Connect Care Wave 1 Launch Event - Update & Telehealth

On Thursday, January 17, staff and physicians are invited to discuss and learn about the the Connect Care Wave 1 launch later this year at the Walter C Mackenzie Campus and Edmonton Zone eCLINICIAN outpatient clinics.

Drop-in booths (09:00-16:00) in the Bernard Snell Hall lobby give visitors a chance to view demonstrations of Connect Care clinical information system (CIS) functions, ask about training and readiness preparations, and get a hands-on look at some devices and tools being considered for clinical workplaces.

A lunchtime celebration tracks where we are in the Connect Care journey, with sharing from Dr. Yiu and site leaders.

Later in the day, a special session for physicians takes place in the Snell Hall Auditorium between 16:00-18:00. A presentation exploring physician fears and hopes is followed by ample opportunity for questions and discussion.


Why Doctors Hate Their Computers - 4

We continue reflection that began with a previous posting about Dr. Atul Gawande's: "Why Doctors Hate Their Computers" New Yorker article.

The publication has lit fires across the Internet and Blogsphere;  clouding conversations about Alberta Health Service's (AHS) upcoming clinical information system (CIS) implementation.

Dr. Gawande's writing resonates with widespread frustration among American physicians, channelling anger about decreased physician satisfaction with today's experience of health care. Memorable quips, such as "revenge of the ancillaries", add to free-floating anxiety about the collateral damage brought by enterprise electronic health record (EHR) initiatives.

Connect Care bears no illusions about how its CIS could impact physicians. We have gone to great lengths to learn from the unanticipated and unwanted struggles of others. We continue to study the fears of our own physicians. Indeed, much of our planning turns on harms-reduction, including careful mitigation of four major harms explored by Dr. Gawande:
  1. Increased Complexity,
  2. Decreased Control,
  3. Decreased Clarity, and
  4. Increased Brittleness.
We'll expand on each of these in upcoming postings. Thanks to all the AHS ACMIOs, physician design leads, directors and analysts who help with these reflections.


Why Doctors Hate Their Computers - 3 - Ways to make EHRs less Time-Consuming

We previously posted about Dr. Atul Gawande's: "Why Doctors Hate Their Computers".  A recent Harvard Business Review article offers strategies for dealing with the most hate-worthy effects of Electronic Health Records (EHR) in the United States. All suggestions resonate with Dr. Gawande's reflection that our problems have more to do with people and processes than products or technology.

1. Standardize and reduce insurance-imposed documentation burdens
As observed by others, the same EHR blamed for burnout in some implementations is credited for satisfaction and retention in other settings. A better predictor of burnout appears to be documentation burden, whether paper or digital. There are huge reimbursement-related micro-documentation pressures in the United States. Whether these have a net-positive effect on health care, in addition to health care billings, is a key question. In any case, it is possible and desirable to deploy EHRs in ways that significantly reduce total informational burdens for physicians.

2. Improve EHR workflows
To the extent that EHRs replicate pre-existing workflows, a huge transformation opportunity is missed. When organizations pair improvement with implementation, many informational peeves are eased, not exacerbated. Process steps can be removed and pathways streamlined. Such optimizations, increase clinician satisfaction and contribute to the variability in reports of physician burnout.

3. Use EHRs to Leverage Innovation
When a digital health record integrates across the continuum of care, health information can flow more like a public utility... a dependable resource that consumer-facing innovations do not have to re-invent. The energy of innovation can shift from system to user. For example, dramatic improvements in the EHR experience follow release of mobile EHR Apps with guessable user interfaces. More importantly, mobility has stimulated release of standardized application interfaces (e.g., Epic's App Orchard) that innovators can use to produce even better user experiences. These reflect the peculiarities of end-user needs and preferences. It is exciting to contemplate innovation unleashed by health record standardization.

The original article is a quick read:


Recruiting Connect Care Super Users

Many of us are part of the first Connect Care clinical information system (CIS) launch later this year. With implementation anxiety growing, we may feel a bit better knowing that capable and confident "Super Users" will be close at hand and ready to help.

