Connect Care December 20, 2019, Newsletter

The December 20, 2019, Connect Care Newsletter is available via the link below; covering 1) Connect Care sequencing, 2) Wave 1 Unit Story, 3) Reporting Content Certification, 4) Champions:


Connect Care Physician Supports during Holiday Period

Escalations of physician help requests have become relatively rare, which is reassuring as we enter the winter holiday season and reduced support staffing.

The CMIO portfolio has organized to ensure that clinical informatics and medical informatics resources are available on-call over this time. User support methods remain the same (see the Support section of the Connect Care Physician Manual) with the CMIO resources available if Help Desk is not able to resolve a problem.


Connect Care Wave Adjustments

With the launch of Connect Care’s Wave 1 in November almost behind us, we are now looking ahead to the next launches, occurring in waves over the next few years.

Following extensive discussion, senior leaders have adjusted the timing and scope of Connect Care’s Waves 2 and 3, and modified the scope of Waves 4 and 5. Wave 1 launched in November 2019 successfully and we want to align upcoming launch plans with lessons learned.

Patient care and safety, along with the needs of staff and physicians, is at the forefront of all of planning decisions, including this one. While mindful of healthcare funding constraints, the Connect Care initiative continues to be fully resourced to achieve its original completion targets. This includes working to resolve outstanding issues and challenges. We want to optimize timing so that staff and physicians within future waves are ready and supported at their launch dates.

Here is a summary of the modified Connect Care wave sequencing and timing:
  • Waves 2 and 3 (launching in May 2020) will include Calgary Zone rural and urgent care sites and the clinics and services aligned with those, and Edmonton Zone suburban sites. 
    • All of the Central Zone rollout, initially planned for Wave 2, will be moved to Wave 4. 
  • Waves 4 and 5 have scope and timelines recalibrated to ensure they are not too compressed by the delay of Central Zone’s rollout. The wave implementation schedule remains the same.  
    • Wave 4 (launching November 2020) will include the Royal Alexandra and Glenrose Hospitals in Edmonton Zone, all of Central Zone and Alberta Children’s Hospital in Calgary Zone.
    • Wave 5 (launching May 2021) includes Peace Country and Grande Prairie hospitals) in North Zone, the Foothills Medical Centre and South Health Campus hospitals in Calgary Zone, cancer programs in the north and south, and the coinciding rural labs.
  • The scope and sequencing of Waves 6, 7, 8 and 9 are being reviewed and details about any changes or updates to those waves will be available in the coming weeks. 
  • The timing for the rollout of Connect Care within Kidney Care North and South is still being determined.   
  • Wave 1 launched in November, 2019 and included the University, Mazankowski and Stollery hosptials, outpatient clinics across Edmonton Zone, the East Edmonton Health Centre, Pharmacy and Diagnostic Imaging sites in the Edmonton Zone, Alberta Public Labs sites in Edmonton and the North Zone, DynaLIFE sites across Alberta and the lab at the Cross Cancer Institute.
For more details about these changes, please refer to the updated Implementation Timeline.

The current plan reflects the best information available today.  We may need to make future adjustments as we continue to learn from, and adapt to, each Connect Care launch. We’ll also continue to be responsive to the needs of patients, families, staff and physicians.


Reminder: Tricky Transitions Tomorrow (optimization clinic)

Complex patient movements can affect how Connect Care orders are placed, when they are activated and how they are approved for action. The second Connect Care Optimization Clinic will seek input from participants about the types of "patient movement" challenges they may have experienced with orders. We will share a flow diagram highlighting key "tricky transitions" and the orders choices that can navigate them successfully.
We continue to experiment with webinar technologies that can serve prescribers joining virtual clinics from inside and outside AHS networks and using different personal computing configurations. Tomorrow, "Zoom" will be the platform in use. Please use the links provided below to try connecting well ahead of time. This will allow for any downloads or other adjustments needed to participate.
Note that there are two (duplicate) sessions. The morning session may better suit surgeon schedules.
Session #1 - December 18, 2019, 0700-0800
  • Meeting ID: 843 908 198
  • Audio: can use computer audio or telephone (647 558 0588 then meeting ID or one-click +16475580588,,843908198)
Session #2 - December 18, 2019, 1200-1300
  • Meeting ID: 359 904 795
  • Audio: can use computer audio or telephone (647 558 0588 then meeting ID or one-click +16475580588,,359904795


Connect Care December 2019 Calendar

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


Pharmacy Information Network Connect Care Interface Update

We previously posted about early efforts to interface Alberta's Pharmacy Information Network (PIN) with Connect Care medication reconciliation workflows, including an "outside information" function for PIN medication reconciliation.

This did not work as well as hoped. The function was removed so that PIN reconciliation reminders would not interfere with workflows. Of safety concern, the laborious task of importing medications from PIN did not benefit from clinical decision supports.

Connect Care users may not appreciate that it remains possible to review PIN dispensing information, even though one is no longer prompted to reconcile "outside" PIN medications. A full PIN list remains available in Netcare. This can be displayed in-context and allows a full history of (eligible) medication dispenses to be reviewed.

Some confusion may relate to orphan PIN medication reconciliation flags "left over" from the early Connect Care launch period. These should not be relied upon. No updates have occurred since early November. It is wise, and easy, to remove these flags:


New Inpatient Consults: Spiritual Care, Indigenous Health

Inpatient referrals to spiritual care and indigenous health services are now supported in Connect Care. Search for "Inpatient Consult to Spiritual Care" or "Inpatient Consult to Indigenous Health" to complete a request, entering contextual information in the usual fashion.

