Practical Paranoia - Why Use AHS Secure Email?

We've previously posted about warranted worry when using email for clinical purposes.

Alberta health Services (AHS) offers a secure email solution that can support sending identifiable patient health information between AHS email and, with "!Private" in the subject line, to non-AHS email addresses.

Clinicians have raised a number of questions. Hopefully, this FAQ helps:


Is Connect Care at risk in new provincial review?

Connect Care participants have expressed concern about recent news reports of a provincial government review of Alberta's health information systems. Is Connect Care at risk?

The review, fulfilling a pre-election promise of the new provincial government, does not reflect second thoughts, or any lack of support, for the Connect Care initiative. Rather, there are information services that Connect Care can offer patients and physicians that may overlap with other provincial offerings, like the provincial electronic health record and public service patient portal. The intent of the review is to consider the most efficient strategy for leveraging Alberta's considerable opportunities. A request for proposals from potential reviewers has been posted and review results are not anticipated until 2020.

The Connect Care initiative continues with unequivocal commitment to its first launch in November 2019, and beyond.


Connect Care Wave 1 - What's Up?

Anyone associated with Connect Care is no stranger to immense complexity! And the number of simultaneously accelerating activities increases week by week. It can be hard to appreciate all that is happening.

A new Wave 1 Activities Timeline can help stakeholders keep up with accomplishments, needs and milestones.

With all clinical content (decision, documentation and inquiry supports) designed, the new priorities relate to content build and validation. It is especially important to re-rally clinical experts to ensure that what is built is what was intended. All levels of training continue to ramp up, with the bulk of end-user training starting just weeks from now. Other immediate happenings relate to device (medical and non-medical) installation, testing and validation.


How much past health data will make it into Connect Care?

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). We've previously explained the principles and processes that determine which, and how much, health information will be available in Connect Care at launch.

Wave 1 launch rapidly approaches and we can answer data conversion questions with more certainty.

In most cases, laboratory and diagnostic imaging results will be complete back to June 1, 2017; bringing over two years of important clinical information into Connect Care. In addition, most vaccination records, genetic data and legacy clinical information system (e.g., eCLINICIAN) data will transfer. Paper records will not be transcribed or copied. However, they may inform chart abstraction (outpatient) or cutover data entry (inpatient) near launch.

Clinicians can be reassured that key health information remains available in the Alberta Netcare Portal; an important safety net during transitions to Connect Care.

In addition to previously shared conversion summaries, take a quick look at the Key Messages for a quick summary of our latest expectations.


More Power to Connect Care Users

Building capacity in clinician communities remains a pillar of the Connect Care physician readiness strategy. Capacity grows at many levels. Our training program emphasizes empowerment of end-users, especially to leverage personalizations that can make the clinical information system (CIS) experience efficient, even enjoyable.

We've previously blogged about building capacity at other levels. Physician Super Users, Power Users, Builders, Analysts, Knowledge Leads and Medical Informatics Leads have already proved invaluable to our clinical system design and build efforts. We are benefiting from skilling-up before launch, which is not typical for other CIS implementations.

One option for physicians seeking more advanced information management skills is the Power User pathway. We've facilitated this opportunity for medical informatics leaders embedded in zones and specialty areas. It is exciting to witness how many have taken advantage of excellent course offerings from Epic. 17 Power Users are certified (completed 8 courses), 66 have started the pathway and 58 have at least two courses completed.

Thanks to all who prepare for CIS mastery... to better help the rest of us avoid being enslaved by the CIS!


Wave 1 Physician Training - Registration Progress

We've previously posted about getting Wave 1 physicians ready for and scheduled into Connect Care training.

A big thank you to all who have heeded the call and submitted preferences for personalized training! We are grateful to have over 1,300 physicians (73% of Wave 1 cohort) already getting lined up for basic training.

Follow-up communications are going out to those who have not yet registered preferences. It is very important that all physicians respond and get matched to acceptable tracks and timelines. Delays reduce options!

The Area Trainers guiding physicians through training are themselves trained, with about 60% completing key preparations this week. Super Users are also key to effective facilitation. About 40% will have finished their own training this week.

Our unique Connect Care training program continues to unfold. We are excited to see, as much as possible, the prospect of clinicians training clinicians coming to fruition. It remains for users to seize the opportunities offered. Taking training seriously is one of the best predictors of satisfaction with a new clinical information system.


