What do Clinicians want from Connect Care?

The Alberta Health Services (AHS) Connect Care initiative aspires to improved health outcomes through use of a one-person-one-record-one-system support for clinical improvement. For improvement to follow implementation, it is vitally important that pCIS users integrate new informational supports into daily workflows in a meaningful way. And that requires meaningful engagement.
Engagement is facilitated when stakeholders understand the purpose of Connect Care, what it means for patients, what benefits users can expect, and how AHS can collaborate with users to promote benefits and avoid harms. The mission, values, goals and core principles of the initiative must make sense, be easily understand, and be compelling.
Users must also be highly motivated. They must be able to see, in a very practical way, how Connect Care will help them to do their work. These are matters of detail, often intimate, and inseparable from the messiness of frontline practice.
So, what do clinicians want from Connect Care? We have summarized impressions gained from interviews, meetings and focus. Follow the link to learn how users prioritize matters of convenience, connection, adaptation, integration and agency.


AHS CIS Physician Design Leads – Opportunity

AHS is seeking applications to fill a Physician Design (PD) Lead position serving the Connect Care initiative and its AHS Provincial Clinical Information System (CIS). The PD is a critically important, influential, role that will significantly impact CIS design and implementation.

CIS design, build, implementation, operation and optimization will require province-wide organizational transformation.  While an enduring CIS will be designed and configured with a provincial lens, conditions for successful adoption have to be optimized at a local level. It is very important that physician perspectives help guide efforts.

The PD Lead is a medical leadership position within AHS with responsibility and accountability for clinical leadership, care transformation, and implementation strategy. These positions will be 0.5-0.6 FTE, within the AHS ML2 contractor band (compensation negotiable), reporting to the AHS CMIO while working closely with zone associate CMIOs.

The PD Lead will be a well-established physician who can advocate effectively for strategic information management initiatives, anticipate impacts on stakeholders, identify issues, and help resolve problems.

Check out the link for more information and application particulars.

Position description: ahs-cmio.ca/designlead


Connect Care Technology Partner Confirmed

Alberta Health Services and Epic Systems Corporation have finalized and signed a contract engaging Epic as the technology partner for AHS’s Connect Care initiative. Effective the beginning of October, 2017, this clears the final hurdle to embarking on a transformative journey that will integrate health information systems across all AHS lines of service and the continuum of care.
Work begins in earnest to align AHS preparations with Epic’s approach for bringing large complex projects like Connect Care to successful implementation.


Meeting Less, Doing More

Among many preparations for the formal kick-off to Alberta Health Services’ (AHS) Provincial Clinical Information System (CIS) has been establishing effective governance and oversight. New committees are struck, terms of reference are approved, meetings are scheduled and day timers filled. The need to rationalize old and new structures is the subject an upcoming governance workshop that will try to resolve issues of overlap and accountability.
Emergence of a systematic approach to formal governance matters to Connect Care stakeholders. We also need, and are working on, an approach to informal channels of influence, oversight and accountability; including User Group coordination and collaboration.
Is this our opportunity for a re-think? A recent Guardian editorial (see link) summarizes evidence that typical organizational meetings accomplish little, kill productivity and are even a health hazard. We can’t escape meetings, but maybe we can moderate their quantity and maximize their quality.


Harmonizing Clinical Documentation

Clinical documentation is about how we build health records. It is also a requirement of all who serve patients. Whether in electronic or written format, proper documentation is mandated by professional, regulatory, legal, accreditation and Alberta Health Services (AHS) expectations. More importantly, it enables inter-professional communication, care coordination, service continuity and outcome monitoring. 
The Clinical Knowledge & Content Management (CKCM) team coordinates program-specific multi-disciplinary clinical documentation working groups. Work is underway to promote best practices, build consensus about documentation norms, expose clinically essential documentation elements, and reduce unhelpful program-to-program variation.
Bringing consistency and efficiency to clinical documentation can reduce health practitioners’ total information burden, streamline complex medical records, speed recovery of clinically important data, and focus caregivers on the communication needs of patients and families. Follow the links to learn more about harmonizing clinical documentation in AHS and how you can get involved.


