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 should

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Variant 2: Home Medication in the EHR is outdated vs. Vitalink medication scheme

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Example when the system is still working on the sync with Vitalink. 

• In 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.

Image RemovedExample when the sync with Vitalink is completed. 

• 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.

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

  • When checking the check box in the example below, the medication list that is validated by the healthcare professional will be uploaded to Vitalink at the end of the contact.

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• In the examples above, each time Vitalink is addressed as external source.
• If Réseau Santé Wallon is addressed as external source, the RSW icon & textual label should be used.

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• If Réseau Santé Bruxellois is addressed as external source, the RSB icon & textual label should be used.

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Example when the home medication of the EHR is in sync with the Vitalink medication scheme (Basic flow). 

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

• When the sync with Vitalink is done, it is visible in the wireframe that there is no difference between the home medication of the local EHR and the medication on Vitalink. 
  • If there would be a difference, the medication lines coming from Vitalink would be highlighted & labeled (cfr. next wireframe). 

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Example when there is no home medication of the EHR. All medication lines are coming from Vitalink (variant 1). 

Ambulant visit - Variant 1: There is no Home Medication data in the EHR

• 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'.

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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).

Ambulant visit - Variant 2: Home Medication in the EHR is outdated vs. Vitalink medication scheme (part I)

• In this wireframe, 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. 
  • Vitalink offers a central print functionality to print a medication scheme for the patient. LINK NAAR DE DATA OVER HOE DE VITALINK PRINT AANSPREKEN

• 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 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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The vitalink data is displayed in a combined overview with the local EHR medication. Here it is visible that one medication line is changed via Vitalink. One medication line is stopped via Vitalink.

Variant 2: Home Medication in the EHR is outdated vs. Vitalink medication scheme (part II)

• 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 that it concerns a new added medication line.

• When the healthcare professional agrees with the combined overview, he/she doesn't have to take any action.
• Only when the healthcare professional doesn't agree, action should be taken (cfr. next wireframe with drop down menu).

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

• For the stopped medication: 
  • This stopped medication line is highlighted to indicate that this is data coming from outside the EHR.
    • The stopped medication line receives another colour to make sure this attracts the attention of the healthcare professional.  
  • This stopped medication line receives an icon, indicating the source.
  • This stopped medication line receives a label (stopped), indicating that it concerns a stopped medication line.
  • The medication line that is stopped becomes 'strike through'.

• When the healthcare professional agrees with the combined overview (agreement with changed medication line & stopped medication), he/she doesn't have to take any action.
• Only when the healthcare professional doesn't agree, action should be taken (cfr. next wireframe with drop down menu).

• 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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Actions via drop down menu: possible to edit changed medication line, prescribe, reject change, check history, ... 

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Actions via drop down menu: possible to re-activate stopped medication line, check history, ... 

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Quick access to most important features when validating, e.g. edit or reject changed medication line. More features are available via drop down menu.

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Quick access to most important features when validating, e.g. re-activate stopped medication line. More features are available via drop down menu.

• For all medication lines, it is possible to do some actions per medication line.
  • This can be done by clicking on the arrow pointing down.
  • Next, a drop down list with actions appear.

• Possible actions for a new / changed medication line are:
• Edit (edit posology, comment, ...)
• Prescribe (make new prescription for patient)
• Reject change (reject the change that was done on Vitalink, the previous medication line (this is now striked through) will become active again)
• History (check history of posology etc)
  • In this case, the medication line can fold open, displaying an overview of all changes over xx time.
  • Another option is displaying a screen overlay with all changes over xx time.
• Don't show on Vitalink (if the patient states that he/she doesn't want that a medication line is visible on Vitalink)
  • If selecting this feature, the icon appears on the medication line. In this way, the healthcare professional is aware of it during a next contact.

• Possible actions for a stopped medication line are:
  • Re-activate (make medication line active again)
  • History (check history of posology etc)

• The drop down list with actions visualized in the wireframe is only an illustration and is not restrictive. This can be enriched with existing features within the hospital software (e.g. substitute, stop medication, instructions of use, ...).

• When validating medication and when confronted with several changes from Vitalink towards the local medication in the EHR, it can also be useful to have a very quick access to the most important features:
  • Edit & reject (in case of new/changed medication line coming from Vitalink)
  • Re-activate (in case of stopped medication line coming from Vitalink).
    • This means that de healthcare professional can reinitiate the previous state of the medication line (cfr. previous medication state in history overview of that medication).

