Introduction

This document contains the stack of UX and other guidelines that all medical software for hospitals that should use when implementing the Vitalink medication scheme should comply with.All software packages .

Content

Terminology & Abbreviations

A list of the terminology used in this document can be found here.

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Abbreviated list: the combined overview of all active medications from the local EHR and Vitalink can be shown in an abbreviated manner by means of the abbreviated list (if there is a Vitalink medication scheme for the patient). The following information is mandatory shown: product name, dosage and posology (with underlying information about the date and remark if relevant). The intention is to show this abbreviated list in relevant places, eg on the dashboard / start page when opening the patient's EHR, on the right/left side of the work screen (sumehr, prescription module, ...).

Please note that the wireframes below illustrate only an example of the workflows described on this page.
They do not represent all features of the hospital software, nor all information.
Only key features that are relevant for the Vitalink workflow are visible on the wireframes.

Legend

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Use Cases

1.Ambulant Visit

Ambulant visit is the use case where the patient visits the hospital without being admitted (= taken into care of the hospital or ocupying a hospital bed).

NOTION! Local EHR 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: Home medication EHR section is already in sync with Vitalink

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• On 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 & TR 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.

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• Here, it is visible that the sync with Vitalink is completed (upper right corner). The healthcare professional can be informed about this by:
  • Using a meaningful icon, combined with another icon expressing a status.
  • Information about the latest validation date of the Vitalink medication scheme (in this case: 29.05. 2019, 19:30).

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• If the user wants to obtain more information (e.g. validated by, sync info, version number, ...) or wants to do manually a new sync with Vitalink, this information can be provided via a tooltip when moving over this status information. For example: 

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

Image RemovedExample when the latest validation was done by a specialist
in an hospital (only the hospital 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. 

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

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

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• On this wireframe (same as previous screenshot), 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.

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• 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 (link) 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.

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• There should be an action button/link to the print feature of the patient friendly medication scheme.

• This combined overview should be enriched with features of the software (e.g. check on interactions, edit medication line, prescribe selection of medication, ...).

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

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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.

• Since healthcare professionals are always validating the active medication when checking this with the patient, it will work the same in the combined overview: they will have to validate and in the same time, the information will be uploaded to Vitalink. 
  • By default all medication lines would be selected (check boxes will be checked).
  • 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.

• When there isn't 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. 

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• 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 if it concerns a new added medication, a change of an existing medication line, a stop of an existing medication line.

• 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 new 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 new medication line receives an icon, indicating the source.
  • This new medication line receives a label (change), indicating if it concerns a new added medication, a change of an existing medication line, a stop of an existing medication line.
  • The medication line that is changed becomes 'strike through'.

• 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.

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8. Within the medication scheme, it should be possible to reactivate stopped/changed medication in a fast way (e.g. via drop down menu per medication line; see below).

9. Within the medication scheme, it should be possible to check the history of this medication line (e.g. via drop down menu per medication line; see below).

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

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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 ! EHR information in this section always holds the HOME MEDICATION  and ADMISSION MEDICATION. 

NOTION2 ! Medication during admission is never uploaded to Vitalink.

Basic flow: Home Medication EHR is already in sync with Vitalink

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Variant 1: There is no data in the home medication of the EHR UITTEKENEN

Follow "Ambulant Visit - Variant 1" until step 4.

Continue with Admission - Basic Flow starting from step 2.

Variant 2: Home Medication is outdated compared to Vitalink UITTEKENEN

Follow "Ambulant Visit - Variant 2" until step 4.

Continue with Admission - Basic Flow starting from step 2.

Variant 3: Vitalink changes during hospital admission

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Variant 4. Discharge over the weekend

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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 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. 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. 

Variant 1: Home hospitalisation after admission

In this case a patient is receiving his hospital treatment at home after an admission in the hospital (= stay in the hospital), the use cases follows the same steps as an admission.

Variant 2: Home hospitalisation without admission

In the case a patient is receiving his hospital treatment at home without previous admission into the care of hospital (=no previous stay at the hospital),  the use cases follows the same steps as the ambulant visit.

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No other use cases have been defined. 

Import

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

Mandatory

When opening a patient's EMR, 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 EMR 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 EMR 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).

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 EMR.

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).

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.

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 authorisations/mandates are set, it must be possible for a member of administrative staff to prepare the EMR by importing the medication scheme for the patient in question. 

Recommendations

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One combined overview of all active medication

Mandatory

It is important that the care giver has one overview of the active medication of the patient. Since information about the active medication can be found both in the local EMR and on Vitalink, the CG wishes to see this information in one combined overview. 

The CG does not want to compare the information from the local EMR and the Vitalink medication scheme manually 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 principle of a combined overview should be kept simple: provide only an indication 'what is on Vitalink'. 'What is in the local file'. Afterwards, the CG can take further decisions around this.

It is important that this combined overview is automatically displayed, clearly indicating what has changed with respect to the local EMR, any alerts concerning medication lines that may be a problem, etc.

In this phase of the flow it is not necessary to show the complete (combined) medication scheme. The presentation of an abbreviated list of the active medication on Vitalink and the active medication from the local EMR with at least the product name, dosage & posology is sufficient to give the care giver a first overview of any changes to medication since the last visit of the patient.

In addition, additional information must be provided with a 'mouse-over' action on the relevant medication line such as at least date information (if applicable: start / stop, from, to) and comments (if applicable).

The aim of this combined overview is that the CG can see at a glance what has changed since the last time he uploaded the patient's medication schedule himself (eg if other caregivers made any changes to it).

In principle, the CG would then have to make the necessary changes to the medication scheme before prescribing new medication (eg, returning to the previous posology of a particular medication, activating deleted medication, etc.) in an ambulant setting or starting the hospital medication in case of an admission.

