I have been checking the discontinue order functionally and found this feature which always clones the order to break into a new order. I was just wondering why we implemented it that way. What was the rationale for doing this at the time? I need to be guided on whether this was intentional or its something that can change Thanks
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The reason for treating discontinue orders as a separate order (rather than simply discontinuing an active order) was because the order to discontinue something is itself a request and, may need to go through a workflow just like any other request.
When OpenMRS is running by itself and you are using very simple workflows, the idea of treating “stop doing X” as an order itself seems unnecessary – i.e., why not just stop X in the database and be done with it?
When you consider OpenMRS as an EMR in a real world system, either running alone or integrating with other systems at scale, stopping X (whether a nursing instruction, a drug, a lab test, etc.) may involve a workflow that requires multiple people or systems to be carried out. For example:
Your patient is getting an insulin through an IV to treat their diabetic ketoacidosis (a potentially life-threatening condition when a type 1 diabetic patient has not gotten any insulin and their sugars get out of control). Your patient has responded well and her sugar has normalized and the associated acidemia (acid in blood) has resolved, so you stop the IV insulin. Now lets consider two approaches…
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Orders are just stopped in the system when discontinued. You stop the insulin and find out a few hours later that your patient has died. Why?!? You discover that you stopped the insulin, but the nurse didn’t notice the change and the insulin wasn’t stopped before your patient’s sugar went fatally low.
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Discontinuing something requires a new “discontinue” order. You stop the insulin. An hour later, you notice that your order to discontinue the insulin has not been completed by the nurse. You contact the nurse and find out he hadn’t noticed your order. Fortunately, the insulin is stopped in time and your patient lives happily ever after.
This is a dramatic example. Another example is when the request to stop an existing order needs to be sent to other (non-OpenMRS) systems and you want to record confirmation that the discontinuation request has been fulfilled by the external system.
It’s feasible that we could come up with another approach to ensure that discontinuation of orders is properly handled & confirmed. Treating the request to discontinue an order the same as any other change request (changing a dose of medication, etc.) seemed like the simplest approach to ensure that the request to stop something could go through the same workflow (whether completely within OpenMRS or involving electronic or non-electronic steps outside of OpenMRS) as any other order.
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