Introduction

The wireframes below have been created based upon observations in several Flemish hospitals.
The observations were based on the use of the home medication throughout the hospital practice.

UX GUIDELINES - Requirements

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

Access to medication information

Access to medication information in a hospital is unlike in primary care, not regulated by governmental guidelines. Each care organisation, including hospitals, are allowed to import and export Vitalink medication via the principle of circle of trust. It is thus up to the hospital security policy to allow hospital staff access to medication information or not. This means that the hospital security management can determine if e.g. administrative staff of a hospital department, a pharmacy assistent has access to the Vitalink information. 

Automatic questioning of Vitalink

• When opening a patient's EHR, it must be checked automatically if the registration of the informed consent is fulfilled, if there is a Vitalink medication scheme for this patient and whether the EHR 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 EHR is opened, independent what the reason for hospital visit is (ambulant visit, emergency room visit or admission).
• An automatic questioning of the Vitalink medication scheme is crucial. The care giver should not take any action (eg no click to start a download).
  
  
• The CG must be able to clearly see whether or not a Vitalink medication scheme has been created for the patient.
  • If not, the CG 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 CG must be able to clearly see that the application is still working on importing the information from the Vitalink medication scheme.
• The CG must be able to clearly see when the import of the Vitalink medication scheme has been completed.
  • Always mention the date & time of the last validation since this is useful to the CG to validate the validity of the Vitalink medication scheme.
  • Other information like date & time of last download, validator, version ... can be visualized via a tooltip (if not enough screen space).
• The CG must be able to clearly see when the application has failed to import the Vitalink medication scheme.
• In the case of a hospital, if all mandatory authorizations/mandates are set, it must be possible for a member of administrative staff to prepare the EHR by importing the medication scheme for the patient in question.

• 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 CG can continue working in the EHR.
  
  
• When the Vitalink medication scheme has been received, the CG 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 CG 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).
   

• 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 update of the Vitalink medication scheme).
• 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

• It is important that the care giver has one combined overview of the active medication of the patient. Since information about the active medication can be found both in the local EHR and on Vitalink, the CG wishes to see this information in one combined overview. 
  • The CG does not want to manually compare the information from the local EHR and the Vitalink medication scheme 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 aim of this combined overview is that the CG can see at a glance what has changed since the last time he/she uploaded the patient's medication scheme (e.g. if other caregivers made any changes to it).

• The principle of a combined overview should be kept simple:
  • Provide an indication 'what is on Vitalink' and 'What is in the local EHR'.
  • It is important that this combined overview is automatically displayed, clearly indicating what has changed with respect to the local EHR, any alerts concerning medication lines that may be a problem, etc.
  • Draw attention to changes, new additions, inconsistencies in this combined overview.
  • Afterwards, the CG can take further decisions related to these medication lines (e.g., returning to the previous posology of a particular medication, re-activating deleted medication, etc.) in an ambulant setting or starting the hospital medication in case of an admission.

• The combined overview of the active medication (medication coming from Vitalink + medication of the EHR) should be visualized in a scheme view as well as in a list view. 
  • It should depend on the user's preference in which view the active medication will open.
  • It is very important that the CG can have a hour view of the medication scheme.

• The CG should be able to make changes directly into the medication scheme. Such an interactive medication scheme would allow to easily change the posology, intake moments, comments, ...

• It should be possible to sort the medication lines via ATC code, CNK code, alphabetical, ...
• Make it also possible to sort on a column.
  • Visually indicate which column has been sorted.
• Ensure that this representation is remembered when opening the Vitalink medication scheme for other patients.

• In some cases it is not necessary to show the complete (combined) medication scheme.
  • When the CG would like to have a global overview on the patient, the software can show an reduced combined overview of the active medication, e.g. an abbreviated list. This can be used on the homepage of the patient file, on a dashboard page, ...
  • The presentation of an abbreviated list of the active medication on Vitalink combined with the active medication from the local EHR should display at least the product name, dosage & posology.
  • In this way, the care giver has a first overview of any changes to medication since the last visit of the patient.
  • In this reduced combined overview, it is also visible which medication line is coming from Vitalink & which medication line is coming from the local EHR.
  • In addition, additional information must be provided via a tooltip or fold out action (if applicable: start / stop, from, to) and comments (if applicable).
  • The CG can also adjust medication lines in the abbreviated list. The possibility should therefore be offered that the caregiver can perform actions on the reduced list of the combined overview without having to open the complete medication scheme.