Super Users support peers in clinical areas, helping them adapt to new workflows, processes and norms while building capacity for meaningful use of the Connect Care CIS. Physician Super Users facilitate prescriber participation in readiness activities, ensure authentic CIS testing, and build relationships to support physicians “at the elbow” prior to, during and following launch.  Super Users get early CIS training and a variety of change agent supports.

With only 10 months (note the new countdown top left!) to go until Wave 1 launch, we need to start thinking about Super Users. Recruitment begins next month, starting with Wave 1 units, departments, areas and locations. Now is the time to start identifying those who could be a good fit for this role.

Visit the Connect Care intranet for general information and email ConnectCareSuperUsers@ahs.ca with nominations. For Physician Super User nominations, email cmio@ahs.ca.


Willy Wonka and the Medical Software Factory

Alberta Health Services (AHS) is well into its Connect Care journey. Part of the adventure involves getting to know, and closely collaborate with, an extraordinary medical software company. Of course collaboration not always easy, but there is no doubt that our partnership with Epic long ago merited sharing the "we" pronoun.

The New York Times recently ran a piece about Epic, its philosophy, leadership and campus. Worth a quick read for some insights to our technology partner's personality.

The comments are worth a quick skim (don flak jacket first) to gauge US backlash against electronic health records. "We" need to do better.


Why Doctors Love Their Computers - 2

We previously posted about an influential piece by Dr. Atul Gawande: "Why Doctors Hate Their Computers".  The New Yorker article continues to attract a lot of attention, and is an essential read for all involved in the Connect Care clinical information system (CIS) launch later this year.

The article has stirred social media widely, stimulating a lot of great discussion.

A UC San Diego physician group (also on Epic) have recently shared reflections about "Why Doctors Love Their Computers" while acknowledging that there remains lots of room for improvement. A good, quick, read that lists 10 reasons why, from primary care and hospitalist perspectives:
Among the reasons we hope to realize are: convenience of mobility, better connections with the circle of care, easier access to essential health information (problems, meds, allergies, etc.), better on-call supports, leveraging documentation of others, faster admissions with personalized ordersets, streamlined discharge summaries, and prescribing that is both easier and safer.


Connect Care Oversight: Stakeholder Advisory Group

For the Alberta Health Services (AHS) Connect Care initiative to succeed, patients, providers and support staff must integrate informational supports into workflows. This happens best when clinical information system (CIS) users have meaningful input into the decisions that affect their CIS experience. A robust oversight strategy with clear governance principles has helped guide Connect Care by purpose and principles.

Sustaining success requires nimble ways to tap into what is happening on the front lines, while monitoring for unanticipated problems. Community-aware calibration requires purposeful consultation with both advisory groups and user groups, tapping into organizational wisdom and end-user pragmatism. As we ready for first launch late this year, advisory group activity ramps up while user groups start to get established.

The Connect Care Stakeholder Advisory Group has its first meeting this week, a good reminder to refresh our shared understanding of how Connect Care oversight works.


Connect Care Inquiry & Research Support Webinars

We’ve previously posted about how the Connect Care clinical information system (CIS) will support clinical inquiry. Connect Care, at its core, is about inquiry and research – learning from the care we deliver to Albertans. We initiate inquiry when we ask questions about what we do and we participate in research when using systematic approaches to answering those questions.

Connect Care affords us powerful tools for inquiry and research support. As these take shape, there is growing interest in what is possible and when it will be available. The Connect Care Clinical Inquiry and Research Team helps by hosting a series of monthly demonstrations showcasing research capabilities and workflows.  The webinars also give opportunity to put questions to the Connect Care team.

Upcoming inquiry & research management webinars are planned as follows:
  • Monday Jan 21st, 2019 12 PM-1PM
  • Tues Feb 19th, 2019 12 PM-1 PM
  • Mon Mar 18th, 2019 12 PM-1 PM
  • Mon Apr 15th, 2019 12 PM-1PM
To request a webinar invitation, please contact CC.Research@ahs.ca. For more information about Connect Care inquiry and research supports, please see relevant Connect Care Handbook entries:


Re-jigging Communications in the New Year

This year (2019) brings Connect Care to its first launch, Wave 1 in the Edmonton Zone on November 2. Where 2018 focused on scope, workflow, configuration and clinical content design, the new year emphasis continues build while starting testing, training, change management and implementation.