AHS CIS Information Sharing Approach

​Information sharing is about how health data is collected, accessed, used, disclosed, and exchanged. Connect Care, as a continuum-of-care one-patient-one-record-one-system initiative, will challenge traditional ways of thinking about information sharing. To the extent that Clinical Information Systems (CIS) integrate across domains with different legislation (e.g. Health Information Act, Hospitals Act, Health Professions Act), regulations (e.g. CPSA charting standards) and policies (e.g., medical staff bylaws), a new and integrative approach to information sharing needs to work for all stakeholders in all settings. As clinicians move from independent to shared digital records, this touches the core of health care professionalism.
Diverse stakeholders have worked to develop a new "Information Sharing Approach" applicable to all AHS CISs, all participating health care providers and all settings. Shared rights, responsibilities and accountabilities are endorsed and embraced to build trust and protect the privacy, confidentiality, security and integrity of health information in all AHS CISs.
Learn more about the approach from the links provided and please provide feedback. The goal is to firm-up new arrangements in fourth quarter 2017.


What’s in a name? – Clinical Decision Support

​As design and build of the AHS Provincial Clinical Information System (CIS) starts, we are reminded that we are NOT building a digital health record. Rather, we are growing a system that supports coordinated care, best practice and clinical improvement. The magic sauce… helping users made good decisions.

Digitizing health information, and delivering it to clinical decision-makers, does not necessarily improve health care. Informed choice is facilitated when information about health is connected with information about how to improve health. Accordingly, "meaningful use" of the CIS is more likely when connections between observations and knowledge serve better processes, outcomes and satisfaction for patients, providers and policy-makers. This is what Clinical Decision Support (CDS) is about. 


Getting Ready - Current State Assessment

As part of our preparation for Connect Care, the AHS Provincial CIS team meets with clinical teams across the province to document what services AHS provides and how technology is used by healthcare providers in their daily work. Right now, AHS supports clinical care with over 1,300 different information systems. This fragments Albertans’ information, also making it harder for clinicians to provide comprehensive care.

Current state assessment teams have already engaged with many clinical teams to learn how the services we deliver interact with technology. Through this work we have already heard from over 800 clinical staff and physicians from across the province, across specialties and across diverse care settings.

We are moving through this process sequentially. As the current state assessments home in on critical clinical workflows, given the size and diverse needs of the organization, intersects with teams focus on smaller segments.  One of our early observations is that we deliver very similar services provincially, with largely the same high level processes. And there is widespread recognition of need for more consistency in how these services are supported with technology. This is great news as we move forward.

Follow the link to view an infographic that illustrates the current areas of work under Connect Care current assessment. We recognize that we have yet to touch all areas within AHS, but be assured that we are working our way through the organization and eventually will meet with representatives from all clinical areas impacted by Connect Care.

Through these initial meetings we have developed a high-level understanding and received good feedback about the process.  As we work with your teams to prepare for Connect Care, we will continue to enhance our understanding of how care is delivered, and where the CIS can have the most positive impacts.


Soft Security Tokens for AHS CIS & AH Netcare Remote Access

​Alberta Health Services (AHS) staff and affiliate clinicians may be authorized to access Clinical Information System (CIS), Netcare or other health information systems remotely from locations outside AHS network firewalls. This remote access requires two-factor authentication; such that the user 1) knows something (username and password) and has something (a Token or other securely recognized device).  Two-factor authentication reduces the risk of a security breach due to loss or theft of any one piece of information.

Some users requiring frequent or varied remote access find a physical security Token inconvenient; and unavailable when needed. These same users may have a smartphone always available and appreciate use of a "soft token" that works as an application. Replacing a "hard token" with "soft token" technology is fairly straightforward. Follow the link provided and work through the instructions starting on page 14.


No Secret Plan

​Connect Care is a significant investment in the future of healthcare in Alberta. This large-scale project will take time to put in place. As the Connect Care team continues to delve into preparations for this initiative, we are undertaking a thorough process to understand how all the pieces fit together.

You will start to see more communications as we work toward the design and build phase of the project. In the meantime, we will continue to collaborate and share our progress with you.

Please visit ahs.ca/connectcare or contact connectcare@ahs.ca with questions.


