G?rard, May I propose a contribution on the the question you pose ?
1 - Concerning the cooperation between actors and roles The two reasons you mention make me think of the Searle's speech acts, amongst other developped afterwards by Vinograd in his "conversation for action". i) - reason one : "illocutionnary" act which can be : -- a request for an action performing (order, instruction, letter where one can find a request, ...) expressed by a requester to an offerer and which implies an answer from the offerer : accept (and then the offerer commit to do what is requested), amend, refuse. -- a commitment for an action performing expressed by the offerer. In practice and depending on the cooperation rules, the commitment is sanctionned by an appointment. The appointment can be in the letter ... -- a report on the the action performing expressed by the offerer to the requester (professionnal opinion or advice following a request, lab result, ...) -- a validation of the report (or of the action performing ?) by the requester ii) - reason two : "propositional" act which gives the content of the speech act : -- professional content for a request, with reason, target, condition of the patients influencing the performing of the requested action -- professional content for the commitment -- for the report. it is interesting to distinguish there the differences of the professional content between a diagnostic and a terapeuthic action. The conversation for action is one of the components of the cooperation. Another one is the coodination of the care plan performing, when for instance an actor/role notifies the following one that the action he was responsible for is performed (or is not performed). May-be other component exists ? Reports and notifications are different : report is sent to the requester within the conversation for action, and notification is sent to the following actors/roles within the workflow coordination, may-be with an another professional content. The information system is intended to support this cooperation messaging. 2 - Concerning the fact that the EHR is the support of cooperation messaging. In the schema you describe, the EHR is the obliged "documentation device" (or I could say messaging device) between HCPs to communicate within the "conversation for action" or for the coodination. One can imagine that there are 3 dossier elements related to the same action performing - in the performer dossier - in the cooperation system - in the requester dossier The utilisation of these "versions" inof the same act the care process should be studied. HI H. Mensch GMSIH -----Message d'origine----- De : owner-openehr-clinical at openehr.org [mailto:owner-openehr-clinical at openehr.org]De la part de Sam Heard Envoy? : mardi 6 septembre 2005 22:27 ? : Gerard Freriks Cc : Dipak Kalra; Thomas Beale; openEHR-Clinical Objet : Spam : Re: 'Actionability' of orders Gerard This area is interesting. At a recent meeting of Standards Australia it was determined that an extract should say if it is for information only or there is, within it, the expectation that some action is required. This should, we felt be boolean ie unambiguous. It took some time to come to this - but an example is an extract containing a medication order that is sent to the pharmacy (action required) and copied to the specialist (no action required). The openEHR instruction class that is almost fully specified now and will be in version 1, will take this sort of thing to a new level. We need more debate on this, Sam Gerard Freriks wrote: Hi, Reading an HL7 list. To me it seems there is exchange of the same data for two reasons. 1- an order, an instruction, an advice, a professional opinion, a letter, a lab result, itself, etc 2- the documentation of , the provision of information about, the order, the instruction, the advise, the opinion,the letter, the lab result, etc. Eg: the prescription on paper handed to the patient, the prescription electronically that is sent and serves as a kind of trigger event to make acts happen at the receiver side. And the documentation of acts in a system about the real world. What they have noticed is one of the fundamental criticisms on the RIM by the philosophical ontologists. In CEN it is simple we deal only with the EHR and considers the EHR a documentation device that deals with reason two only: documentation of what has happened. A lab test that is sent to an EHR system as data (information about the patient) is received and stored in the in-tray of the system. The physician reads the data and accepts it to the healthcare record at that moment he documents the reception of the lab results and make them part of the EHR. Then he is able to formulate a comment about them or act up on them. The comments or the actions will be documented again in the EHR. In CEN we deal with the EHRextract for exchange only. The extract is an abstract of that what has been documented. Question: Is data that is not yet documented part of the extract? If so. How is that indicated? If not what should we do? I think it should not, because the EHR is there to document what has happened in the view of the healthcare provider. Orders, instruction, letters them selves are outside of the scope of the EHR. I think that next to the EHR extract we need something that indicates that it is not an extract of what is documented but something that is an order, instruction, advice, a letter, a lab result, that is data to the receiver until he documents the reception and accepts it to his record system. I prefer a new construct that carries the notion that it is a trigger. Since the content of this new construct will be the same information as an EHR-extract I foresee an envelope for the EHR indicating that it is an extract of a document and an envelope indicating that it is a trigger. The signature placed on the extract of the document indicates: I sign this and take responsibility for the content of the extract. The signature placed on the trigger indicates: I order you, I instruct you to do something and I take responsibility for that order, instruction. Gerard -- <private> -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 654 792800 On 17-aug-2005, at 17:45, Lloyd McKenzie wrote: We have a circumstance in community prescribing where there is a central EHR record of prescriptions. In some circumstances, the electronic rendition is 'actionable', meaning that any pharmacy can download and submit a dispense on the prescription. In other cases, the electronic rendition is 'non-actionable', meaning that a pharmacy can only dispense against the prescription if they have a paper copy of the order. The way we're thinking about dealing with this is by the presence or absence of a 'pre-condition' on the on the order indicating that a paper copy of the order must be reviewed prior to dispensing. (classCode = VRF-verification, performer.participationMode = WRITTEN). If the pre-condition is present, then the order is 'non-actionable'. If there's no pre-condition, then the order is 'actionable'. I'm posting this because I feel it's a fairly generic problem, and likely spans areas outside of just pharmacy. Are people comfortable with modeling things this way? If not, what are your recommendations? Thanks for your thoughts. Lloyd -- Dr. Sam Heard MBBS, FRACGP, MRCGP, DRCOG, FACHI CEO and Clinical Director Ocean Informatics Pty. Ltd. Adjunct Professor, Health Informatics, Central Queensland University Senior Visiting Research Fellow, CHIME, University College London Chair, Standards Australia, EHR Working Group (IT14-9-2) Ph: +61 (0)4 1783 8808 Fx: +61 (0)8 8948 0215 - If you have any questions about using this list, please send a message to d.lloyd at openehr.org -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20050907/58bc7bec/attachment.html>
