1.Ambulant Visit

Ambulant visit is the use case where the patient visits the hospital without being admitted (= taken into care of the hospital or occupying a hospital bed).

Local EHR information in this section always holds the HOME MEDICATION as opposite to the admission where there is mention of HOME MEDICATION and ADMISSION MEDICATION.

Basic flow: Home medication EHR section is already in sync with Vitalink

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit of the patient) Vitalink medication scheme is imported.
2	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version that is already present in the EHR Home Medication. The EHR Home Medication section and Vitalink medication scheme are in sync.
3	OPTIONAL: Home medication EHR can be updated in the combined overview during the preparation for the ambulant visit Vx'.
4	OPTIONAL: Preparing of ambulant visit stops. The local medication scheme is now version 1'.
5	Start ambulant visit.
6	End ambulant visit. The caregiver made changes to the Home medication EHR. The Home Medication EHR is now Version 1".
7	The Home medication EHR version V1'' is exported to Vitalink. The Vitalink medication scheme now becomes Version 2.
8	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's in the EHR.
9	The Home medication EHR is now on Version 2 of the medication scheme. The Home medication EHR section and Vitalink are in sync.

Variant 1: There is no Home Medication data in the EHR

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit with patient) Vitalink medication scheme is imported.
2	There is no data in the Home medication EHR section so the EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically.
3	Vitalink send the latest version 1 of the medication scheme to the EHR.
4	The Home medication EHR is now also Version 1. The EHR and Vitalink medication scheme are in sync.
5	OPTIONAL: Local medication can be updated in the combined overview during the preparation for the ambulant visit to V1'.
6	OPTIONAL: Preparing of ambulant visit stops. The EHR holds now version 1'.
7	Start ambulant visit. Updates and changes are executed in the combined overview during the visit.
8	End ambulant visit. The caregiver made changes to the Home medication EHR section. The Home medication EHR is now Version 1".
9	The Version 1" of the EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 2.
10	Vitalink sends the updated identification code for each medication (URI's) back to the EPD. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's in the EHR.
11	The Home medication in the EHR is now Version 2. The EHR and Vitalink medication scheme are in sync.

Variant 2: Home Medication in the EHR is outdated vs. Vitalink medication scheme

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit with patient) The EHR holds the home medication version 1. The home medication section of the EHR is outdated versus Vitalink.
2	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically.
3	Vitalink send the latest version 2 of the medication scheme to the EHR. The Vitalink medication scheme is imported and updates, changes, etc are shown in a combined overview. The caregiver can validate/reject changes.
4	If you validate the Vitalink medication scheme, you keep to version 2 in your EHR. If you reject changes in the combined overview, the home medication section of your EHR will now hold Version 2' and is not in sync with Vitalink (because you have already made some changes to it).
5	OPTIONAL: Home medication in the EHR can be updated in the combined overview during the preparation for the ambulant visit to V2'.
6	OPTIONAL: Preparing of ambulant visit stops. The EHR holds now version 2'.
7	Start ambulant visit.
8	End ambulant visit. The caregiver made changes to the home medication in the EHR. The EHR holds now Version 2".
9	The home medication EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 3.
10	Vitalink sends the updated identification code for each medication (URI's) back to the EPD. The EHR requests Version 3 of the medication scheme from Vitalink to update the version and URI's in the EHR.
11	The Home medication in the EHR is now Version 3. The EHR and Vitalink medication scheme are in sync.

Variant 3: Vitalink medication scheme changes

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit of the patient) The home medication section of the EHR holds version 1 of the medication scheme
2	The EPD requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version that is already present in the EPD. The EHR and Vitalink medication scheme are in sync.
3	OPTIONAL: Home Medication in the EHR can be updated in the combined overview during the preparation for the ambulant visit to version 1'.
4	OPTIONAL: Preparing of ambulant visit stops. The EHR holds now version 1'.
5	Start ambulant visit.
6	In the meantime, a new medication scheme was uploaded to Vitalink by another Caregiver. The Vitalink medication scheme is now Version 2.
7	End ambulant visit. The caregiver made changes to the home medication in the EHR. The EHR holds now Version 1".
8	The Home medication of the EHR is exported to Vitalink. The export failed because the version of the medication scheme in Vitalink is more recent than the one in the EHR.
9	Since the EHR holds the master medication scheme version V1", the EHR has to provide an interface (= combined overview) in order to show medication changes between Version 1 and Version 2 of the Vitalink medication scheme and the home medication of the EHR Version 1". The caregiver can validate/reject changes. We recommend to show a notification that there is newer version of the medication scheme on Vitalink.
10	The caregiver can validate/reject changes. The EHR holds now version 2'.
11	The home medication of the EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 3.
12	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 3 of the medication scheme from Vitalink to update the version and URI's in the EHR.
13	The EHR holds now Version 3. The EHR and Vitalink medication scheme are in sync.

If the Vitalink medication scheme changes during the preparation of the ambulant visit and the person responsible notices,

he/she can download the new version of the medication scheme and take the needed actions (see Variant 2: Home Medication EHR is outdated vs. Vitalink medication scheme Step 2 - 4).

2. Admission

A hospital admission is the moment when a patient is taken being admitted to the care of the hospital. It means the hospital is in charge of the care of this patient. This admission can be only for a couple of hours (policlinical, day clinic, etc.) or for several days, weeks, months and thus include an overnight stay. There are also different types of hospital admission: the admission can be planned e.g. for a surgery or can be an unplanned (urgent) admission e.g. in case of a car accident.

EHR information in this section always holds the HOME MEDICATION and ADMISSION MEDICATION.

