ACTION archetypes

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An example of how an Instruction for a Procedure will be recorded in an Electronic Health Record using an ACTION archetype.

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ACTION archetypes

  1. 1. ACTION archetypes An example of how an Instruction for a Procedure will be recorded in an Electronic Health Record using an ACTION archetype.
  2. 2. Instruction/Action for Procedure ACTION = information recorded as a result of performing the Instruction, including the planning phase
  3. 3. INSTRUCTION attributes <ul><li>In addition, from the open EHR Reference Model (RM): </li></ul><ul><li>Author/Composer </li></ul><ul><li>Patient </li></ul><ul><li>Date of the Instruction </li></ul><ul><li>Expiry time </li></ul><ul><li>Note: These elements from the RM are universally availably and not modelled explicitly in the archetype </li></ul>Explicitly modelled
  4. 4. ACTION attributes Explicitly modelled <ul><li>From the RM: </li></ul><ul><li>Author/Composer </li></ul><ul><li>Patient </li></ul><ul><li>Participations </li></ul><ul><li>Time of being performed </li></ul><ul><li>ISM transition </li></ul>
  5. 5. 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
  6. 6. 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
  7. 7. Record ‘Procedure Scheduled’ instance Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed Planned duration Scheduled Date/Time
  8. 8. 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
  9. 9. 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
  10. 10. Record ‘Procedure Abandoned’ instance Procedure Planned Procedure Scheduled Procedure Performed Failed Attempt Procedure Abandoned Procedure Completed Reason for abandonment
  11. 11. 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
  12. 12. Direct from the openEHR RM… <ul><li>The Instruction and Action classes are designed to satisfy the following requirements: </li></ul><ul><li>All kinds of interventions, from simple medication orders to complex multi-drug courses should be representable using the same model; </li></ul><ul><li>Instructions should always have a narrative expression, with an optional machine-processible expression in cases where automation will be used; </li></ul><ul><li>The freedom must exist to model any particular intervention in as much or little detail as required by circumstances; </li></ul><ul><li>Clinicians must be able to specify Instruction steps in their own terms, i.e. using terms like </li></ul><ul><li>“ prescribe”, “dispense”, “start administering”, etc; </li></ul><ul><li>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; </li></ul><ul><li>It should be possible to provide a coherent view of the state of execution of an Instruction </li></ul><ul><li>even if parts of it have been executed in different healthcare provider environments; </li></ul><ul><li>It must be possible to record ad hoc actions in the record, i.e. acts for which no Instruction </li></ul><ul><li>was defined (at least in the EHR in question); </li></ul><ul><li>Instructions must integrate with notification / alert services; </li></ul><ul><li>An interoperable expression of computable workflow definitions of Instructions will be supported. </li></ul><ul><li>Reference: open EHR EHR Information Model - http://www.openehr.org/releases/1.0.2/architecture/rm/ehr_im.pdf </li></ul>© Ocean Informatics 2011

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