Connect Care Technology Partner

After almost a year of evaluation – and consultation involving hundreds of clinicians, staff and patients – Alberta Health Services (AHS) has announced that Epic is the chosen vendor responding to a Request for Proposal (RFP) to help build the AHS Provincial Clinical Information System (CIS). The CIS provides the technology platform to enable Connect Care, an AHS-led initiative to transform healthcare delivery in the province. 

The RFP process was thorough and conducted with fastidious care. A first phase narrowed the field to 3 vendors felt most able to address the full range of AHS integration needs, with capacity to implement sustainably for an entire province. The second phase engaged hundreds more evaluators, site visits, reference reports and financial analyses to complement a deep dive examination of 24 functional domains and 4 areas. The results were consistent and clear, with strong agreement across domains, areas, regions, disciplines and experiences.

Epic started in 1979 and has grown to serve as the largest continuum-of-care digital health record provider for complex health care organizations like ours. Epic develops software to help people get well, stay well and prepare future generations to be healthier. 

Now that Epic has been selected as the preferred vendor, contract negotiations proceed while comparing an emerging understanding of our current state with a detailed assessment of what Epic has ready to go. The gap analysis will be informed by readiness assessments, strategic transformation analyses and listings of CIS capabilities prioritized for early attention. All this helps prepare for collaborative design and build, which begins fall 2017.

The Connect Care integration goal remains to migrate the majority of AHS clinical systems to the AHS Provincial CIS over the next 4-6 years. Existing systems will be kept functioning and current until ready for transition. Transitions will be guided cost-effectively, with support for AHS teams to safely prepare for changes.

Keep a close eye on the Connect Care web and SharePoint sites for the latest news.


Connect Care Information Gateways

Alberta Health Services has opened a new website that can help stakeholders learn about Connect Care, follow developments, ask questions and discover why Connect Care matters. There are views optimized for patients and families, and others focused on the information needs of health care professionals. An intranet (Insite) page is open to all of AHS. Connect and find out why you should Care!
An internal AHS site (SharePoint) is used by teams working on Connect Care. It offers a single point of contact for finding detailed information about progress, projects, resources and governance. Optimized to support a community of practice, there are discussion boards, blogs, team tools, calendars and progress dashboards. If you are not able to connect, and are an involved AHS staff member, please send a request to the connect care email intake.


“Connect Care” is our CIS Initiative

Connect Care encompasses all the work being done to transform the way we provide care at AHS, and empower change with information. The initiative attends to information gaps that can frustrate integration of health services across the continuum of care. Connect Care will enable use of the AHS Provincial Clinical Information System (CIS) to support the work we do and enhance the quality of care we provide. 


CIS Physician Design Leads

We are thrilled to welcome four physician design leads as senior medical leaders who will help guide the design and development of the AHS Provincial Clinical Information System (CIS). Starting July 1, 2017, reporting to the CMIO, this group works in “triad” (clinical-operations-technology) relationships stewarding the CIS.
Echo Enns is a family physician and hospitalist who has served in diverse leadership positions including Physician Lead of both the Peter Lougheed and the Foothills Medical Center hospitalist programs (first of their kind in Canada), She has lead several QI projects, including medication reconciliation, optimization of discharge summaries, ward communications, and paging etiquette. Echo's deep understanding of front-line clinical work-flows will be invaluable to CIS design.
Vanessa McLean also brings a wealth of AHS leadership experience to the CIS initiative, from f​ront-line to administrative roles, including an impactful stint as South Zone Medical Director. Vanessa’s broad experience includes building collaborative relationships with varied stakeholders, troubleshooting and leading during critical incidents, participating in strategic planning, and working with teams to achieve operational objectives.
Stuart Rosser, currently in his third year as Site Chief for the Medicine Program at the Royal Alexandra Hospital in Edmonton, knows well the administrative, logistical, and clinical requirements for delivering care to a broad range of patients. His leadership has emphasized physicians' personal accountability for the value they add to the healthcare system, emphasizing education, administration, and quality improvement. Has worked on zone CIS projects and provincial information stewardship initiatives, with a deep understanding of the work that will be required to align clinical, business, and IT requirements.
Chris White, previously a program leader for the Calgary Neuromuscular Program, is currently a Clinical Associate Professor in the Department of Clinical Neuroscience at the University of Calgary. He remains a busy clinician who deeply understands the reality of clinical settings and information intersects. In his previous role as South Health Campus Site Lead, Chris was instrumental in fostering collaborative partnerships between clinicians, administration and IT. This site achieved significant stakeholder alignment, key to a successful implementation of integrative clinical programs and teams. 
fifth design lead position remains open, with recruitment underway. We are seeking a physician experienced with clinical support programs like diagnostic imaging, laboratories, microbiology or pathology.​
AHS CIS MD Roles: handbook.ahs-cis.ca/?=12381
Design Lead Posting: li.ahs-cmio.ca/designlead