• Visualize changes in the following way:
  
  • Newly added medication with respect to the local EHR:
    
    • 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).
    • Display a textual label indicating 'new'.
    • Display an icon, indicating that the related medication line of coming from Vitalink.
  • Change in posology, intake moment, etc:
    
    • Strike through the medication line that has been replaced (in this way the CG 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 EHR and the medication line from Vitalink in a clustered way (in this way the 2 'associated' medication lines are placed underneath each other, making the comparison easier for the CG).
    • 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:
    
    • Strike through 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 e.g. using a drop down menu or by having a shortcut (buttons / links) on the related medication line.   
  
  • When the CG 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).
  • At a next opening of the EHR it is shown as a local scheme.
    
    
• Provide the option to display an alert or notification:
  
  • This can be the case when, for example, 2x same type of medication is displayed but with a different product name. 
    • Make sure that these medication lines are grouped/clustered.
    • Next, provide an alert on these medication lines.
  • This can be the case when there is an incomplete medication line.
    • Make sure that it is pointed out that the medication line isn't complete.
    • Aks, via an alert / notification if the CG can complete the medication line. 
  • An alert or notification can be an icon or textual 
    • Via a tooltip, more information can be provided.

• The CG 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 EHR.

• In addition, the CG also has certain expectations regarding the visualization and use of this medication scheme. The CG 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 GP a complete overview of all active medication before removal).
  • Adjusting a medication line: click on edit icon or link of medication line will lead 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 CG a complete overview of all active medication before prescribing new medication).
  • To upload the complete medication scheme to Vitalink (validate).

• 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).
• Visualize 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 CG, but can be interesting for a print version of the medication scheme or for other reasons.
  
  
• Show interactions between medication lines through (e.g. via an alert).

Start Vitalink with one click

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

Prescribe

During an ambulant visit

• 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.
• Visualize newly added medication in a different way in the medication scheme. In this way the CG has a clear overview of what will be added.
• During the prescription of a medication, the CG 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 CG has indicated to work with Vitalink.

• 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).
• While prescribing, the CG should be able to indicate that he/she would like to starting working with Vitalink (if there isn't yet a Vitalink medication scheme). 
  
  

• 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.
  • 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.

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

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

• The CG 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).

During a hospital stay

• Make sure that it is easy & quick to substitute home medication with hospital medication.
• The home medication should be remembered since it is important for the re-substitution to home medication afterwards. 
• New prescriptions made during a hospital stay are not uploaded to Vitalink.
• Only if they stay applicable for the home medication, they will be validated and uploaded to Vitalink when discharging the patient (of when having a weekend at home during a hospitalization). 

Validate & upload to Vitalink

• After prescribing and completing the consultation it is important that the combined medication scheme is shown before validating and uploading.
• This means that the CG must actively press the 'Validate & update Vitalink' button before the complete medication scheme is uploaded to Vitalink.
  • This can be done at the end of the consultation, but also after prescribing medication. 

• When the active medication isn't validated & updated to Vitalink when the CG is closing the patient file, the EHR should show a notification (screen overlay), indicating that the active medication isn't yet validated & uploaded to Vitalink. 
  • The CG can check the medication scheme and validate & update Vitalink (1 click).

• When printing the patient friendly medication scheme for the patient, it must also be possible to Validate & Update Vitalink as from there.

• If Vitalink is still syncing, and when the CG wants to continue, he/she should be able to 'Validate' the active medication.
  • This is an internal validation (within the EHR).
  • This means also that the CG has seen only the local EHR active medication.
  • No upload to Vitalink will be done.

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

Visualisation of the print version of the Vitalink medication scheme

• 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 EHR. 
• This print should be visualised on the screen. In this way, the CG & patient can go through it together.  
• When printing the patient friendly medication scheme, it must also be possible to 'Validate & update Vitalink'.
• Print version of the Vitalink medication scheme:  in-depth information regarding the Vitalink medication print.

How to handle mistakes

• If there is a problem with a medication line on Vitalink, the software of the EHR should notify the CG about this. 
  • When having a Vitalink medication scheme with an incorrect medication line, it is important not to block the entire Vitalink medication scheme, but to alert to CG about it & ask to reinterpret the corrupted medication line.
  • It is important to get as much as information as possible on this 'incorrect' medication line. 
  • Even full text is better than nothing.
  • In this way, at least something can be displayed.
  • Next, the CG can update the medication line(s).

