Surely the issue here is not merely that of the (binary?) nature of a
Speech Act, but the significance of that act to the enterprise within
which it occurs.
Thus even a delivery 'for information only' might invoke some action on
the part of the receiver, even if it is only the obligation to record its
arrival, e.g. for audit purposes.
What is missing here are definitions of the protocols governing the
performance of these acts by the enterprise's actors. This 'deontic
ontology' would permit the parties suitably to label each transaction and
to relate those labels to the appropriate protocols, which would indicate
the appropriate actions and enable the identification of, and recovery
from, transmission and other errors.
Formal languages, such as LOTOS etc., for defining such protocols hav
ebeen around for years, particularly in the telecoms industry. I suggest
that you investigate the inclusion of a suitable metalanguage.
Bernie
On Wed, 7 Sep 2005, Sam Heard wrote:
> Date: Wed, 07 Sep 2005 05:57:29 +0930
> From: Sam Heard <sam.heard at oceaninformatics.biz>
> Reply-To: openehr-clinical at openehr.org
> To: Gerard Freriks <gfrer at luna.nl>
> Cc: Dipak Kalra <d.kalra at chime.ucl.ac.uk>,
Thomas Beale <thomas.beale at oceaninformatics.biz>,
openEHR-Clinical <openEHR-Clinical at openehr.org>
> Subject: 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
>
________________________________________________________________________
Prof Bernard Cohen, Dept of Comp Sc, City Univ, Northampton Sq.
London EC1V 0HB tel: ++44-20-7040-8448 fax: ++44-171-477-8587
b.cohen at city.ac.uk WWW: http://www.soi.city.ac.uk/~bernie
"Patterns lively of the things rehearsed"
-
If you have any questions about using this list,
please send a message to d.lloyd at openehr.org
