ACTION archetypes

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


Planned duration

Scheduled Date/Time

Record ‘Procedure Performed’ instance


Description of procedure performed

Duration of procedure

Start time of procedure

Device used

Record ‘Failed Attempt’ instance


Description of procedure performed

Reason why it failed

Duration of failed attempt

Start Date/Time for procedure

Device used

Record ‘Procedure Abandoned’ instance


Reason for abandonment

Record ‘Procedure Completed’ instance


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

© Ocean Informatics 2011

Technology

ACTION archetypes