initial states for instructions / when do we need actions?

pablo pazos pazospablo at
Sat Jul 23 01:35:29 EDT 2016

Hi Etienne, did you checked the ISM specs? I think the flow phases you mention are mappable to the current states of the ISM.

Also consider this conversation is about INSTRUCTION handling, not ACTION handling, ACTIONs are used to modify the state of the INSTRUCTION/ACTIVITY.

Kind regards,
Eng. Pablo Pazos Gutiérrez

From: etienne at
To: openehr-technical at
Subject: Re: initial states for instructions / when do we need actions?
Date: Fri, 22 Jul 2016 19:35:12 +0200
CC: openehr-clinical at; sec at

Thank you very much for the schema.
However I believe that the handling of an Action should start earlier before the "INITIAL" state.
Preliminary informal suggestion, according to some generic guidelines, regardless of the details of the current context of the patient
It could be useful to record temporarily proposals by student, junior assistant or nurse, or simply when a staff member is considering some action while waiting on more information from the lab.
Nothing yet done, but information could be useful to be recorded temporarily as an element of discussion.
The decision for he action is confirmed by an authorised member of the staff.
Although not yet scheduled.
The author of an order is also responsible to specify a time range, from "very urgent" to "to be done within on month".
If the time would have been outdated the order should be reevaluated.
- etc as on the schema .....
For example a treatment for 10 days is actually started. 
Or a bacteriology test which necessitate at least 24 hours.
Completely executed.
In priciple a conclusion is expected.
Etienne Saliez
On Wednesday, 13 July 2016 00:28:54 CEST Heath Frankel wrote:
> Hi Pablo,
> Some comments below.
> Heath
> 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:
> struction_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 ->
> [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
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