Netcare Scheduled Downtime - May 28, 2020, 20:30-

The Alberta Netcare Portal electronic health record will be taken offline for scheduled maintenance during the evening of of May 28:
  • Thursday May 28, 2020, 20:30 PM - Friday May 29, 2020, 05:00 AM
Downtime information is available:
Laboratory and other test results and reports will continue to be available in Connect Care. However, the Connect Care Netcare tab will not work during these time periods.

Alberta Health introduces Secure Messaging Service during Pandemic

Alberta Health is sponsoring a new voluntary service that can help physicians securely message with patients during the COVID-19 pandemic.  BrightSquid is the selected provider for "MHR Secure Mail" and Alberta Health is making it available at no cost to participating physicians until July 31, 2020.

While any Canadian physician can sign up, the target audience for the Alberta Health promotion is physicians who do not already have a patient portal or other secure communication service available to their patients. There is no requirement to use MHR Secure Mail, or to use it in preference to other secure communication tools.

Physicians sign up for the BrightSquid service and invite their patients to participate. A link to BrightSquid is available via MyHealthRecords, which is also where patients can launch MyAHS Connect for secure communications with physicians who use Connect Care as their record of care.

Physicians using AHS information systems should continue to use the secure clinical messaging services provided by AHS, with priority given to communication tools integrated with clinical information systems. Future postings (or in our FAQ Channel) will address questions about how Connect Care physicians can support patients seeking clarity about secure clinical communications in Alberta.


Alberta Health Health Information Systems Review Posted

We've previously posted about reviews contracted to Ernst and Young respecting Alberta Health Services performance and Health Information System strategy.

The second of these reports, "Review of Connect Care, Alberta Netcare and MyHealth Records: final report", is released by government for public access today:
The report recommendations will be considered by Alberta's health informatics stakeholders as the province emerges from the first wave of COVID-19 and works to reinvigorate informatics coordination on multiple fronts.

Physicians may not identify with all of the report assumptions or findings but these are matters of detail and the focus moving forward needs to be on high-level recommendations. The CMIO portfolio would welcome reflections or suggestions via cmio@ahs.ca.


All Prescriber Bulletin: Diet & Nourishment Orders - Default Frequency

All-user-bulletins highlight developments that all physicians need to be aware of when using the Connect Care clinical information system.

Diet & Nutrition Order - Start and Frequency Parameters
As of 1200 Thursday, May 21, 2020, all inpatient users of Connect Care will see a small change in diet and nourishment orders. The default frequency button, “Effective Now”, will be replaced by “Now or Specify Date/Time.” This reflects new functionality to more precisely set  time-dependent changes to a patient’s diet. This also supports the entry of multiple linked diet orders and a layered approach to progression along a nutrition plan.

For example, for patients expecting an NPO interruption to their usual diet, the expected series of diet orders can be placed all at once. This is done by using the starting date, time, and (if required) conditions to be met. All orders will appear in the active orders, with clear reflection of the starting date,  time and duration for each.

This update could affect personalizations. System-level ordering tools such as Preference lists, Therapy Plans, Treatment Plans, and Order Sets will be automatically updated. Personalized order lists, panels or plans that include diet orders using "Effective Now" will experience a hard-stop during ordering, alerting to the need to update the personalization to specify the new parameters.


Recording Zoom Virtual Visits

Alberta Health Services is working on security features that will satisfy privacy protections needed in order for clinical Zoom sessions to be recorded (even in part).

Until such tools are available, in-Zoom recording functions have been disabled for all AHS accounts. Similarly, Zoom’s Live streaming tools for social media are disabled. Work is underway to support special requests for Zoom recording, where this is the best way to meet a specific and important clinical need.

Current requests for local recording can only be considered for Zoom meetings which do not expose personal health information, such as non-clinical administrative and educational sessions. Any recordings are saved to local storage temporarily, en-route to secure AHS storage (e.g., SharePoint). The temporary storage device must be encrypted and compliant with AHS security policies.

Please contact ahszoom@ahs.ca for more information.


