A couple of week ago someone mebtioned that ACTION archetypes are not being developed or used a lot, and maybe is because we actually don’t need to put data on ACTIONs as part of the clinical record, but maybe only as event trigger and logs of ehat happened. With tgis I mean: ACTION recording might be used ti send notifications to other statems (like whe a lab test is done, the results are sent or queried), or to keep the log of real world events that happened and may change the status of another entity (i.e. INSTRUCTION/ACTIVITY).
What is the opinion of the community about the role of the ACTION ENTRY in the openEHR Information Model and as a EHR entity, from the point of view of it’s use in current systems?
Think that an ACTION can happen without any previous instruction. For example, a medication taken without a previous prescription. That information has to be stored not just as a log, but as proper clinical data. So it seems OK that ACTION includes part of the clinical record.
Hi David. A medication taken should be an action or an observation? What matters more, the event of taking the drug ot yhat thr drug eas taken? I think the latter can occur when a doctor asks the patient for medication taken. I agree the real time record of the event can also occur.
The recommendation is to always use the same archetypes you would have used to originally record that information. That is the best way to ensure the systems work when retrieving information. For example if you query about medications taken by the patient you only have to query the ACTION archetype instead of searching information scattered in other archetypes.
Hi Pablo,
Actions are absolutely necessary and can carry different/additional information than the instruction.
An instruction is actually useless without an action. It is the action that puts the action into a particular state at a particular time. When an instruction is created it should also be accompanied with an action otherwise the instruction workflow is not yet invoked.
Take a medication ( I am not clinical so please excuse my ignorance but hopefully this demonstrates the intended technical solution), a clinical pathway may suggest a class of drug to be taken at a particular dosage, frequency and duration. This may be recommended by a decision support system by creating the instruction and an action to put it into the planned state. The doctor can then prescribe a generic drug using an action indicating particular form and strength and the state is transitioned to active with a care flow step of prescribed. Next the pharmacy dispenses the particular product and indicates administration instructions to the patient. The new action is still in active state but now has care flow step of dispensed, the time is the dispense time. The patient can now enter the administration of each dose, each action is an active step. Finally the system can optionally create a completed action when it determines each dies has been taken or the expires under some other criteria.
Personally I disagree with the original post indicating that action archetypes are not being developed of used a lot. They are absolutely essential in any system recording instructions such as our care planning systems. If they are not then there are fundamental misunderstandings of the instruction/action model.
Hi David,
I haven’t been involved in the instruction/action modelling recently but I know that this principle of having the same item structure archetype girl the activity and action was preferred in the early days, it has recently deviated for some archetypes at least as the information requirements didn’t align with this principle. I will leave it to the modellers to comment further.
I personally think that there should be more information in the action than the instruction but can also see the efficiencies of having minimal information in the action when an action can occur many times for any particular instruction. I guess it comes down to the the use case but my rule would be that only information that is common to all actions should go in the instruction otherwise you need to update the instruction as you go through the state transitions, which in my view is not desirable.