Introduction

This document contains UX guidelines that all medical software that use the Vitalink medication scheme should comply with.

All software packages should also comply with the UX guidelines for every software package in Vitalink found here.

Terminology & Abbreviations

A list of the terminology used in this document can be found here.

Combined overview: if a new Vitalink medication scheme is available for the patient, the medication lines from Vitalink are shown together with the medication lines from the local EMR. The origin of each medication line will be visually indicated as well as changes, additions or stops. Certain medication lines are displayed in a clustered way to clearly show the changes. After manipulation on the combined overview, it is this combined overview that will be uploaded to Vitalink. There are no two medication schemes (local vs. Vitalink), but one combined overview is shown in one medication scheme module of the EMR.

Abbreviated list: the combined overview of all active medications from the local EMR and Vitalink can be shown in an abbreviated manner by means of the abbreviated list (if there is a Vitalink medication scheme for the patient). The following information is mandatory shown: product name, dosage and posology (with underlying information about the date and remark if relevant). The intention is to show this abbreviated list in relevant places, eg on the dashboard / start page when opening the patient's EMR, on the right side of the work screen (sumehr, prescription module, ...).

Automatic questioning of Vitalink

See wireframes 2.1 - 2.4.

Mandatory

When opening a patient's EMR, it must be checked automatically if the registration of the informed consent & therapeutic relationship is fulfilled, if there is a Vitalink medication scheme for this patient and whether the EMR has the most recent version of the Vitalink medication scheme.

This automatic questioning is done for all patients as soon as their file in the EMR is opened.

An automatic questioning of the Vitalink medication scheme is crucial. The general practitioner should not take any action (eg no click to start a download).

Automatic import and analysis of the information from the Vitalink medication scheme in a combined overview should take a minimum of time (preferably 4 to 6 seconds or less on average, with a maximum of 10 seconds). 
This takes place in the background and starts immediately when the patient's medical record is opened. In the meantime, the GP can continue working in the EMR.
When the Vitalink medication scheme has been received, the GP can easily switch between his/her work screen and the medication scheme (eg through tabs or other interaction mechanisms). This may not take more than one click on the screen.

It is important that the vendor can monitor the performance in an active way if the automatic import and analysis of the information from the Vitalink medication schedule takes more than a pre-determined number of seconds (eg after more than 10 seconds). If, after an adjustable period of, for example, 60 - 120 seconds, a connection has not yet been established with Vitalink, the connection will be terminated automatically. The GP is hereby informed about the problem in a user-friendly and concrete way and should be able to send the error easily (ask for error report).

The GP must be able to clearly see whether or not a Vitalink medication scheme has been created for the patient. If not, the GP must be able to indicate that he/she wants to make use of the Vitalink medication scheme for the patient in question, if applicable.

The GP must be able to clearly see that the application is still working on importing the information from the Vitalink medication scheme.

The GP must be able to clearly see when the import of the Vitalink medication scheme has been completed.

The GP must be able to clearly see when the application has failed to import the Vitalink medication scheme.

Recommendations

• Display visually that the application is working on the Vitalink medication scheme.
  
  • This can be done, for example, by a progress indicator or an icon indicating that the Vitalink medication scheme is loading.
    
    
• Display visually that the Vitalink medication scheme has been collected.
  • This can be done, for example, by an icon indicating that all data from Vitalink has been retrieved (+ mandatory information: date & time of last download).
    
    
• If it is not possible to obtain data from the Vitalink medication scheme, also visualise it and indicate why there is a problem / what the problem is (in understandable language).

One combined overview of all active medication

See wireframes 2.1-2.4 and 3.1-3.4.

Mandatory

It is important that the GP has one overview of the active medication of the patient. Since information about the active medication can be found both in the local EMR and on Vitalink, the general practitioner wishes to see this information one combined overview.

The GP does not want to compare the information from the local EMR and the Vitalink medication scheme manually to determine what has changed. Comparing two different schemes is too time-consuming, too complex and can lead to mistakes. Methods where they can 'update' per line, 'upload' are not well understood. Rows in a table using different status icons can not be interpreted unambiguously.

