Introduction

The wireframes below have been created based upon observations in several Flemish hospitals.
The observations were based on the use of the home medication throughout the hospital practice.

Wireframes

1.Ambulant Visit

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

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 & circle of trust 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.

Example when the sync with Vitalink is completed. 

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

Example 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. 

• 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.

    

• 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.

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

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

• 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). 

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

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

• 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'.

Variant 2: Home Medication in the EHR is outdated vs. Vitalink medication scheme

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).

• 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.

• It is important that there is a visual difference between data from Vitalink vs. data from the local medication scheme of the EHR.
• In this example, it is visible that new medication was added on Vitalink.
• It is important that a changed medication, stopped medication, added medication is clearly indicated (here: the label 'new' is used in combination with the Vitalink icon) (cfr. next wireframe).
  
  
• List view vs. scheme view: the healthcare professional should be able to select the preferred view of the active medication list (combined overview).
  • 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 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.

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

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.

• 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.

Actions possible on a medication line

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

• For all medication lines, it is possible to do some actions per medication line.
  • This can be done by clicking on the ... indication which is positioned in a vertical way at the end of the medication line.
  • Next, a drop down list with actions will 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 and other related information) 
  • 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.
  • Keep in mind, this is a software feature; this means that the software provides the feature to display the history of all changes that has been made towards a medication line).
• 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.
  • At any time, when selecting this action, a notification should be displayed to ask if the healthcare professional is sure to continue without uploading all relevant medication data towards Vitalink (cfr. wireframe below).
  • When the healthcare professional wants to change a medication line, he/she can do this by using the drop down list with actions via the ... indication. 

Notification if one or more medication lines are marked as 'Don't show on Vitalink'.

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

• Possible actions for a stopped medication line are:
  • Re-activate (make medication line active again)
  • History (check history of posology etc, this is a software feature, no Vitalink feature, cfr. explanation above)

• The drop down list with actions visualised 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, ...).