Visible Agency

As we progress with Connect Care configuration and build, then check back with stakeholders through Adoption & Validation, the time has come to transition from vendor-facilitated presentations to AHS-facilitated demonstrations. Happily, our technical specialists and clinical informaticians (including physician leads, physician builders and medical informatics leads) have trained to the point that they can confidently share the emerging clinical information system (CIS) features and workflows with AHS users. Such interactions build confidence and help translate user reactions to sensible re-configuration requirements.

Such AHS Connect Care CIS “agency” will be apparent at Adoption & Validation #2 in August, by which time clinical leads will have access to a new Connect Care simulation and demonstration environment since late July.

A key to Connect Care agency is for physician leaders to master CIS design and function. We are pleased to report that, to date, 54 physician leaders have completed a 1-day Epic overview course, 40 have completed a 3-day course, 18 have completed basic physician builder training, 2 have completed advanced physician builder training and 1 has progressed to advanced competency in Epic analytics. Others are in-training and too many to count have completed self-directed online learning modules.


Connect Care: How are we doing so far?

Almost 9 months since the official (contractual) start of Connect Care, the time is right to acknowledge what we've collectively accomplished. Although we wish some configuration tasks were further along, the Connect Care initiative continues to achieve a myriad of (ambitious) milestones early in its (shortened) 5-year plan.

Thankfully, many requirements for a provincial clinical information system (CIS) were anticipated. We leverage the good work of Strategic Clinical Networks, Quality Safety & Outcomes, Clinical Knowledge & Content Management, Strategic Transformation Questions, eSafety, infrastructure enhancement and other efforts to transform health care provincially.

We also acclimatize a critical success factor... being inclusive. All zones, sites, disciplines and stakeholders are involved, including input from patient advisors. All deserve credit for rapid progress in many areas:

  • Credible Oversight: A robust and enduring provincial oversight structure brings governance, advocacy and community empowerment to Connect Care, ensuring representative guidance through design and build, and responsive optimization indefinitely. The associated committees, councils, advisory groups and workgroups have proved positive and productive. The decision-making experience already nurtures curious, collaborative and empowered stakeholders.
  • Early Engagement: Over 3,000 physicians, clinicians, staff and patients have participated in groundwork, scoping, direction-setting, clinical system design and adoption & validation activities; often in demanding multi-day sessions. They directly ensure commitment to purpose over product.
  • Shared Decision-Making: Already many thousands of answered questions address how Connect Care is configured to support the way we work. Many more thousands guide the selection, adaptation and development of clinical content (documentation, decision and inquiry supports) to help patients, practitioners and policy-makers. 
  • Dynamic Build: To date, reactions to the emerging Connect Care build have been very positive. Iterative exposure of work completed, review by stakeholders and then re-adjustment continues, with responsive build activities finishing by early 2019 when simulation and testing begins.
  • Principles-Based: Guiding principles for governance, system build, design management, scope management, decision support, documentation, embedded analytics, eSafety and many other domains help decision-makers work to a common purpose. 
  • Solid Foundation: Disaster resilient data centres are built and linked, with the CIS software installed and taking shape. Clear frameworks guide selection and deployment of wireless, workstations and mobile devices.
  • Scope Managed: The capabilities of our integration partner (Epic Systems) are known, potentially important clinical or safety gaps explored, and decisions about complementary systems made; emphasizing integration, simplicity and sustainability.
  • Implementation Plans: Work continues to sequence roll-out waves. Use of resources and change agents is carefully choreographed. Plans for training and supporting over 7,000 prescribers and 110,000 staff are underway, with zones and sites ramping up their own effector streams.
Rapid change, with such profound implications, occurs on a scale never before experienced in our organization.  It solidifies our identity as a principled public service and prepares us for even greater change as we get ready for CIS implementation starting late 2019.


Connect Care Town Hall Meetings

An increasing proportion of the Alberta Health Services (AHS) community has had direct exposure to Connect Care. Committees, councils, advisory groups, workgroups, direction-setting, system design and now adoption & validation have actively involved a wide range of stakeholders, giving tangible experience of what Connect Care is and how it progresses. Initiative awareness surveys confirm that “the word is out”.

With awareness comes changing information needs. In order to broaden our community understanding, while more dynamically responding to questions of the day, quarterly Connect Care Town Halls offer a new option for updates, questions and answers.

The first takes place July 11, 2018. To accommodate anticipated numbers, a telehealth session for North and Edmonton Zones (1230-1330) will be followed by a second for Central, Calgary and South Zones (1400-1500). Telehealth locations and connection details will be posted to Connect Care Insite.


Connect Care July Calendar

A summary of key Connect Care happenings in July 2018 has been posted to the Alberta Health Services internal Connect Care website, linked below.