Most Connect Care participants continue invaluable contributions, building on all that has been learned since we started our journey. The many new participants pulled into readiness prep need help building a Connect Care awareness sufficient to their needs.

Both Connect Care newcomers and veterans can benefit from reinforcement of key concepts and re-connection with key communication channels. We'll use this blog to help followers re-cycle and re-invigorate.

For starters:


School for Change Agents - Free Webinar Opportunities

Alberta Health Services has enjoyed innovative input from Helen Bevan (@helenbevan) on more than one occasion. A thought-leader in healthcare engagement, adoption and change management, she has helped initiate a "School for Change Agents" through the National Health Service in Britain.

A series of free online 5 webinars start later this year. International participants are welcomed.

With 2019 bringing transformation through Connect Care implementation, most of us can benefit from new ideas about change awareness, support and management. Please consider registering, as below.


Connect Care Wave 1 Launch Event

In collaboration with the University of Alberta and Stollery Hospital Medical Staff Society, Alberta Health Services presents in the leadership lecture series about:

"Connect Care: Learning to Love your Clinical Information System"
January 17, 2019, 1600-1800, Bernard Snell Hall, Walter C Mackenzie Centre, Edmonton,
with videoconferencing widely available.
A wine and cheese reception will follow in the foyer.

The presenting panel includes Rob Hayward (CMIO), Tim Graham (Associate CMIO), Stuart Rosser (Physician Design Lead), Stewart Hamilton (Senior Medical Advisor), Jacques Lovely (Senior Leader Clinical Operations) and local Connect Care leaders.

Session objectives:
  • Share updates about Connect Care status and launch timelines
  • Understand Connect Care conditions for success
  • Explore clinician fears and hopes
We hope to see as many clinicians as possible at this kick-off event for the first wave launch (November 2019).


Why Doctors Love Their Computers - 1

We previously posted about an influential piece by Dr. Atul Gawande: "Why Doctors Hate Their Computers".  The New Yorker article has attracted a lot of attention, upping our clinicians' angst about the Connect Care clinical information system (CIS) launch later this year.

The Gawande article, and many others like it, raises important considerations for us as we move from system design through testing, adoption, training and readiness. Harms reduction is, unequivocally, the biggest chunk of change management.

However, Dr. Gawande's concerns reflect (roughly) just one dimension of our prospects. Many of his concerns do not, exactly, apply to our situation. Other challenges need to be exposed, explored, and mitigated. More importantly, there is a huge upside for physicians that we also need to understand, plan for, and realize.

BytesBlog will devote the first postings of 2019 to an exploration of how we can move from "why doctors hate their computers" to "why doctors love their computers." I have no doubt that we will come to love the Connect Care achievement. But we have a lot of stormy transformation to navigate first. Please use BytesBlog comments and email links to contribute your thoughts, helping us broaden the discussion and prepare together to take ownership of CIS use... for success!

Obviously, we are not alone in these discussions. A recent HealthcareITNews article references a report about how vendors (specifically Epic) are connecting with physicians to better understand the information management problems they need to solve. A related American Medical Association initiative, the "Digital Health Implementation PlayBook" captures practical steps clinicians can take to benefit from eHealth, while avoiding harms.


What a year, going and coming!

What a year its been... and what a year to come!

Congratulations to the Connect Care build team, who worked to a December 31 deadline for build buckets 1-4... and made it! Thanks also to the many committees, workgroups, experts, advisors and validators who worked the deliberations guiding design. The outcome is a Connect Care clinical information system (CIS) environment with AHS workflows, preferences and needs expressed; a major milestone in an incredibly big and complex venture!

The outcome is important, but so too is the process. We've built effective oversight, support, design and configuration capacity. Diverse stakeholders have learned how to work efficiently, forging a provincial perspective on how a digitally-enabled healthcare workplace should emerge and evolve.