Secure Clinical Messaging for users of AHS Clinical Information Systems

As tempting as it is to send clinical queries via email, this can risk a privacy breach. Alberta Health services (AHS) provides clinicians with tools for secure transmission of clinical information via email, including encrypted email to external (non-AHS) addresses. These should be used in all health service contexts where AHS has responsibility for the legal record of care. Such records can be paper-based,  AHS supported Electronic Medical Records or any of the AHS clinical information systems (CIS).

Transitory communications (e.g. request to meet) do not require secure transmission if they do not contain information that might identify a patient. Non-transitory communications about patients and the care they receive (e.g., patient instructions) must be protected and recorded or referenced in the record of care. 

Clinicians interacting with patients via email or messaging systems should use the most secure and integrated system available:
  • Connect Care Messaging
    • Use messaging solutions within Connect Care when both sender and recipient have access. This includes clinicians who do not use Connect Care as the record of care but have access to the Provider Portal. 
  • AHS Secure E-Mail
    • If both sender and receiver have AHS email addresses (@albertahealthservices.ca or @ahs.ca or @covenanthealth.ca or @albertapprecisionlabs.ca), then clinical communications can be securely sent and received using AHS email.
    • If the sender has an AHS email address but the receiver does not, then add “!Private” to the subject line so the email message is encrypted. 
  • External Approved Solution
    • If none of the above are appropriate for clinical communication, consider use of an external clinical secure messaging solution that meets Health Information Act requirements. Some have been approved for use with AHS records, to be replaced when Connect Care and its patient portal are fully implemented province-wide. 
    • An instance of the BrightSquid secure messaging system, "MHR Secure Mail", is available to Alberta physicians during the COVID-19 pandemic at no cost and can be used when no other AHS-provisioned system is available or appropriate.
We will update the Connect Care physician manual as secure communication options evolve in Alberta.


Practical Paranoia - Protecting Personal Devices

Personal computing devices (laptop, notebook, tablet, desktop) may support clinical work when physicians take call from remote sites, or otherwise participate in the provision of healthcare services outside AHS facilities. 

Because identifiable personal health information could appear on data storage devices which, if stolen, could risk a privacy breach, it is essential that personal devices be configured in compliance with AHS policy and legislative requirement, including:
  • Password protection with a strong and well maintained code
  • Inactivity timeouts that re-challenge for a device password after automatic system suspend or sleep states
  • Hard drive encryption
  • Firewall protection
  • File sharing off or appropriately protected
Encryption is a method of protecting information by converting it to a format that's unreadable by anyone except those with a special key (usually a very long password). All Windows operating system devices must have native hard drive encryption enabled (BitLocker). All Macintosh operating system devices must also have native hard drive encryption enabled (FileVault).


Virtual Health Office Hours - Connect Care Zoom Integration

The Virtual Health team will be holding Office Hours again on Monday, May 19, 2020 from 12:00-13:00.

The session will focus on how AHS Enterprise Zoom teleconferencing is integrated with the Connect Care clinical information system. There will be a live demo to illustrate virtual encounter scheduling and visits, also featuring the patient experience and how it can be facilitated by MyAHS Connect. Experienced panelists will be available for Q&A. Please use the registration link to sign up:


Emergent Blood Product Administration Attestation

Complex title! New tips and demos cover some essential knowledge (and Connect Care skills) that all who order unmatched blood products can benefit from.

Emergency blood product administration bears extraordinary risk. The related workflow includes:
  • a phone call to the blood bank to initiate product preparation;
  • a "Transfuse Emergent Blood Product" order entered by the provider;
  • an attestation note completed by the ordering provider. 
These actions allow the work of lab and nursing staff to proceed. The attestation confirms that the use of un-crossmatched blood is clinically necessary for patient care. 


COVID-19 and Connect Care #17 - Connect Care COVID-19 Reports

We've previously posted about excellent provincial COVID-19 reports maintained by AHS Data & Analytics as Tableau visualizations, and about how those can be accessed through links in the Connect Care Physician Manual and, within Connect Care, Learning Home Dashboards. The Tableau visualizations combine data abstracted from the CIS and and data from other AHS sources.

