Thinking ahead - Barcoding Technology

A core Connect Care strategy is avoidance of hybrid (mixed paper and digital) workflows. This is particularly important where data re-entry is error-prone and puts patients at risk. An important example relates to medication administration. Mistakes involving just a character or two can make the difference between intended or unintended person, medication, dose, route or frequency.

Accordingly, Alberta Health Services (AHS) takes the opportunity of Connect Care to implement barcoding technology in medication workflows. A unique identifier will appear on all medications dispensed by AHS pharmacies. When medications are administered, providers scan the patient wristband as well as the medication. This simplifies data entry, safety checks and documentation.

Another core Connect Care strategy is to "close the loop" on as many workflows as possible. In the case of medication administration, this means workflow-attuned tracking so that there is an unbroken informational chain from plan, reconciliation, adverse reaction check, order, pharmacy receipt, decision support, dispensing, administration, documentation and effect monitoring. Barcoding locks down one more step in closed-loop medication management.

Physicians will be less affected by medication barcode scanning than other members of the multidisciplinary team. Still, it is important to understand an important change to team workflows that affect us. Questions can be directed to connectcare@ahs.ca.


Launch Readiness Assessments

Among many preparations for the first Connect Care launch later this year are Launch Readiness Assessments (LRA). These bring together all participants in the Connect Care initiative to  report on progress and problem-solve impediments. Each LRA spans the better part of a day, with rapid updates from diverse groups. This taking-the-temperature is invaluable for nimble adjustment and collaborative coordination.

LRAs are scheduled for 150, 120, 90, 60 and 30 days pre-launch. Our 120 day LRA occurs next week. Participants from across the province will meet to review each stream of work for their current state of readiness, identify potential risks and share ideas on how to mitigate those risks.

To learn more about readiness activities, visit the Connect Care Readiness page on Insite.


Workflow Walkthrough

With the Connect Care Wave 1 launch (November 3, 2019) getting closer, there are more opportunities to view and validate the emerging clinical information system. We can see and influence how information tools will affect and be affected by our work and workplace.

"Workflow Walkthroughs" allow street-smart clinicians to review exactly how Connect Care can support complex clinical activities. A Walkthrough event includes detailed demonstration of one or more high-risk, high-complexity, multidisciplinary or high-volume workflows. Patient journey videos are interspersed with feedback and discussion opportunities. The goal is to discover what more we need to do to get the system attuned to our biggest challenges.

The first Walkthrough event will be held June 26, 2019, at the Bernard Snell auditorium in the Mackenzie Health Sciences Centre (Edmonton) with options for telehealth remote access. Workflow Walkthrough videos will also be made available on Insite (details to come). The first Walkthrough will be most relevant to Wave 1 and 3 clinicians.

Although all interested physicians are encouraged to contribute, the Walkthrough event spans an entire workday. Only some parts will pertain. Please take a look at the tentative agenda (updates to come in future postings) and consider whether any of the 45 minute blocks offer an important feedback opportunity.


Did you notice?

If you did... way too OCD!

Our Connect Care Wave 1 launch countdown timer (top of left column) just gained a day.

After extensive consideration, the Connect Care Provincial Program Office has decided that the original Wave 1 Launch date of November 2, 2019 will move to November 3, 2019 at 0400.

The original date fell on the same day as the switch from Day Light Savings Time (DST) to Mountain Standard Time (MST). By launching on November 3, after the time change, the activation of Connect Care order entry, documentation and other functions will be more straightforward.


Ottawa Hospitals and Clinics Launch Epic

The Ottawa Hospital launched their implementation of Epic this weekend! Together with the Family Health Clinic, Heart Institute, Hawkesbury Hospital and St. Francis Memorial Hospital, Ottawa hospital joins the Children's Hospital of Eastern Ontario in adopting an Epic-based fully-integrated clinical information system.

This launch anticipates our own. We are grateful to our Ottawa colleagues for granting a small AHS team opportunity to directly observe go-live processes.


Training Drives EHR User Satisfaction

A recent article in Applied Clinical Informatics explores correlations between end-user satisfaction with Electronic Health Records (EHR) and approaches to training. Worth a skim as we put our own physician training program in motion!

The authors examine the experience of a very large number of EHR implementations recorded through the "ARCH" initiative, which includes systems similar what we have been designing. Differences in user satisfaction appear to have less to do with technology  than how users are prepared to take advantage of that technology. To quote a principal conclusion: "If health organizations offered higher-quality educational opportunities for their care providers - and if providers were expected to develop greater mastery of EHR functionality - many of the current EHR challenges would be ameliorated."

