Instance structures of ACTION

Purpose

This page is created to facilate understanding of the EHR information model specification especially on the class ACTION. All ENTRY subclass like OBSERVATION and EVALUATION have a dedicated instance structures in the section 8.4 of the EHR Information Model specification except ACTION. The ACTION class is arguably the most complex ENTRY class due to its use of standard Instruction state machine.

Clnical Case

The clinical case modelled here is based on an example given by Dr. Andrew Gledhill as part of dicussion around Medication archetype. Basically it's about a medication of Amoxicillin 500 mg IV every 8 hrs for 4 days.

Instance Structures

1. Precribing Medication Order

The prescribing of the medication order should result in creation of the following instance structures:

INSTRUCTION
   name = 'medication'
   activities[0] =
   ACTIVITY "Amoxicillin 500 mg IV, every 8 hrs, 4 days" // to be structrued

ACTION
   name = 'medication'
   ism_transition =
   current_state = 'planned'

2. Administration / Execution of the Medication Order

The execution of the order should result in the following instances in the EHR, normally 12 instances given that the order is followed faithfully.

ACTION
   name = 'medication'
   ism_transition =
   current_state = 'active'
   details = 'Amoxicillin 500 mg IV'

3. Completion of the Medication Order

Once the 4 day course of the medicaiton is over, the last action will be created effectly setting the medicaiton order to 'completed' state.

ACTION
   name = 'medication'
   ism_transition =
   current_state = 'completed'

Summary

This is still a very simple and standard scenario. It doesn't cover for instance, suspension of a medication, reviewing of an ongoing medication etc.

Note that in both ACTIONs starting and finishing the medication order, the details of the ACTION is not needed, only when recording the administration of the medication, the details are required in the ACTION, normally copying from the ACTIVITY.