Connect Care users can also access a wide range of relevant reports internal to the Connect Care CIS. These include a "Connect Care COVID-19 Pulse" dashboard (open Dashboards activity) and a number of other operational reports and dashboards (visualizations).

After opening the Dashboard activity, conduct a "Catalogue" search for all reports, components and dashboards containing the keyword "COVID". Not all reports are open to all users. Those who currently work where Connect Care is the record of care will value details about bed and ventilator capacity, hospitalization and ICU rates, test positive and pending trends, etc., etc.
  • From Connect Care Hyperspace: go to the Dashboards activity within Connect Care landing page and select the drop-down menu just to the right of the title of the dashboard that appears by default. This gives access to a search interface. Search for all items matching "COVID".


Summative Connect Care Documents to Netcare - Types Released

We previously posted about efforts to ensure that clinically useful summative documents transfer from Connect Care to the the Alberta Netcare Portal. All emergency, inpatient and outpatient adjustments will be fully operational mid-June when a needed Netcare software update is activated. This update is important for outpatient consultation letters, which will start transferring thereafter.

To avoid confusion, the following summative documents will copy from Connect Care to Netcare (ultimately, retrospective to the launch of Connect Care as teams work to resubmit older documents):
  • Emergency
    • Emergency Department Provider Note (summary of ED encounter)
  • Inpatient
    • Admitting History and Physical
    • Labour and Delivery Report
    • Operative Report
    • Consultation Report
    • Discharge Summary
    • Deceased Summary
  • Outpatient
    • Letter to Referring Physician (Communication)


Virtual Care and Collaboration - By the Charts

We've previously posted about rapid uptake of new virtual collaboration and care supports, clearly of value as clinicians adapt to COVID-19 pandemic challenges.

Videoconferencing using AHS's secure enterprise instance of Zoom continues to grow, with meeting and virtual visit volumes following an anticipated word-week pattern. The number of active users (repeat videoconference use) also continues to grow.

We'll soon have sharable tracking tools, additionally revealing how advanced account update and Connect Care integrated video visits progress.

Congratulations to AHS communications and virtual health teams for being so nimble and responsive to rapidly changing needs!


Blood Product Orders

The Connect Care clinical information system (CIS) has Epic's integration engine interfaced with a WellSky system for blood product management. Related workflows accommodate this integration while also addressing safety, accreditation and Canadian Blood Services requirements.

Physicians sometimes struggle with transfusion orders. We've updated Manual, Guide and Demo supports to help:


Supervising Prescriber Selection for Trainees - Optimizing Workflows

We previously posted about a Connect Care change needed to ensure that orders, results and documentation are appropriately linked to responsible physicians when trainees participate in healthcare.

The tweaked logon workflow brings Connect Care in line with expected practice, while ensuring that the right physicians get the right information when test results report late or documentation requires co-signature. Explicit supervisor declaration is mandated by medical staff bylaws, professional regulation and residency training program requirements.

Some trainees have struggled with this change, especially when working in high-volume clinics where they have more than one supervising prescriber. Tips and demos can help:


Virtual Health Office Hours Update

We've previously posted about a helpful series of webinars and open discussion sessions hosted by AHS Virtual Health services. Registration is available for the next set of sessions.

Register for upcoming Zoom for Virtual Care Office Hours by clicking the link for session(s) of interest in the list below. These continue to run every Tuesday and Thursday from 12:00 p.m. to 13:00 p.m. (check the  Virtual Health Insite page for last-minute changes):


Time to Promote MyAHS Connect

Clinicians continue to adapt to social distancing. In addition to expanded use of Virtual Care for patient support at-a-distance, Connect Care providers can leverage communication tools in the MyAHS Connect patient portal. We'll be posting more about this in the coming weeks.

Any patient who interacts with a facility or provider where Connect Care is in play can be invited to use MyAHS Connect. For patients who activate, some capabilities can help with clinical communication:
  • Secure Messaging - clinicians can communicate with patient portal users and can take advantage of messaging pools to quickly screen incoming messages.
  • Results Messaging - results released through the patient portal can be annotated as a form of quick and targeted communication.
  • Video Visits - teleconferencing integrated with the patient portal can be easier for patients and providers to use.
For now, check out a growing list of postings in our FAQ channel:


Summative Connect Care Documents to Netcare - Good News Update

We previously posted about correcting a gap in summative document (e.g., consult, discharge summary, operative note, etc.) sharing with the Alberta Netcare Portal. There were situations where documents initially authored by trainees were not exchanging as expected. The fix became effective April 24, 2020.