• Example: when importing the Vitalink medication scheme, and when having a medication line with issues, there should be as much as information as possible retrieved from the medication line until the information can no longer be read (due to the corrupted construction).
  • Eg if the posology is still correct this can be downloaded but it is not possible anymore to download correct information for the intake moments).
  • The rest of the information (from the corrupted construction) should be downloaded as 'free text' (shown in the comments field).
  • In this way, the CG can add the missing information to the active medication and upload it towards Vitalink.

• CGs are open to complete this information 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, CGs often receive error messages that they do not understand.
  • It is important that the CG is well informed why the medication scheme can not be uploaded to Vitalink.
  • Inform the CG 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 which 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."

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

WIREFRAMES

1.Reduced combined overview

Example of a dashboard page, visualizing the active medication of the patient. The system is still working on the sync with Vitalink.

• It can be useful to have on the homepage / dashboard page of the patient file of the EHR a reduced / abbreviated list of the active medication.
  • In this way, the healthcare professional can see in a glance, when opening the patient file, some basic information on what medication the patient is taking & what the changes are regarding to the last visit of the patient.

• This reduced list of active medication should also present to combined overview of the active medication of the EHR & the medication coming from Vitalink. 
  • The software / user can decide which information is useful to shop in such a reduced combined overview. 
  • It is recommended to display at least the product name, dosage & posology.

• This reduced combined overview will work in the same way as the complete combined overview.
  • In the wireframe, it is visible that the local active medication is visualised. In the meantime, the system is syncing with Vitalink (automatically).
  • It is clearly indicated that the system is working on the sync with Vitalink.

Example of a dashboard page, visualising the combined active medication overview of the patient (Vitalink medication lines + local EHR medication lines).

• In this example, it is visible that the sync with Vitalink is completed.
• A reduced combined overview is displayed. 
• It is visible that on Vitalink one new medication line was added.
• It is visible which medication lines are coming from Vitalink (Vitalink icon).
• It is visible that 2 medication lines are only available in the local medication scheme.
• The section about 'If needed' medication is folded in.

• The healthcare professional should be able to do some actions (manipulations on the medication lines) as from here, or as from the complete combined overview).
  • It should be possible to go to the home medication module of the EHR with one click (e.g. by clicking on the title bar 'home medication').
  • If a sorting mechanism (e.g. on ATC class) is selected in the complete combined overview, the same sorting mechanism is used in this reduced combined overview.

Example of dashboard page, visualizing the admission medication when the patient is hospitalized. 

• When the patient is hospitalized, a 2nd tab or sub navigation 'Admission medication' should appear on the homepage / dashboard page: representing the home medication in a reduced way.
• When opening the EHR when the patient is hospitalized, this 'Admission medication' tab should be opened by default. 
  • The healthcare professional will be able to navigate to the Admission medication module of the EHR via one click.
  • When in the tab 'Admission medication', no Vitalink indication is visible. 
  • All medication lines coming from Vitalink are validated or rejected or edited by the healthcare professional before transferring the home medication towards the admission medication. 

2. Ambulant Visit

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

Example when the system is still working on the sync with Vitalink. 

• In this wireframe, the home medication of the local EHR is visible. 

• It is visible that the system is syncing with Vitalink (upper right corner).
  • This is done automatically, without interference of the healthcare professional.
  • It is important that the automatic sync starts when opening the EHR of the patient (and not only when opening the medication module of the EHR).
  • The healthcare professional should be aware that the system is syncing with Vitalink. Therefore it is recommended to use an icon and/or textual label expressing what the system is doing.
  • The sync can only be done with Vitalink if IC & circle of trust are OK.

• While syncing, the healthcare professional can do all actions in the medication module of the hospital software (add new medication, re-prescribe, transfer to admission medication, ...).
• It is possible to validate the active medication list of the local EHR; but preferably this is only done when the Vitalink data are synced with the medication data of the local EHR. 
• The automatic import and analysis of the information from the Vitalink medication scheme should take a minimum of time. Preferably 4 to 6 seconds or less; with a maximum of 10 seconds.

Example when the sync with Vitalink is completed. 

 Example when the latest validation was done by a general practitioner. 

Example when the latest validation was done by a specialist in an hospital (the hospital + name of the specialist will be visible). 