The principle of a combined overview should be kept simple: provide only an indication 'what is on Vitalink'. 'What is in the local file'. Afterwards, the GP can take further decisions around this.

It is important that this combined overview is automatically displayed, clearly indicating what has changed with respect to the local EMR, any alerts concerning medication lines that may be a problem, etc.

In this phase of the flow it is not necessary to show the complete (combined) medication scheme. The presentation of an abbreviated list of the active medication on Vitalink and the active medication from the local EMR with at least the product name, dosage & posology is sufficient to give the general practitioner a first overview of any changes to medication since the last visit of the patient.

In addition, additional information must be provided with a 'mouse-over' action on the relevant medication line such as at least date information (if applicable: start / stop, from, to) and comments (if applicable).

The aim of this combined overview is that the GP can see at a glance what has changed since the last time he uploaded the patient's medication schedule himself (eg if other caregivers made any changes to it).

In principle, the GP would then have to make the necessary changes to the medication scheme before prescribing new medication (eg, returning to the previous posology of a particular medication, activating deleted medication, etc.).

He can also adjust this in the abbreviated list. The possibility should therefore be offered that the general practitioner can perform actions on the shortlist of the combined overview without having to open the complete medication scheme.

After obtaining the information from Vitalink, the GP sees who has validated the last Vitalink medication scheme and when.

The abbreviated list means the following:

• If after the automatic questioning it is determined that the active medication from the local EMR corresponds with the Vitalink medication scheme, no further action is taken.
  • Still, it remains valuable to see the active medication.
  • Showing a short list with at least the product name, dosage & posology is sufficient to give the general practitioner a first overview of all active medication or any changes.
  • For example, a tooltip with a 'mouse-over' action shows additional information such as a start or stop date and/or a note regarding the medication line. In the overview itself it can be indicated that there is additional information so that the GP knows which medication lines he/she can possibly carry out a 'mouse-over' action on.
  • With all medication lines the indication 'Vitalink' will be displayed so that the GP clearly knows that there is no difference between the local EMR and the Vitalink medication scheme.
    
    
• If, after the automatic questioning, it is determined that the active medication from the local EMR does not match the Vitalink medication scheme, one combined overview of all active medication from the local EMR and all active medication stored in the Vitalink medication schedule will automatically be shown.
  
  • The display of a list with at least the product name, dosage and posology is sufficient to give the general practitioner a first overview of any changes.
  • Draw attention to changes, new additions, inconsistencies in this combined overview.
  • Additional information such as a start or stop date and/or a note regarding the medication line is shown via, for example, a tooltip. In the overview itself it can be indicated that there is additional information so that the GP knows which medication lines he/she can possibly carry out a 'mouse-over' action on.

• Draw attention to changes, new additions, inconsistencies in this combined overview.
  
  
• Visualise clearly which medication line comes from where (Vitalink vs. local). A medication line from Vitalink has the Vitalink icon displayed. A medication line from the local EMR is displayed without an icon.
  
  
• Visualise changes in the following way:
  
  • Newly added medication with respect to the local EMR:
    
    • Emphasise this with a different background colour so that attention is drawn to it (note: people with colour blindness do see colour shades, so for them it is also visible that there is a difference of colour with the other lines).
  • Change in posology, intake moment, etc:
    
    • Cross out the medication line that has been replaced (in this way the GP clearly sees what he/she had prescribed and how this was replaced by medication prescribed by another health care provider).
    • Display the relevant medication line from the local EMR and the medication line from Vitalink in a clustered way (in this way the 2 'associated' medication lines are placed underneath each other, making comparison easier for the general practitioner). By keeping the unique URI once the mapping has been made, the connection between 2 'associated' medication lines can be better and faster verified next time. A 'reference algorithm' can be worked out for this.
  • Removal of prescribed medication:
    
    • Cross out the medication line that has been removed.
      
      
• The necessary changes (make the deleted medication line active again, change the modified posology to previous posology, etc) can be done by right-clicking on the relevant medication line or by clicking on an action button.
  
