How to define transitions in the ISM

Heather Leslie heather.leslie at
Sun Jul 1 03:21:21 EDT 2018

Hi Pablo,

Every archetype ideally needs to be designed for the maximal dataset and universal use case. The ACTION archetypes are no different.

But you have picked up on a major gap in our tooling at present – the modellers need the ability to be able to constrain the ACTION archetypes in templates for each use case:

  *   to show what data points are relevant for each pathway step, and
  *   which steps are relevant to our use case.

It is also not currently possible for modellers to record the proposed workflow or transitions in any template at present. This is another major gap and, in practice, is usually managed on a project by project basis a negotiated by the parties involved – verbally, word docs etc.

This is a relatively unexplored area where we need more tooling and/or standardised processes to communicate the requirements of the clinicians and intent of the modellers to the software engineers implementing systems.

No silver bullet here, yet. But open to collaborate with anyone who has suggestions…



From: openEHR-clinical <openehr-clinical-bounces at> On Behalf Of Pablo Pazos
Sent: Sunday, 1 July 2018 4:12 AM
To: For openEHR clinical discussions <openehr-clinical at>
Subject: Re: How to define transitions in the ISM

Hi Silje,

I got the issue with complex workflows.

With the current solution you'll need to provide more metadata to the developers so they can implement the correct workflows, like possible or impossible transitions from one state to another, because constraints are not in the archetype.

On the other hand, simple workflows can be completely specified in the archetype without providing extra medadata separately from the archetype, since both states and possible transitions can be specified there, like the little toy state machine on my previous message. The issue is the AE doesn't allow to express constraints for the ISM_TRANSITION.transition (DV_CODED_TEXT) attribute (a constraint that can explicitly state a list of valid transitions to reach that state, I think "transition" is about inbound transitions not outbound, but that is a separate issue). I'll test if this can be done using LinkEHR.

Also for complex flows, it would be good to provide the possible transitions, even if the list of possibilities is big, this is just to make the archetype contain all the metadata needed for implementation, without the need of providing that externally to the archetype. I know this requires more work in the archetype, but it might be less work in total, since the problem will need to be solved as you said, in the business logic. IMO this approach does not add more constraints to the archetype, just more information, and made the implicit freedom of transitions explicit.

Maybe this should be considered case by case, and modeling tools should allow to constraint the transition, but leave that to the modeler. I think a good approach is to constraint what can be constrained, for instance on the medication archetype there are a lot of transitions between active states, but maybe there are less transitions between other states, and those can be in the archetype. This would remove a little friction at development time.

It would be nice to know how other modelers do this and how other implementers deal with non defined transitions in ACTION archetypes.


On Wed, Jun 27, 2018 at 4:35 AM, Bakke, Silje Ljosland <silje.ljosland.bakke at<mailto:silje.ljosland.bakke at>> wrote:
Hi Pablo!

I’ll try to answer your question about how clinical modellers solve this problem. Have a look at the ACTION.medication archetype ( This archetype has 11 separate steps for the ACTIVE state. In each medication management context, one or more of these will be relevant, and often in a way or order that’s not possible to predict. We therefore “solve” the problem by leaving it to the business logic of the application. This may be frustrating for the implementers (I don’t know, is it?), but it makes our work manageable. Designing ACTION archetypes is complex in the first place, and I’m not sure we’d get any published if we needed to map out all possible combinations and orders of pathway steps too.


From: openEHR-clinical <openehr-clinical-bounces at<mailto:openehr-clinical-bounces at>> On Behalf Of Pablo Pazos
Sent: Wednesday, June 27, 2018 3:45 AM
To: For openEHR clinical discussions <openehr-clinical at<mailto:openehr-clinical at>>
Subject: How to define transitions in the ISM

Hi all,

I'm testing the AE for a new workshop, and designed a simple state machine for and order so my students can use it as basic for more complex state machines.


What the AE is not allowing is to specify the ISM_TRANSITION.transition : DV_CODED_TEXT.

The problem is if I have two states mapped to ASSIGNED, how a software knows which one is the state to activate if the transition "initiate" is not define. Also I want to specify that from new should happen a "plan_step" transition to change the state to ASSIGNED. Seems we are missing important metadata in the archetype.

How do clinical modelers solve those problems?

Will test LinkEHR to see how they define the ISM and the valid transitions.


Ing. Pablo Pazos Gutiérrez
pablo.pazos at<mailto:pablo.pazos at>
+598 99 043 145
skype: cabolabs
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+598 99 043 145
skype: cabolabs
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