...

Combined overview: if a new Vitalink medication scheme is available for the patient, the medication lines from Vitalink are shown together with the medication lines from the local EMR. The origin of each medication line will be visually indicated as well as changes, additions or stops. Certain medication lines are displayed in a clustered way to clearly show the changes. There are no two medication schemes (local vs. Vitalink), but one combined overview is shown in one medication scheme module of the EMR.

Import

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

• The user must be able to clearly see that the application is still working on obtaining the information from the central schemeVitalink.
• The user must be able to clearly see when the process of obtaining data from the central Vitalink medication scheme has been completed.
• The user must be able to clearly see when the application has failed to obtain the data from the central Vitalink medication scheme.

When opening a patient's record and the patient already has a Vitalink medication scheme:

• it must be checked automatically whether the EMR has the most recent version of that medication scheme.
• it's crucial that the central Vitalink medication scheme is questioned automatically. The user does not need to take any action (eg no click to start a download or to go to the scheme).

The automatic collection and analysis of the information from the Vitalink medication scheme in a combined overview should take a minimum amount of time (preferably on average 4 to 6 second or less, with a maximum of 10 seconds). This happens in the background and starts immediately when the EMR is opened. In the meantime, the GP nurse can continue working in the record. When the scheme has been received, the user can easily switch between the homepage work screen and the medication scheme. This may not take more than one action/click.

The work screen mentions the status of the medication scheme with a symbol:

• There is no central Vitalink medication scheme for this patient.
• The central Vitalink medication scheme is still downloading.
• The central Vitalink medication scheme is downloaded + date and time of the download (an existing scheme can also be emptied and has a version number, which is not the same as no scheme -> status 1).

...

• User can continue to work in the EMR (outside the scheme module) while the central Vitalink medication scheme is being collected.
• Retrieving a central the Vitalink medication scheme takes a maximum of 10 seconds.
• The user can navigate to the medication scheme module with a single click from the patient overview page or dashboard.
• The user should be able to see the download status of the central Vitalink medication scheme (downloading, downloaded or error).
  
• Patient overview page or dashboard should display the general status of the scheme (no central Vitalink medication scheme, downloading central scheme, central scheme downloaded).

The import must also be able to be done in bulk. There are nurses who download all electronic records before their day starts, so they don't need to synchronise with Vitalink during the day. Sometimes there is no network or a very bad connection, so it won't be possible to have a continuous connection with Vitalink.

It's therefore important that a selection of medication schemes can be retrieved on request (eg overnight bulk collection of a specific amount of schemes for the next day). This means that these schemes will be stored locally.

...

• If there is an informed consent and a therapeutic relationship, the schemes will be imported.
• If there is an informed consent and no therapeutic relationship, the therapeutic relationship can be created automatically or by reading an e-ID card. Afterwards the scheme Vitalink medication schemes can be imported.
• If there is no informed consent (therapeutic relation is irrelevant), the nurse should ask consent from the patient (eg when he/she visits the patient) and register.

When a nurse is part of the "circle of trust", he/she still needs IC from every patient but the TR is established through the "circle of trust".

Even after import in bulk, it will always be necessary to check automatically whether or not a more recent central Vitalink medication scheme exists when opening a patient's electronic nursing record. This automated check will be done based on the version number of the central Vitalink medication scheme.

If a more recent central Vitalink medication scheme is available, the most recent central medication scheme will automatically be retrieved. If this is not the case, the nurse can rely on the already downloaded local scheme for the administration of the medication.

If there is no network connection when the patient's electronic nursing record is opened, the nurse can rely on the local scheme that he/she downloaded at the start of her day. This implies that any changes made by the nurse will later be uploaded to the central schemeVitalink. If in the meantime a newer version of the central Vitalink medication scheme is available, than it must be reported to the nurse so that the changes by the nurse can be added to the more recent scheme.

In summary:

• Software package offers the possibility to download the medication scheme for a list of patients in advance.

• Notification if IC is missing, TR is missing, there is no central scheme, etc.

Export

When a Vitalink medication scheme is downloaded in the EMR of a patient, the proprietary local scheme should not be used anymore. From that moment on, you always have to work with the Vitalink scheme.

When the patient's Vitalink scheme is first acquired, the user is informed of this and he/she has the possibility to add certain medication from the proprietary scheme in a simple way to the Vitalink scheme. This way no data is lost. For visualisation, check the chapter Visualisation below. 