  • When the GP does nothing, he/she agrees with the overview of the active medication that he/she sees (deleted medication will disappear, adapted posology will be retained and the previous posology will disappear, etc) and at a next opening of the EMR it is shown as a local scheme.
    
    
• Provide the opportunity to display an alert:
  
  • With, for example, 2x same type of medication but with a different product name. These will also be displayed under each other for clustering.
  • For example, an incomplete medication line.
  • Give, for example, a tooltip after a 'mouse-over' action for the relevant medication line, more information about why there is an alert (eg incomplete medication line).

Recommendations

• Show interactions between medication lines through an alert.

Start Vitalink with one click

See wireframe 2.1.

Mandatory

If there is no Vitalink medication scheme present or not yet used, it must be possible to start the creation / use it with one click.

If it is indicated that there will be worked with Vitalink for this patient, the active medication from the local EMR will be shown in a combined overview with the medication from Vitalink if a Vitalink medication scheme already exists for this patient. If this is not the case, the active medication will be shown from the local EMR and will then be uploaded to Vitalink, if necessary/applicable.

The GP must be able to see at all times that a Vitalink medication scheme is available for the patient.

When in the settings of the application it is stated overarching to work with Vitalink, the data of the Vitalink medication scheme is automatically retrieved and thus shown in the combined overview.

Recommendations

• If starting with the creation of a Vitalink medication scheme, it is important that all active medication is automatically uploaded from the local EMR to Vitalink.
  • It is not the intention that the GP will transfer all medication lines manually, line by line.
  • Afterwards, details of intake, comments, ... can be entered on the medication scheme itself.

Interactive/Dynamic medication scheme

See wireframes 4.1 - 4.5.

Mandatory

From the combined overview of all active medication it should be possible to open the complete medication scheme with the combined overview via one click.

Since this is a combined overview of information from the local EMR and information from Vitalink, it is important that it clearly shows when (date & time) and by whom the version of Vitalink was last modified.

Just like in the shortlist of the combined overview of the active medication, the general practitioner wants to see the following in the complete medication schedule:

• What has changed to the active medication of the patient?
• Information regarding changes, additions, deletion, ... of a medication line.

If the local medication scheme is made interactive, this should work bi-directionally (an adjustment of an intake moment on the medication scheme should lead to an adjustment in the list of active medication).

Recommendations

• The GP wants to see the following extra information per medication line:
  • Name of the health care provider who prescribed / adjusted the medication. This information is sent with the medication scheme to Vitalink. This gives added value to the interpretation of the scheme and in this way it is clear to other care providers which medication is prescribed by whom.
  • For which pathology is the medication prescribed? (not compulsory to enter during prescribing, but desirable).
    • The pathology should be selected in a quick way when prescribing medication. Preferably, the offered choice list prefers the diagnoses present in the EMR.

• In addition, the GP also has certain expectations regarding the visualisation and use of this medication scheme. The GP does not view this as a static page, but wants to use it for:
  
  • Adjusting intake moments: provide dynamic input fields to adjust the intake moments to the medication scheme itself (bi-directional operation).
  • Repetitive prescribing: provide check boxes to select one or more medication line(s) and prescribe one-by-one (the GP then has a complete overview of all active medication before prescribing repeatedly).
  • Removing a medication line: provide check boxes to select one or more medication line(s) and remove them with one click (this gives the GP a complete overview of all active medication before removal).
  • Adjusting a medication line: double click (or other action such as right-click) on a medication line leads to the prescription module where, for example, the posology can be adjusted.
  • Not showing a medication line on Vitalink (by default, everything is on 'show on Vitalink').
  • Adding a note: provide a dynamic input field to enter a comment on a medication line (in this way the comments field will be used more and better).
  • Adding new medication: provide an action button to start the flow to add new medication (this gives the GP a complete overview of all active medication before prescribing new medication).
  • To upload the complete medication scheme to Vitalink (validate).
  • Placing the medication scheme on a 'to do' list for later upload to Vitalink (delayed validation).

