Re: initial states for instructions / when do we need actions?

[Thomas Beale]

On 22/07/2016 18:35, Etienne Saliez wrote:


Thank you very much for the schema.

However I believe that the handling of an Action should start earlier 
before the "INITIAL" state.


- "SUGGESTED"

Preliminary informal suggestion, according to some generic guidelines, 
regardless of the details of the current context of the patient


- "POROPSED"

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.


- "VALIDATED"

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If the time would have been outdated the order should be reevaluated.



the above 3 action types would normally be mapped to the 'PLANNED' state 
- that's the point of the standard state machine - to be reasonably 
simple, but to allow any action plan to be mapped to it.



- etc as on the schema .

- "STARTED"

For example a treatment for 10 days is actually started.

Or a bacteriology test which necessitate at least 24 hours.



this would probably be mapped to the ACTIVE state.


- thomas

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RE: initial states for instructions / when do we need actions?

[pablo pazos]

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
http://cabolabs.com

From: etie...@saliez.be
To: openehr-technical@lists.openehr.org
Subject: Re: initial states for instructions / when do we need actions?
Date: Fri, 22 Jul 2016 19:35:12 +0200
CC: openehr-clini...@lists.openehr.org; s...@lists.openehr.org



 
 
Thank you very much for the schema.
 
However I believe that the handling of an Action should start earlier before 
the "INITIAL" state.
 
- "SUGGESTED"
Preliminary informal suggestion, according to some generic guidelines, 
regardless of the details of the current context of the patient
 
- "POROPSED"
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.
 
- "VALIDATED"
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 .
 
- "STARTED"
For example a treatment for 10 days is actually started. 
Or a bacteriology test which necessitate at least 24 hours.
 
"COMPLETED"
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-boun...@lists.openehr.org]
> On Behalf Of pablo pazos Sent: Tuesday, 12 July 2016 12:29 PM
> To: openeh technical <openehr-technical@lists.openehr.org>; openehr clinical
> <openehr-clini...@lists.openehr.org>; s...@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_in
> 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 ->
> 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?
&g

Re: initial states for instructions / when do we need actions?

[Etienne Saliez]

Thank you very much for the schema.

However I believe that the handling of an Action should start earlier before 
the "INITIAL" 
state.

- "SUGGESTED"
Preliminary informal suggestion, according to some generic guidelines, 
regardless of the 
details of the current context of the patient

- "POROPSED"
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.

- "VALIDATED"
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 .

- "STARTED"
For example a treatment for 10 days is actually started. 
Or a bacteriology test which necessitate at least 24 hours.

"COMPLETED"
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-boun...@lists.openehr.org]
> On Behalf Of pablo pazos Sent: Tuesday, 12 July 2016 12:29 PM
> To: openeh technical ; openehr clinical
> ; s...@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_in
> 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 ->
> 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!___
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RE: initial states for instructions / when do we need actions?

[pablo pazos]

yes I will, BTW there is another conversation that is related to this and to 
improving the specs, the subject is: "ACTIVITY.description vs 
ACTION.description archetypes‏"

if anyone can take a look at it, would be helpful.

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

Subject: Re: initial states for instructions / when do we need actions?
To: openehr-technical@lists.openehr.org
From: thomas.be...@openehr.org
Date: Thu, 14 Jul 2016 08:25:53 +0100


  

  
  




Hi Pablo

can you raise a PR for this, with some summary of the changes you
  think are needed?

thanks

- thomas





On 14/07/2016 05:16, pablo pazos wrote:



  
  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

http://cabolabs.com



  


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Re: initial states for instructions / when do we need actions?

[Thomas Beale]

Hi Pablo

can you raise a PR for this, with some summary of the changes you think 
are needed?


thanks

- thomas


On 14/07/2016 05:16, pablo pazos wrote:
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
http://cabolabs.com 


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RE: initial states for instructions / when do we need actions?

[Heath Frankel]

Hi Pablo,
Some comments below.

Heath

From: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] On 
Behalf Of pablo pazos
Sent: Tuesday, 12 July 2016 12:29 PM
To: openeh technical ; openehr clinical 
; s...@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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