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Ambulant visit - End of the contact 

• After checking the active medication with the patient, updating medication and / or prescribing medication, the healthcare professional will validate the medication scheme (the combined overview). 

• Like already indicated:
  • When the healthcare professional agrees with the combined overview (agreement with changed medication line & stopped medication), he/she doesn't have to take any action.
  • When the healthcare professional doesn't agree, action should be taken to edit, reject, re-activate, ...the medication lines until correct.

• Validating the combined overview will work the same as validating the active medication in the local EHR: the healthcare professional will have to validate the medication scheme and at the same time, the information will be uploaded to Vitalink. 
• By default all medication lines would be selected (check boxes will be checked) to upload to Vitalink. 
  • The healthcare professional can de-select medication lines in the exceptional cases they would not wish to share those with other healthcare professionals.
  • This action entails a big risk and thus a specific confirmation should be asked if the healthcare professional is sure he/she does not want to update medication line X to Vitalink. 

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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).

• 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.

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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.

• 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. 

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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.

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Example of notification when the healthcare professional closes the medical record without validating & updating the medication scheme towards Vitalink.

• If closing the patient record without validating & updating the medication scheme towards Vitalink:

  • A notification appears with the question to update Vitalink or not.

  • Below the action buttons, the medication list / scheme should be visualized.

  • In this way, the user can easily check & validate towards Vitalink.

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

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Example of screen overlay with visualization of patient friendly medication scheme. As from here, it is also possible to validate & update the medication scheme towards Vitalink.

Patient friendly medication scheme 

• 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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Example of sync of home medication of EHR with Vitalink. One new medication line is added via Vitalink.

Image RemovedNotification that there is a newer version on Vitalink.

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Example of newer version of Vitalink medication scheme that is showed in the combined overview.

Ambulant visit - Variant 3: Vitalink medication scheme changes

• When syncing with Vitalink: one new medication line is added to the local EHR home medication.
  • This is the Vitalink medication scheme that is validated on 29.05.2019, 19:30

• The healthcare professional checks with the patient the active medication, also the new medication line coming from Vitalink. 
  • This medication line coming from Vitalink is correct.
  • The healthcare professional agrees and doesn't have to take any action.
• The healthcare professional prescribes from the current medication scheme; no changes on medication lines are done.

• At the end of the contact, the healthcare professional wants to validate & update Vitalink.

• In the meantime, another healthcare professional has updated Vitalink.
• The healthcare professional receives a notification explaining that there is a newer version of the Vitalink medication scheme.

• The medication scheme above becomes the local home medication of the EHR.
  • Cfr. wireframe: 'Medication abc' is not highlighted anymore as a new medication line coming from Vitalink.

• The newer Vitalink medication scheme (validated 12.06.2019, 8:36 – uploaded to Vitalink by another healthcare professional during the current contact) is now visualized in the combined overview with the local home medication of the EHR.
  • It is visible that one medication line has been changed.
  • It is visible that one medication line has been stopped.

• The healthcare professional checks those changed/stopped medication lines with the patient. 
  • When the healthcare professional agrees with the combined overview (agreement with changed medication line & stopped medication), he/she doesn't have to take any action.
  • Only when the healthcare professional doesn't agree, action should be taken (use drop down menu to select edit, reject, re-activate, ...).

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

Preparation of ambulant visit by support staff
-- Nurse, hospital pharmacist assistant or a medical secretary checks medication list and this list is correct

• • Often a nurse, hospital pharmacist assistant or a medical secretary prepares an ambulant visit.
  • This healthcare professional checks for example upfront the active medication of a patient.

• This type of healthcare professionals have no validation rights related to the active medication, but they indicate in the local EHR that the medication is checked.
  • Therefore they use the action button 'register internal check'. 
  • In this wireframe, this button is active but not highlighted since the Vitalink sync is not yet done.
• This type of healthcare professionals can add / edit / stop / ... medication in the local home medication of the EHR, just in an informative way (to inform the healthcare professional with validation rights). 

• When a nurse, pharmacist assistant or medical secretary would open the patient record in the EHR, the system will start automatically checking if there is a Vitalink medication scheme for this patient. If yes, there will be a sync with Vitalink.

• Here, it is visible that the system is syncing the local EHR home medication list with the Vitalink medication scheme.

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Example when a nurse, pharmacist assistant or medical secretary can add/edit/stop medication and register internal check (once Vitalink is synced).  