• When the sync with Vitalink isn't possible, it should be indicated that the sync couldn't be done successfully (status information). 
  • When doing a mouse over, more information about the failure should be provided via a tooltip. 
  • It should be possible to initiate a new sync with Vitalink. 

• When there isn't a Vitalink medication scheme for the patient, this should be indicated.

  • It should be possible to create a Vitalink medication scheme for the patient via 1 click.

  • When checking the check box in the example below, the medication list that is validated by the healthcare professional will be uploaded to Vitalink at the end of the contact.

    

• In the examples above, each time Vitalink is addressed as external source.
• If Réseau Santé Wallon is addressed as external source, the RSW icon & textual label should be used.

• If Réseau Santé Bruxellois is addressed as external source, the RSB icon & textual label should be used.

Example when the home medication of the EHR is in sync with the Vitalink medication scheme (Basic flow). 

• When the sync with Vitalink is done, it is visible in the wireframe that there is no difference between the home medication of the local EHR and the medication on Vitalink. 
  • If there would be a difference, the medication lines coming from Vitalink would be highlighted & labeled (cfr. next wireframes). 

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

Example when there is no home medication of the EHR. All medication lines are coming from Vitalink (variant 1). 

• When the sync with Vitalink is done, it is visible in the wireframe that all medication lines are coming from Vitalink. There was no home medication in the EHR.
  • It is visible that the medication lines are coming from Vitalink due to the highlighting colour, the icon & the label 'new'.

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

Example when the Vitalink data is displayed in a combined overview with the local EHR medication. Here it is visible that one new medication line is added via Vitalink (variant 2).

• In this wireframe, the combined overview is visible. This means that the home medication of the local EHR is visualized together with the Vitalink medication data. 
  • It is important that the user can see at a glance what is new (added), changed, stopped on Vitalink in comparison with the previous active medication in the local EHR that the healthcare professional has checked with the patient during a previous contact.
  • Medication lines that have no Vitalink icon are medication lines coming from the local EHR (in this case 3 medication lines).

• It is important that there is a visual difference between data from Vitalink vs. data from the local medication scheme of the EHR.
• In this example, it is visible that new medication was added on Vitalink.
• It is important that a changed medication, stopped medication, added medication is clearly indicated (here: the label 'new' is used in combination with the Vitalink icon) (cfr. next wireframe).
  
  
• List view vs. scheme view: the healthcare professional should be able to select the preferred view of the active medication list (combined overview).
  • The list view in the wireframe illustrates only an example. It should be adapted towards the needs of the healthcare professionals (extra columns, features, ...).
  • It is very important for healthcare professionals to have an hour scheme visualization. This means that the Vitalink data should be mapped on the hour scheme which will result in an hour medication scheme that the healthcare professional is used to.

• A 'Sort by' feature should provide sorting on alphabetical order, ATC class, CNK code, medication type (e.g. antibiotics), ... 
  • When using the sort feature, all items will be sorted in this way, each time within the section chronic, acute, if needed.

• There should be an action button/link to the print feature of the patient friendly medication scheme. 
  • Vitalink offers a central print functionality to print a medication scheme for the patient (cfr. guidelines about Vitalink print scheme).
• This combined overview should be enriched with features of the software (e.g. check on interactions, edit medication line, prescribe selection of medication, ...).

• Here, it is visible that a new medication line was added on Vitalink. 
  • This medication line is visualized in a combined overview with the medication of the local EHR.
  • This new medication line is highlighted to indicate that this is data coming from outside the EHR.
  • This new medication line receives an icon, indicating the source.
  • This new medication line receives a label (new), indicating that it concerns a new added medication line.

• When the healthcare professional agrees with the combined overview, he/she doesn't have to take any action.
• Only when the healthcare professional doesn't agree, action should be taken (cfr. next wireframe with drop down menu).

The Vitalink data is displayed in a combined overview with the local EHR medication. Here it is visible that one medication line is changed via Vitalink. One medication line is stopped via Vitalink.

• In this example, it is visible that one medication line has been changed on Vitalink. One medication line has been stopped.
  • These medication lines are visualized in a combined overview with the medication of the local EHR.

