initial states for instructions / when do we need actions?

Heath Frankel heath.frankel at oceaninformatics.com
Tue Jul 12 20:28:54 EDT 2016


Hi Pablo,
Some comments below.

Heath

From: openEHR-technical [mailto:openehr-technical-bounces at lists.openehr.org] On Behalf Of pablo pazos
Sent: Tuesday, 12 July 2016 12:29 PM
To: openeh technical <openehr-technical at lists.openehr.org>; openehr clinical <openehr-clinical at lists.openehr.org>; sec at lists.openehr.org
Subject: ISM: initial states for instructions / when do we need actions?

Hi all,

This message is related to my previous message "ACTIVITY.description vs ACTION.description archetypes‏" (didn't got any answers :( but this is focused on when we need actions to change a instruction state, and what's the initial state.

Considering the specs:
http://www.openehr.org/releases/RM/latest/docs/ehr/ehr.html#_the_standard_instruction_state_machine_ism

I think when an instruction is firstly recorded, it should have a state. But I'm not 100% if that state should be INITIAL, or can also be PLANNED, SCHEDULED or ACTIVE, since at least for SCHEDULED and ACTIVE I think we need an ACTION to be recorded to trigger the transition, but it is not clear that we need that to trigger the transition "initiate (INITIAL -> PLANNED)".

[HKF: ] I personally consider the Initial state as your standard state diagram starting point rather than a usable state. The AE has allowed the initial state to be used, which I think is incorrect and we translate this to a subsequent state for real use.

1- Is INITIAL the state associated with an instruction when no action is recorded?

[HKF: ] This is how I consider this. In fact I usually explain to my developers that an instruction is not initiated unless there is an action to start the instructions workflow. Without an action, it is just a definition of an instruction that is waiting to have its workflow started.

2- If what it's recorded is a medication prescription, I guess the initial state should be PLANNED, do we need to record an action alongside with the instruction to make the "initiate (INITIAL -> PLANNED)" transition? OR, we can just set the initial state to PLANNED, even though no actions are recorded for the instruction/activity?

[HKF: ] As indicated, I would have an ACTION with a PLANNED state to make this clear. You may choose to go straight to Active.

3- On the case of recording a treatment that should be scheduled, do we also need an action to trigger the "schedule (INITIAL -> SCHEDULED)" transition? (I guess yes if the instruction is created at one time, and the schedule comes later).

[HKF: ] As above.

3.1- If yes, what happens on the case the instruction includes scheduling? Should we include an action to trigger the transition or can we set the state to SCHEDULED directly?

[HKF: ] Sorry, I don’t understand this one.

At least for me this is not 100% on the specs. If this happens to others, we might need to improve the specs and add more examples to make this topic clear for newcomers.

Thanks!


--
Kind regards,
Eng. Pablo Pazos Gutiérrez
http://cabolabs.com
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