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).


Mea Culpa - Resisters are not Obstructionists

An earlier posting (http://bytesblog.ca/2018/11/25.html) introduced a possible categorization of prescriber responses to clinical information system (CIS) implementation. We wanted to stimulate reflection about how to support change for different CIS-adoption phenotypes, including 'obstructionists', 'minimalists', 'partialists', 'partners' and 'exemplars'.

Some colleagues rightly pointed out that the word 'obstructionist' unfairly brands persons who express genuine concern about how a CIS could affect patient care and professional satisfaction. The scientific literature and popular press abound with reports about negative effects of electronic health records.

A good point is made, and accepted. We will do our best to avoid harm when working with clinician communities to implement Connect Care. However things unfold, some clinicians will (for whatever reason) oppose implementation. Avoidance could be passive or active. The effect is the same.

We have changed the linked backgrounder (and this posting) to refer to "resisters" instead of "obstructionists", as this less judgemental term focuses our attention on the effect of, not the reason for, objecting to CIS implementation.

Please always feel free to comment on postings or linked documents. Connect Care is about learning.


Connect Care December 2018 Calendar

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

Build buckets 1-4 remain a top priority, closely followed by initiation of build for the many specialty clinical system design decisions which have accrued. Training and readiness activities ramp up with substantive new content appearing in Readiness Playbooks, curricula and provider community engagement.


Connect Care Readiness Resources Growing

With more and more attention to Wave 1 (less than a year away!) preparations, Connect Care readiness resources are emerging and maturing. These will continue to grow and consistently discoverable via Connect Care's space on the Alberta Health Services (AHS) internal website (ahs-cis.ca/insite):
  • Training & Learning Resources - with updates about the Connect Care training strategy
  • Readiness Resources - where the Readiness Playbook takes shape and key orientation presentations are added
  • Leader's Toolkit - providing presentation, handout and other materials that can help bring staff up to speed about how Connect Care will affect them
The current internal AHS training and readiness resources have broad applicability. Considerations specific to physicians and prescribers are also gathered and available in the Connect Care Clinician Handbook:


Connect Care November 30 Newsletter Posted

The November 30, 2018, Connect Care Newsletter is available via the link below; covering new readiness resources, reflections from Barb Kathol and Mackenzie Health success with Epic.


Connect Care November 2018 Calendar

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

Multiple parallel priorities continue. Workflow direction and decisions continue to be expressed through build and configuration in Build buckets 1-4, to be completed within another month. Clinical System Design has hit peak activity for decision-making and is shifting attention to facilitation of build activities, all to be completed by February 2019.

Connect Care's first launch, Wave 1 at the University of Alberta Hospital campus, is less that a year away. Recent work has focused on building leadership awareness and planning how non-medical devices will intersect with clinical workspaces.


Innovative new App facilitates Patient-Centred Cancer Care

Cancer Control Alberta and the Alberta Cancer Foundation have partnered to develop, test and release an innovative mobile application that can help patients and families participate in collaborative care.

"My Care Conversations" allows one to use a smart phone (iOS or Android) to record care planning interaction(s) with health care providers. The recording can then be used for review and understanding, or for sharing and discussing with family and trusted friends.

Very well received in pilot testing, this patient-centred support has been shown to reduce anxiety, improve compliance and facilitate more informed decision making.

Strategies for extending this work into Connect Care and patient portal tools are being considered.

For more information:


Minimum Use Norms

Given that improper clinical information system (CIS) use can compromise service and safety, all CIS users have interest in peer-endorsed norms for appropriate and meaningful CIS use. These “minimum use” tasks constitute a subset of practices essential to safe patient care and coordination.

Other CIS practices may be necessary for chronic disease management, integrated care planning and appropriate use of applications, modules, registries, portals and analytics.

CIS minimum use norms are consistent with best practice but should be followed in the spirit of not unfairly increasing information burdens for others contributing to a shared health record.

The Connect Care Council recently endorsed a starter-set of CIS minimum use norms. These are posted to the Connect Care Clinician Handbook, with feedback welcomed via cmio@ahs.ca:


Resisters, Minimalists, Partialists, Partners and Exemplars

The Alberta Health Services (AHS) Connect Care clinical information system (CIS) can facilitate rapid access to health information across the continuum of care. However, the CIS cannot serve if it is not used consistently and effectively by all who share in care. Indeed, the legal record of care is vulnerable to inconsistent or ineffective CIS use. With Wave 1 implementation looming, it is important to anticipate prescriber engagement, adoption and CIS-use patterns.

