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.

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• 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).

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• 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.

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• 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. 

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• 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).

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• 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.

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• 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

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). 

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• 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).

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• 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, ... 

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• 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. 

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• 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.

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

Patient Print

VOORBEELD PRINT BERT ERIN PLAKKEN

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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. 

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

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.

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• 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. 

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