• After syncing with Vitalink, it is visible that one new medication line is added from Vitalink to the local EHR medication list.
  • Since the sync with Vitalink is done, the button to register that the medication is checked becomes highlighted.
• The nurse, pharmacist assistant or medical secretary will check with the patient if all medication listed is still relevant (= actively taken).

• If the patient indicates that the listed medication is correct (= combined overview of local medication list of the EHR and the medication on Vitalink), the nurse / pharmacist assistant / medical secretary will do what he/she normally does: click on 'Register internal check'.
• This will result in an additional date, which would be the internal check date (visible on the next wireframe).

Preparation of ambulant visit by support staff
-- Nurse, hospital pharmacist assistant or a medical secretary checks medication list and this list is not correct

• When the nurse / pharmacist assistant / medical secretary is changing a medication line of the home medication of the EHR, the medication line becomes highlighted (+ icon + textual label).
  • The same for adding, stopping, ... home medication from the EHR.

• When the nurse / pharmacist assistant / medical secretary should change / stop a medication line from Vitalink (according to the information the patient is providing), this isn't possible due to the access rights to Vitalink.
  • Since the nurse / pharmacist assistant / medical secretary can't change a Vitalink medication line, the EHR allows for duplication of a medication line. In this way, the healthcare professional can report the changes stated by the patient.
    • This action will result in a duplicated medication line that is only available in the local EHR. 
    • It is important that the URI of the medication line is copied when duplicating ! 
    • These two medication lines (original medication line coming from Vitalink & medication line that is duplicated and changed) are grouped / visualized together.
    • These two medication lines can never be both validated towards Vitalink.  
  • Duplicating a medication line will be done via an action on the drop down menu.

• Next, the nurse / pharmacist assistant / medical secretary clicks on 'Register internal check'. 

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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 no changes.

• On this screen, the specialist is logged in while in consultation with the patient.
• The specialist can see the internal check date by the nurse / pharmacist assistant / medical secretary in the right upper corner (10.06.2019, 10:05).
  
  • Since the internal check date is more recent than the Vitalink medication scheme date, the specialist will know that the Vitalink medication line is checked by the nurse / pharmacist assistant / medical secretary and is reported as 'actively taken by the patient'.
  • When the Vitalink validation date would be more recent than the internal check date, the specialist will know that in the meantime another healthcare professional has updated the Vitalink medication scheme.

• When seeing this medication list, the specialist can assume that this is the correct active medication of the patient.
• The specialist can start the ambulant visit. 

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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.

• On this screen, the specialist is logged in while in consultation with the patient.
• The specialist can see the internal check date by the nurse / pharmacist assistant / medical secretary in the right upper corner (10.06.2019, 10:05).
  
  • Since the internal check date is more recent than the Vitalink medication scheme date, the specialist will know that the Vitalink medication line is checked by the nurse / pharmacist assistant / medical secretary and is reported as 'actively taken by the patient'.
  • When the Vitalink validation date would be more recent than the internal check date, the specialist will know that in the meantime another healthcare professional has updated the Vitalink medication scheme.

• When seeing this medication list, the specialist sees that there are two medication lines that are grouped since they are (almost) the same.
  • The specialist will see that the posology is different for the Vitalink medication line vs. local EHR medication line.
  • The specialist will see that the local EHR medication line is added by a nurse / pharmacist assistant / medical secretary and has the most recent update date.

• 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. 

 
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 ! 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.

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Example of synced home medication.

Admission - Variant 2: Home Medication EHR is outdated compared to Vitalink

• 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.

Image RemovedExample of admission medication, transferred from the home medication. 

The healthcare professional selects at the end the admission the medication that should be transferred to 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 Removed
     
  • Or by opening the drop down menu via the arrow pointing down (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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Example of home medication after transferring the admission 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.
• Medication that is substituted can be re-substituted by using the resubstitute icon of via the drop down menu.

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• 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. 

• 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.
  • The healthcare professional decides in this example to stop the Lormetazepam EG. 

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Example of home medication that is ready to be validated & uploaded to Vitalink.

• Next, the healthcare professional can validate the relevant lines of the home medication and update Vitalink.

Variant 3: Vitalink changes during hospital admission

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Variant 4. Discharge over the weekend

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• This means that no update of the medication will be available on Vitalink.
• This is only done when no mediation problems are expected. 

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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Image RemovedExample 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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Example of a dashboard page, visualizing the combined active medication overview of the patient (Vitalink medication lines + local EHR medication lines).

