Episode-Oriented Medical Record
Medical documentation needs a high-level organisational layer. Without it, even well-structured clinical entries remain fragmented and hard to follow over time.
An episode-oriented medical record organises documentation around Episodes of Care. Each episode captures the longitudinal course of a specific health problem across multiple care encounters. It strengthens continuity and enables clinically meaningful navigation across diagnosis, problem, and past medical history views. It also supports outcome- and cost-oriented analysis while preserving event-level detail, provenance, and auditability. Derived views are generated from a single source of truth.
Electronic Health Record - Requirements and Information Model
This document outlines the requirements, architecture, and information model for an episode-oriented electronic medical record according to Solon (J.P. Messerli 2025)
Data Model of the Episode-Oriented Medical Record according to Solon in openEHR
This Masterclass thesis explores implementation options for Solon’s episode-oriented medical record using the international openEHR standard, validates the approach on real cases, and centres on governance, interoperability, and computable clinical lists (J.P. Messerli 2025)
Tutorial Session 1
Tutorial Session 2
Summary - Masterclass Thesis
Background and challenge
Healthcare digitalisation has made electronic health records central to care, yet the organisation of clinical data remains a challenge that affects care quality, continuity and decision-making. Traditional source- or problem-oriented records struggle to support complex, cross-setting care pathways. This thesis investigates whether an episode-oriented medical record, as described by Solon, can be implemented within the openEHR standard and whether it offers practical benefits.
Organising scheme and core design
The work adopts a three-part organising scheme: care encounters provide the point-in-time chronological spine; Episodes-of-Care anchor the clinical content for each health problem; and administrative encounters define periods for operational grouping and reporting. Every clinical entry is linked to an Episode-of-Care selected by the clinician and to the contact at which it was captured. Familiar overviews such as the episode, diagnosis, problem and past medical history lists are generated as computed views from the same source data, preserving provenance and consistency.
Method and evaluation
Using a design-science approach, a comprehensive data model was developed and assessed with eight clinician-focused user stories and a realistic sample history of 132 entries. Three openEHR-conformant implementation patterns were evaluated: folder-based directory indexing, link-based referencing and a cluster-based relationship model. To compare these approaches, a structured evaluation framework was developed and applied.
Results and openEHR feasibility
The results confirm that episode-oriented records are fully realisable within existing openEHR specifications, without changes to the Reference Model. Episodes are represented as Episode-of-Care compositions that act as the single source of truth; contacts are captured explicitly; clinical statements reside in clinical compositions. Lists are treated as derived views, avoiding duplication while preserving auditability.
Practical recommendation
In practice, a pragmatic hybrid offers a balanced solution in which governed attributes are expressed in CLUSTERs, complemented by a FOLDER-based index for navigation and selective LINKs where explicit cross-document references are beneficial. The choice is context-dependent, shaped by local governance, performance expectations, operational policies, and multi-vendor or cross-repository constraints.
Contribution and outlook
The thesis contributes validated design principles for episode-centred data structures in openEHR and outlines implementation guidance. These findings provide a foundation for future developments in clinical information systems and care-coordination tools.