• For the changed medication:
  • This changed medication line is highlighted to indicate that this is data coming from outside the EHR.
  • This medication line is visualized closely together with the related medication line(s) that already existed in the local EHR.
    • This can be done based on the unique URI that each medication line has. 
    • This can be done based on the product name, substance name, ...
    • By doing so, it is easier for the healthcare professional to analyse and decide on the medication lines.
       
  • This changed medication line receives an icon, indicating the source.
  • This changed medication line receives a label (change), indicating that it concerns a changed medication line.
  • The medication line that is changed becomes 'strike through'.

• For the stopped medication: 
  • This stopped medication line is highlighted to indicate that this is data coming from outside the EHR.
    • The stopped medication line receives another colour to make sure this attracts the attention of the healthcare professional.  
  • This stopped medication line receives an icon, indicating the source.
  • This stopped medication line receives a label (stopped), indicating that it concerns a stopped medication line.
  • The medication line that is stopped becomes 'strike through'.

• When the healthcare professional agrees with the combined overview (agreement with changed medication line & stopped medication), he/she doesn't have to take any action.
• Only when the healthcare professional doesn't agree, action should be taken (cfr. next wireframe with drop down menu).

• It is highly recommended to not use too many colour indications for highlighting data coming outside the EHR.
  • Therefore, only one colour is used to indicated new medication & changed medication lines.
  • Another colour is used for highlighting stopped medication lines.

Actions possible on a medication line

Actions via drop down menu: possible to edit changed medication line, prescribe, reject change, check history, ... 

• For all medication lines, it is possible to do some actions per medication line.
  • This can be done by clicking on the ... indication which is positioned in a vertical way at the end of the medication line.
  • Next, a drop down list with actions will appear.

• Possible actions for a new / changed medication line are:
• Edit (edit posology, comment, ...)
• Prescribe (make new prescription for patient)
• Reject change (reject the change that was done on Vitalink, the previous medication line (this is now striked through) will become active again)
• History (check history of posology and other related information) 
  • In this case, the medication line can fold open, displaying an overview of all changes over xx time.
  • Another option is displaying a screen overlay with all changes over xx time.
  • Keep in mind, this is a software feature; this means that the software provides the feature to display the history of all changes that has been made towards a medication line).

Actions via drop down menu: possible to re-activate stopped medication line, check history, ... 

• Possible actions for a stopped medication line are:
  • Re-activate (make medication line active again)
  • History (check history of posology etc, this is a software feature, no Vitalink feature, cfr. explanation above)
• When a medication line is stopped, the software still shows the medication line until a healthcare professional removes this medication line manually. 
• By default, this medication line is not selected when transferring all medication lines to Vitalink. 

• The drop down list with actions visualised in the wireframe is only an illustration and is not restrictive.
• This can be enriched with existing features within the hospital software (e.g. substitute, stop medication, instructions of use, ...).

Quick access to most important features when validating, e.g. edit or reject changed medication line. More features are available via drop down menu.

Quick access to most important features when validating, e.g. re-activate stopped medication line. More features are available via drop down menu.

• When validating medication and when confronted with several changes from Vitalink towards the local medication in the EHR, it can also be useful to have a very quick access to the most important features:
  • Edit & reject (in case of new/changed medication line coming from Vitalink)
  • Re-activate (in case of stopped medication line coming from Vitalink).
    • This means that de healthcare professional can reinitiate the previous state of the medication line (cfr. previous medication state in history overview of that medication).

Example when medication line is folded out to see more details.

• It is also possible to fold out a medication line to see more details like creator of the medication line, ... 
• This action can be done by clicking on the arrow pointing down. Next, the section with details will fold out.

Validating at the end of the ambulant visit

Example of 'Validate & update Vitalink' button on top of the list of the combined overview of the active medication. 

• After checking the active medication with the patient, updating medication and / or prescribing medication, the healthcare professional will validate the medication scheme (the combined overview). 

• Like already indicated:
  • When the healthcare professional agrees with the combined overview (agreement with changed medication line & stopped medication), he/she doesn't have to take any action.
  • When the healthcare professional doesn't agree, action should be taken to edit, reject, re-activate, ...the medication lines until correct.

• Validating the combined overview will work the same as validating the active medication in the local EHR: the healthcare professional will have to validate the medication scheme and at the same time, the information will be uploaded to Vitalink. 
• By default all medication lines would be selected (check boxes will be checked) to upload to Vitalink. 
  • The healthcare professional can de-select medication lines in the exceptional cases they would not wish to share those with other healthcare professionals.
  • This action entails a big risk and thus a specific confirmation should be asked if the healthcare professional is sure he/she does not want to update medication line X to Vitalink. 