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Example of dashboard page, visualizing the admission medication when the patient is hospitalized. 

• 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 Vitlaink. 
  • 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 visualized. In the meantime, the system is syncing with Vitalink (automatically).
  • It is clearly indicated that the system is working on the sync with Vitalink.

• 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.

• 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. 

6. Other use cases

No other use cases have been defined. 

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UX GUIDELINES: mandatory & recommended criteria

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

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• 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.

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• 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).

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Recommendations

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One combined overview of all active medication

Mandatory

• 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).

• The principle of a combined overview should be kept simple:
  • Provide an indication 'what is on Vitalink' and 'What is in the local EHR'.
  • It is important that this combined overview is automatically displayed, clearly indicating what has changed with respect to the local EHR, any alerts concerning medication lines that may be a problem, etc.
  • Draw attention to changes, new additions, inconsistencies in this combined overview.
  • Afterwards, the CG can take further decisions related to these medication lines (e.g., returning to the previous posology of a particular medication, re-activating deleted medication, etc.) in an ambulant setting or starting the hospital medication in case of an admission.

• The combined overview of the active medication (medication coming from Vitalink + medication of the EHR) should be visualized in a scheme view as well as in a list view. 
  • It should depend on the user's preference in which view the active medication will open.
  • It is very important that the CG can have a hour view of the medication scheme.

• The CG should be able to make changes directly into the medication scheme. Such an interactive medication scheme would allow to easily change the posology, intake moments, comments, ...

• It should be possible to sort the medication lines via ATC code, CNK code, alphabetical, ...
• Make it also possible to sort on a column.
  • Visually indicate which column has been sorted.
• Ensure that this representation is remembered when opening the Vitalink medication scheme for other patients.

• In some cases it is not necessary to show the complete (combined) medication scheme.
  • When the CG would like to have a global overview on the patient, the software can show an reduced combined overview of the active medication, e.g. an abbreviated list. This can be used on the homepage of the patient file, on a dashboard page, ...
  • The presentation of an abbreviated list of the active medication on Vitalink combined with the active medication from the local EHR should display at least the product name, dosage & posology.
  • In this way, the care giver has a first overview of any changes to medication since the last visit of the patient.
  • In this reduced combined overview, it is also visible which medication line is coming from Vitalink & which medication line is coming from the local EHR.
  • In addition, additional information must be provided via a tooltip or fold out action (if applicable: start / stop, from, to) and comments (if applicable).
  • The CG can also adjust medication lines in the abbreviated list. The possibility should therefore be offered that the caregiver can perform actions on the reduced list of the combined overview without having to open the complete medication scheme.

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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).
• Display a textual label indicating 'new'.
• Display an icon, indicating that the related medication line of coming from Vitalink.

...

• Strike through 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 EHR and the medication line from Vitalink in a clustered way (in this way the 2 'associated' medication lines are placed underneath each other, making the comparison easier for the CG).
• 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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• This can be the case when, for example, 2x same type of medication is displayed but with a different product name. 
  • Make sure that these medication lines are grouped/clustered.
  • Next, provide an alert on these medication lines.
• This can be the case when there is an incomplete medication line.
  • Make sure that it is pointed out that the medication line isn't complete.
  • Aks, via an alert / notification if the CG can complete the medication line. 
• An alert or notification can be an icon or textual 
  • Via a tooltip, more information can be provided.

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 EHR.

• In addition, the CG also has certain expectations regarding the visualization 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: click on edit icon or link of medication line will lead 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).

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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

• 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

Mandatory

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prescription

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• 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.

• 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).

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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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module

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During a hospital stay

Mandatory

• 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

Mandatory

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,

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• When printing the patient friendly medication scheme for the patient, it must also be possible to Validate & Update Vitalink as from there.

• If Vitalink is still syncing, and when the CG wants to continue, he/she should be able to 'Validate' the active medication.
  • This is an internal validation (within the EHR).
  • This means also that the CG has seen only the local EHR active medication.
  • No upload to Vitalink will be done.

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)

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Visualization 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 EHR. 
• This print should be visualized 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

Mandatory

• 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).

• Example: when importing the Vitalink medication scheme, and when having a medication line with issues, there should be as much as information as possible retrieved from the medication line until the information can no longer be read (due to the corrupted construction).
  • Eg if the posology is still correct this can be downloaded but it is not possible anymore to download correct information for the intake moments).
  • 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 add the missing information to the active medication and upload it towards Vitalink.

• CGs are open to complete this information 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 which 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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