ounces at openehr.org] On Behalf Of Ian McNicoll
> Sent: Tuesday, 13 December 2011 7:38 PM
> To: For openEHR clinical discussions
> Subject: Re: Revision of Instructions - clinical implications
>
> Hi Diego,
>
> The issue is that that the 'current version' of the EHR should re
...@openehr.org] On Behalf Of Rong Chen
Sent: Monday, 12 December 2011 6:31 PM
To: For openEHR clinical discussions
Subject: Re: Revision of Instructions - clinical implications
Ian,
This is indeed a very interesting question. I am inclined to think revision
based approach seems to be more
--- On Tue, 13/12/11, Ian McNicoll wrote:
From: Ian McNicoll
Subject: Re: Revision of Instructions - clinical implications
To: "For openEHR clinical discussions"
Date: Tuesday, 13 December, 2011, 11:19
Hi Jag,
It is a little simplistic, since it is quite common for the recording
The precise 'choreography' of these things like versions, updates, error
corrections, etc. can not be solved in a standard.
The standard must be so flexible that it can document whatever choices are made
by the implementation.
Then it is a deployment issue for implementers to solve.
Gerard Frer
e or a future date.
> Reissue and repeat prescriptions are just descriptions of a prescription.
>
> Regards
>
> Jag
>
>
> Dr. S Jagannathan
>
> --- On *Mon, 12/12/11, Sam Heard * wrote:
>
>
> From: Sam Heard
> Subject: RE: Revision of Instructions - clinical implic
ATHAN
Sent: Sunday, 11 December 2011 3:06 AM
To: For openEHR clinical discussions
Subject: Re: Revision of Instructions - clinical implications
?
If that is the case. then there really is no need for Instruction separately as
such.
The 'what' can be specified and the context may be ob
Hi Gerard,
I agree, but openEHR is not just about standards, it is about
implementation and we need to be able to think through the
implications of particular approaches, where different options are
available. The issues being discussed are directly related to the
openEHR specifications and not p
r openEHR clinical discussions
>> Subject: Re: Revision of Instructions - clinical implications
>>
>> Hi Diego,
>>
>> The issue is that that the 'current version' of the EHR should reflect
>> what is currently believed to be true and 'safe' about
Hi Diego,
The issue is that that the 'current version' of the EHR should reflect
what is currently believed to be true and 'safe' about the patient's
record without having to trawl through previous versions.
So If I query for all medication orders, I should get back the
original order, as well as
As Thomas said, the versioning of Instructions happens anyways, on the
technical implementation level. So I guess what Ian is after is more
on the clinical level - which way is more intuitive to the clinicians.
I know cases where the dose changes are anticipated, e.g. based on lab
tests, temperatu
then if this already happens, I don't understand Ian's question
2011/12/12 Thomas Beale :
> On 12/12/2011 09:14, Diego Bosc? wrote:
>> If revision means changing and losing the original data (the 200 value
>> is lost forever) then I think we shouldn't do that. As a bad
>> prescribed medication can
If revision means changing and losing the original data (the 200 value
is lost forever) then I think we shouldn't do that. As a bad
prescribed medication can harm the patient I think we need always to
be able to track the source of the problem. If revision is supposed to
store original and revised
Ian,
This is indeed a very interesting question. I am inclined to think revision
based approach seems to be more intuitive here if the update is not due to
an obvious dosing error.
Cheers,
Rong
On 11 December 2011 12:06, Ian McNicoll
wrote:
> Interesting discussion but so far no-one has address
environment.
Cheers, Sam
From: openehr-clinical-bounces at openehr.org
[mailto:openehr-clinical-boun...@openehr.org] On Behalf Of S JAGANNATHAN
Sent: Sunday, 11 December 2011 3:06 AM
To: For openEHR clinical discussions
Subject: Re: Revision of Instructions - clinical implications
If
penehr-clinical-bounces at openehr.org
[mailto:openehr-clinical-boun...@openehr.org] On Behalf Of S JAGANNATHAN
Sent: Sunday, 11 December 2011 2:45 AM
To: For openEHR clinical discussions
Subject: Re: Revision of Instructions - clinical implications
Following a clinical examination/consulta
-boun...@openehr.org
[mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Seref Arikan
Sent: Sunday, 11 December 2011 2:24 AM
To: For openEHR clinical discussions
Subject: Re: Revision of Instructions - clinical implications
would it be wrong to say instruction = request; action = response ?