• In addition to the name of the health care provider, show the specialty of the health care provider who has added or adjusted a medication line if this is given via Vitalink.
  
  
• Make it possible to drag medication from the 'chronic' to 'temporary' or 'if necessary' category, taking into account the corresponding specifications for each of these categories (eg with regard to the end date).
  
  
• Visualise medication that was prescribed during the current consultation in a different way (icon and / or color).
  
  
• Showing the version number is less important for the GP, but can be interesting for a print version of the medication scheme or for other reasons.
  
  
• The GP wants to know possible interactions between medication lines.
  
  
• In some cases, the GP may want to adjust the order of the medication lines in the Vitalink medication scheme.
  
  • Make sorting possible on the columns of the medication scheme that is shown locally (eg alphabetically, per pathology (if indication is entered), per intake moment, most recently added medication on top (so also the last changes are at the top), chronic / temporary /If necessary.
  • Visually indicate which column has been sorted.
  • Ensure that this representation is remembered when opening the Vitalink medication scheme for other patients.

Prescribe medication

Mandatory

Prescribed medication is automatically added to the medication scheme (combined overview), unless explicitly chosen not to. This means that the medication is entered via structured entry fields.

Visualise newly added medication in a different way in the medication scheme. In this way the GP has a clear overview of what will be added.

During the prescription of a medication, the GP must be able to indicate whether the medication may or may not be shown on Vitalink. By default, all medication is shown on Vitalink if the GP has indicated to work with Vitalink.

Recommendations

• If the GP decides to prescribe medication during the consultation, the shortened list of the combined overview (information derived from local EMR and from Vitalink) with product name, dosage, posology or the complete medication scheme (with the extensive combined overview) should be the base of the page on which they start when creating a prescription.
• On this prescription page it is important that the complete medication scheme can be opened with one click (if it is not already fully shown) or it can be displayed that the GP wishes to work with Vitalink (if this is not yet the case for the patient).
  
  

• With regard to prescribing itself, the focus should be on its speed. This can be done by focusing on the simple prescription flow, which can simplify the user interface.

  • Split the functionalities for easy prescribing vs. complex prescribing.
  • Place the complex prescribing module behind a button / link. This can then be reached via one extra click (this is not a problem since complex prescribing (weekly scheme, 'phasing out' scheme, etc.) occurs less frequently). Domus Medica or other GP associations can provide best practices with regard to good interfaces for complex prescribing.
  • Provide structured entry fields so that a one-off data input is possible (automatic transfer of data to the Vitalink medication scheme).
  • Provide standard posologies for frequently used medication.
  • Show the most frequently used dosage, administration unit, drug route, ... via eg radio buttons so that a quick selection is possible. Less used options can be included behind a choice menu (drop-down list).
  • Simplify working with templates to save frequently used prescriptions (eg provide two action buttons: Prescribe vs. Prescribe and save as template).
• Simplify the addition of indications / pathologies (pharmacists & patients are asking for this).

  • Provide quick selections / suggestions for indications / pathologies per medication. In this way, the GP can send the most current indication to the Vitalink medication scheme in one click. 

  • If the suggestion of indication / pathology does not match, the GP should simply be able to enter another indication / pathology as free text.

• The GP can indicate whether or not medication can be shown on Vitalink, both in the prescription module and on the interactive medication scheme (combined overview).
• Ensure that prescription by substance name is possible (this is then adjusted by a pharmacy in the Vitalink medication scheme to the generic variant).

Validate the Vitalink medication scheme

See wireframes 4.1 and 5.1.

Mandatory

After prescribing and completing the consultation it is important that the combined medication scheme is shown before validating and uploading.

This means that the GP must actively press the 'Validate medication scheme' button before the complete medication scheme is uploaded to Vitalink.

It may be desirable for some GPs to not show this medication scheme at the end of the consultation. When the EMR is closed, the medication scheme is automatically forwarded to Vitalink. If the GP has seen a clear overview of changes to the active medication in advance via the combined overview (on the start screen and / or on the prescription screen, ...), this can be sufficient. This should be adjustable for the GP. The responsibility for this lies with the GP.

