Bridging the HL7 template - 13606 archetype gap with detailed clinical models

The idea of two level modeling has been taken up in healthcare information systems development. There is ongoing debate which approach should be taken. From the premise that there is a lack of clinician's time available, and the need for semantic interoperability, harmonization efforts are important. The question this paper addresses is whether Detailed Clinical Models (DCM) can bridge the gap between existing approaches. As methodology, a bottom up approach in multilevel comparison of existing content and modeling is used. Results indicate that it is feasible to compare and reuse DCM with clinical content from one approach to the other, when specific limitations are taken into account and precise analysis of each data-item is carried out. In particular the HL7 templates, the ISO/CEN 13606 and OpenEHR archetypes reveal more commonalties than differences. The linkage of DCM to terminologies suggests that data-items can be linked to concepts present in multiple terminologies. This work concludes that it is feasible to model a multitude of precise items of clinical information in the format of DCM and that transformations between different approaches are possible without loss of meaning. However, a set of single or combined clinical items and assessment scales have been tested. Larger groupings of clinical information might bring up more challenges.