The New Year begins with another deadline rush. All essential clinical system design (CSD) decisions need to be set by February 8, 2019. We are about 75% there, moving at a pace that should close the gap on time. Parallel CSD build continues, providing us with the documentation, decision and inquiry supports that will allow Connect Care to support clinical improvement.

Moving forward, our focus shifts from design and build to testing, training and readiness. The wave 1 first launch is a mere 10 months away. A lot of tough work coming in 2019! But we continue our Connect Care journey with confidence born of tremendous accomplishment already to hand.


Alberta Health Personal Health Record Progress

The Alberta Health Personal Health Record project continues to evolve, transitioning to a new phase with new software in the first quarter of 2019. Previously an Internet offering based on the "HealthVault" program, and available to limited pilot-test populations, a new platform will better accommodate the smaller screen sizes of mobile devices.

The re-designed offering, to be launched as "MyHealth Records", provides a secure online digital health portfolio that can be used to gather, manage and track personal health information. MyHealth Records will give adult Albertans the ability to view some of their health data from the Netcare provincial electronic health record. This includes recent medications dispensed from participating Alberta pharmacies, many immunizations administered in Alberta and some common laboratory test results.

Uptake of MyHealth Records can shift how Albertans relate to health information and to their healthcare team. Assistance will be available for users should they have any questions or require help. A call-in line will provide troubleshooting advice and will also connect users to Health Link 811 should users have any questions about health information released on MyHealth Records.

Clinicians can visit the MyHealth Records webpage (myhealth.alberta.ca/mhr-provider) to learn more, and send questions or comments to myhealthrecords@gov.ab.ca.


Identifying Patient Records in Connect Care

As we move toward a single Alberta Health Services (AHS) clinical information system (CIS), the way patients' medical record numbers need to be standardized.

Medical record numbers are used to ensure that an individual's health record remains unique. Currently, patients are assigned different medical record numbers at each care setting they visit. Over time, most Albertans have accrued multiple facility-specific identifiers.

The introduction of the Alberta Unique Lifetime Identifier (ULI) helped, giving one identifier that could be referenced at all sites. However, this Alberta Health maintained ULI does not apply to all patient populations and, for technical reasons, it can take longer to generate than the creation of a health record demands.

The Connect Care CIS adopts a one-patient-one-record-one-system model. A Connect Care provincial medical record number (pMRN) will apply anywhere and anytime AHS facilitates care. It is unique, can occur only once per patient, and is created or retrieved whenever a patient interacts with AHS. Moreover, when the pMRN and ULI are used together, positive patient identification is more efficient and patients are more confidently linked to their Connect Care record.

The new pMRN will apply wherever Connect Care serves as the record of care, including at partner sites such as Covenant Health.


Connect Care Communications Preferences Survey

From Alberta Health Services Community Engagement & Communications:

As work continues on Connect Care, Alberta Health Services (AHS) Community Engagement & Communications wants to make sure you are getting the information you need, in ways that work for you.

Connect Care will transform care in our province and change the way we work. To help us better understand your awareness about Connect Care and the best ways to keep you informed, we invite you to take a short online survey.

It will take about two minutes to complete, and your responses are anonymous. The survey will remain open until end of day, December 15.  Please encourage your teams and colleagues to take the survey as well.
Your feedback will help shape future communications and engagement related to Connect Care. We will repeat this survey regularly to track how we are doing.

We sincerely appreciate your time and valuable input.

Thank you for your help.                   

Colleen Turner
Vice President, Community Engagement & Communications


HIMSS Canadian Prairies Chapter Inaugural Virtual Event

We would like to invite members of the Alberta Health Services health informatics communities to join colleagues from across Manitoba, Saskatchewan and Alberta to celebrate the season and our first HIMSS Canadian Prairies Chapter event – a webinar: HIMSS Canadian Prairies Chapter is Coming to Town. Presenters will reflect on their health IT views and experiences from Alberta, Saskatchewan, Manitoba and HIMSS International.
HIMSS is a global advisor and thought leader supporting the transformation of health through information and technology. As a mission driven non-profit, HIMSS offers a unique depth and breadth of expertise in health innovation, public policy, workforce development, research and analytics to advise global leaders, stakeholders and influencers on best practices in health information and technology.