The GP receives feedback on the upload of the Vitalink medication scheme when the patient's EMR is closed.

In the context of home visits it is necessary that the GP can download and open different Vitalink medication schemes in advance (= combined overview) in the EMR.

It must be possible at all times to be able to open the EMR, and consequently the Vitalink medication scheme of different patients at the same time (eg telephone contact with another patient during a consultation).

If the GP does not want the medication scheme to be uploaded to Vitalink now (will have to do it later) , he should have the option to validate later (put it on a 'to do' list) and to not validate it yet.

If the GP decides, at a later date, to validate this medication scheme, Vitalink must check whether the Vitalink medication scheme in the EMR is the latest version.

• This means that when opening an item from the 'to do' list, the relevant Vitalink medication scheme must be re-loaded.
• If applicable, a message should be shown that a more recent Vitalink medication scheme will be shown.
• The medication schemes that are 'to be validated later' must also be removed from the 'to do' list if they stay to long.

A medication scheme can not 'to be validated' for more than 5 number of days. This number of days must be parametrisable. Afterwards, the GP is obliged by a notification to validate the medication scheme (and is uploaded to Vitalink) or take another action (not validate).

In case of a home visit, the upload of the medication scheme to Vitalink will possibly take place later if there is no internet connection at that moment (the medication scheme is temporarily placed on a 'to do' list and when connected this medication schedule is automatically uploaded to Vitalink).

Recommendations

• The GP must be able to open the medication scheme (combined overview) at any time before closing the patient's EMR.
• It is important that the 'to do' list for later validation of medication schemes and uploading to Vitalink can be managed efficiently.
  

  • Provide the GP with a reminder functionality in which he/she can set up to be reminded within x time to validate the medication scheme on the 'to do' list and send it to Vitalink.

Visualisation of the print version of the Vitalink medication scheme

Mandatory

It should be taken into account that an official print version of the medication scheme for the patient is offered by Vitalink, it is thus not mandatory to develop an own patient print for your EMR. This print should be visualised on the screen by the GP & possibly the patient during the consultation, or be printed to give to the patient.

Click here for more in-depth information regarding the Vitalink medication scheme print.

How to handle mistakes

See wireframes 3.4 and 4.4.

Mandatory

If a medication scheme is removed from Vitalink and can not be fully visualised by the interpreting software package (eg if there is a problem with a medication line, posology or other), it is important to get as much information as possible on each medication line so that at least 'something' in the Vitalink medication scheme can be shown.

The GP who collects this 'incomplete' Vitalink medication scheme also wants to see as much as possible of the incomplete / incorrect information. If necessary, he/she can supplement the incomplete / incorrect / missing information from his/her professional expertise. 

If possible, as much of the information as possible should be retrieved from the medication line until the information can no longer be read (due to the corrupted construction) (eg if posology is still correct this can also be downloaded but for example the intake moments are not).

The rest of the information (from the corrupted construction) should be downloaded as 'free text' (shown in the comments field). In this way, the GP can supplement the Vitalink medication scheme as good as possible.

GPs are open to refilling this information again to the medication line; in any case it is better to have minimal information regarding the active medication of the patient than no information (eg now the complete Vitalink medication scheme is sometimes blocked by one corrupted medication line).

A medication line that lacks information must be displayed as an 'alert' so that this clearly stands out in the combined overview. More information about the error is given at mouse-over or click on the medication line.

When at the end of a consultation the medication scheme can not be uploaded to Vitalink, GPs often receive error messages that they do not understand.

It is important that the GP is well informed why the medication scheme can not be uploaded to Vitalink. Inform the GP in a targeted and concrete manner. Avoid technical error messages (translate the return code and show the technical error message only after the error message that is formulated in an understandable way). For example:

• "The Vitalink medication scheme can not be uploaded. There is an error in the medication line medication x."

• "The Vitalink medication scheme can not be uploaded. There is currently no connection possible with Vitalink."

Recommendations

• Provide sufficient functional & technical tests to prevent bugs.
• Ensure that the GP can complete the information in an easy way.