We are now pleased to note that all gaps going back to November 3, 2019 when Connect Care first launched, have been filled.


Summative Clinical Documents: Connect Care to Netcare

The Alberta Netcare Portal provides a cradle-to-grave, read-only, aggregated view of information from multiple databases about key health events in an individual’s life; information that any health care provider may need in order to serve an individual. Key to this electronic health record (EHR) function is capture of key "summative" documents from a clinical information system (CIS) like Connect Care. 

Summative documents are high-value clinical notes that analyze diverse information sources and interpret these at healthcare milestones, such as outpatient visits or inpatient admissions. Included are discharge summaries, consultation reports, operative reports and transfer summaries.

While Connect Care has been sending summative documents to Netcare since launch, some gaps emerged. Summaries prepared by trainees (e.g., medical students, residents) were not transferring if bearing a "Cosign Needed" status. This departed from how such records were handled previously through provincial eScription. 

As of April 24, 2020, all summative Connect Care documents (in approved categories) transfer to Netcare, even when a final signature is pending. As previously, the document is released to facilitate clinical communication and gets re-released with any updates or when the responsible physician has fully signed-off. Work has begun to apply this same rule to any summative notes that missed transfer to Netcare between launch (November 3, 2019) and April 24, 2020.


COVID-19 and Connect Care #16 - Provincial COVID Reports

The AHS Data & Analytics team has produced a number of excellent interactive reports. These explore Alberta Health Service's (AHS) emerging experience with the COVID-19 pandemic and provide valuable information about case, hospitalization and critical care loads provincially.

The associated "Tableau" dashboards can be accessed from within the AHS intranet or with use of an AHS security FOB from outside AHS locations. Key dashboards are available to all AHS clinicians. Some require special permissions.

We list provincial COVID-19 report access points in the Connect Care Physician Manual, which appears on all Connect Care learning home dashboards for physicians. At this point, two simple ways to track this work:
  • From the Manual: Follow Report links listed in the COVID-19 sections in the Home area of the Manual.
  • From Connect Care: go to your specialty's learning home dashboard (Dashboards activity within Connect Care landing page), look for a group of COVID-19 links at the top left, open the Manual, then the COVID-19 Content section and then click on one of the listed Reports links.


Connect Care Micro-Downtime - Monday, April 27, 2020, 22:00-22:10

There will be a two minute pause to the Connect Care production environment sometime between 22:00-22:10 on April 27, 2020.

This should not affect most users. For those signed on at the time, their active session will be suspended automatically, with on-screen notice. Work stops for the 2-minute gap. Work can continue (session data will have been saved) after the pause.


COVID-19 and Connect Care #15 - Professional Billing Reversions

We previously posted about Connect Care professional billing changes resulting from Alberta Health policy changes. Changes affected complex modifiers and built-in overhead considerations.

This area is proving volatile. Policy has shifted and changes required for April 1, 2020, are now pushed back to later in the year (October 1, 2020); together with some other changes.

While the addition of "z-codes" (at this moment not financially different from prior codes) is live in Connect Care, clinicians need not worry as their claims will be automatically corrected before submission. It is still wise to update billing personalizations to reflect the Z addition if working in a publically funded facility, as these appear destined to stay.


Virtual Health Webinars and Office Hours

AHS Virtual Health offers a variety of services that can help clinicians trying to provide health care when physically distanced from their patients.

The current pandemic has dramatically increased the numbers of both patients and providers in self-isolation or otherwise unable or ill-advised to attend AHS clinics. The current and enduring goal is to support quality virtual care, anytime, anywhere. AHS staff, clinicians in all disciplines, and physicians can visit ahs.ca/virtualhealth for more information and resources.