2011 1:14 AM
> To: openEHR clinical discussions
> Subject: Revision of Instructions - clinical implications
>
> There is a discussion on the technical lists about handling
> INSTRUCTIONS and subsequent ACTIONS in openEHR. Heather Leslie has
> provided an excellent explanation o
On 12/12/2011 09:14, Diego Bosc? wrote:
> If revision means changing and losing the original data (the 200 value
> is lost forever) then I think we shouldn't do that. As a bad
> prescribed medication can harm the patient I think we need always to
> be able to track the source of the problem. If rev
Hi Thomas,
As I was typing my previous email, I wished I 'said out-loud' what was
going through my mind, that it was going down the HL7 fork in the road.. I
offered it to clarify prior conversations that seemed to be becoming
circular, rather than propose a HL7 model. I understand that if there is
In your specific scenario I agree that it's a new order - stop the original
order and commence a new one with the appropriate dosage or frequency.
Heather
Sent from my phone
On 11/12/2011, at 22:06, Ian McNicoll
wrote:
> Interesting discussion but so far no-one has addressed my original
On 11/12/2011 19:51, rjsearle at gmail.com wrote:
> Hi Thomas,
>
> As I was typing my previous email, I wished I 'said out-loud' what was
> going through my mind, that it was going down the HL7 fork in the
> road.. I offered it to clarify prior conversations that seemed to be
> becoming circular
From: openehr-clinical-bounces at openehr.org [openehr-clinical-bounces at
> openehr.org] On Behalf Of Eunice Ab [euniceab at googlemail.com]
> Sent: Sunday, 11 December 2011 3:26 AM
> To: For openEHR clinical discussions
> Subject: Re: Revision of Instructions - clinical impli
ent: Sunday, 11 December 2011 5:20 PM
> To: For openEHR clinical discussions
> Subject: Re: Revision of Instructions - clinical implications
>
> Agreed,that is exactly how I understood it. So strictly speaking the
> instruction is an action preceding another action!!
>
> Sent f
27;replaced') by
another instruction.
Colin
From: openehr-clinical-bounces at openehr.org [openehr-clinical-bounces at
openehr.org] On Behalf Of Eunice Ab [eunic...@googlemail.com]
Sent: Sunday, 11 December 2011 3:26 AM
To: For openEHR clinical discussions
Subject: Re: Revision of Instructi
-clinical-bounces at openehr.org] On Behalf Of pablo pazos
Sent: Sunday, 11 December 2011 8:43 AM
To: openehr clinical
Subject: RE: Revision of Instructions - clinical implications
But we are talking about the openEHR model, so we should consider the
semantics of the terms we use based on those
On 11/12/2011 12:16, Heather Leslie wrote:
> In your specific scenario I agree that it's a new order - stop the
> original order and commence a new one with the appropriate dosage or
> frequency.
>
> Heather
IN that case, what you would have chronologically in openEHR is:
* INSTRUCTION (#
On 11/12/2011 11:06, Ian McNicoll wrote:
> Interesting discussion but so far no-one has addressed my original
> question, other than Thomas, and I do not think we can assume that a
> Medication list is necessarily modelled as a persistent composition.
> Even then I suspect the same issue still a
On 11/12/2011 07:14, rjsearle at gmail.com wrote:
> Sounds like:
> action = instruct
> result = new instruction (eg take your tablets)
>
> subsequently:
> action = follow instruction (take tablets)
> result = tablets taken
>
> So if I understand this correctly, the instruction is NOT the act of
>
Ian,
Medication list in my book is a kind of Folder or Section that assembles data
and information already stored in the Patient Record.
