initial states for instructions / when do we need actions?

pablo pazos pazospablo at
Thu Jul 14 00:16:06 EDT 2016

Hi Heath, thanks for taking the time to answer, this is really useful and I think your comments should be included in the specs as examples of how the instruction/action interaction and the effect of that interaction on the ISM should work.

First it makes total sense for me to have INITIAL as the current state when no ACTION was recorded for the INSTRUCTION. And it also makes sense to include a "placeholder" ACTION (might not have much info but the next state) for INSTRUCTIONS that need to be on PLANNED when the INSTRUCTION is created (like the medication case).

About 3.1 I was thinking of a case where the event of creating the INSTRUCTION also includes the coordination/scheduling of ACTIONs that will be performed. I think this is just another case of my previous paragraph: we need an ACTION to change the state to SCHEDULED.

Thanks a lot!

Kind regards,
Eng. Pablo Pazos Gutiérrez

From: heath.frankel at
To: openehr-technical at; openehr-clinical at; sec at
Subject: RE: initial states for instructions / when do we need actions?
Date: Wed, 13 Jul 2016 00:28:54 +0000

Hi Pablo,
Some comments below.

From: openEHR-technical [mailto:openehr-technical-bounces at]
On Behalf Of pablo pazos

Sent: Tuesday, 12 July 2016 12:29 PM

To: openeh technical <openehr-technical at>; openehr clinical <openehr-clinical at>; sec at

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:

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.




Kind regards,

Eng. Pablo Pazos Gutiérrez

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