Starting April 28, AHS Virtual Health will host regular virtual webinars and office hours for those seeking just-in-time learning, problem-solving or tips related to virtual care. These occur Tuesday and Thursday from 12:00 p.m. to 13:00 p.m., until further notice.

Details will be updated on the Virtual Health insite page. Upcoming topics include:
  • AHS Zoom for beginners
  • Scheduling Virtual Appointments
  • Protecting Patient Privacy
  • Making the Most of Basic Accounts
  • AHS Zoom Integration with Connect Care
  • Group Sessions for Multidisciplinary Teams
  • Ad Hoc, On-Demand, Videoconference Sessions
  • Clinical Best Practices for Virtual Care


Practical Paranoia - Important message from our CEO

We've previously posted about additive privacy and security challenges emerging in the context of a pandemic.

Dr. Verna Yiu reminds us about the vigilance needed to avoid situations where our pandemic activities increase the risk of privacy breaches:

Dear AHS staff, physicians and volunteers,

Protecting privacy and ensuring that patient information remains confidential is as important now as it has ever been.

During this state of emergency, our obligations to our patients have not changed. The Health Information Act (HIA), the Freedom of Information and Protection of Privacy Act (FOIP), AHS’ privacy policy and best practices still apply.

We each have a duty to protect the information entrusted to us. We can only collect, use, access, and disclose the information needed to perform our AHS job, duties, and responsibilities. As healthcare professionals, our patients trust us to appropriately access and safeguard their health and personal information. We must always remain fully committed to ensuring this trust is never broken through inappropriate collection, access, use, or disclosure.

Under no circumstances should staff or physicians access or disclose health records of individuals they are not providing a health care service to. For example accessing information outside of your role – even if your reason is concern for colleagues, friends, neighbours or loved ones – is a privacy breach.

A privacy breach occurs when there is an unauthorized collection, use, disclosure, access to, or disposal of personal or health information. It’s a serious matter that will be investigated by our Privacy team and could result in potential workplace disciplinary action, college sanctions, fines, and/or criminal charges. It is your individual responsibility to report any breach you discover, even if it did not originate from you. Report privacy breaches here.

I encourage each of you to be vigilant and advocate for patient privacy and the confidentiality of our information. If you need support or are unsure what information you can and cannot access in your AHS role, speak with your manager or contact infocare@ahs.ca. More information is available on the InfoCare Insite pages.

Dr. Verna Yiu
AHS President and CEO


COVID-19 Guidance from AHS Scientific Advisory Committee

Part of Alberta Health Services' COVID-19 pandemic response involves rapid collection and analysis of guidance for clinicians, staff and patients. A Scientific Advisory Group (SAG), reporting to the Emergency Coordination Centre (ECC), connects clinicians, operations, researchers and other experts to review, synthesize and interpret emerging evidence about management of COVID-related phenomena at population and patient levels.

Rapid Response Reports examine recommendations from provincial, national and international bodies, considering the supporting evidence and purported impacts. The reports back recommendations for AHS policy and practice. A helpful byproduct is an inventory of emerging evidence, recommendations and analyses.

SAG clinical guidance, together with recommendations emerging from Strategic Clinical Networks, Provincial Advisory Groups, Clinical Area Councils and other collaboratives, inform the production of decision, documentation and inquiry supports for clinical information systems (including Connect Care). Such "clinical content" provides clinicians with actionalbe aids to applying recommendations at the point of decision-making. Examples include order sets, documentation templates, calculators, flowsheets and reports; expressed in clinical information system and paper formats.

SAG recommendations and supporting reports are gathered online at a new AHS website:


Physician Trainee Bulletin - Selecting a Supervisor

All-user-bulletins highlight developments physicians need to be aware of when using the Connect Care clinical information system.

Selecting a Supervising Prescriber
Prescriber Trainees, including medical students, residents and fellows, are “supervised” by a fully licensed prescriber who must co-sign or attest to at least some Trainee activities in the Connect Care Clinical Information System (CIS).

From April 17, 2020, Trainees must identify a “default” Supervising Prescriber when logging on to the CIS. This Supervisor is automatically notified, when required, about documentation or orders requiring co-sign, while also receiving results of trainee-ordered tests when those are routed to In-Baskets.

