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

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit of the patient) Vitalink medication scheme is imported.
2	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version that is already present in the EHR Home Medication. The EHR Home Medication section and Vitalink medication scheme are in sync.
3	OPTIONAL: Home medication EHR can be updated in the combined overview during the preparation for the ambulant visit Vx'.
4	OPTIONAL: Preparing of ambulant visit stops. The local medication scheme is now version 1'.
5	Start ambulant visit.
6	End ambulant visit. The caregiver made changes to the Home medication EHR. The Home Medication EHR is now Version 1".
7	The Home medication EHR version V1'' is exported to Vitalink. The Vitalink medication scheme now becomes Version 2.
8	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's in the EHR.
9	The Home medication EHR is now on Version 2 of the medication scheme. The Home medication EHR section and Vitalink are in sync.

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

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit with patient) Vitalink medication scheme is imported.
2	There is no data in the Home medication EHR section so the EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically.
3	Vitalink send the latest version 1 of the medication scheme to the EHR.
4	The Home medication EHR is now also Version 1. The EHR and Vitalink medication scheme are in sync.
5	OPTIONAL: Local medication can be updated in the combined overview during the preparation for the ambulant visit to V1'.
6	OPTIONAL: Preparing of ambulant visit stops. The EHR holds now version 1'.
7	Start ambulant visit. Updates and changes are executed in the combined overview during the visit.
8	End ambulant visit. The caregiver made changes to the Home medication EHR section. The Home medication EHR is now Version 1".
9	The Version 1" of the EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 2.
10	Vitalink sends the updated identification code for each medication (URI's) back to the EPD. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's in the EHR.
11	The Home medication in the EHR is now Version 2. The EHR and Vitalink medication scheme are in sync.

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

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit with patient) The EHR holds the home medication version 1. The home medication section of the EHR is outdated versus Vitalink.
2	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically.
3	Vitalink send the latest version 2 of the medication scheme to the EHR. The Vitalink medication scheme is imported and updates, changes, etc are shown in a combined overview. The caregiver can validate/reject changes.
4	If you validate the Vitalink medication scheme, you keep to version 2 in your EHR. If you reject changes in the combined overview, the home medication section of your EHR will now hold Version 2' and is not in sync with Vitalink (because you have already made some changes to it).
5	OPTIONAL: Home medication in the EHR can be updated in the combined overview during the preparation for the ambulant visit to V2'.
6	OPTIONAL: Preparing of ambulant visit stops. The EHR holds now version 2'.
7	Start ambulant visit.
8	End ambulant visit. The caregiver made changes to the home medication in the EHR. The EHR holds now Version 2".
9	The home medication EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 3.
10	Vitalink sends the updated identification code for each medication (URI's) back to the EPD. The EHR requests Version 3 of the medication scheme from Vitalink to update the version and URI's in the EHR.
11	The Home medication in the EHR is now Version 3. The EHR and Vitalink medication scheme are in sync.

Variant 3: Vitalink medication scheme changes

Situation / Action	Information
1	OPTIONAL: Support staff starts preparation of the ambulant visit (eg. for staff meeting or oncology visit of the patient) The home medication section of the EHR holds version 1 of the medication scheme
2	The EPD requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version that is already present in the EPD. The EHR and Vitalink medication scheme are in sync.
3	OPTIONAL: Home Medication in the EHR can be updated in the combined overview during the preparation for the ambulant visit to version 1'.
4	OPTIONAL: Preparing of ambulant visit stops. The EHR holds now version 1'.
5	Start ambulant visit.
6	In the meantime, a new medication scheme was uploaded to Vitalink by another Caregiver. The Vitalink medication scheme is now Version 2.
7	End ambulant visit. The caregiver made changes to the home medication in the EHR. The EHR holds now Version 1".
8	The Home medication of the EHR is exported to Vitalink. The export failed because the version of the medication scheme in Vitalink is more recent than the one in the EHR.
9	Since the EHR holds the master medication scheme version V1", the EHR has to provide an interface (= combined overview) in order to show medication changes between Version 1 and Version 2 of the Vitalink medication scheme and the home medication of the EHR Version 1". The caregiver can validate/reject changes. We recommend to show a notification that there is newer version of the medication scheme on Vitalink.
10	The caregiver can validate/reject changes. The EHR holds now version 2'.
11	The home medication of the EHR is exported to Vitalink. The Vitalink medication scheme now becomes Version 3.
12	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 3 of the medication scheme from Vitalink to update the version and URI's in the EHR.
13	The EHR holds now Version 3. The EHR and Vitalink medication scheme are in sync.

If the Vitalink medication scheme changes during the preparation of the ambulant visit and the person responsible notices,

he/she can download the new version of the medication scheme and take the needed actions (see Variant 2: Home Medication EHR is outdated vs. Vitalink medication scheme Step 2 - 4).

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

Situatie / Actie	Info
1	The EHR requests the latest version of the Vitalink medication scheme. This action can be done manually by a user action, but is preferably done automatically. Vitalink responds with the same version 1 that is already present in the EHR. The EHR and Vitalink medication scheme are in sync.
2	OPTIONAL: The home medication section in the EHR is possibly updated to Version 1' in preparation to become admission medication.
3	During admission, Admission medication (= medication during an admission in the hospital) A is determined. This admission medication scheme will hold relevant information from the home medication Version 1', possibly substituted to the clinical formularium.
4	During admission numerous changes (A to Z) can happen to the admission medication. These changes are local to the EHR and are not communicated nor affecting the Vitalink medication scheme.
5	At discharge, a new home medication scheme Version 1" is determined in the EHR, as much as possible re-substituted to the original medication of the patient at the start of the admission.
6	The home medication of the EHR version 1" is exported to Vitalink. The Vitalink medication scheme now becomes Version 2.
7	Vitalink sends the updated identification code for each medication (URI's) back to the EHR. The EHR requests Version 2 of the medication scheme from Vitalink to update the version and URI's locally.
8	The EHR holds now Version 2. The EHR and Vitalink medication scheme are in sync.

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.