Currently the ehr_im specification requires ism_transition required for class ACTION. This seems to be an issue for so called ad hoc ACTIONs, i.e. ACTIONs that have no INSTRUCTION. If this attribute is required, the software needs to supply a value of ism_transition every time when an ad hoc ACTION is recorded. The semantics of ism_transition attribute of ad hoc ACTION is not well explained in the specs and it seems too restricted to set an explicit value, e.g. COMPLETED for ism_transition of ad hoc ACTIONs.