Inevitably, a few physicians will object to CIS adoption. Whether motivated by principle, workflow concerns, ability or other reasons, the effect will be accept little interaction with the Connect Care record. These ‘resisters’ could be beyond the reach of essential communication, collaboration, decision support and care planning tools.

Other ‘minimalist’ clinicians will do only those CIS tasks absolutely essential to close encounters. Incomplete work on problem lists, medications, allergies, documentation and orders will shift information burdens to others.

Closely related ‘partialist’ phenotypes will use essential CIS features but miss all the efficiency gains to be had from personalization workshops and optimization services.

CIS ‘partners’ will use the CIS safely and collaboratively, while also enjoying decreased information burdens, increased satisfaction and generally improved clinical performance. They will seek and master the personalizations and automations made available through the system.

Finally, CIS ‘exemplars’ will not only master the CIS but additionally develop personalizations and automations to share with colleagues, and so raise the capacity of their clinical community.

As we get ready for CIS testing, training, and implementation, the time is right to look around (and within) to anticipate clinician reactions to Connect Care. We’ll need to manage to these reactions to have any hope of helpful adaptation to massive changes in the clinical workplace.

Backgrounder: Connect Care Prescriber Compliance


Capacity-Building and Compensation

Connect Care provides resources to support physician engagement, adoption and change-management. These are used to build capacity in prescriber communities. Contracted contributions are resourced, and the costs of building training, development and up-skilling programs are covered.

Connect Care investments have yielded excellent results. Over 70 physician leaders are oriented, trained, supported and mobilized. A growing cadre of clinician-builders already empower clinical system design. Hundreds of physicians are positioned for power-user and super-user roles. And knowledge leads prove invaluable to clinical content build.

Capacity-building efforts recognize the importance of compensation. However, ‘compensation’ is framed in terms of opportunity, career advancement, continuing professional development, gaining mandated e-health literacy, and mastering tools needed for clinical improvement, innovation or inquiry. We welcome feedback and input to an emerging Connect Care prescriber compensation strategy, which will continue to develop:


Netcare User Interface Changes Coming

An Alberta Netcare Portal (ANP) update is planned for November 29, 2018. Unlike other updates, this includes user interface changes. Electronic Health Record content and function remains unchanged.

A few quick reads can help clinicians anticipate the changes:
For users accessing ANP within the Alberta Health Services (AHS) intranet (portal.albertanetcare.ca), the FireFox browser works best on both Windows and Apple devices. This update is Internet Explorer 11 compatible (common on AHS Windows devices). Other Internet browsers (Chrome, Safari) are not supported.

For users seeking ANP from outside AHS (access.albertanetcare.ca), access continues via a Citrix Receiver session which can be launched from any Internet browser (Firefox or Chrome recommended).

Those who make frequent use of flowsheets, critical results filters or the quick-search function will want to re-discover how these are accessed, as they are no longer part of the page-top header and require additional click(s) to locate as part of new 'Documents' tab displays.


eHealth Literacy Resources Posted

‘Electronic health,’ also known as ‘eHealth,’ refers to how patients and providers use information and communication technologies (ICT) – including digital health records, portals and mobile apps – to improve health. While many of our staff and clinicians already use ICT effectively, others may not be as comfortable.

eHealth competence is not the same as clinical information system (CIS) competence. Connect Care-specific training – about how to navigate CIS interfaces and get work done – begins a few months before each Wave launch. Now is the time to build general eHealth competence and get ready to care and collaborate in a digitally-enabled workspace. For anyone interested in getting an early start, a new set of resources that can help.

The eHealth Competence program offers tools and resources to help Connect Care stakeholders learn about everything from computer basics to topics like privacy-protection, clinical documentation and information management. Self-assessment tools help choose the best learning pathway for different areas and eHealth comfort levels.

The current resources are optimized for nursing and allied health. Physician and prescriber-optimized resources will be released in the new year, coupled with a scheme for gaining professional development credits.

More information about the eHealth Competence program, self-appraisal tools and aides for managers are now available on Insite. New learning modules become available in early 2019.