The data is stored in (formally committed to) the database.
Any change after the data is committed needs to be recorded fully in the audit
trail. Time, commit
On 11/12/2011 05:06, Colin Sutton wrote:
> An instruction is an imperative e.g. "Take two tablets daily", the action is
> "Took the tablets" or "Forgot the tablets" or "Ignored the instruction".
> The instruction stays the same, or is superseded (figuratively 'replaced') by
> another instruction.
RA medication revision shall be a new entry always, even if it?s only to
change the dosage...because you have to enter a new information at a
different point of time.
We have to differentiate acts from actions, although for both of them
there?s a doing in the sense of the word, therefore they are
Interesting discussion but so far no-one has addressed my original
question, other than Thomas, and I do not think we can assume that a
Medication list is necessarily modelled as a persistent composition. Even
then I suspect the same issue still arises. We do not want to hide the
previous valid Ins
...@btinternet.com
Subject: RE: Revision of Instructions - clinical implications
To: openehr-clinical at openehr.org
I have to humbly disagree that there will be any loss of historical
information.
As I said before I have no intention of trying to change anything about open
ehr and would personally wish to
Dear Jagannathan,
I see the big confusion developing.
There is HL7 thinking and 13606 thinking. (and openEHR thinking)
In HL7 'the act' of documentation is modeled as an Act with a specific mood
code.
In 13606 'the act' of documentation is about either an Observation archetype,
an Evaluation ar
Hi,
Think it's easy to distinguish one from another if you think on a paper record.
Instructions and actions are separated there. Instructions are the orders (
instructions) recorded when finishing patient 's evaluation and actions are
recorded when they were either performed, or suspended, o
cal-bounces at openehr.org [openehr-clinical-bounces at
> openehr.org] On Behalf Of Eunice Ab [euniceab at googlemail.com]
> Sent: Sunday, 11 December 2011 3:26 AM
> To: For openEHR clinical discussions
> Subject: Re: Revision of Instructions - clinical implications
>
> Hello
pazos wrote:
From: pablo pazos
Subject: RE: Revision of Instructions - clinical implications
To: "openehr clinical"
Date: Saturday, 10 December, 2011, 23:13
But we are talking about the openEHR model, so we should consider the semantics
of the terms we use based on those semanti
Sat, 10 Dec 2011 17:02:57 +
From: sjagannat...@btinternet.com
Subject: Re: Revision of Instructions - clinical implications
To: openehr-clinical at openehr.org
When you instruct someone do to something then it is an action.
Jag
--- On Sat, 10/12/11, Thomas Beale wrote:
From: Thomas Beale
com/ppazos
Date: Sat, 10 Dec 2011 22:18:54 +
From: sjagannat...@btinternet.com
Subject: RE: Revision of Instructions - clinical implications
To: openehr-clinical at openehr.org
Not an expert on' openEHR semantics'
But in simple terms it is still a matter of something + an attribut
. Pablo Pazos Guti?rrez
LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
Blog: http://informatica-medica.blogspot.com/
Twitter: http://twitter.com/ppazos
Date: Sat, 10 Dec 2011 17:02:57 +
From: sjagannat...@btinternet.com
Subject: Re: Revision of Instructions - clinical implications
To
Marking Actions as something 'done', 'not done', etc is normal of
course. In openEHR, such actions can be matched up with states in the
abstract state machine, so that you can query afterward on what is
active, suspended, completed etc. But things like 'intended' are not
meaningful possibiliti
Hi
I thought the data structures were to support the clinicians workflow view.
I just wondered why you mentioned the 'Act' model would not work.
As Jag explained all the things he listed including instructions are all
actions . and why do we have to restrict the definition of 'an action'
to w
uch as for a procedure- proposed, done, not done, postponed,
> recommended, instructed(as well!) etc. and for drugs-prescribed, taken,
> dispensed etc.