A copy of the last downloaded scheme from Vitalink can be stored locally in the EMR of the user. This version of the scheme is called a local scheme.

Visualisation

When performing export or import, it is important that user sees the differences between his/her local scheme and the central Vitalink medication scheme. For this we want a combined overview. The goal of this combined overview is that the user can see at a glance what has changed in relation to Vitalink or the central or local scheme when export or import.

The principle of a combined overview should be kept simple. Provide an indication which line belongs to the to  "Central schemeVitalink" and or "Local scheme", which is a duplicate, which lines are missing, etc. Afterwards the user can take further actions.

It's important that this combined overview is automatically displayed when export or performing an import. It needs to clearly indicate what has changed compared to the local or central Vitalink medication scheme, any alerts regarding lines where there might be a problem, duplicates or missing lines, etc. must be clearly visualised. 

...

• Show all the medication (both locally and centrallyVitalink) automatically in one overview.
• Visualise the author which uploaded the last central Vitalink medication scheme.
• State the patient's date of birth, name, and INSS.
• There is an author shown for each line.
• Visualise which line comes from where (local- or central scheme). The lines that are stored centrally have the Vitalink icon displayed next to them.
• Permanent medication and temporary medication are displayed separately with a clear indication of the start and stop date.
• Medication is arranged alphabetically in the scheme per component (temporary, permanent, etc).
• There is a separate section with "Indien nodig" medication.

...

• Draw attention to changes, omissions and new additions in this combined overview in the following way:
  • Newly added medication with respect to the local scheme:
    • Emphasise this in any way you want so that the attention is drawn to it (note: If you chose for a different colorcolour, users who are colourblind do see color colour shades, so for them it is also visible that there is a difference of color colour compared to other lines).
  • Change in posology, intake moment, etc:
    • Visualise in any way the line that has been replaced and what the line has become (in this way the user clearly sees what has changed).
    • Display the relevant line from the local scheme and the central scheme in a clustered way (in this way the two "associated" lines are placed underneath each other, which makes it easier for the user to make a comparison). By keeping track of the unique URI once the mapping has been made, the connection between two "associated" lines can be more efficiently verified next time.
  • Removal of a line/medication:
    • Visualise in any way the line that has been removed.
  The necessary changes (eg restore the deleted line, restore the original posology before changes, etc) can be done by right-clicking on the line or by clicking a specific action button
  • • .
• When the user does nothing, he/she agrees with the overview of the active medication that he/she sees (deleted lines will disappear, adjusted posology will be retained and the previous posology will disappear, etc). The local scheme will be in sync with the central Vitalink medication scheme.

Changes

It's important for a nurse that there is a clear overview in the medication scheme for modified lines (eg change in intake, posology, etc), discontinued lines and new lines. This means that an automatic comparison is always required between the local scheme and the central Vitalink medication scheme.

Changes, additions and removals are shown individually. This means that when two nurses perform a home visit with the same patient, both nurses should see the changes, additions or removals at the next consultation of the patient's scheme. This keeps each nurse aware of the changes.

...

When opening a patient's electronic nursing record, the local version will be compared with the central Vitalink version. If they're the same, nothing will happen. If they're different, both schemes will be shown in a combined overview. When the nurse made his made  choices in the combined overview, the local scheme will be in sync with the central Vitalink medication scheme.

After prescribing and completing the consultation with the patient, it is important that the local scheme and central scheme are shown in a combined overview and validated before uploading. When the nurse closes the patient's electronic nursing record, the combined overview will be shown automatically.

How to handle mistakes?

If a scheme is downloaded and can not be fully visualised by the interpreting EMR (eg if there is a problem with a line, posology, etc), it is important to provide the user with as much information as possible on each line so that at least "something" in the scheme can be shown. The user who downloads this "incomplete" scheme also wants to see the incomplete/incorrect information. If necessary, he/she can supplement the incomplete/incorrect/missing information from his/her professional expertise.

...

It's important that the software vendor can monitor the performance in an active way if the automatic collection and analysis of the information from the central Vitalink medication scheme takes more than a pre-defined number of seconds (eg after more than 10 seconds). If after a long period of time (eg 60 seconds) a connection hasn't yet been established with Vitalink, the EMR should stop trying to make connection and inform the user about the problem in a user-friendly and concrete way. Afterwards, there should be a notification on the homepage work screen that displays that no connection to Vitalink can be made.

...