Thanks for pointing me to this thread, Silje. I will elaborate on your thread, in order to show how deep this pain might go.
My primary directive is to scope a use case to such an extent, so that chosen or created archetypes have a well-defined purpose for each specific use case. The use cases have users. Some archetypes might be used by users with the same roles, but others not. In addition, some might overlap with other archetypes, but their purpose shall not. If an archetype is reused for a different use case, then its purpose shall remain. This might result in having for each specific use case a separate set of archetypes - which I often encounter in the international clinical knowledge manager.
But this is not the case for Medication management (ACTION.medication.v1). I understand the instruction state machine used in ACTION.medication, and I also understand why the author of the archetype came to this solution. It is an effective way to extend its applicability in different use cases. But the issue arises when we have to maintain it, as it has several purposes. And this was when the pain started to grow in me.
First, medications are usually managed within a workflow in a healthcare facility. For inpatients concerning the medication order, these workflows might differ among departments, facilities, and regions - sometimes substantially. It may differ again if it is a common drug, antibody (active immunization), biologics, chemotherapeutic, and infusions in general. Usually, these workflows are managed by physicians, specialists, or nurses.
Consequently, some authors created a different ACTION archetype, named Transfusion, as they realized that these “medications” are managed differently, namely by a team of specialists.
Second, in some contexts, the management of drugs might differ again, namely for a medication dispense usually encountered in drug rehabilitation programs, where a drug is given to the patient under the watchful eye of a healthcare professional, to make sure the patient consumes it as intended. And this is only one example.
Here, I have not found a suitable ACTION archetype - yet. But I recommend creating a separate ACTION archetype in the future. This is usually managed by psychiatrists, specialists, and nurses and includes legal frameworks, which are applied on top.
Third, there also exists medication administration, for which this archetype ACTION.medication is great but does not really represent the steps semantically as encountered in several Swiss facilities. For example, when a drug has been administered, the state shall be semantically equal to completed. But in the current ACTION.medication archetype, it is still considered active, which does not make sense for this use case.
Consequently, I simply accepted that they are considered “active” states and will explain these to the implementers, such that they also accept this. This is usually managed by the nursing staff, rarely by physicians.
Fourth, a prescription requires a very different management approach compared to the previous three points. And we also handle this in our system quite differently compared to the administration and order. The ACTION.medication.v1 also applies to this use case, which might be a smart move to reuse an archetype, but its purpose is very different in my eyes, as a prescription is not the same as a medication order. The main use case for a prescription is when a patient requires a document to attest that the patient is entitled to acquire the enlisted drugs. The acquisition may be delegated to healthcare services such as home nursing. But the management of the medication is not done by the healthcare provider but is delegated to the patient. This is a very different medication management, which is usually not performed by a healthcare professional but the patient.
Consequently, I highly recommend splitting the ACTION.medication to accommodate the specific use cases, and also focus on who manages the medication.
To sum up, medication management is highly dependent on the subject who manages it. And we have seen in the previous four points that the manager might differ. And I highly recommend focusing on the manager, such that the ACTION.medication.v1 archetype shall be split to such an extent, that there is an ACTION.prescription.v0 and an ACTION.medication.v2. And in the near future, additional ACTION archetypes that respect the perspective of the manager. After all, it’s not just about the medication; it’s about who’s calling the shots!