We have come across situations with activities that continue across contacts. This can be either expected (as in cronic conditions) or by convenience (the patient re-arrives after some days and we need the same activities). In both cases it is desired that the activities are closed (=COMPLETED) when the patient is discharged, for a variety of reasons. For both ease of use and for better history tracking it is desirable on re-arrival of the patient to be able to just continue existing activities rather than go through a new order session to create new instructions with (some or all of) the same activities.
So we suggest a new transition "re_start" that takes an activity from a final state back to active state:
COMPLETED -> re_start -> ACTIVE
Our current need does not involve ABORTED, but it seems reasonable to consider whether the same should be available there for completeness.
Possibly similar for CANCELLED, but that would in any case be a different transition (re_initiate?).
Why not use SUSPENDED and a CAREFLOW_STEP which covers the semantic of such a clinical decision?
well normally, 'suspend' is a clinical decision that the patient can no longer have this medication or treatment at the moment, e.g. aspirin and other anti-coagulants will be suspended for surgery etc. This case I understand to be where the patient no longer needed the medication, but later on did, and the original order was still active/usable.
This is the same as continuation or adjustment of a dose. The way to handle this is to issue a new request based on the previous and start the new activity. You might want to add a order_id or some other identification to tell that the INSTRUCTION is correlated or a follow up from a previous one.
For some activities, e.g. medication, completing and continuing are definite clinical decisions for which the “overhead” of a new request is fine. For some activities going on in a careplan we find this to produce “overhead” that feels very unnecessary. The request is to open up for some pragmatism in the modelling, where judged appropriate. In fact, in some situations the suggested approach seems to even match better with how users actually think of it.
Absolutely. Just made a care flow step which matches the intention with the corresponding state (completed or suspended).
I am on this topic because we have seen the same need on Taskplan. We've found the need to be able to actually close some processes as opposed to hibernate or suspend it.