Connect Care Physician Training - Good News

Today we are pleased to receive official confirmation that the Royal College of Physicians and Surgeons of Canada has completed its review of the Connect Care physician training program, including its eHealth literacy components. Specialist physicians are eligible for a full 12 hours of continuing professional development hours (at 3 credits per hour for a total of 36 credits) upon completing their assigned training and satisfying the associated competency assessment. This is good recognition, representing a significant portion of the credits specialists need to accrue yearly (90%!).

We await final word from the College of Family Physicians of Canada.


Connect Care July 2019 Calendar

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

High priority activities continue to advance device interfaces. Business continuity and datacentre failover exercises begin. Super User training is underway.

Clinical content validation activities are top priority so that we can ensure acceptability of documentation, decision and inquiry supports in time for personalization and launch.


Connect Care July 5, 2019 Newsletter Posted

The July 5, 2019, Connect Care Newsletter is available via the link below; covering 1) Timeline Updates, 2) New Connect Care Experience Videos, and 3) Waves 1 anad 3 Workflow Walkthrough.


Practical Paranoia - Sending Clinical Email

Clinicians should take great care when using electronic mail to communicate about clinical work, especially messages that may contain identifiable patient information.

We look forward to Connect Care launch, as the clinical information system (CIS) has advanced clinical communications tools.  These include email, text/chat, image capture and telehealth. Everything that happens within Connect Care stays within Connect Care. The physician and patient portals securely extend these clinical communication channels to those without full CIS access.

But what are we to do before Connect Care deployment is wide enough for all recipients to to receive? Before launch, and during transition periods when some but not all areas have launched, Alberta Health Services (AHS) secure email should be used for clinical communications.

Any email sent from one AHS address (ending with @ahs.ca or @albertahealthservices.ca or @covenanthealth.ca or @albertapubliclabs.ca) to another is automatically encrypted and acceptable for clinical communications.

An additional step is needed to protect email sent from an AHS address to a non-AHS address. It is easy. Just add "!Private" (remember the exclamation mark comes before, with no space, "private") anywhere within the email subject line. The recipient will receive instructions about how to decrypt the protected message. This will work even if there are attachments. And simply adding "!private" to the subject works with any email management software (e.g., Outlook, Apple Mail, Web mail, etc.).

For more information:


Privacy Awareness - an Essential Clinical Skill

Privacy awareness is essential to good clinicianship. It does not come naturally and so we all need training. Our digital world presents ever-changing threats to information security, making it hard to know when we may unintentionally weaken the vigilance our patients expect. Breaches harm patients, and can be devastating for clinicians.

On the eve of Connect Care implementation, Alberta Health Services has overhauled its universal privacy awareness training. A new online elearning module, called "InfoCare - On Our Best Behaviors" is now available on MyLearningLink.ahs.ca (MLL). This privacy awareness training is required of all physicians prior to gaining access to Connect Care. The module is engaging, case-based, and easy to complete. It highlights a series of behaviors that physicians can promote for patient care, professionalism and Connect Care readiness.

InfoCare is delivered through MLL, which is most commonly used on AHS computers in AHS facilities. As physicians are more likely to complete the course on personal devices outside AHS facilities, we have prepared a summary of tips that can help those using personal devices. To complete privacy awareness training:
  • Go to MyLearningLink.ahs.ca (we recommend the Chrome Internet browser for those who do not have access to Internet Explorer 11 on Windows 7 or 10).
  • Sign on with your usual AHS credentials (same as those for email)
  • Search the Course Catalogue for courses containing the word "InfoCare"
  • Register for and complete the course online
  • Verify that your confidentiality and user agreement is accepted and the course is marked as complete.
  • Tips: Using MyLearningLink


Compensation for Connect Care Physician Training

Training registration emails and scheduling surveys have gone out to almost 2,000 physicians touched by Connect Care's Wave 1 launch later this year. This makes clinician training real and immediate.

A dedicated team of physicians, educators and technical experts have collaborated to develop customized learning pathways for Alberta’s physicians. A mix of in-person, self-directed and case-based modules will take between 8-12 hours to complete, varying with users’ needs. Basic training is as brief as possible, with progress to personalization and optimization contingent upon satisfactory completion of privacy awareness training and a competency assessment.