Example when the system is still working on the sync with Vitalink. The healthcare professional can already validate (without sending data to Vitalink).

• When the sync with Vitalink is not yet done, and when the healthcare professional would like to validate already, it is possible to validate & continue. This means that no update to Vitalink is send for this patient.
  • But normally this shouldn't be this case since the sync & analysis of the combined overview should be done in 4 to 6 seconds or less; with a maximum of 10 seconds.

Example when there is no Vitalink medication scheme for the patient. By default it is indicated that a Vitalink medication scheme will be created when validating the active medication.
The healthcare professional can uncheck this option and continue with only (internal) validating.

• When there isn't yet a Vitalink medication scheme for the patient, this is indicated via status information. 
  • Next, the healthcare professional can validate and create a Vitalink medication scheme at the same time.
  • It should be set by default that if there not no Vitalink medication scheme, a new one will be created when validating the medication. 
  • The healthcare professional can uncheck this option and can continue with only internal validating the active medication. 

Partial upload of the medication scheme to Vitalink

Example of notification when the healthcare professional validates the medication scheme without selecting all medication.  

• If validating the active medication list / scheme without selecting all medication lines: 

  • A notification appears with the message to select all medication lines.

  • Below the action buttons, the medication list / scheme should be visualized.

    • In this way, the healthcare professional can easily check / select & validate towards Vitalink.

No Vitalink update when closing patient record

Example of notification when the healthcare professional closes the medical record without validating & updating the medication scheme towards Vitalink.

• If closing the patient record without validating & updating the medication scheme towards Vitalink:

  • A notification appears with the question to update Vitalink or not.

  • Below the action buttons, the medication list / scheme should be visualized.

  • In this way, the user can easily check & validate towards Vitalink.

• When a change or other action is necessary, the healthcare professional can start from here (using the drop down list with actions).

Patient Print

Example of screen overlay with visualization of patient friendly medication scheme. As from here, it is also possible to validate & update the medication scheme towards Vitalink.

• An alternative for validating & updating to Vitalink at the end of a contact is doing so when having the patient friendly medication screen open. Often this is one of the last actions the healthcare professional does when working in the patient file.
  • The healthcare professional can choose if he/she wants to print or wants to print & immediately validate the medication scheme towards Vitalink. 
  • In this way, the healthcare professional doesn't need to validate anymore before closing the patient file in the EHR. 
• As an alternative, it is also possible to use the Patient medication scheme that is provided by Vitalink. This will be offered in pdf format.

Support staffs prepares patient visit

Example when a nurse, pharmacist assistant or medical secretary opens the medication module of the EHR.

• Often a nurse, hospital pharmacist assistant or a medical secretary prepares an ambulant visit.
• This healthcare professional checks for example upfront the active medication of a patient.

• This type of healthcare professionals have no validation rights related to the active medication, but they indicate in the local EHR that the medication is checked.
  • Therefore they use the action button 'register internal check'. 
  • In this wireframe, this button is active but not highlighted since the Vitalink sync is not yet done.

• This type of healthcare professionals can add / edit / stop / ... medication in the local home medication of the EHR, just in an informative way (to inform the healthcare professional with validation rights). 
• When a nurse, pharmacist assistant or medical secretary would open the patient record in the EHR, the system will start automatically checking if there is a Vitalink medication scheme for this patient. If yes, there will be a sync with Vitalink.
• Here, it is visible that the system is syncing the local EHR home medication list with the Vitalink medication scheme.

Example when a nurse, pharmacist assistant or medical secretary can add/edit/stop medication and register internal check (once Vitalink is synced).  

-- Nurse, hospital pharmacist assistant or a medical secretary checks medication list and this list is correct

• After syncing with Vitalink, it is visible that one new medication line is added from Vitalink to the local EHR medication list.
• 3 medication lines are only available in the local EHR (they have no Vitalink icon). 
  • Since the sync with Vitalink is done, the button to register that the medication is checked becomes highlighted.
• The nurse, pharmacist assistant or medical secretary will check with the patient if all medication listed is still relevant (= actively taken).

