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Wireframes

1.Ambulant Visit

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

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• 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 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. 

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Support staffs prepares patient visit

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

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• 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

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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. 

2.Admission

Variant 2: Home Medication is outdated compared to Vitalink

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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 medication line coming from Vitalink is clearly indicated (highlight, icon, label).
• The healthcare professional can add/edit/stop/... medication from the home medication of the EHR before transferring it to the admission medication.

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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. 

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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: Image Added
     
  • Or by opening the drop down menu via the Image Added icon (visible at each medication line) and via selecting the feature 'substitution':

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• 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.

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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.

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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.

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• 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.

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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. 

3. Reduced combined overview

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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.

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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.

• 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.

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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.