title: Evaluation of software maintain ability with open EHR - a comparison of architectures.
abstract: OBJECTIVE
  To assess whether it is easier to maintain a clinical information system developed using open EHR model driven development versus mainstream methods.
  
  
  METHODS
  A new open source application (GastrOS) has been developed following open EHR's multi-level modelling approach using .Net/C# based on the same requirements of an existing clinically used application developed using Microsoft Visual Basic and Access database. Almost all the domain knowledge was embedded into the software code and data model in the latter. The same domain knowledge has been expressed as a set of open EHR Archetypes in GastrOS. We then introduced eight real-world change requests that had accumulated during live clinical usage, and implemented these in both systems while measuring time for various development tasks and change in software size for each change request.
  
  
  RESULTS
  Overall it took half the time to implement changes in GastrOS. However it was the more difficult application to modify for one change request, suggesting the nature of change is also important. It was not possible to implement changes by modelling only. Comparison of relative measures of time and software size change within each application highlights how architectural differences affected maintain ability across change requests.
  
  
  CONCLUSIONS
  The use of open EHR model driven development can result in better software maintain ability. The degree to which open EHR affects software maintain ability depends on the extent and nature of domain knowledge involved in changes. Although we used relative measures for time and software size, confounding factors could not be totally excluded as a controlled study design was not feasible.
authors.affiliation: National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand. Electronic address: k.atalag@auckland.ac.nz.
authors.forename: Koray
authors.initials: K
authors.lastname: Atalag
authors.affiliation: Ocean Informatics Pty. Ltd., Brisbane, Australia.
authors.forename: Hong Yul
authors.initials: HY
authors.lastname: Yang
authors.affiliation: Department of Computer Science, The University of Auckland, Auckland, New Zealand.
authors.forename: Ewan
authors.initials: E
authors.lastname: Tempero
authors.affiliation: National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand; Department of Computer Science, The University of Auckland, Auckland, New Zealand.
authors.forename: James R
authors.initials: JR
authors.lastname: Warren
mesh_terms: D066289:Data Curation / Q000379:methods*; D057286:Electronic Health Records / Q000458:organization & administration*; D033181:Information Dissemination / Q000379:methods*; D016247:Information Storage and Retrieval / Q000379:methods*; D062527:Meaningful Use / Q000458:organization & administration*; D012984:Software; D012985:Software Design
keywords: Archetypes; Electronic health records; Software design; Software maintainability; Standards; openEHR