• If the patient indicates that the listed medication is correct (= combined overview of local medication list of the EHR and the medication on Vitalink), the nurse / pharmacist assistant / medical secretary will do what he/she normally does: click on 'Register internal check'.
• This will result in an additional date, which would be the internal check date (visible on the next wireframe).

-- Nurse, hospital pharmacist assistant or a medical secretary checks medication list and this list is not correct

• When the nurse / pharmacist assistant / medical secretary is changing a medication line of the home medication of the EHR, the medication line becomes highlighted (+ icon + textual label).
  • The same for adding, stopping, ... home medication from the EHR.

• When the nurse / pharmacist assistant / medical secretary should change / stop a medication line from Vitalink (according to the information the patient is providing), this isn't possible due to the access rights to Vitalink.
  • Since the nurse / pharmacist assistant / medical secretary can't change a Vitalink medication line, the EHR allows for duplication of a medication line. In this way, the healthcare professional can report the changes stated by the patient.
    • This action will result in a duplicated medication line that is only available in the local EHR. 
    • It is important that the URI of the medication line is copied when duplicating ! 
    • These two medication lines (original medication line coming from Vitalink & medication line that is duplicated and changed) are grouped / visualized together.
    • These two medication lines can never be both validated towards Vitalink.  
  • Duplicating a medication line will be done via an action on the drop down menu.

• Next, the nurse / pharmacist assistant / medical secretary clicks on 'Register internal check'. 
• This will result in an additional date, which would be the internal check date (visible on the next wireframe).

Example when a specialist is logged in and checks the internal check done by the nurse, pharmacist assistant or medical secretary. There are no changes.

Example of tooltip when mouse over on the date that the internal check was done. In this way it is visible who the internal check of the medication scheme has done.

• On this screen, the specialist is logged in while in consultation with the patient.
• The specialist can see the internal check date by the nurse / pharmacist assistant / medical secretary in the right upper corner (10.06.2019, 10:05).
  
  • Since the internal check date is more recent than the Vitalink medication scheme date, the specialist will know that the Vitalink medication line is checked by the nurse / pharmacist assistant / medical secretary and is reported as 'actively taken by the patient'.
  • When the Vitalink validation date would be more recent than the internal check date, the specialist will know that in the meantime another healthcare professional has updated the Vitalink medication scheme.

• When seeing this medication list, the specialist can assume that this is the correct active medication of the patient.
• If the specialist wants to see more information on who has checked the medication scheme, this can be retrieved by doing a mouse over on the internal check date. Next a tooltip with the name appears.
• The specialist can continue with the ambulant visit. 

Example when a specialist is logged in and checks the internal check done by the nurse, pharmacist assistant or medical secretary. There are changes.

• On this screen, the specialist is logged in while in consultation with the patient.
• The specialist can see the internal check date by the nurse / pharmacist assistant / medical secretary in the right upper corner (10.06.2019, 10:05).
  
  • Since the internal check date is more recent than the Vitalink medication scheme date, the specialist will know that the Vitalink medication line is checked by the nurse / pharmacist assistant / medical secretary and is reported as 'actively taken by the patient'.
  • When the Vitalink validation date would be more recent than the internal check date, the specialist will know that in the meantime another healthcare professional has updated the Vitalink medication scheme.

• When seeing this medication list, the specialist sees that there are two medication lines that are grouped since they are (almost) the same.
  • The specialist will see that the posology is different for the Vitalink medication line vs. local EHR medication line.
  • The specialist will see that the local EHR medication line is added by a nurse / pharmacist assistant / medical secretary and has the most recent update date.

• If needed, the specialist can check with the patient the change the nurse / pharmacist assistant / medical secretary has made. Next, the specialist can decide to remove the Vitalink medication line.
• When validating the home medication, it will be the medication line that was created by the nurse / pharmacist assistant / medical secretary that will be uploaded to Vitalink.
• The specialist can continue with the ambulant visit. 

Variant 3: Vitalink medication scheme changes

Example when a specialist is logged in and checks the internal check done by the nurse, pharmacist assistant or medical secretary. There are changes.
The specialist notices new changes that are made on Vitalink after the internal check.

• In this example, Vitalink is updated by another healthcare professional (e.g. general practitioner) after the internal check of the nurse / pharmacist assistant / medical secretary.
• The specialist can see this via the Vitalink validation date. Since this date is 12.06.2019, 13:10 he/she can see that this date is more recent that the internal check date (10.06.2019, 10:05).
• The specialist will check with the patient the change the nurse / pharmacist assistant / medical secretary has made and the new Vitalink updates. 
• The specialist can continue with the ambulant visit. 