Chapters represent the grassroots of HIMSS. Canadian Prairies Chapter of HIMSS is the newest of the 57 chapters that serve a valuable role in bringing healthcare system professionals together in a local forum.
We look forward to “seeing” you at this virtual event on December 17th. Please share with your colleagues and within your networks – everyone is invited to attend, whether they are already a HIMSS member, or are just considering it. To register for the event, click here.  


Connect Care Data Conversion

Data conversion is about how historical health information is selected and managed for transfer from legacy information systems to the Connect Care clinical information system (CIS). Considerations include which information to transfer, how it should be transformed, how much to include, and how to make it accessible.

The conversion of data transferred from legacy systems to the CIS started in early 2018 and will be completed by the Wave 1 launch in November 2019, providing physicians and clinicians with the information they need for decision-making and patient care. Connect Care Groundwork and Scoping Recommendations helped set the conversion project scope. Appropriate data types were prioritized into three tiers based on clinical value and conversion effort.

  • Tier 1 includes allergies, encounters (admissions, transfers and discharges), imaging, labs and problem lists. Work on converting these data types has begun.
  • Tier 2 and Tier 3 data types are still being finalized by the conversion team. Details will be released as they become available. 

Based on this analysis, a conversion list describes systems that will be integrated and data types that will be converted. No important clinical data will be lost during the migration to Connect Care.

Before July 2017 several clinical data types were not consistently defined using measures or ranges standardized across Alberta. Accordingly, July 2017 serves as the default start date for data conversion into the Connect Care CIS. Other systems, including Alberta Netcare (launched directly into the right chart) will make historical data accessible to clinicians.

A 1-page ‘Byte’ and a more detailed ‘FAQ’ provide information about Application Integration and Data Conversion, both available on Insite and the Connect Care Clinician Handbook.


Connect Care Application Integration

Clinicians have been asking about how they will access information from health information systems that will be fully integrated into the Connect Care clinical information system (CIS); and how the provincial CIS will work with those few applications that AHS will keep in parallel with the CIS.

The majority of AHS’s health information systems will be integrated into the Connect Care CIS, with functions and databases replaced by a seamless information environment. The integration work will involve data conversion, so that information from replaced systems is transformed to fit CIS data definitions, decision supports and other dependencies. Not all data will be suitable for conversion, leaving some historical material outside of the CIS for a period of time. Clinicians will be able to access this data for as long as it is needed.

While the Connect Care CIS will be a pivotal integrative technology, some external applications are needed to support the whole of AHS' business operations over time. If and how these applications will "talk" to each other (interoperate) is also addressed by the Connect Care Integration strategy.

Integration and interoperation of health data are intensive processes, requiring technical specialists to build transfers and exchanges. A list of integrations to be completed as part of the Connect Care initiative is maintained within Connect Care SharePoint spaces. The list includes all integrations confirmed by the Connect Care Executive Committee (CCEC).

Intensive integration, data conversion and interoperability work anticipates Connect Care launch, in continuity with our earliest scope management principles and processes:


Connect Care Scope Management Progress

Scope management is about how we identify important CIS clinical, functional or safety gaps, prioritize gap-mitigation strategies and select systems that fill gaps while working with the CIS.

We posted about Connect Care scope management over a year ago, emphasizing a principles-based approach to decision-making about which health information systems to integrate into the provincial clinical information system (CIS). We later reported about methods for choosing which data, and how much, to transfer from retiring information systems to Connect Care and later still surfaced options for accessing historical data that may remain in legacy systems. As we get closer to implementation, there is more clarity about which applications are integrated into the CIS and what data can be converted.

The short Byte and Principles, linked below, have been updated. Improved SharePoint resources cover all aspects of scope management, including a list of all integrations to be completed as part of the Connect Care initiative. The presentation gives a reminder about scope management principles and processes. (note that some links will only work on the AHS intranet).