot easier!• Demographics model is challenging• Identifiers can be confusing• Getting data out is difficult

– Unit of openEHR committal is Compositions– Need Extract model to come to life

• There’s really no real incentive to use standards

• We need scientific evidence that proposed benefits are realised

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