3.Admission

Variant 2: Home Medication is outdated compared to Vitalink

Example of synced home medication.

• In this example, it is visible that the home medication of the EHR is synced with the Vitalink data. 
• Vitalink has newer information, which is added to the home medication of the EHR.
• The new medication line coming from Vitalink is clearly indicated (highlight, icon, label).
• 3 medication lines are not on Vitalink, they are only available in the local EHR.
• The healthcare professional can add/edit/stop/... medication from the home medication of the EHR before transferring it to the admission medication.

Example of new sync with Vitalink that has been done before transferring to admission medication.

• The healthcare professional can validate this medication scheme towards Vitalink before starting to transfer medication from the home medication to the admission medication.
• This validation towards Vitalink is not obliged but strongly recommended.
• In this example it is visible that at this moment (new date: 31.05.2019) everything of the local EHR is in sync with Vitalink. 
• In this way, when syncing again with Vitalink at discharge, there will be less difference between the medication schemes. 

Example of selection made to transfer home medication to admission medication.

• In this case, the healthcare professional decides to transfer only 6 medication lines to the admission medication. 
• These medication lines can be selected via checking the check boxes.
• Next the healthcare professional can press the button to do the transfer to the admission medication.
• When transferring home medication to admission medication, the URI of the medication line stays linked to the transferred medication line.
  • In this way, the medication can always be resubstituted to the original product when it is substituted during admission. 
  • When the medication line has no URI (since there is no Vitalink medication scheme, only a local EHR home medication list), another unique identification should be provided to the medication line that is transferred from home medication to admission medication. 
    • This ensures also the easy resubstitution of the product to the original product after admission. 
  • Resubstitution is not obliged but it is recommended. 
  • By applying the approach described above, the resubstitution process would be easy & fast for the healthcare professional. 

Example of admission medication, transferred from the home medication. 

• The healthcare professional is in the section 'Admission medication'. 
• The 6 medication lines that were indicated to be transferred to the admission medication are visible.
• It is possible to substitute the medication.
  • This can be done by clicking on the substitute icon on each medication line: 
     
  • Or by opening the drop down menu via the  icon (visible at each medication line) and via selecting the feature 'substitution':

• Next, a screen overlay opens with the substitution options.
• The active medication will be displayed in list of scheme view, depending on the choice of the healthcare professional. 
  • For admission, scheme view is normally preferred; so by default it should open in scheme view.
  • The healthcare professional should be able to select within the scheme view the most appropriate view (by day / by hour / ...).

• The healthcare professional can add/edit/stop/... medication lines in the admission medication.

The 1st and 3rd medication line are substituted in the admission medication.
The healthcare professional selects at the end the admission the medication that should be transferred to the home medication.

• When discharging the patient, the admission medication will be transferred to the home medication module.
  • This can be done by checking the check boxes of the medication lines that need to be transferred.
  • Next the healthcare professional can press the button to do the transfer to the home medication.
  • In this example, the healthcare professional decides to only transfer 5 medication lines to the home medication.

Example of home medication after transferring the admission medication to the home medication.
The former medication lines from the home medication that were not transferred to the admission medication are visualized with a grey background.

• The admission medication is transferred to the home medication.
• Via the substitute icon, it is clearly visible for the healthcare professional which medication lines should be put in their original state (product) for the hospital discharge. 
• Medication that is substituted can be re-substituted by using the resubstitute icon of via the drop down menu.
  • The substitution medication can be replaced by the original medication via click on this re-substitution icon, automatically, the original product will be put in the home medication scheme. 

                                                                or     

• The medication lines that were originally in the home medication but were not transferred to the admission medication, are visualized in a grey background. 
  • In this way, the healthcare professional can easily identify and evaluate if these medication lines are still relevant. 
  • Medication lines that aren't relevant anymore can be stopped via the drop down menu per medication line.

Example of home medication after transferring the admission medication to the home medication.
One medication line is resubstitued. One medication line isn't substituted. 

• The healthcare professional decides in this example to resubstitute the Omneprazole; the Betahistine stays in the substituted product. 
• The healthcare professional decides in this example to stop the Lormetazepam EG. 

• Next, the healthcare professional can validate the relevant lines of the home medication and update Vitalink.

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.