FW: Questions about the relationship between Instruction, workflow and Action

pablo pazos pazospablo at hotmail.com
Wed Aug 1 10:39:38 EDT 2012

Hi Sam,
I'm reviving this thread :D 

I'm working on a project and we need to define a simple state machine, this is the way I think it should be done and it would be very nice to have you comments about this:
The idea is to record physical activity recomended by a clinician.

There is one INSTRUCTION (the recommendation) with many ACTIVITIES (each one a recommended sport or activity).We have 4 states: INITIAL, SCHEDULED, ACTIVE and COMPLETED.
And there are 2 ACTIONS, one to record the scheduling of the activity and other to record the initiation and end of the activity. (Let's say these are SCHED_ACTION and INIT_END_ACTION).
When a recommendation is created (INSTRUCTION and ACITIVITIES), the current state is INITIAL (that should be saved on the repository that you mentioned in your email).
Now we need to model the state machine: INITIAL --(schedule)--> SCHEDULED --(start)--> ACTIVE --(finish)--> COMPLETED.
So, we create a ISM_TRANSITION on the SCHED_ACTION with current_state = INITIAL and careflow_step = schedule.And in the INIT_END_ACTION we have 2 ISM_TRANSITIONs with curr_state = SHCEDULED and careflow_step = start, and the other, curr_state = ACTIVE and careflow_step = finish.
The third part should be to provide the entry point to execute that ISM, so we set the SCHED_ACTION.archetypeId to each ACTIVITY.action_archetype_id, so when the INSTRUCTION is on INITIAL, only a SCHED_ACTION could be executed.
And, on any ACTION execution, we update the repository with the action executed and the new state (and we keep all the actions and transitions taken so we can reproduce the process later).

What do you think? That's the right way to do it?
Kind regards,
Ing. Pablo Pazos Gutiérrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
Twitter: http://twitter.com/ppazos

From: sam.heard at oceaninformatics.com
To: openehr-technical at openehr.org
Subject: RE: Questions about the relationship between Instruction,	workflow	and Action
Date: Wed, 7 Dec 2011 13:09:31 +0930

Hi Pablo, The design principles are that the Instruction should remain unaltered by people basing actions on this instructions – as the action and instructions could be disconnected at any moment. For example, the instruction (medication order) should not be changed by anyone just to give a medication etc. So the state of the instruction is carried in the record of the action (if appropriate). We have decided to name the pathway steps and attach a machine readable state to that step. This makes it much easier for clinicians to model and to see what is going on. In our openEHR repository we maintain an instruction index – that is a pointer to all instructions and all actions that relate to that instruction – and the current state of the instruction.  You will see an archetype ACTION in the openEHR repository and the careflow_steps are archetyped to provide a name and the current state matches an openEHR code for state. This means that a careflow step being carried out will set the state to a particular machine state. Hope this helps. Cheers, Sam
From: pazospablo at hotmail.com
To: openehr-clinical at openehr.org; openehr-technical at openehr.org
Subject: Questions about the relationship between Instruction, workflow and Action
Date: Sun, 4 Dec 2011 15:36:36 -0300Hi everyone! I'm trying to understand how to execute a state machine of a fully structured INSTRUCTION, and I have some questions and thoughts to share with you... The first issue is about archetyping an ACTION that execute and ACTIVITY of an INSTRUCTION. Modeling an ACTION, the Archetype Editor let me archetype the ACTION.ism_transition attribute, but not the ACTION.instruction_details. Both attribute classes (ISM_TRANSITION and INSTRUCTION_DETAILS) are specializations of PATHABLE, so those shouldn't be archetypable (see http://www.openehr.org/releases/1.0.2/architecture/rm/ehr_im.pdf page 53).Is this a bug in the AE or is an issue in the specs?  If the "ACTION.instruction_details" attribute can't be archetyped in the AE, how could I know what specific structure the "ACTION.instruction_details.wf_details" attribute will have? Is the "ACTION.instruction_details.wf_details" attribute related somehow with the "ACTIVITY.description" attribute?  The description of the "ACTION.instruction_details.wf_details" attribute says: condition that fired to cause this Action to be done (with actual variables substituted),What is the meaning of "with actual variables substituted"? This makes me think having an ACTIVITY in memory, creating an instance of an ACTION to record the execution of that ACTIVITY, copying the ACTIVITY.description structure into the ACTION.instruction_details.wf_details, and the update the correspondent fields into the wf_details with actual execution data. Does this make any sense? or I'm just to twisted :D  The last one!Now only ACTIONs can change a state on the ISM, but I think an ADMIN_ESTRY could change the state also, e.g. to move a "planned procedure" to the "scheduled" state, there is an administrative step of coordinating date & time, not a clinical action. Again, does this make any sense?! 
 Thanks a lot!
Kind regards,
Ing. Pablo Pazos Gutiérrez 		 	   		   		 	   		  
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