Introduction

This document contains UX guidelines that all medical pharmacy 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.

Automatic questioning of Vitalink

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.

An automatic questioning of the Vitalink medication scheme is crucial. The pharmacist should not take any supplementary 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 pharmacist can continue working in the EMR.
When the Vitalink medication scheme has been received, the pharmacist can easily switch between his/her work screen (delivery screen, ...) and the Vitalink 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 pharmacist is hereby informed about the problem in a user-friendly and concrete way and should be able to report the error easily (ask for error report).

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

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

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

The pharmacist 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).

Delivery of medication

See wireframe AP 3.0.

Mandatory

When the pharmacist scans medication, it is shown in the delivery screen of the EMR. It is visually shown whether or not the scanned medication is included in the Vitalink medication scheme (if the patient has a Vitalink medication scheme and the registrations with regard to informed consent and therapeutic relationship are in okay).

Scanned medication is automatically added to the medication scheme (please note, this does not mean an automatic validation of the medication scheme, the validation must be done explicitly by the pharmacist afterwards). The pharmacist can then decide for himself if he/she does not wish to include the medication in the Vitalink medication scheme. The pharmacist can also decide which self-care medication and OTC products are / will not be included in the medication scheme.

• Show for each scanned medication line whether the medication (or OTC product) is already included in Vitalink.
  
  
• Scanned medication is automatically set to 'record in Vitalink medication scheme'.
  
  
• Provide the option of not including scanned medication in the Vitalink medication scheme.
  
  
• Provide the opportunity to add extra information at any time to the scanned medication that flows to Vitalink.

The pharmacist must be able to switch between the delivery screen and the combined overview of all medication via one click. This is possible via tabs and / or possibly a keyboard shortcut.

In addition to quickly switching between the delivery screen and the combined overview, the pharmacist must also be able to deliver medication quickly. Double work such as entering the posology twice and other repetitive entry of data should be avoided (eg in the case of entering posology for medication scheme and the printing labels). It is mandatory to comply with the one-time entry of data.

Recommendations

• Show by means of an icon or a label whether the medication has already been included in Vitalink or not.
  
  
• The pharmacist must be able to decide for himself whether he/she wants to see the delivery screen when scanning medication or the screen with the Vitalink medication scheme.
  
  
• In order to be able to deliver faster and more efficiently, the possibilities for input of posology and intake moments need to be improved (see Group 1, 2 & 3 below).
  
  • Provide structured entry fields.
  • Provide pre-filled information where possible. Therefore create, for example, groups of medication:
    
    • Group 1: Medication with always fixed posology & intake moment & shape.
      
      • When this medication is selected: give default value for posology, intake moment & form (but make sure that this can be easily adjusted).
    • Group 2: Medication with fixed intake moment & shape.
      
      • When this medication is selected: give default value for intake moment & shape (but make sure that this can be easily adjusted).
      • Also make sure that the most used posologies are easy to select (eg show 1x / day, 2x / day, 3x / day as radio buttons (selectable via one click), and display the other options via a drop down menu).
    • Group 3: Medication that is always variable.
      
      • As described above, give the most used posologies, intake moments and shapes in a way that they can be selected with one click (buttons, radio buttons, ...).
      • Provide a 'more' button in which multiple selection options of posology, intake moment, ... are displayed.
    • This remark also applies to indication / pathology.

• Focus on simple input. If a complex entry is necessary, it is no problem that the pharmacist has to carry out an extra click for this.
  
  
• Simplify working with templates to save frequently used intake moments, ... (for example, provide 2 action buttons: 'Add' vs. 'Add and save as template').
  
  
• Integrate input for delivery, medication scheme and creating labels for the medication. It is not desirable that the pharmacist should enter this 2x or 3x. These may not be separate modules. It must always start from a structured data input.
  
  
• Analyse the information on the delivery screen. Which information is primary? Which information is secondary (and therefore not a problem if the pharmacist has to click to retrieve this information)?
  
  • By reducing the number of columns in the delivery screen, the medication scheme could possibly be integrated in the delivery screen.
    
    • If this is not possible, a switch by means of a single click between the delivery screen and the medication scheme remains a requirement.
    • If this is possible, calling up the medication scheme remains a prerequisite (without additional information from the delivery screen).

One combined overview of all active medication

See wireframes AP 3.1 - 3.4.

