I have just had an interesting conversation with Diego during a coffee break, and several doubts arose around the representation of procedures.
At the CKM we have an ACTION archetype to represent any type of procedures. It is described as “A clinical activity carried out for screening, investigative, diagnostic, curative, therapeutic, evaluative or palliative purposes”. So far, so good.
Now the doubt is about what happens when the procedure is something simple and non-invasive that just generates an OBSERVATION. For example, a temperature taking. Should we always have the ACTION.Procedure instance generated together with the OBSERVATION.Temperature? Or do we just need to record the procedure “temperature taking” as part of the protocol of the OBSERVATION?
If the answer is to have both archetype instances, then probably most OBSERVATIONs will allways have an ACTION linked to it. If the answer is that in some cases we only need to record the OBSERVATION with a protocol, then we are creating a division of all the universe of procedures, as typically defined in terminologies such as SNOMED CT.
In theory you are correct but in many clinical records the date of the observation acts as a sufficient proxy for activity being performed.
Where we do use actions is where we need to track the workflow of the procedure though there is not always a direct correlation between the procedure tracked and the observation.
As an example a blood pressure will often be taken as part of a vital signs measurement. Ie the requested and tracked procedure is “perform vital signs measurement’ every 4 hrs”.
I would use a single procedure action archetype to track the ‘vital signs process’ in the same composition as the individual observations.
That is not 100% correct, actions can be recorded without any related instruction/activity.
I agree with Ian, action recording makes sense when there is some tracking going on, if just the measures are needed (from the clinical point of view) no actions will be recorded, just obs.
What about the need to track a workflow of a kind – e.g. something we are dealing with right now: A sick note (medical certificate to inform employer and authorities for social benefits) is needed to be made in the EHR. The form will change status – from started on, filled in, signed, maybe co-signed, sent (the careflow steps are not fully identified). Is this relevant for an ACTION, or is it “something else”? It’s not really medical information, but still related to the patient.
What about the need to track a workflow of a kind – e.g. something we are dealing with right now: A sick note (medical certificate to inform employer and authorities for social benefits) is needed to be made in the EHR. The form will change status – from started on, filled in, signed, maybe co-signed, sent (the careflow steps are not fully identified). Is this relevant for an ACTION, or is it “something else”? It’s not really medical information, but still related to the patient.
I agree with Sam. You could certainly use an action archetype for this purpose. The consent archetype developed by Heather for NEHTA actually does this yo track the consenting process. Sorry I can’t provide a link - something weird with my browser when trying to access CKM.
I was more concerned about the correctness of storing process information like tracking the various states a document is in, in openEHR-archetypes. It has more to do with the business logic in the software. (E.g. when signed, the form can be sent electronically). But even so, it’s being documented in the EHR, so it’s probably right to store it in archetypes. I’m still mulling over these things. Learning, though..