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Use Cases
1.Ambulant Visit
DEFINITIEAmbulant visit is the use case where the patient visits the hospital without being admitted (= taken into care of the hospital).
NOTION! Local EMR information in this section always holds the HOME MEDICATION as opposite to the admission where there is mention of HOME MEDICATION and ADMISSION MEDICATION.
Basic flow
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Local medication and Vitalink medication schema are in sync.
Everything that happens to the medication scheme when the patient is present in the hospital, is up to the hospital.
Some examples of what can happen:
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Variant 1:
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Local Medication EMR is already in sync with Vitalink
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Variant 2: Local Medication EMR is outdated vs. Vitalink medication
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Variant 3: Vitalink changes during preparation.
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Local EMR imports the data from Vitalink.
Local medication and Vitalink medication schema are in sync.
Everything that happens to the medication scheme when the patient is present in the hospital, is up to the hospital.
Some examples of what can happen:
- Support staff prepares the ambulant visit (eg. for staff meeting or oncology visit with patiënt).
- Local medication can be updated in the combined overview during the preparation for the ambulant visit version 1'.
- Preparing of ambulant visit stops.
- Start ambulant visit.
- Updates and changes are executed in the combined overview during the visit.
- There is a local change in resect to the online Vitalink medication scheme version 1'.
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Variant 2: Local Medication EMR is outdated vs. Vitalink medication
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Variant 4: Vitalink changes in the period between the preparation and the ambulant visit
Situation / Action
The Vitalink medication scheme is imported and updates, changes, etc are shown in the combined overview. The care giver can validate/reject changes.
There are two possible scenario's:
- The CG choses to import the Vitalink medication scheme version 2 with no regard to the medication in the local EMR.
Local EMR and Vitalink are in sync. - The CG combines information from the Vitalink medication scheme and the local medication scheme.
Local medication scheme now becomes version 2'.
Everything that happens to the medication scheme when the patient is present in the hospital, is up to the hospital.
Some examples of what can happen:
- Support staff prepares the ambulant visit (eg. for staff meeting or oncology visit with patiënt).
- Local medication can be updated in the combined overview during the preparation for the ambulant visit version 1'.
- Preparing of ambulant visit stops.
- Start ambulant visit.
- Updates and changes are executed in the combined overview during the visit.
- There is a local change in resect to the online Vitalink medication scheme version 1'.
The medication scheme in the local EMR is exported to Vitalink and becomes version 2.
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Variant 3: Vitalink changes during patient visit
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Variant 5: Vitalink changes during ambulant visit
The local EMR holds a medication schema version 1. Vitalink also holds a medication schema version 1.
Local medication and Vitalink medication schema are in sync.
Everything that happens to the medication scheme when the patient is present in the hospital, is up to the hospital.
Some examples of what can happen:
- Support staff prepares the ambulant visit (eg. for staff meeting or oncology visit with patiënt).
- Local medication can be updated in the combined overview during the preparation for the ambulant visit version 1'.
- Preparing of ambulant visit stops.
- Start ambulant visit.
- Updates and changes are executed in the combined overview during the visit.
- There is a local change in resect to the online Vitalink medication scheme version 1'.
During this period of time, a newer version of the medication scheme version 2 was uploaded to Vitalink.
The local EMR tries to export the medication scheme to Vitalink but fails because the Vitalink medication scheme version is more recent.
The local EMR version is outdated.
The local EMR has to provide an interface (= combined overview) in order to show medication changes between version 1 and version 2 of the Vitalink medication scheme and the local version 1'. We recommend to show a notification that there is a newer version of the medication scheme on Vitalink.
Afterwards, the user has the possibility to continue editing v1' with the new updates from Vitalink version 2 or to upload the local medication schema version 2' to Vitalink.
The medication scheme in the local EMR is exported to Vitalink and becomes version 2.
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2. Admission
DEFINTIE ONTBREEKT
NOTION! Local EMR information in this section always holds the HOME MEDICATION and ADMISSION MEDICATION.
Basic flow: Local Medication in EMR is already in sync with Vitalink
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| Situatie / Actie | Info |
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| 1 | The local EMR holds a medication schema version 1. Vitalink also holds a medication schema version 1. Local medication and Vitalink medication schema are in sync. |
| 2 | Patient is admitted to the hospital. The hospital translates the home medication to admission medication. The local medication scheme is now version 1'. |
| 2-3 | During admission, an admission medication scheme (= medication during an admission in the hospital) is determined. This admission medication scheme will hold relevant information from the home medication version 1', possibly substituted to the clinical formularium. |
| 3 | At discharge, a new home medication scheme version 1" is determined in the local EMR, possibly re-substituted to the original medication of the patient at the start of the admission. |
| 4 | The medication scheme in the local EMR is exported to Vitalink and becomes version 2. Local EMR and Vitalink are in sync. |
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2. Admission
A hospital admission is the moment when a patient is taken being admitted to the care of the hospital. It means the hospital is in charge of the care of this patient. This admission can be only for a couple of hours (policlinical, day clinic, etc.) or for several days, weeks, months and thus include an overnight stay. There are also different types of hospital admission: the admission can be planned e.g. for a surgery or can be an unplanned (urgent) admission e.g. in case of a car accident.