Business Continuity Management Partner Selected

AHS is pleased to announce that Recovery Planner has been selected as the software vendor to support the Business Continuity Management (BCM) Program following a request for proposal process. BCM is a process that identifies events that could impact the continuity of services AHS provides. Recovery Planner has been on the forefront of delivering proven cost-effective resiliency solutions since 1999.

The software, named “RPX,” is built on a modern cloud platform and expresses standards and industry best practices. With planning, analysis, and real-time capabilities, RPX will better support the management of continuity and recovery of critical business, facilities, equipment and supplies, as well as staffing and technology services, in the event of a disruption (for example, the Fort McMurray wildfires, IT outages, labour action, or breaks in supply chain management).

Implementation of RPX will also support downtime and recovery objectives for a planned or unplanned Connect Care disruption by providing a platform for plan documentation, storage, access, training and plan activation. The goal is to implement RPX in a manner that supports Connect Care objectives and timelines. The “how” is in development.


When does Clinical System Design stop?

The enthusiasm, energy and productivity of Area Councils (AC) and Specialty Workgroups (SWG) continues to amaze us. Alberta Health Services (AHS) witnesses extraordinary collaboration, reduction of unhelpful variation and informational integration. Indeed, more important than any clinical information system (CIS) configuration may be the principles, relationships, and processes learned through clinical system design (CSD). Growing new ways of designing and optimizing clinical content (documentation, decision and inquiry supports) helps AHS mature as a learning healthcare organization.

ACs and SWGs understand that essential specialty CSD should wrap up as 2018 comes to a close, leaving January 2019 for unfinished or deferred issues. All specialty CSD decisions need to be recorded by a hard deadline of February 8, 2019. This milestone is critical to readying the CIS for testing and training.

So, if specialty CSD must deliver by February 8, 2019 and the value of specialty CSD is as an enduring process, then what becomes of CSD once testing and training start? The short answer is that CSD continues indefinitely. It must. There is no other way to ensure that the CIS grows with AHS, both helping AHS to learn and optimizing what works best.

Appreciating that CSD is a core Connect Care activity, today’s time-boxed work just gets us to a starting line. It allows a basic CIS to be built; enough to illustrate the value of CSD and to teach skills for meaningful use.

The really valuable CSD work begins once the CIS is deployed. Accordingly, we have begun planning systematic processes for tackling all the “parking lot” issues left over from CSD build; and anticipating all the new needs arising post-launch. The appetite for new uses of CSD tools will be great, priorities must be set and design capacity must continue to grow.


In-System Inquiry guided by the Clinical Improvement Lifecycle

We've previously posted about how Connect Care in-system inquiry tools can help AHS grow as a learning healthcare organization.

Key characteristics of a health system that can learn include:

  • Every patient’s characteristics and experience are available for study
  • Best practice knowledge is immediately available to support decisions
  • Improvement is continuous through ongoing study (closed loop)Inquiry happens routinely and economically
  • Curiosity and inquiry is valued and embedded in organizational culture
Connect Care in-system reporting and analytics tools will provide AHS staff with the ability to create and use real time data about patients, populations and the health system as a whole. This data can then be transformed into information that guides evidence-informed decisions in service of continuous clinical improvement.

Clinical information system (CIS) facilitated clinical improvement emulates continuous quality improvement lifecycles. Today’s internal and external evidence generates tomorrow’s ideas which are then critically examined to evaluate the impact of the change and stimulate ideas for further clinical improvement. A simple clinical improvement lifecycle can help guide Connect Care planning for in-system inquiry.


What level of in-system inquiry maturity do we need?

As part of Reporting Content Review, Alberta Health Services (AHS) analysts help clinical information system (CIS) users design reports, dashboards and visualizations that will be deployed through self-serve, in-system, analytics tools supporting decision making. The possibilities are limitless... early configuration work is intimidating to say the least.

It can help to envision a stepwise progression towards the reporting maturity AHS needs to attain HIMSS Level 6 and 7 recognition. Early in-system reports, dashboards and visualizations should focus on gaining insight about user on-boarding and adoption. Soon, data becomes available to support tracking minimum acceptable CIS use. Once use is solid, attention can shift to indicators of meaningful use and charting quality. Thereafter, gaining insight from internal evidence about health processes and outcomes becomes possible. Appreciating this can help prioritization of in-system reporting capabilities for launch and the months that follow.