>
> Jag
>
>
>
> --- On *Sat, 10/12/11, Thomas Beale oceaninformatics.com>*wrote:
>
>
> From: Thomas B
prescribed, taken,
dispensed etc.
Jag
--- On Sat, 10/12/11, Thomas Beale wrote:
From: Thomas Beale
Subject: Re: Revision of Instructions - clinical implications
To: openehr-clinical at openehr.org
Date: Saturday, 10 December, 2011, 17:15
In a trivial sense that is
Well in an HL7 modelling view of the world this would be true. But
ontologically it is not, if 'action' means something that was done,
which is what it means in openEHR. All Actions in openEHR are 'actual'.
An Action may be used to record some clinical thing being 'not done' as
well, since tha
: Eunice Ab
Subject: Re: Revision of Instructions - clinical implications
To: "For openEHR clinical discussions"
Date: Saturday, 10 December, 2011, 17:04
Hi Thomas and Seref
Many thanks for your response ... this was what I thought too but then
does that not mean that all that is ne
In a trivial sense that is of course true. But the interesting part of
an Instruction is /what /is being instructed, which is where the
potential complexity lies.
- thomas
On 10/12/2011 17:02, S JAGANNATHAN wrote:
> When you instruct someone do to something then it is an action.
>
>
> Jag
On 10/12/2011 17:04, Eunice Ab wrote:
> Hi Thomas and Seref
>
> Many thanks for your response ... this was what I thought too but
> then does that not mean that all that is needed to be able to capture
> both under actions is an attribute of 'type' for 'intended' and
> 'actual' OR 'request'
Hi Thomas and Seref
Many thanks for your response ... this was what I thought too but then
does that not mean that all that is needed to be able to capture both under
actions is an attribute of 'type' for 'intended' and 'actual' OR 'request'
and 'response' rather than separating them to remov
When you instruct someone do to something then it is an action.
Jag
--- On Sat, 10/12/11, Thomas Beale wrote:
From: Thomas Beale
Subject: Re: Revision of Instructions - clinical implications
To: openehr-clinical at openehr.org
Date: Saturday, 10 December, 2011, 16:49
Instruction defines
Further: an Instruction might not get performed at all. But you want a
record of it anyway.
- thomas
On 10/12/2011 16:49, Thomas Beale wrote:
> Instruction defines what Activities should be performed. Actions record
> the execution of those activities, which might not be exactly the same
> as w
would it be wrong to say instruction = request; action = response ?
On Sat, Dec 10, 2011 at 4:49 PM, Thomas Beale <
thomas.beale at oceaninformatics.com> wrote:
>
> Instruction defines what Activities should be performed. Actions record
> the execution of those activities, which might not be exac
Instruction defines what Activities should be performed. Actions record
the execution of those activities, which might not be exactly the same
as what was ordained. So Instruction = intended; Action = actual.
- thomas
On 10/12/2011 16:00, S JAGANNATHAN wrote:
> Isn't 'Instruction' itself an a
On 10/12/2011 15:44, Ian McNicoll wrote:
>
> I am not totally comfortable with this approach, since it feels to me
> as if we are asserting that the original order was incorrect. This
> would obviously be ok if we were indeed correcting an order which had
> never been actioned but for a valid, acti
There is a discussion on the technical lists about handling
INSTRUCTIONS and subsequent ACTIONS in openEHR. Heather Leslie has
provided an excellent explanation of the process but there is one
comment that I feel merits some further clinical discussion.
"But: how is that change of the Instruction
Hello
I think I have asked this question before. I always wondered why
'instructions' were separated from 'actions' as I thought an 'instruction'
was an 'action' too.
I really look forward to the answer to the question.
Many thanks.
Eunice
Eunice Bamgboye
-- next part -
Isn't 'Instruction' itself an action?
Jag
Dr. S Jagannathan
198 St Johns Road
Edinburgh
EH12 8SQ
--- On Sat, 10/12/11, Ian McNicoll wrote:
From: Ian McNicoll
Subject: Revision of Instructions - clinical implications
To: "openEHR clinical discussions"
Date: Saturd
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