There are no fees for Connect Care courses, certification, resources or supports. As with other Alberta informatics initiatives, financial compensation is not provided for time lost to training. However, we expect that physicians will receive continuing medical education (CME) credits and be eligible for Alberta Medical Association continuing medical education program funding. Connect Care training resources are invested in building informatics capacity in physician communities. This allows physicians to train physicians, peers to help peers, and builders to express physician needs.

Physician training slots open well in advance of Connect Care launch in each zone, program or facility. Participating physicians are notified by email and encouraged to respond promptly with scheduling preferences. Once training track(s) are assigned, physicians should complete basic training as soon as possible, allowing more time for personalization pre-launch. Effective personalization makes transitions easier.

Physicians can direct questions or concerns to zone medical leaders and their associate chief medical information officer. The following resources can help:


A deep look at Connect Care

After years of planning, consultation and development, Connect Care stakeholders were given a full day to delve into the emerging clinical information system last week.

Representatives from sites and programs in launch Waves 1 and 3 gathered from across the Edmonton Zone for our first "Workflow Walkthrough" event. This provided  was a chance for users to see how the Connect Care system will be used in a number of important workflows, with priority given to high-volume, high-complexity or high-risk contexts. A preliminary big-picture overview, used demonstrations of the new Connect Care build to illustrate a full patient journey through the health care system.

Attendees watched videos and live demonstrations, and had opportunities to ask questions and log issues or change requests.  Workflow walkthroughs are an important part of readiness preparations for each of the many Connect Care launch waves.


MyLearningLink for Connect Care Physician Training

“MyLearningLink” (mylearninglink.ahs.ca, or “MLL”) is Alberta Health Services’ (AHS) online learning management platform. It is used to deliver courses offered to all AHS stakeholders in all areas. It is also used to facilitate the registration, scheduling, delivery, completion tracking and assessments for Connect Care training. Users can find, access and complete any self-directed e-learning courses or assessments that can be completed online. MyLearningLink is important to Connect Care.

Unfortunately, until recently, the MLL environment focused on education needs of AHS staff working in AHS facilities on AHS-provisioned systems. Courses are approved for Internet Explorer (IE, version 11) running under Windows 7 on AHS desktop computers. But Connect Care users need to train at non-AHS locations on non-AHS computers.

Fortunately, MLL is upgraded to work on networks both inside and outside of the AHS “intranet”. Testing and support for users of Apple operating systems is coming.

For now, we  have prepared a tip giving interim advice for clinicians who may have difficulty replicating the standard AHS computer set-up. Please try this out and send any feedback, questions or suggestions to mip@ahs.ca.


First Workflow Walkthrough Successful

We previously posted about the nature and importance of Workflow Walkthroughs before each wave of Connect Care implementation.

Waves 1 and 3 shared a Workflow Walkthrough for the Edmonton Zone for most of the day on June 26. A comprehensive patient journey was illustrated using the emergent Connect Care clinical information system. This gave a tangible view of how all phases and settings of care relate. There followed deeper dives into information flows associated with complex multidisciplinary collaborative care. Participants were able to ask questions and point out areas requiring more attention.

Similar Workflow Walkthroughs will be repeated for other implementation waves, allowing local workflow adaptations to be explored.

Key demonstrations are available for viewing online (note that an AHS username and password are required):


Connie and Carey - Our Virtual Connect Care Team

Connect Care will change the way we work. A series of short workflow-oriented videos highlight strategies for navigating the change, and leveraging features that can ease the way. Connie and Carey, are our virtual guides, are introduced together with some early insights about transformation challenges.

This short (4 min) video is of broad relevance:


Honest Conversations: 1. Setting the Stage

Unfortunate timing. The academic and popular press brims with testimonials about physician Electronic Health Record (EHR) dissatisfaction, just as we rally physicians for Connect Care launch.

Fortunate timing. The products of our collaborative design are emerging, bringing our stakeholders fully into review and validation. We have our eyes on Connect Care well before its first use; and we are totally committed to making the toolkit as helpful as possible for clinicians.

So, this is exactly the right time for us to confront EHR angst. We won't get things precisely right, but we can ensure that we are on the best pathway to continuing improvement. And take time for honest conversations about where things have gone wrong with large EHR initiatives elsewhere.