Meet the CISU

The Clinical Inquiry Support Unit (CISU) supports clinicians to use Clinical Information Systems to drive clinical change.  We design, implement and evaluate clinical decision support tools and optimize CIS functionality for clinical inquiry use. We are part of a larger CIS Analytics Community of Practice and are committed to helping clinicians identify and use the right tool to produce reliable data products that meet clinical improvement needs. We are also a key stakeholder in the overall AHS Analytics Strategy, identifying opportunities to integrate AHS data outputs with the CIS and feeding CIS data to the analytics community for their use.
CISU delivers:
  • Clinical Decision Support Surveillance
  • CIS Use Surveillance
  • Research Protocol Registration and Initial Configuration
  • Clinical Metric Design and Configuration& Clinician Dashboard Templates
  • Reporting Workbench Templating
  • Disease Registry Design and Configuration


Internet-aware File Naming Conventions

File naming conventions have evolved from systems optimized for paper or index cards to ones attuned to computer file managers and, most recently, natural language processors. Current best practices build names in ways that are internet-safe, file-system optimized, and easiest to search and browse in disk directories, website management systems, online databases and internet search engines. Please see and consider the linked file naming guide, which draws upon international (ISO) standards, Internet best practices, AHS CIS guides, and AHS Health Information Management procedures to improve the usefulness of shared digital file collections for all stakeholders.
File naming norms: ahs-cis.ca/filenames


AHS e-Mail File Attachment Size Limit Increase

Email can fail if attachments are too large. We are pleased to learn that the allowed size is increased to 50 megabytes (MB).

AHS Email norms: li.ahs-cmio.ca/emailnorms


Protecting Important Credentials

AHS staff were recently advised to change any AppleID passwords they may have. This was in reaction to a news report about a hacker group claiming to have the ability to delete millions of Apple customer credentials. The threat did not materialize. Perhaps more important is the fact that genuine risks are unlikely to hit the news and often result from users willingly giving their credentials to ‘phishers’… one can’t always know when it might be important to change a password. Another approach is to implement ‘2-factor’ authentication, with the result is that, even if one’s credentials are discovered, it is not possible to log on to an account if the hacker does not also have a second factor; such as a smart phone, smart watch or authentication device. Typically, users are alerted to suspect logon attempts. Please consider turning this on for Apple, Google and other online services you commonly use.
Phishing description: li.ahs-cmio.ca/2ff
2-factor description: li.ahs-cmio.ca/2fw
Google instructions: li.ahs-cmio.ca/2fg
LinkedIn instructions: li.ahs-cmio.ca/2fl
Apple instructions: li.ahs-cmio.ca/cismd


Towards a Caring Information System – Connecting Care

As AHS embarks on its Connect Care journey, we are reminded of gaps that can be bridged with a comprehensive, continuum of care, integrated, clinical information system. Information gaps can fragment care in a frustrating, if not dangerous, way for patients. A compelling personal testimonial can be found in Eric Dishman’s talk about the need for team-work powered by information.


