From a clinical standpoint, “Active Orders” is a very common concept. Active Orders represent all orders that have been placed on a patient’s chart that have not been discontinued or expired. This would include any orders that are scheduled in the future. For example, all these would be considered active orders:
- aspirin 81 mg - one tab by mouth daily.
- vitamin D - take 50,000 units by mouth each Sunday.
- chest x-ray - for shortness of breath tomorrow morning.
- hematology referral - for unresponsive anemia. patient scheduled for 12-Aug-2016 at 9am.
“Activated” means that the order could be carried out. It distinguishes from a “pending” or “draft” order (which we don’t currently support; with the current design, all orders are activated when saved).
“Active” represents any activated order that has not been discontinued or expired.
I believe we have used “Started” to distinguish between active orders scheduled for the future versus already underway.
We will not always be guaranteed a clean signal of when orders are being applied to the patient or when they are completed. We will have these details in the happy path, where every aspect of the order’s life cycle are performed within the same system; however, many orders are carried out across multiple systems & workflows. For example, an order for a lab test may be printed and carried out through a separate system without a reliable signal when/if it is completed, there may be no signal when/if a referral is completed, etc. In these cases (where we don’t have reliable closed loops), we use business rules to decide when orders should be auto-expired. A crude approach that covers 80% or more cases is prescriptions without an computer-understandable duration don’t auto-expire (i.e., remain active until discontinued) and tests auto-expire after 24 hours.