Inpatient workflows remain largely unchanged: Trainees can still select the “co-sign” checkbox when they seek review of orders or documentation. All mandated co-signs (e.g., discharge summaries), and any laboratory results reported post-discharge, are routed to the In-Basket of the Supervising Prescriber.

Outpatient workflows are also affected, as mandated co-signs (e.g., outpatient notes, consultation Communications Letters, etc.) are routed to the Supervising Prescriber.


COVID-19 and Connect Care #14 - Training Progress

We've previously posted about the move to virtual training methods to avoid tight gatherings in computer training labs.

Kudos to the Connect Care Training and eLearning teams for their fabulous work designing, developing then delivering online learning! Nimble, responsive and quick!

Many groups of physicians are recruited, re-deployed or otherwise placed in positions where they need to master new skills to work at sites where Connect Care is the record of care.

Basic and personalization training is provided in a mix of self-directed and instructor facilitated virtual learning. Many of these courses are already completed, moving physicians to competency in priority areas; including emergency, critical care, inpatient medicine/pediatrics/surgery. Supports are provided to learners 0700-2100 7 days week.


Medical Students Step-up for Connect Care

Alberta's 3rd and 4th year medical students -- off-ward during the COVID-19 pandemic -- make invaluable contributions to our pandemic response; including contact tracing, patient education and direct supports to front-line physicians.

In addition, University of Alberta medical students have rallied to help to Connect Care clinicians at Wave 1 sites in the Edmonton Zone. Many pandemic-response providers are newly trained, or re-trained for new roles, as part of staff redeployment. For these clinicians, COVID challenges can be complicated by unfamiliar Connect Care workflows.

Medical students are tooling up to serve as super-users. They will help clinicians who may struggle with new ways of ordering, documenting and communicating. Other clinical informatics roles expand our clinical system design and testing capacity, while fanning-out practical tips for busy physicians.

Student contributions reflect a lot of work! Super users complete advanced learning modules in multiple tracks (e.g., surgery, emergency, inpatient, critical are), while mastering virtual user-support technologies. Medical student leaders also organize scheduling so that supports are available at all times.

A big thank-you to our medical learners and education leaders! Their initiative helps clinicians stay on task.


Connect Care Scheduled Downtime - Thursday, April 09, 2020, 00:30-02:30

The Connect Care production environment (PRD) needs periodic maintenance. The next scheduled update will occur Thursday April 09, 2020 in the early morning hours of (between midnight 00:30 and 02:30).  Hyperspace will be affected.

The updates relate to a few security enhancements and are not expected to take long. There will be no change in functions post-update.

While PRD is offline, access to "PRDSRO" remains. This is a read-only copy of the most recent production (PRD) and allows all patient data to be reviewed. Any urgent orders or documentation that must be completed while PRD is offline can be handled through a combination of paper, eScription (provincial dictation) and Netcare activities. Try to postpone and avoid use of paper, as PRD is likely to be restored quickly.

Any paper ordering or charting will be uploaded by support staff once the downtime finishes. Physicians will want to validate this work. Charting deficiency notifications may appear later in In-Basket but can be addressed with the smartphrase ".DOWNTIME".

Additional instruction remains available in the Connect Care Physician Manual:


Virtual Collaboration and Care - By the Numbers

We've previously posted about supports for virtual collaboration and care, rapidly expanded to address COVID-19 needs.

Uptake has been impressive, suggesting that self-registration for basic AHS Zoom access has worked well. Scalable processes for allocating advanced accounts are firming up. And deep integration with the Connect Care clinical information system will be available soon.

As of early April, 2020:
  • ~8700 registered  basic users
  • ~830 registered advanced users
  • > 9,000 virtual meetings or visits
  • >1,007,400 meeting/visit minutes
  • > 38,000 meeting participants
  • ~40 full webinars
In addition, associated webinar technologies have assured our Connect Care training programs continued maximal productivity as new groups of clinicians are prepared to work where Connect Care is the record of care.

Congratulations to AHS communications and virtual health teams for being so nimble and responsive to rapidly changing needs!