Netcare BPMH Forms and eSafety

The “Best Possible Medication History” (BPMH) form, which can be generated from the Alberta Netcare Electronic Health Record, can help practitioners gain an appreciation of medications that a patient should be taking, and actually is taking. However the form has limitations. It can be used safely if practitioners are aware of these limitations and take care to protect against error. 
​Netcare BPMH safety tips: li.ahs-cmio.ca/bpmhtips
Med Rec info: li.ahs-cmio.ca/bpmhinfo


CMIO April Appointments

We are delighted to have Stephanie Ladouceur join the Chief Medical Information Office as its executive associate. Formerly an acting business manager and team support coordinator at AHS Supportive Living, Stephanie brings a wealth of experience and enthusiasm to a challenging role. A quick study, already she helps smooth our way to the AHS Provincial Clinical Information System.
David Meurer also started with the CMIO in April 2017, bringing many years of experience with clinical guidance development and coordination in the Emergency Medicine Strategic Clinical Network. David serves as Program Director Provincial eQuality and eSafety, a role critical to preparations for the provincial CIS.
·   Stephanie Ladouceur, Executive Associate
·   David Meurer, Program Director


AHS Clinical Telehealth Vision Presentation

Clinical Telehealth helps clinicians deliver health services, share expertise and exchange information – anytime and anywhere – when clinician and client cannot be in the same place. Given Alberta’s broad geography, telehealth tools, skills and supports are increasingly instrumental for provision of equitable, patient-focused, and high-quality care. Advent of a provincial clinical information system, and rapid emergence of “lean” telehealth tools, assures rapid expansion of Clinical Telehealth in diverse AHS lines of service. Dr. Jonathan Choy, our AHS Telehealth Medical Director, will be presenting about Clinical Telehealth successes and aspirations. Join him May 6 from 0800-0900 in the Edmonton Zone Walter Mackenzie Health Sciences Centre, Classroom D, or via teleconference by registering using the link provided.
Register for videoconf: li.ahs-cmio.ca/cthrounds
Clinical telehealth on insite: li.ahs-cmio.ca/cth


Strategic Transformation Progressing with 3 Streams of Work

Adoption of a seamlessly integrated Clinical Information System (CIS) gives opportunity to improve outcomes, control costs, and support caregivers.  But first we have to simplify and streamline our everyday work. The AHS Provincial CIS Strategic Transformation Initiative promotes collaborative answering of questions about how to transform CIS-sensitive health care policies, processes and norms.
The work of transformation is ramping up; with three pathways yielding results:
Technical: managing our infrastructure (wires and things) and infostructure (software and systems) to take advantage of communications, coordination and other capabilities a CIS can provide.
Capacity: harmonizing and improving existing operations, services and processes so they work best in an integrated continuum-of-care system.
Transformative: rethinking strategies and reshaping how we operate, especially when practices vary without good reason, or we have not figured out how to do something a CIS depends upon.
With a number of strategic transformation questions coming to fruition, there are now regular presentations to executive so that the associated work packages are reviewed, endorsed and allocated.
STQ Catalogue: stq.ahs-cis.ca
STQ Resources: ahs-cmio.ca/stqresources
STQ Collaboratory: ahs-cmio.ca/stqcollaboratory


e-Health Policy Symposium – Towards Person-Centred Integrated Health in Alberta

Wide-area integrated digital health records crossing the continuum of care are emerging in Alberta and other provinces. Primed by our experience of a province-wide Electronic Health Record (Netcare), we will soon grapple with information sharing implications of an AHS Clinical Information System, where there are no borders between inpatient, outpatient, community and other healthcare contexts. Added to this paradigm change is the prospect of direct patient access through portals and personal health records. While these developments open extraordinary opportunity for improving personal and population health, a shared health record also stretches understandings of patient-provider privilege, professionalism and informational accountability.
The O’Brien Institute for Public Health and the Institute of Health Economics, in collaboration with Alberta Health, are co-hosting an invitational meeting to allow key stakeholders and informants to consider how best to promote information sharing to the advantage of patients, populations and health care.  Provocative presentations set the stage during an open morning session, followed by an invitational afternoon session that considers strategies to enable a seamless flow of health information across the continuum of care.
Check out the link for more information and registration particulars.
   February 14, 2017
Westin Edmonton
10135 100 Street NW
Information & Registration: li.ahs-cmio.ca/symposium