An excellent starter read gives insight into the American experience. Please take a look and give the Fortune magazine article some thought. We will work our way through its harms inventory and re-affirm our own commitment to harms-avoidance and harms-reduction.


What is CII?

Alberta's physicians are inundated with health informatics acronyms. A relative newcomer is "CII", which stands for Community Information Integration. This references both new technology and information services.

The technology joins the Alberta Netcare Portal suite. It enables exchange of certain types of summative health information between electronic medical records (EMR) and the Netcare electronic health record (EHR). Standards-aware, it could also exchange health information with the Connect Care clinical information system (CIS).

The associated information service initially focuses on private, group and networked physician offices that use compatible EMRs. An early priority is to capture care synopses, including lists of visit diagnoses, allergies and other key information, for patients served by those clinics. The synopsis is added to the patient's Netcare record. In addition, specialty consults documented with compatible EMRs are captured and added to Netcare.


Connect Care Implementation Timeline Tweaks

As Connect Care continues to unfold, implementation details are smoothed out. Recent adjustments to Waves 1 through 6 affect when some sites and programs launch.
We've already posted about the need to move Wave 1 launch from November 2 to November 3 in order to accommodate the switch from daylight to standard mountain time.

Other changes accommodate clinical services that need to co-deploy:
  • Provincial Tuberculosis (TB) services will be included in Waves 1 and 2. 
  • Some community Addiction & Mental Health clinics need to launch with parent sites in Waves 2 through 6. 
  • Wildfire impacts delay some North Zone plans. 
  • Grande Prairie Hospital launch depends upon an unconfirmed opening date. 
  • Calgary Zone tweaks reflect careful sequence process analysis.
  • Alberta Kidney Care, Alberta Screen Test and Cancer Control Alberta provincial programs launch in Waves 4 and 5. 
  • Details continue to firm up for some programs outside core AHS sites in Waves 7-9.  
To prepare for these changes, some technology infrastructure (internet and hardware) assessments also shift. Updates continue to be posted on Connect Care intranet spaces:


Made it - Specialty Clinical System Design Build

Re-doubled Congratulations to the Connect Care team!

We are now 100% complete for build of clinical content (decision, documentation and inquiry supports) in the specialty clinical system design stream. This meets our June 24 milestone.

A big thanks to our build team, partnering with operations, CMIO, human factors, safety, training and clinician builders.


Just-in-time Communications

We’ve all been feeling the summer heat… more Connect Care intensity than nice weather!

As validation, training, readiness and implementation activities accelerate, clear communication can minimize chaos and confusion. There are way too many newsletters, SharePoint sites and Insite pages, agendas and minutes to follow. 

We are redoubling efforts to maintain a steady, but concise, feed of clinical content updates through blogging channels. All channels are listed in ahs-cis.ca/mdresources.

All physicians interested in Connect Care should subscribe to the general-interest physician blog (bytes.connect-care.ca). Any clinician involved in Connect Care design, validation, training or readiness activities should follow the blog for informaticians (informatics.connect-care.ca). Those directly involved in clinical content validation should also follow the internal Clinical System Design blog (csd.connect-care.ca).

Please skim our blog tips for instructions about how to subscribe. This way you can get digests to your email and not worry about visiting the sites.

Thanks for attending to this advice. We’ll keep the blogs going and rely upon the communications team to use them as source material for more formal Connect Care communications.


What will become of MyChart?

With Connect Care launch soon upon us, users of current clinical information systems, including the eCLINICIAN ambulatory care record in the Edmonton Zone, prepare for transitions. Naturally, there are many concerns and many questions.

We've recently received a number of requests about support for patients using, and depending upon, the eCLINICIAN MyChart patient portal. This is deployed through a number of specialty and primary care clinics, providing users with access to test results, secure communications, scheduling and other health information services.

Connect Care will launch with its own patient portal, "MyAHS Connect". This is configured as a clinical service for those receiving care where Connect Care is the record of care. We've previously described the nature of the offering and will soon offer a lot more detail about how patients will be enrolled and supported.

With release earlier this year of the Alberta Health public service patient portal, MyHealth Records (see past posting), it is important to coordinate portal offerings in the province of Alberta. Accordingly, the answer to questions about exactly what Connect Care will offer and how eCLINICIAN patients will be transitioned is... "its complicated".

