My answer would be the following. I write it down to make clear I understood the reaction by Sam.
-1- An EHR is there to document what has happened -2- An EHR doesn't contain workflow states. That is handled outside the EHR. It is in the EHR-system -3- There will be archetypes that help document a Plan, an Instruction, an Observation. E.g. to Plan for treatment, resulting in an Instruction to give medicines via injection , and the Observation that at the medication/ injection has been administered at a specific point in time by a specific healthcare provider. -4- Each archetype mentioned is almost the same has almost the same structure and will share common internal archetypes. There will be small subtle differences between these archetypes. Plans and Instruction can (but must not be always) less specific than the Observation when something has happened. The Observation is about a specific place, using specific methods, by specific person, at a specific time, etc. The Plan and Instruction can be more vague about the: where, when, what, with what, how, by whom, etc. Gerard -- <private> -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 On 10-mei-2006, at 5:43, Sam Heard wrote: > Dear All > > I will take this slowly. The implementation and modelling processes > are different. > > Modelling: > > First, each action is a recording which leaves some > 'instruction' (which may or may not be recorded) in some state > (active, completed, cancelled etc). An Instruction is a recording > that calls for some action to take place, and may or may not lead > to a recording of this action in the EHR. It can be set to > time_out. Otherwise the current state is set by the action record > that is generated when someone does what is instructed. As the > machine states in which the 'action leaves the instruction' are > recorded as part of the action, the archetype of the care pathway > steps are in the action archetype. This was not immediately obvious > to me - but as soon as you consider that an action can be recorded > without an instruction, it is clear that this is where it must be. > Also, the instruction is not altered as the actions are being > carried out - a distinct advantage which will become clear with > more implementation experience. > > Summary: Actions are things done to patients in response to > instructions - in health care these are requests or orders by a > provider (generally). Instructions beget actions, and are left in a > known state after these actions. > > Implementation: > > It seems possible to predetermine all aspects of an action record > in the instruction record that generates the action. For example we > could say, "Give the baby her MMR vaccination" or we could say > "Give the baby her MMR vaccination using a 25G needle in the right > thigh laterally at 08:00 on 21/6/06 using batch no: AE43445". It is > unlikely but possible. > > What becomes clear from this is the specification for what could be > recorded is pretty much in line with the specification for what > could be instructed - the categorical difference is that an > instruction will have timing ( times a day after meals), whereas an > action will have a time (08:00 on 26/6/06). > > This is the reason that the archetypes for instructions and actions > are sharing a data structure - it is an embedded archetype and the > first time we have used this, although the openEHR model has been > geared for this from very early days. -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060510/a757ecb3/attachment.html>
