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- This means that the admission medication will be transferred to the home medication.
- Next the home medication will be validated & uploaded to Vitalink.
- Often, a patient friendly medication scheme will be printed for the weekend home stay.
- Also from here it is possible to validate & upload the medication list to Vitalink (cfr. ambulant visit).
- Also from here it is possible to validate & upload the medication list to Vitalink (cfr. ambulant visit).
- After the weekend, the home medication is normally not changed. However, a Vitalink sync will be done.
- Next, the home medication will be transferred again to the admission medication.
- When having a discharge over the weekend, medication is normally not substituted.
- When having a final discharge, the medication is re-substituted as much as possible to the original medication.
- In some cases, when having a discharge over the weekend, the admission medication is not transferred to the home medication.
- 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.
5. Other use cases
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
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MANDATORY & RECOMMENDED UX GUIDELINES
Access to Vitalink
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 EHR, it must be checked automatically if the registration of the informed consent is fulfilled, if there is a Vitalink medication scheme for this patient and whether the EHR has the most recent version of the Vitalink medication scheme.
- This automatic questioning is done for all patients as soon as their file in the EHR is opened, independent what the reason for hospital visit is (ambulant visit, emergency room visit or admission).
- An automatic questioning of the Vitalink medication scheme is crucial. The care giver should not take any action (eg no click to start a download When opening a patient's EHR, it must be checked automatically if the registration of the informed consent is fulfilled, if there is a Vitalink medication scheme for this patient and whether the EHR has the most recent version of the Vitalink medication scheme.
- This automatic questioning is done for all patients as soon as their file in the EHR is opened, independent what the reason for hospital visit is (ambulant visit, emergency room visit or admission). An automatic questioning of the Vitalink medication scheme is crucial. The care giver should not take any action (eg no click to start a download).
- 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 EHR.
- 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 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
- CG must be able to
- indicate that he/she wants to make use of the Vitalink medication scheme for the patient in question
Recommendations
- , if applicable.
- The CG must be able to clearly see Display visually that the application is still working on the Vitalink medication scheme.
This can be done, for example, by a progress indicator or an icon indicating that importing the information from the Vitalink medication scheme is loading.
Display visually that the Vitalink medication scheme has been collected.This can be done, for example, by an icon indicating that all data from Vitalink has been retrieved (+ mandatory information: date & time of last download). - If it is not possible to obtain data from the Vitalink medication scheme, also visualise it and indicate why there is a problem / what the problem is (in understandable language).
One combined overview of all active medication
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:
- .
- The CG must be able to clearly see when the import of the Vitalink medication scheme has been completed.
- Always mention the date & time of the last validation since this is useful to the CG to validate the validity of the Vitalink medication scheme.
- Other information like date & time of last download, validator, ... can be visualized via a tooltip (if not enough screen space).
- The CG must be able to clearly see when the application has failed to import the Vitalink medication scheme.
- In the case of a hospital, if all mandatory authorizations/mandates are set, it must be possible for a member of administrative staff to prepare the EHR by importing the medication scheme for the patient in question.
- 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 EHR.
- 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).
Recommendations
- Display visually that the application is working on the Vitalink medication scheme.
- This can be done, for example, by a progress indicator or an icon indicating that the Vitalink medication scheme is loading.
- This can be done, for example, by a progress indicator or an icon indicating that the Vitalink medication scheme is loading.
- Display visually that the Vitalink medication scheme has been collected.
- This can be done, for example, by an icon indicating that all data from Vitalink has been retrieved (+ mandatory information: date & time of last update of the Vitalink medication scheme).
- This can be done, for example, by an icon indicating that all data from Vitalink has been retrieved (+ mandatory information: date & time of last update of the Vitalink medication scheme).
- If it is not possible to obtain data from the Vitalink medication scheme, also visualise it and indicate why there is a problem / what the problem is (in understandable language).
One combined overview of all active medication
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.
- 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;
- Visualize changes If after the automatic questioning it is determined that the active medication from the local EMR corresponds with the Vitalink medication scheme, no further action is taken.
- Still, it remains valuable to see the active medication.
- Showing a short list with at least the product name, dosage & posology is sufficient to give the general practitioner a first overview of all active medication or any changes.
- For example, a tooltip with a 'mouse-over' action shows additional information such as a start or stop date and/or a note regarding the medication line. In the overview itself it can be indicated that there is additional information so that the CG knows which medication lines he/she can possibly carry out a 'mouse-over' action on. With all medication lines the indication 'Vitalink' will be displayed so that the CG clearly knows that there is no difference between the local EMR and the Vitalink medication scheme.
- If, after the automatic questioning, it is determined that the active medication from the local EMR does not match the Vitalink medication scheme, one combined overview of all active medication from the local EMR and all active medication stored in the Vitalink medication schedule will automatically be shown.
- 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.
- Draw attention to changes, new additions, inconsistencies in this combined overview.
Visualise clearly which medication line comes from where (Vitalink vs. local). A medication line from Vitalink has the Vitalink icon displayed. A medication line from the local EMR is displayed without an icon.
Visualise changes in the following way:- Newly added medication with respect to the local EMREHR:
- 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.
- Change in posology, intake moment, etc:
- Cross out 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 EMR 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 general practitionerCG).
- 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.
- Removal of prescribed medication:
- Cross out Strike through the medication line that has been removed.
- Cross out Strike through the medication line that has been removed.
- Newly added medication with respect to the local EMREHR:
- The necessary changes (make the deleted medication line active again, change the modified posology to previous posology, etc) can be done by right-clicking on the relevant medication line or by clicking on an action button.by e.g. using a drop down menu or by having a shortcut (buttons / links) on the related medication line.
- When the CG does nothing, he/she agrees with the overview of the active medication that he/she sees (deleted medication will disappear, adapted posology will be retained and the previous posology will disappear, etc) and at .
- At a next opening of the EMR EHR it is shown as a local scheme.
- Provide the opportunity option to display an alert or notification:
- WithThis can be the case when, for example, 2x same type of medication is displayed but with a different product name. These will also be displayed under each other for clustering.
- For example, an incomplete medication line.
-
- 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
- Show interactions between medication lines through an alert (like this is already the case in the hospital software).`
Interactive/Dynamic medication scheme
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