He can also adjust this in the abbreviated list. The possibility should therefore be offered that the caregiver can perform actions on the shortlist of the combined overview without having to open the complete medication scheme.

After obtaining the information from Vitalink, the CG sees who has validated the last Vitalink medication scheme and when.

The abbreviated list means the following:

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• The display of a list with at least the product name, dosage and posology is sufficient to give the care giver a first overview of any changes.
• Draw attention to changes, new additions, inconsistencies in this combined overview.
• Additional information such as a start or stop date and/or a note regarding the medication line is shown via, for example, a tooltip. In the overview itself it can be indicated that there is additional information so that the GP knows which medication lines he/she can possibly carry out a 'mouse-over' action on.

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• 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).

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• Cross out 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 EMR and the medication line from Vitalink in a clustered way (in this way the 2 'associated' medication lines are placed underneath each other, making comparison easier for the general practitioner). 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.

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• With, for example, 2x same type of medication but with a different product name. These will also be displayed under each other for clustering.
• For example, an incomplete medication line.
• Give, for example, a tooltip after a 'mouse-over' action for the relevant medication line, more information about why there is an alert (eg incomplete medication line).

Recommendations

• Show interactions between medication lines through an alert.

Interactive/Dynamic medication scheme

Mandatory

From the combined overview of all active medication it should be possible to open the complete medication scheme with the combined overview via one click.

Since this is a combined overview of information from the local EMR and information from Vitalink, it is important that it clearly shows when (date & time) and by whom the version of Vitalink was last modified.

Just like in the shortlist of the combined overview of the active medication, the general practitioner wants to see the following in the complete medication schedule:

• What has changed to the active medication of the patient?
• Information regarding changes, additions, deletion, ... of a medication line.

If the local medication scheme is made interactive, this should work bi-directionally (an adjustment of an intake moment on the medication scheme should lead to an adjustment in the list of active medication).

Recommendations

• 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 EMR.

• In addition, the CG also has certain expectations regarding the visualisation 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: double click (or other action such as right-click) on a medication line leads 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).
  • Placing the medication scheme on a 'to do' list for later upload to Vitalink (delayed validation). IS DIT IETS WAT MOET KUNNEN BIJ ZIEKENHUIZEN

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• Make sorting possible on the columns of the medication scheme that is shown locally (eg alphabetically, per pathology (if indication is entered), per intake moment, most recently added medication on top (so also the last changes are at the top), chronic / temporary /If necessary.
• Visually indicate which column has been sorted.
• Ensure that this representation is remembered when opening the Vitalink medication scheme for other patients.

Export

Start Vitalink with one click

Mandatory

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.

Recommendations

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Prescribe

During an ambulant visit

Mandatory

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.

Visualise 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.

Recommendations

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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.

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• 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.

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At discharge

TO BE COMPLETED

Validate the Vitalink medication scheme

Mandatory

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 medication scheme' button before the complete medication scheme is uploaded to Vitalink.

It may be desirable for some CGs to not show this medication scheme at the end of the consultation. When the EMR for that patient is closed, the medication scheme is automatically forwarded to Vitalink. If the CG has seen a clear overview of changes to the active medication in advance via the combined overview (on the working screen and / or on the prescription screen, ...), this can be sufficient. This should be adjustable for the CG. The responsibility for this lies with the CG.

The CG receives feedback on the upload of the Vitalink medication scheme when the patient's EMR is closed.

In the context of ambulant visits or future hospital admissions it is necessary that the CG can download and open one or different Vitalink medication schemes in advance (= combined overview) in the EMR.

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

If the CG does not want the medication scheme to be uploaded to Vitalink now (will have to do it later) , he should have the option to validate later (put it on a 'to do' list) and to not validate it yet. RELEVANT?

If the CG decides, at a later date, to validate this medication scheme, Vitalink must check whether the Vitalink medication scheme in the EMR is the latest version.

• This means that when opening an item from the 'to do' list, the relevant Vitalink medication scheme must be re-loaded.
• If applicable, a message should be shown that a more recent Vitalink medication scheme will be shown.
• The medication schemes that are 'to be validated later' must also be removed from the 'to do' list if they stay to long.

A medication scheme can not 'to be validated' for more than X number of days. This number of days must be parametrisable. Afterwards, the CG is obliged by a notification to validate the medication scheme (and is uploaded to Vitalink) or take another action (not validate).

Recommendations

• The CG must be able to open the medication scheme (combined overview) at any time before closing the patient's EMR.
• It is important that the 'to do' list for later validation of medication schemes and uploading to Vitalink can be managed efficiently.
  

  • Provide the CG with a reminder functionality in which he/she can set up to be reminded within x time to validate the medication scheme on the 'to do' list and send it to Vitalink.

Visualisation of the print version of the Vitalink medication scheme

Mandatory

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 EMR. This print should be visualised on the screen by the CG & possibly the patient during the consultation, or be printed to give to the patient.

Click here for more in-depth information regarding the Vitalink medication scheme print.

How to handle mistakes

Mandatory

If a medication scheme is removed from Vitalink and can not be fully visualised by the interpreting software package (eg if there is a problem with a medication line, posology or other), it is important to get as much information as possible on each medication line so that at least 'something' in the Vitalink medication scheme can be shown.

The CG who collects this 'incomplete' Vitalink medication scheme also wants to see as much as possible of the incomplete / incorrect information. If necessary, he/she can supplement the incomplete / incorrect / missing information from his/her professional expertise. 

If possible, as much of the information as possible should be retrieved from the medication line until the information can no longer be read (due to the corrupted construction) (eg if posology is still correct this can also be downloaded but for example the intake moments are not).

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 supplement the Vitalink medication scheme as good as possible.

CGs are open to refilling this information again 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 that 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."

Recommendations

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