We are pleased to note that many learnings resonate with our training principles and design. We must do our best, as Connect Care initiative and as emerging Connect Care users, to leverage these efforts to apply best practices adapted to Alberta realities.


Wave 1 Physician Training Orientation

With just 5 months until Connect Care's Wave 1 launch in the Edmonton Zone, it is time for affected physicians to learn about and plan for the training that will ready them for adoption.

All physicians who are likely to use Connect Care at first launch receive an electronic mail notification from Edmonton Zone medical affairs. This explains about the training program and, in particular, how Medical Affairs works with physicians to match them to the most appropriate training track at the most convenient time.

Physicians can learn more by skimming any of the following resources (shortest listed first; all recently updated). Better still, view the short (5 minute) physician training orientation video.


Physician Wellness and Burnout - Will we be part of the problem, or its solution?

There seems no end in sight to missives about physician burnout... and the culpability of Electronic Health Records (EHR).

We've previously noted that EHR harms experienced south of the border are instructive, but not necessarily predictive. We have opportunity to design Connect Care to avoid micro-documentation, signal degradation and physician disengagement. At least that's our everyday preoccupation!

Dr. Terrence Cascino, past president of the American Academy of Neurology, visits the University of Alberta from the Mayo Clinic on Friday June 28, 2019, when he will contribute to the Dean's Lecture Series from 0800-0900 in Bernard Snell Hall at the Walter Mackenzie Centre in Edmonton. His talk is entitled: Physician Wellness and Burnout. Try to attend!

Our anticipatory reflections might include a new angle on burnout: economic harms. Part of the total cost of ownership of a (sub-optimally deployed) clinical information system?


Our Next Big Push... Clinical Content Validation

Validation is about how clinical experts review, correct and approve clinical information system (CIS) content (documentation, decision and inquiry support) to ensure that it serves the intended purpose, is free of significant safety risks, and is compatible with acceptable workflows.

Although content validation applies to documentation (e.g., note templates, handover reports, etc.) and inquiry (e.g., dashboards, reporting workbench templates, etc.), formal validation processes focus on complex clinical decision supports; especially Order Sets, Order Panels, SmartSets, Therapy Plans, Express Lanes and Protocols. All validation is informed by Connect Care principles and is organized for meaningful clinical input.

Clinical content validation begins when content is built and ready for review. Many validation activities started in early 2019. However, the bulk of complex clinical decision supports validation occurs in May, June and July of 2019. Outpatient orders (SmartSets) must be validated by end of June, while some inpatient Order Set validation will continue through the end of August 2019. The content most needed for training curricula is prioritized for earlier validation.

Area Councils, medical informatics leads, clinical knowledge leads and clinical informatics leads, plus a number of other stakeholders, are oriented to validation processes; allowing us to ramp-up and address this next readiness challenge over the next few months.


Non-Medical Device Workflows

The Connect Care communications team has produced a nice video illustrating how clinicians can interact with non-medical devices (computers, mobility, etc.) in inpatient environments.


Digital Professionalism - Its about Quality

The Alberta College of Physicians and Surgeons promotes professionalism; including helping us re-imagine what that means for a digitally-enabled professional. Dr. Ewan Affleck, a renowned eHealth innovator (former CMIO among many other roles), is working with the College to consider how our understanding of professionalism, indeed what it means to be an effective clinician, can adapt to an increasingly complex informational milieux.

The CPSA has recently posted a nice backgrounder about Digital Medicine, a growing focus for College thinking and advocacy:


Anticipating Cyber Attacks

Exercising practical paranoia includes anticipating attack and planning for collateral damage. Clinicians working in digitally-enabled workplaces should recognize that cyber attacks are both likely and likely to damage to one's practice, patients, finances and reputation.

The latest Alberta Medical Association newsletter includes a short piece about cyber attacks, emphasizing likely damages and making a case for cyber liability insurance. Categories of harm include theft of funds, theft of data, damage to data, recovery expenses, privacy breach fines and extortion. Worth a read and reflection:


Connect Care Physician Area Trainer Opportunities

We've previously posted about Physician Area Trainer recruitment, a great opportunity for interested clinicians to benefit from exceptional clinical information system orientation and change management coaching. Stipend-supported Area Trainers can supplement their usual clinical activities, play a pivotal role at Connect Care launch and positively impact health care in Alberta.

In addition to a posting and role description, linked below is an early guide for clinicians potentially interested in the Area Trainer role. The guide clarifies how Area Trainers are themselves trained. The support stipend is explained. Overall time expectations are outlined for before, during and after launch.