With completion of the first Adoption & Validation session, configuration teams are busy at work implementing decisions made in build buckets 1 and 2. They confront new questions while tackling development tasks and now have clear processes for just-in-time access to clinical, operational and governance consultation. Specialty Clinical System Design has started, with Area Councils establishing specialty workgroups to take on document, decision and inquiry support customization tasks. Training and support plans are tangible, with recruitment and certification of curriculum developers under way. Most importantly, an approved change management framework guides preparations for a fall Clinical and Operational Readiness (CORe) launch.


Connect Care June 29 Newsletter Posted

The June 29, 2018, Connect Care Newsletter is available via the link below, covering the first Adoption & Validation session in Calgary, data conversion and the clinical information system build collaboratory.


Connect Care Adoption & Validation #2 Preparations

The next Adoption & Validation session takes place in Edmonton, August 14 to 16, 2018 at the Shaw Conference Centre. This second consultation shifts attention to workflows and configuration choices not previously covered, and some where active change continues. The topics will relate to build ‘buckets’ finishing over the summer. Accordingly the call for subject matter expertise will also be tailored.

We emphasize that lack of participation in Adoption & Validation 2 carries no implication about which clinical areas are important or which subject matter experts are most involved in Connect Care design and build. Many parallel clinical system design, data conversion, implementation planning and other activities tap into the broad range of input needed to ensure that Connect Care takes shape as users would want.

Invited participants can expect to hear from the Connect Care Program Office within the next two weeks.


Connect Care Data Conversion Progressing

Alberta Health Services (AHS) has started the process of bringing (or “converting”) data from current health information systems into the Connect Care clinical information system (CIS). This will ensure that clinicians will have the information they need to serve patients and populations.

In early 2018, the Connect Care conversion team reached out to clinicians, leaders and technical experts across Alberta to get input about the amount and kind of information that needs to be available in Connect Care. This input helped inform scoping recommendations for data conversion. The Connect Care Executive Committee approved both data scoping principles and processes.

The CIS data conversion initiative applies data conversion principles to the extraordinarily complex task of assessing the quality of source system data and meta-data (data properties and relationships). This helps determine if health data can be safely imported and placed in a fully integrated CIS, where meta-data abounds with links to clinical context, purpose, decision and how the information is used in clinical, inquiry and instructional workflows. Additionally, data must be “normalized” to reference the same units, expected ranges and meta-data terminologies.

Where the risks associated with conversion are too great, Connect Care will default to health data captured directly to the CIS. Clinicians are supported through transitions with read-only access to legacy health information systems. Of course the Alberta Netcare Portal (EHR) eases continued access to older information, helping clinicians review historical health data when adding richly connected new information to the Connect Care health record.


Physician Access to Digital Records when Patients Complain

​In mid-August 2016, the Office of the Information & Privacy Commissioner of Alberta (OIPC) publicly reported its investigation into the alleged misuse of EHR records by two physicians who were responding to a patient complaint about the quality of their care, in the case Gowrishankar v JK. There have been developments since we last explored possible implications of this case.

The two physicians, with AHS and the AMA as interested parties, appealed the OIPC’s decision.  In January 2018, the Court of Queen’s Bench of Alberta released its decision on the appeal.  It did not change the majority of the OIPC’s findings, but the Court did find that the physicians’ use and disclosure was in compliance with the Alberta Health Information Act.

In February 2018, the patient appealed the decision of the Court of Queen’s Bench of Alberta to the Court of Appeal of Alberta.  While the appeal to the Court of Appeal is outstanding, the AHS policy and procedures related to the use and disclosure of health information remain the same and should be followed.
A backgrounder and FAQ express AHS’ understanding of the information and disclosure processes, along with appropriate documentation, implicated in the case and its appeal.


Connect Care Adoption & Validation #1 a Success

Adoption & Validation is one of the major activities occurring during design of the Connect Care clinical information system (CIS). The relationships between design and build activities are summarized in an online presentation: How the system is built. The first Adoption & Validation session occurred last week at the Calgary Telus Convention Centre and was a big success.

The formal sessions proved very helpful to those working to shape the AHS CIS. Lots of good discussion tapped expertise and experience from all corners of the province. Many groups, including Area Councils, Specialty Workgroups and Committees took opportunity to meet and tackle complex issues. Indeed, the intensity and productivity of these “un-sessions” reflect how far we’ve come in just over half a year. Connect Care goals are taken for granted. Stakeholders are deeply engaged, and a problem-solving spirit moves us forward more than any leadership team could have hoped for.

Physician leads gathered at various times during the week, including a standing-room-only discussion about mobile solutions. The group resolved to hold similar meets at upcoming sessions, each addressing a theme of particular interest to physicians.

The next Adoption & Validation session will take place in Edmonton, August 14 to 16, 2018.


AHS Recognized for Integration Accomplishments

Befitting our Connect Care ambitions, AHS has recently been cited among the top 5 organizations worldwide for health system integration. And we've only just begun!