Which test results and reports can be released, how records can be shared and how different portals will be linked are all matters of ongoing deliberation. We will communicate more fully as reliable details emerge.

For now, MyChart users can be assured that our intent is to continue equivalent or better services. Exactly how and when this happens continues to be worked out. Stay connected! The following resources are subject to change:


Getting There - Specialty Clinical System Design Build

Congratulations to the Connect Care team!

We are tracking 97% complete for build of clinical content (decision, documentation and inquiry supports) in the specialty clinical system design stream. This is a massive accomplishment, given the thousands of decisions to be tracked, translated, built and configured. This also ensures that we can move forward with testing, clinical validation and training.

A big thanks to our build team, partnering with operations, CMIO, human factors, safety, training and clinician builders.


Connect Care June 21, 2019 Newsletter Posted

The June 21, 2019, Connect Care Newsletter is available via the link below; covering 1) Uses of Barcoding Technology, and 2) Upcoming Readiness Events.


Getting to know Enterprise Content Services

The Connect Care clinical information system (CIS) will improve continuity of care by promoting "One Person, One Record, One System". This does not mean that the CIS databases contain anything and everything that could be important to a patient or population.

The CIS interoperates with an Enterprise Content Management (ECM) system, which can capture, manage, store, preserve, link and deliver a wide range of information objects that might relate to a patient's chart, but not constitute core content. ECM tools and processes allow for unstructured information to be managed wherever that information exists, while still preserving meaningful links to the health record.

Enterprise Content Services (ECS) enable users to digitize, store, manage and retrieve documents and images in association with Connect Care workflows. Connect Care ECM systems deploy as Connect Care deploys. Accordingly we'll be hearing more about ECM as workflow testing, validation, training and readiness activities ramp up.


Barcoding in Connect Care - Getting to HIMSS 6

Barcodes are graphic compositions of lines, symbols or shapes organized in ways that convey information to optical devices. Barcodes can be incorporated into identity cards, patient wristbands, medication labels, laboratory test collection tubes or scannable documents.

We know from the experience of others that good barcoding aligns with best practice. The connection is so strong that the Health Information and Management System Society (HIMSS) looks for this as a marker of organizations that have achieved advanced use of digital health records. Indeed, good barcoding for patient identification, medication management, blood product administration, medical imaging and supply management merits Stage 6 (out of 7) HIMSS certification.

We aspire to this level of digitally enabled transformation at AHS and will seek HIMSS stage 6 within 6 months of each Connect Care implementation wave.


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.


Getting Ready - Implementation Stream Activities

This is a busy time! While we have done well to design the clinical content to be used at Wave 1 launch, there are growing demands for stakeholder contributions to the testing and validation of that content. In parallel, demand grows for physician participation in a wide range of launch readiness activities.

We've already heard about Launch Readiness Assessments and Workflow Walkthroughs. In addition, implementation stream activities include a number of other practical tasks. Watch for more information about the following:
  1. Launch Readiness assessments: Structured comprehensive reviews of each Connect Care project stream, identifying risks and mitigation plans. These occur at 150, 129, 90, 60, and 30 days pre-launch.
  2. Shadow Charting: Relevant to a limited number of complex or high-risk workflows and  applications, users document cases in both legacy and Connect Care environments, providing an invaluable opportunity to check devices, interfaces, multi-disciplinary workflows, and information flows.
  3. Appointment conversion: The conversion of appointments, referrals, cases, and waitlists from legacy systems into Connect Care.
  4. Abstraction: Patient information not converted may be manually entered into outpatient charts ahead of launch.
  5. Cutover: Key information and orders for admitted patients is entered into Connect Care in the 24-48 hours prior to launch. Cutover includes both technical and clinical elements.
  6. Protocol Conversion: Many complex or timed protocols, primarily in Oncology and Research, will be converted for continuation in Connect Care.
  7. Command Centre: Safe and well-coordinated surveillance, leadership and trouble-shooting support rapid, efficient and responsive issues detection and resolution while deploying assets like Super Users to areas of greatest need.
To learn more about readiness activities, visit the Connect Care Readiness page on Insite (AHS login required).


              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.