Connect Care May 10 2019 Newsletter Posted

The May 10, 2019, Connect Care Newsletter is available via the link below; covering 1) Wave 1 Physician Super User and Area Trainer recruitment, and 2) Sneek peek at non-medical devices.


Sneak Peak - Inpatient non-medical devices

Intense work continues to prepare our workplaces for Connect Care launch. We make much of "going digital" but may not appreciate all the technology that must be in place to free us from paper constraints.

The technologies of immediate interest to clinicians allow us to directly interact with the clinical information system (CIS). These devices are "non-medical" to the extent that they are not subject to regulations governing medical measurements or interventions (medical devices).

The Connect Care non-medical device mix will include, in addition to conventional desktop computers, mobile workstations, wall-mounted large-screen dashboard displays, notebook computers and tablets. The Information Technology team has released a video demonstrating some inpatient non-medical devices planned for Connect Care:


Practical Paranoia

Physicians serve patients with care, compassion and respect. Key to respect is privacy protection. Its loss can negatively impact health every bit as much as diagnostic or therapeutic harms.

Unfortunately, health information is increasingly attractive to criminals. It can be stolen and held for ransom or for re-selling to the highest bidder. And criminals learned long ago that technical and security hacks are not worth the effort. The easiest way breach a fortification is to simply walk through the front door with a user's trusted credentials. And the easiest way to get those is to dupe us into giving them up. Our greatest security vulnerability is neuron, not electron, based.

Thus the need for practical, purposeful paranoia. Physicians should adopt an attitude of universal mistrust when it comes to information sharing. Keep clinical content (of all types) to secured clinical information systems. Never accept requests for logon credentials.

And so on. We could list many do's and don'ts. But that would miss the point. New neuron-targeted tricks are inevitable. The goal is to protect against what will appear on future lists.

We'll be revisiting this topic frequently, sharing learnings from as many of our colleagues as possible. Please offer suggestions and questions to keep the paranoia alive!


Connect Care May 2019 Calendar

A summary of key Connect Care happenings in May 2019 has been posted to the Alberta Health Services (AHS) internal Connect Care website, linked below.

High priority activities continue to relate to infrastructure, build, validation, training and readiness.

Area councils and specialty workgroups start to see products of their specialty clinical system design and orderset work. Content is corrected and refined, getting it ready for launch while informing training curricula and readiness assessment events.


Wave 2 Launch Event in Lacombe and Red Deer

Implementation of Connect Care takes a phased approach, with each implementation wave bringing Alberta Health Services closer to becoming the most integrated and accessible healthcare system in Canada. The first wave launches in November, 2019, bringing the University of Alberta Hospital, Stollery Childrens Hospital, Mazankowski Heart Instituted and all eCLINICIAN clinics to full clinical information system (CIS) implementation.

After a short period for review and optimization, a second wave launches a year from now at select sites in the Calgary and Central Zones.

Operational and clinical leaders gathered in Lacombe April 24 for an energizing introduction to wave 2 readiness preparations. Demonstrations gave attendees a tangible sense of how clinical care, including medical device use, bridge to Connect Care.

Later in the day, zone physicians gathered in Red Deer to see the emerging CIS and discuss how to take advantage of workflow-enhancing mobile solutions. Super User and Area Trainer roles were promoted, with the Central Zone ACMIO, Dr. Steven Turner eager to hear from interested physicians.


How Connect Care will Affect Us

Everyone wants to know: how will Connect Care affect me?

To anticipate what is coming, we have developed a "Day in the Life" poster series with short vignettes highlighting impacts for a wide range of clinical and support roles. These are available for download on the Alberta Health Services intranet (Insite)... worth checking from time to time as the collection grows and improves. Two directly relate to physician experiences:

Thanks to those willing to be showcased, these posters feature real Alberta Health Services providers in their everyday roles, showing how Connect Care can affect (and improve!) workflows. Patient and family stories are also featured. We hope to accrue 60 or more posters, featuring situations just like yours.

You are encouraged to download, print (both colour and black-and-white versions available) and share the posters among colleagues. If you have any suggestions for enhancements or additions, please email connectcare@ahs.ca.


Back Again!

Outward facing Connect Care communications took an (invited) break during the weeks immediately leading up to today's provincial election. We've missed sharing through this blog!

Back again, we'll resume daily postings about topics of interest to Connect Care users. Remember that there are other communications channels more attuned to specific interests; including medical leadership, clinical system design, medical informatics, primary care and clinical builders.