Mandatory

It is important that the pharmacist has one overview of the active medication of the patient. Since both information about the active medication can be found in the local EMR and on Vitalink, the pharmacist wishes to see one combined overview. This overview must be shown on the first working screen of the application.

The pharmacist 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 pharmacist can take further decisions around this.

It is important that this combined overview is displayed automatically, clearly indicating what has changed with respect to the local EMR, any alerts regarding medication lines that may be a problem, etc.
The purpose of this combined overview is that the pharmacist can see at a glance what has changed since the last time he uploaded the patient's medication scheme.

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

Concretely, the combined overview means the following:

• Draw attention to changes, new additions, inconsistencies in this combined overview.
  
  
• The list of medication stored in the local EMR can continue to exist, but the focus should be on the combined overview of information from Vitalink and information from the local EMR.
  
  
• 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 color so that attention is drawn to it (note: people with color blindness do see color shades, so for them it is also visible that there is a difference of color with the other lines).
  • Change in posology, intake moment, etc:
    
    • Cross out the medication line that has been replaced (in this way the pharmacist clearly sees what has changed).
    • 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 pharmacist). 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 pharmacist 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 AP 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.

The pharmacist 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 pharmacist will transfer all medication lines manually, line by line. All products in the recent delivery history must be able to be transferred to the medication scheme in one go, whereby as much information as possible is filled in automatically and the pharmacist only has to add the 'missing' or 'to be validated' information.
  • Afterwards, details of intake, comments, ... can be entered on the medication scheme itself.
    • The transfer of the products from the recent delivery history in one go assumes that after the transport in the interface it is indicated on which medication lines there is still missing information that the pharmacist must complete.
    • All medication lines remain customisable.

Interactive/Dynamic medication scheme

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.

The pharmacist wants to see the following in the complete medication scheme:

• 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 pharmacist 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. This will usually be entered by the general practitioner).

• In addition, the pharmacist also has certain expectations regarding the visualisation and use of this medication scheme. The pharmacist 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).
  • Removing a medication line: provide check boxes to select one or more medication line(s) and remove them with one click (this gives the pharmacist 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 delivery module where, for example, the intake moments 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).
  • 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 delivered during the current delivery in a different way (icon and / or colour).
  
  
• Showing the version number is less important for the pharmacist, but can be interesting for a print version of the medication scheme or for other reasons.
  
  
• The pharmacist wants to know possible interactions between medication lines, but not all possible interactions.
  
  
• In some cases, the pharmacist 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.

Validate the Vitalink medication scheme

See wireframe AP 4.1.

Mandatory

Pharmacists state that if they have final responsibility for the uploaded of the Vitalink medication scheme, they want to see the full Vitalink medication scheme (combined overview) before uploading the scheme.

This means that if they choose to see the medication scheme when scanning medication or actively go there, they can press a 'Validate Vitalink medication scheme' button (or a 'Validate Vitalink medication scheme later' button).

The pharmacist can choose whether he/she is validating at that time or is not yet doing anything and is waiting for the creation of the bill.

On the screen regarding the creation of the bill, the pharmacist must be able to call up the medication scheme and then validate or validate it without opening it (when the pharmacist has already checked the Vitalink medication scheme during the delivery).

In case of a complicated medication scheme, the pharmacist must be able to place the medication scheme on a 'to do' list so that it can be analysed in detail later and then uploaded to Vitalink. So a 'validate later' button must be present.

The combined overview of the medication scheme is always accessible with one click (eg via switching between 2 tabs) and is therefore never closed.

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

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

If the pharmacist 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.

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

Recommendations

• It is important that the 'to do' list for later validation of medication schemes and uploading to Vitalink can be managed efficiently.

  • Provide the pharmacist 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

t 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 wireframe 3.4.

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 'something' in the Vitalink medication scheme can be shown.

The pharmacist who collects this 'incomplete' Vitalink medication scheme also wants to see 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 pharmacist can supplement the Vitalink medication scheme as well as possible.

Pharmacists are open to refilling this again; 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 pharmacy visit the medication scheme can not be uploaded to Vitalink, pharmacists often receive error messages that they do not understand.

It is important that the pharmacist is well informed why the medication scheme can not be uploaded to Vitalink. Inform the pharmacist 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 pharmacist can complete the information in an easy way.