Integrated Health Records – Improving Patient Care for Albertans​

​Collaboratively brought to you by the Alberta Network for Health Information Exchange (ANHIX) and Canada’s Health Informatics Association (COACH), this conference features public and private sector experts sharing insights about health information system integration. Alberta’s initiatives and impacts are explored as they relate to clinical practice, service quality and patient outcomes; highlighting objectives for an AHS provincial Clinical Information System. Check ​​ out the link to see the latest speaker and session line up, and to register to join what promises to be a very engaging discussion!
February 8, 2017
Delta Calgary South
Calgary, Alberta 
 Information & Registration: li.ahs-cmio.ca/anhix


CMIO Director Analytics and Special Projects

Leahann Mcelveen joins the Chief Medical Information Office (CMIO) as Program Director for Analytics and Special Projects, transitioning from her current role as Information Stewardship Office (ISO) director. Leahann has provided exceptional service and exemplary oversight while leading complex inter-organizational supports for the provincial Electronic Medical Record Information Sharing Framework.  Prior to joining the ISO in 2012, Leahann was a senior portfolio officer with the Office of the Information and Privacy Commissioner (OIPC) and a lead instructor for the University of Alberta’s Information Access & Protection of Privacy program.
Leahann will report to the CMIO, working closely with AHS Research & Analytics, the AHS Provincial CIS initiative, and strategic transformation efforts.  She will guide the development of structures, processes and controls necessary facilitate information sharing within and between clinical information systems to promote clinical improvement, inquiry and instruction.
 AHS CMIO: ahs.ca/cmio


Clinical Improvement Clinician Handbook

​A wealth of clinical informatics information, and Clinical Information System (CIS) specifics, can be found on internal and external AHS websites, SharePoint spaces, and policy and procedure databases. A common lament of busy clinicians is that these materials may not be well suited to their more practical questions or to the kinds of devices they use in diverse workplaces; or may be too technical or detailed.  Accordingly, a “CI Clinician Handbook” supports sharing of brief guides and tips, largely prepared by clinicians for clinicians; as a form of peer-to-peer mentoring and support. The handbook is part of the Clinical Improvement Collaboratory.
CIS public website: ahs-cis.ca/public
CIS AHS Insite: ahs-cis.ca/private
CI Clinician Handbook: handbook.ahs-cis.ca
CI Collaboratory: clinicalimprovement.ca


Clinical Information Systems – Key Concepts

​The work of evaluating a technology platform for the Alberta Health Services Provincial Clinical Information System (CIS) continues, with expectation of selection within a matter of months. Accordingly, preparations for design and build are well underway. This involves pulling together diverse groups in AHS, understanding (multiple variants of) prevailing workflows, and transforming practice to align with best guidance and CIS-enabled optimization. With critically important discussions and documents unfolding, it becomes clear that information management terms are not always jointly understood. Happily, stakeholders have agreed to collaboratively define “CIS Key Concepts,” then stick to a common interpretation as work continues.
CIS Key Concepts: handbook.ahs-cis.ca?=concepts 


Alberta Health Personal Health Record – Release Immanent

Alberta Health and Alberta Health Services will launch the first phase of the Personal Health Record (PHR) on MyHealth.Alberta.ca by the end of January 2017. The PHR offers a secure online space where Albertans can enter and manage their own health information. The content can be shared with health care teams through printed summaries or personal device displays.  
The first phase of the initiative focuses on information gathered from and managed by individuals. There are tools for recording health measurements, documenting health histories, and setting health and wellness goals. Other tools allow capture of health data from medical devices and smartphones connected to Windows-compatible computers. The only information captured from the Alberta Netcare EHR will be dispensed medications. Future phases will bring selected laboratory test results, transcribed reports and immunization records into the PHP.
CBC News article: news.ahs-cis.ca/php-cbc


AHS Provincial CIS – Senior Program Officer Appointed

​Barbara Kathol joins the AHS Provincial CIS team as its new Senior Program Officer starting January 16, 2017, completing the CIS leadership triad with Rob Hayward (CMIO) and Penny Rae (CIO). Most recently serving as an executive director at the Foothills Medical Centre, Barb brings extensive experience with enterprise information system implementations, information technology governance and clinical operations leadership. Moving forward, she will serve all zones and programs as they transform while getting ready for the CIS and the many process optimizations it will enable.
 CIS governance: ahs-cis.ca/cisgov
 CIS project overview: ahs-cis.ca/cisproj