Post on 15-Jun-2015
description
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ACTION archetypes
An example of how an Instruction for a Procedure will be recorded in an Electronic Health Record using an ACTION archetype.
Instruction/Action for Procedure
ACTION = information recorded as a result of performing the Instruction, including the planning phase
INSTRUCTION attributes
In addition, from the openEHR Reference Model (RM): •Author/Composer•Patient•Date of the Instruction•Expiry time
Note: These elements from the RM are universally availably and not modelled explicitly in the archetype
Explicitly modelled
ACTION attributes
Explicitly modelled
From the RM: •Author/Composer•Patient•Participations•Time of being performed•ISM transition
ACTION Pathway attributes
Planned
Postponed
Cancelled
Active
Suspended
Cancelled
Completed
Scheduled
Clinicians name the steps in terms that make sense for the clinical purpose mapping steps in any care pathway process to states in the ISM.
These are the steps in the carrying out of an Instruction where it makes clinical sense to record some data in the EHR
States are also defined in the Reference Model (RM) (aka the ‘Instruction State Machine’ (ISM)).
NAMED CLINICAL
STEPS
RM STATES
Record ‘Procedure planned’ instance
Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed
Reason for procedure
Description of planned procedure
Device planned
RM States
Creation of an Instruction often coincides with the creation of a corresponding ACTION recording appropriate data against the Planned pathway step.
Simultaneous INSTRUCTION & ACTION
Record ‘Procedure Scheduled’ instance
Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed
Planned duration
Scheduled Date/Time
Record ‘Procedure Performed’ instance
Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed
Description of procedure performed
Duration of procedure
Start time of procedure
Device used
Record ‘Failed Attempt’ instance
Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed
Description of procedure performed
Reason why it failed
Duration of failed attempt
Start Date/Time for procedure
Device used
Record ‘Procedure Abandoned’ instance
Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed
Reason for abandonment
Record ‘Procedure Completed’ instance
Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed
Description of Procedure completed
Record the completion of the Procedure…& close the loop
initiated by the Instruction
Direct from the openEHR RM…The Instruction and Action classes are designed to satisfy the following requirements:All kinds of interventions, from simple medication orders to complex multi-drug courses should be representable using the same model;Instructions should always have a narrative expression, with an optional machine-processible expression in cases where automation will be used;The freedom must exist to model any particular intervention in as much or little detail as required by circumstances;Clinicians must be able to specify Instruction steps in their own terms, i.e. using terms like
“prescribe”, “dispense”, “start administering”, etc;Instructions representing diverse clinical workflows must be queryable in a standard way, so that it can be ascertained what Instructions are ‘active’, ‘completed’ and so on for a patient;It should be possible to provide a coherent view of the state of execution of an Instruction
even if parts of it have been executed in different healthcare provider environments;It must be possible to record ad hoc actions in the record, i.e. acts for which no Instruction
was defined (at least in the EHR in question);Instructions must integrate with notification / alert services;An interoperable expression of computable workflow definitions of Instructions will be supported.
Reference: openEHR EHR Information Model - http://www.openehr.org/releases/1.0.2/architecture/rm/ehr_im.pdf
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