...

• The GP 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 who.

Prescribe medication

x

Validate the Vitalink medication scheme

x

Visualization of the print version of the Vitalink medication scheme

x

...

• • 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 GP also has certain expectations regarding the visualization and use of this medication scheme. The GP 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).
  • Repetitive prescribing: provide check boxes to select one or more medication line(s) and prescribe one-by-one (the GP then has a complete overview of all active medication before prescribing repeatedly).
  • 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 GP 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).
• In addition to the name of the health care provider, show the specialty of the health care provider who has added or adjusted a medication line if this is given via Vitalink.
  
  
• Visualize medication that was prescribed during the current consultation in a different way (icon and / or color).
  
  
• Showing the version number is less important for the GP, but can be interesting for a print version of the medication scheme or for other reasons.
  
  
• The GP wants to know possible interactions between medication lines, but not all possible interactions.
  
  
• In some cases, the GP may want to adjust the order of the medication lines in the Vitalink medication scheme.
  
  • 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 / acute /If necessary.
  • Visually indicate which column has been sorted.
  • Ensure that this representation is remembered when opening the Vitalink medication scheme for other patients.

Prescribe medication

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.

Visualize newly added medication in a different way in the Vitalink medication scheme. In this way the GP has a clear overview of what will be added.

During the prescription of a medication, the GP 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 GP has indicated to work with Vitalink.

Recommendations

• If the GP decides to prescribe medication during the consultation, the shortened list of the combined overview (information derived from local EMR and from Vitalink) with product name, dosage, posology or the complete medication scheme (with the extensive combined overview) should be the base of the page on which they start when creating a prescription.
• On this prescription page it is important that the complete medication scheme can be opened with one click (if it is not already fully shown) or it can be displayed that the GP wishes to work with Vitalink (if this is not yet the case for the patient).
  
  

• 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.
  • Place the complex prescribing module behind a button / link. This can then be reached via one extra click (this is not a problem since complex prescribing (weekly scheme, 'phasing out' scheme, etc.) occurs less frequently). The umbrella organization can provide best practices with regard to good interfaces for 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).
• Simplify the addition of indications / pathologies (pharmacists & patients are asking for this).

  • Provide quick selections / suggestions for indications / pathologies per medication. In this way, the GP can send the most current indication to the Vitalink medication scheme in one click. If the suggestion of indication / pathology does not match, the GP should simply be able to enter another indication / pathology as free text.

• The GP can indicate whether or not medication can be shown on Vitalink, both in the prescription module and on the interactive medication scheme (combined overview).
• Ensure that prescription by substance name is possible (this is then adjusted by a pharmacy in the Vitalink medication scheme to the generic variant).

Validate the Vitalink medication scheme

zie wireframe 4.1 & 5.1

Mandatory

After prescribing and completing the consultation it is important that the complete Vitalink (combined) medication scheme is shown before validating and uploading.

This means that the GP must actively press the 'Validate Vitalink medication scheme' button before the complete medication scheme is uploaded to Vitalink.

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

The GP receives feedback on uploading the Vitalink medication scheme when the patient's EMR is closed.

In the context of home visits it is necessary that the GP can download and open 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 GP does not want the medication scheme (now, will have to do it later) to be uploaded to Vitalink, he should have the option to validate later (put on a 'to do' list) or to not validate it yet.

If the GP 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.

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

In case of a home visit, the upload of the medication scheme to Vitalink will possibly take place later if there is no internet connection (the medication scheme is temporarily placed on a 'to do' list and when connected this medication schedule is automatically uploaded to Vitalink).

Recommendations

• The GP 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.
  

  • In addition to the automatic notification after 4 days, provide the GP 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.

Visualization of the print version of the Vitalink medication scheme

Mandatory

It should be taken into account that the print version of the medication scheme for the patient may evolve in the future.

Depending on the needs of the patient, different types of displays may be necessary.

Each view will be built on the same dataset. This view should be able to be viewed on the screen by the GP & possibly the patient during the consultation, or be printed to give to the patient.

• A display type can be selected on the combined overview of the medication scheme.
• It must be easy to alternate between the different types of view so that the GP can decide in consultation with the patient which visualization of the medication scheme is best suited for the patient.

An exact implementation of this representation(s) will have to be offered by the software supplier.

Recommendations

• Ensure that the GP can easily switch between the different display types.

• Keep the preference for a specific type of display for each patient, so that the GP can know which type he / she should select during a subsequent consultation.

How to handle errors

zie wireframe 3.4 & 4.4

Miscellaneous

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