NOTION1 ! Local EMR information in this section always holds the HOME MEDICATION and ADMISSION MEDICATION.
NOTION2 ! Medication during admission are never uploaded to Vitalink.
Basic Flow
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Variant 1: There is no medication present in the local EMR
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| Situatie / Actie | Info |
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| 1 | The local EMR holds a medication schema version 1. Vitalink also holds a medication schema version 1. Local medication and Vitalink medication schema are in sync. |
| 2 | Patient is admitted to the hospital. The hospital translates the home medication to admission medication. The local medication scheme is now version 1'. |
| 2-3 | During admission, an admission medication scheme (= medication during an admission in the hospital) is determined. This admission medication scheme will hold relevant information from the home medication version 1', possibly substituted to the clinical formularium. |
| 3 | At discharge, a new home medication scheme version 1" is determined in the local EMR, possibly re-substituted to the original medication of the patient at the start of the admission. |
| 4 | The medication scheme in the local EMR is exported to Vitalink and becomes version 2. Local EMR and Vitalink are in sync. |
Variant 2: Home Medication is outdated compared to Vitalink
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| Situatie / Actie | Info |
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| 1 | The local EMR holds a medication schema version 1. Vitalink also holds a medication schema version 1. Local medication and Vitalink medication schema are in sync. |
| 2 | Patient is admitted to the hospital. The hospital translates the home medication to admission medication. The local medication scheme is now version 1'. |
| 2-3 | During admission, an admission medication scheme (= medication during an admission in the hospital) is determined. This admission medication scheme will hold relevant information from the home medication version 1', possibly substituted to the clinical formularium. |
| 3 | At discharge, a new home medication scheme version 1" is determined in the local EMR, possibly re-substituted to the original medication of the patient at the start of the admission. |
| 4 | The medication scheme in the local EMR is exported to Vitalink and becomes version 2. Local EMR and Vitalink are in sync. |
Variant 3: Vitalink changes during hospital admission
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Is admission medication deleted or frozen or re-used in case of a future admission?
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Variant 4. Discharge over the weekend
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Variant 1: Home Medication is synchronised with Vitalink
The scenario is identical to Ambulant Visit - Variant 1.
Variant 2: Home Medication is outdated compared to Vitalink
This scenario is identical to "Ambulant visit - Variant 2" .
Variant 3: Vitalink changes during hospital admission
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Variant 4. Discharge over the weekend
Often patients with a long admission in the hospital are allowed a stay during the weekend at home. 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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3. Transfer to other hospital
A transfer to another hospital takes place when the patient, in view of his treatment, is moved to an other hospital for further treatment without a previous discharge in the first hospital.
Basic Flow
In the case of a patient transfer to another hospital, the normal flow is similar as to the basic flow during admission. All medication updates are transferred to Vitalink as if it were a normal discharge.
In the case medication (e.g. intravenal medication, hospital specific medication) is not uploadable to Vitalink, the medication is passed on to the receiving hospital via the transfer note (via the hub, via the eHealth box or others). This is because information during and related to an admission is often hospital-related and not adaptable to home medication as is the purpose of the Vitalink format.
4. Home hospitalisation
Home hospitalisation is the use case where a patient is actually admitted to the hospital but the treatment is provided to the patient in his home. This means that the patient is not physically staying in the hospital.
Notion! It is important to update medication during home hospitalisation to Vitalink in order to make sure that in normal care or emergency cases primary care workers can also see and/or intervene in the Vitalink medication scheme of the patient.
Home hospitalisation after admission
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3. Transfer to other hospital
A transfer to another hospital takes place when the patient, in view of his treatment, is moved to an other hospital for further treatment without a previous discharge in the first hospital.
Basic Flow
In the case of a patient transfer to another hospital, no updates are performed to the Vitalink medication scheme. All medication information (This is the admission medication of the local EMR) is passed on to the receiving hospital via the transfer note via the eHealth box. This is because information during and related to an admission is often hospital-related and not adaptable to home medication as is the purpose of the Vitalink format.
4. Home hospitalisation
Home hospitalisation with admission
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There is no local medication info. Vitalink holds a medication scheme Vx.
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Local EMR Home medication is possibly updated to Vx'
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The new medication scheme is uploaded to Vitalink Vx+1.
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Home hospitalisation without admission
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Home hospitalisation after admission
In the case a patient is receiving his hospital treatment at home without previous admission in the hospital, the use cases follows the same steps as the ambulant visit.
5. Other use cases
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Below you can find use cases for which Vitalink medication scheme cannot be used:
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Import
Access to medication information.
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