Medication during admission is never uploaded to Vitalink.

Basic flow: Home Medication EHR is already in sync with Vitalink

Situatie / Actie	Info
1	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version 1 that is already present in the EHR. The EHR and Vitalink medication scheme are in sync.
2	OPTIONAL: The home medication section in the EHR is possibly updated to Version 1' in preparation to become admission medication.
3	During admission, Admission medication (= medication during an admission in the hospital) A is determined. This admission medication scheme will hold relevant information from the home medication Version 1', possibly substituted to the clinical formularium.
4	During admission numerous changes (A to Z) can happen to the admission medication. These changes are local to the EHR and are not communicated nor affecting the Vitalink medication scheme.
5	At discharge, a new home medication scheme Version 1" is determined in the EHR, as much as possible re-substituted to the original medication of the patient at the start of the admission.
6	The home medication of the EHR version 1" is exported to Vitalink. The Vitalink medication scheme now becomes Version 2.
7	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's locally.
8	The EHR holds now Version 2. The EHR and Vitalink medication scheme are in sync.

Variant 1: There is no data in the home medication of the EHR UITTEKENEN

Follow "Ambulant Visit - Variant 1" until step 4.

Continue with Admission - Basic Flow starting from step 2.

Variant 2: Home Medication is outdated compared to Vitalink UITTEKENEN

Follow "Ambulant Visit - Variant 2" until step 4.

Continue with Admission - Basic Flow starting from step 2.

Variant 3: Vitalink changes during hospital admission

Situation / Action	Information
1	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version that is already present in the EHR. The home medication of the EHR and Vitalink medication scheme are in sync.
2	OPTIONAL: Home medication in the EHR is possibly updated to Version 1' in preparation to become admission medication.
3	During admission, Admission medication (= medication during an admission in the hospital) A is determined. This admission medication scheme will hold relevant information from the home medication Version 1 or 1', possibly substituted to the clinical formularium.
4	During admission numerous changes (A to Z) can happen to the admission medication. These changes are in the EHR and are not communicated nor affecting the Vitalink medication scheme.
5	At discharge, a new home medication scheme Version 1" is determined in the local EHR, as much as possible re-substituted to the original medication of the patient at the start of the admission.
6	However, in the meantime, a new medication scheme was uploaded to Vitalink by another Caregiver. The Vitalink medication scheme is now Version 2.
7	When the home medication in the EHR, version 1" is exported to Vitalink, the export will fail because the version 2 of the medication scheme in Vitalink is more recent than the Home medication scheme of the EHR, which was based upon version 1 of Vitalink.
8	However, the hospital EHR holds the master medication scheme. Therefor the EHR has to provide an interface (= combined overview) in order to show medication changes between Version 1 and Version 2 of the Vitalink medication scheme and the home medication of the EHR in Version 1". The caregiver can validate/reject changes. We recommend to show a notification that there is newer version of the medication scheme on Vitalink.
9	After validation/rejection, the home medication in the EHR is now version 2'.
10	The home medication of the EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 3.
11	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's in the Home medication.
12	The EHR holds now Version 3. The EHR and Vitalink medication scheme are in sync.

Variant 4. Discharge over the weekend

Often patients with a long admission in the hospital are allowed a stay during the weekend at home. In the hospital system this weekend stay is not seen as a discharge.
However, during this period, the medication for the stay at home is treated as in the case of a discharge after an admission. After the weekend home stay, actions are taken as if with a new admission.

This means that the admission medication will be transferred to the home medication.
Next the home medication will be validated & uploaded to Vitalink.
Often, a patient friendly medication scheme will be printed for the weekend home stay.
- Also from here it is possible to validate & upload the medication list to Vitalink (cfr. ambulant visit).
After the weekend, the home medication is normally not changed. However, a Vitalink sync will be done.
Next, the home medication will be transferred again to the admission medication.
When having a discharge over the weekend, medication is normally not substituted.
When having a final discharge, the medication is re-substituted as much as possible to the original medication.
In some cases, when having a discharge over the weekend, the admission medication is not transferred to the home medication.
- This means that no update of the medication will be available on Vitalink.
- This is only done when no mediation problems are expected.

3. Transfer to other hospital

A transfer to another hospital takes place when the patient, in view of his treatment, is moved to an other hospital for further treatment without a previous discharge in the first hospital.

Basic Flow

In the case medication (e.g. intravenal medication, hospital specific medication) is not uploadable to Vitalink, the medication is passed on to the receiving hospital via the transfer note.
This is because information during and related to an admission is often hospital-related and not adaptable to home medication as is the purpose of the Vitalink format.

4. Home hospitalisation

Home hospitalisation is the use case where a patient is actually admitted to the hospital but the treatment is provided to the patient in his home. This means that the patient is not physically staying in the hospital.

Notion! It is important to update medication during home hospitalisation to Vitalink in order to make sure that in normal care or emergency cases primary care workers can also see and/or intervene in the Vitalink medication scheme of the patient.

Variant 1: Home hospitalisation after admission

In this case a patient is receiving his hospital treatment at home after an admission in the hospital (= stay in the hospital), the use cases follows the same steps as an admission.

Variant 2: Home hospitalisation without admission

In the case a patient is receiving his hospital treatment at home without previous admission into the care of hospital (=no previous stay at the hospital), the use cases follows the same steps as the ambulant visit.

Legend

Symbol	Meaning
	The Home Medication EHR section is in sync with Vitalink.
	The Home Medication EHR section is not in sync with Vitalink.
	Admission medication.
	User action.
	User action that caused an error.
	Automatic action. No user input required.

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Use Cases Hospital Care