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MnM call 20060605:
There were discussions at the last few HL7 modeling harmonization = events=20 regarding a revision on the way we think about acts.
Here is a fragment of the Act = Definition:=20
Acts are the pivot of the RIM; all domain information and processes = are=20 represented primarily in Acts. Any profession or business, including = healthcare,=20 is primarily constituted of intentional actions, = performed and=20 recorded by responsible actors. An Act-instance is a record of such an=20 intentional action. Intentional = actions are=20 distinguished from something that happens by forces of nature (natural = events).=20 Such natural events are not Acts by themselves, but may be recorded as = observed=20 (Observation).
Some questions that came up are:
Snake bites and bee stings are "intentional acts." The bee decides to = give=20 its life to defend the hive, and the snake not only decides to bite, but = to=20 envenomate, as well. ...pete gilbert
The Proposal has been to remove the requirement for Acts to be called = intentional, and instead say that a snake bite can be called a substance = administration, someone stabbing me with a knife is performing an Act, = and a=20 gun-shot hitting me in a cross-fire is also an Act. Car accident is an = act as=20 well and so is me being hit by a lightning strike.
So, all distinctions between acts that are ordered scheduled and = billed for=20 vs. those events of nature would go away. When the Act class was still = called=20 "Service" this kind of change was unthinkable, now it is a notion that = is=20 seriously entertained.
The reason why people want this change is that it allows them to use = the Act=20 attributes and participations (time, performer, etc.) to describe any = incident=20 just like acts.
The downside of this is that it causes a great shift in the modeling = of=20 Observations. In the past, people would use Observations to describe = events of=20 nature, and unintended incidents such as gunshot wounds or car accident=20 injuries. In fact there is still a sizable group of people who would = like to=20 think of procedure history (e.g., appendectomy 20 years ago) as an = Observation=20 in a collection of "patient history" Observations. I think the RIM was = trying to=20 make that appendectomy a Procedure regardless of whether it is recent = and known=20 from first hand reports or if it is only known through patient = recollection or=20 even hearsay. But now we would be moving even more information items = that used=20 to be understood as Observations over into being other specific Acts = such as=20 Procedures or SubstanceAdministrations.
If we are to move forward and allow snakebites, gunshots and = swallowing=20 poison to be fully represented as Acts, rather than just Observations, = we need=20 to come up with some guidelines. Specifically, we need to answer the = following=20 questions:
1. Are there some things that should always be modeled as Acts, and = never=20 Observations (keeping in mind that Observations are a type of Act)?
2. Are there some things that should be modeled as Observations and = never as=20 discrete Acts?
3. Are there some things that can appropriately be modeled either = way, and if=20 so, what's the criteria for deciding which approach to use?
4. Might there be circumstances where we would want both an = Observational and=20 an 'Act' view of the same event in an instance, and if so, how do we = model the=20 relationship between them?
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