Connect Care Optimization Clinic #2 - Tricky Transitions

Optimization clinics are delivered by peers, usually a clinician informatician or super user, with focus on challenging use cases. A short presentation is followed by questions, discussion and suggestions from participants. Any new tips are posted to the Physician Manual or Physician Updates.

A second Connect Care Optimization Clinic is offered a two times of day (duplicate clinics) to better fit physician schedules. All are welcome. Please try the meeting link ahead of time to ensure that your computer is ready before the session.
  • Topic: Tricky Transitions
  • Facilitators: Rob Hayward, Alan Sobey
  • Date: December 18, 2019
  • Time #1: 0700-0800
    • Meeting Link: clinic-a.connect-care.ca
    • Meeting ID: 843 908 198
    • Audio: can use computer audio or telephone 
      • Canada +1 647 558 0588 (then meeting ID)
      • One click: +16475580588,,843908198
  • Time #2: 1200-1300
    • Meeting Link: clinic-b.connect-care.ca
    • Meeting ID: 359 904 795
    • Audio: can use computer audio or telephone 
      • Canada +1 647 558 0588 (then meeting ID)
      • One click: +16475580588,,359904795
  • Description:
    • Complex patient movements can affect how Connect Care orders are placed, when they are activated and how they are approved. Our focus will be on the sorts of problems that may arise when patients transition to settings or phases along a care pathway. 
    • We’ll demonstrate and discuss how Connect Care physicians can take corrective action, with a focus on Orders clean-up.


Connect Care System Update - December 12, 2019

A scheduled downtime in the early hours of December 12, 2019 allows Connect Care production servers to be updated with a number of enhancements.

Mostly, these relate to change-needs arising from our early post-launch experience. Some updates reflect our commitment to keep Connect Care current with Epic's latest enhancements. For example, improvements will be noticed by physicians using the Android version of Haiku.

The downtime window will also be used for updates and fixes to Dragon Medical One, including correction of microphone persistence and voice command issues.

A complete list of changes, keyed to Epic modules, includes notes about what users may notice:

Downtime Resources for Physicians

Connect Care has its first scheduled downtime overnight (early hours of Thursday Dec 12, 2019 sometime between 0030-0430).

Straightforward instructions for physicians (which complement the more detailed Connect Care Downtime Resources at ahs-cis.ca/downtime) have been updated and streamlined:


All-User Bulletin: Connect Care Service Interruption

All-user-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Service Interruption Dec 10, 10:10 - what to do
While preparing for a system update Thursday morning (see post), the Internet servers that support Connect Care Hyperspace were being prepared and a few encountered a brief outage.

This affected some Hyperspace users who may have noticed error messages or loss of access to patient charts. Although the unplanned, unscheduled, interruption lasted only minutes, some workstation sessions may remain ineffective. The solution is to simply re-boot the workstation.

Mobility remained active during this time, a reminder that Canto, Haiku and Rover are alternate ways to get into a chart.

The incident has been analyzed and this kind of server adjustment will not be attempted again in this way.


Connect Care Scheduled Downtime

The Connect Care production environment (PRD) needs periodic maintenance. This allows system fixes to be installed without risking database content and also gives opportunity to install quarterly software updates.

The first scheduled update will occur Thursday December 12, 2019, sometime between 0030-0430 in the early morning hours. While access to PRD is taken offline, access to "PRDSRO" remains. This is a read-only copy of the most recent production (PRD) and allows all patient data to be reviewed. Any urgent orders or documentation that must be completed while PRD is offline can be handled through a combination of paper, eScription and Netcare activities. Try to postpone and avoid use of paper, as PRD is likely to be restored quickly.

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

Additional instruction remains available in the Connect Care Physician Manual:


Connect Care December 6, 2019, Newsletter Posted

The December 6, 2019, Connect Care Newsletter is available via the link below; covering 1) Connect Care's first month, 2) eHealth, 3) Champions:


All Physician Bulletin - In-System Dictation Downtime

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Dragon Medical One brief Downtime Dec 06, 0100-0200...
There is a scheduled Dragon Medical One (DMO) outage set for December 6 sometime between 0100 and 0200 (overnight). The vendor hopes it may be complete in <10 mins.
During this time, physicians will receive an error message if they try to start a new in-system dictation using DMO. Any dictation initiated before the downtime will be saved, but users will not be able to start another dictation session until the upgrade is complete.

Of course all other methods of documentation remain available within Connect Care. Users who strongly prefer DMO can record a few text notes and return later to delete and dictate or supplement and dictate.


One Month of Connect Care

A Message from Dr. Verna Yiu, AHS President and CEO 

Dear staff, physicians and volunteers,

We now have one month officially behind us in our Wave 1 Connect Care journey.  Congratulations to all of our sites and teams across AHS who have provided strong support for our Wave 1 colleagues as they pave the way for Connect Care across the province. For the past 30 days, teams have been working around the clock to provide support and help resolve issues. We are so proud of your collaborative spirit.

As we work together to become more comfortable and confident using Connect Care, we know there will be challenges along the way. Learning new systems and work flows can be difficult, and there have been issues as we figure it out. It is good to remember the long-term goals. 

Connect Care will:
  • House all AHS, partner and affiliate medical records to support care wherever Connect Care is in place.
  • Provide common decision-making tools and resources for clinicians, to ensure all our physicians and staff have access to the same clinical standards and best healthcare practices.
  • Eventually allow all patients across Alberta to have access to their health information through the patient portal, MyAHS Connect.
Ultimately, Connect Care means  the whole healthcare team, including patients, will have the best possible information throughout their care journey. 

Our healthcare providers and supporting teams are at the heart of all we do. We’ve taken some time to talk to several staff, physicians and patients involved in Wave 1 about what this month-long experience has meant to them.

Thank you for such a successful launch. Thank you for your patience and resilience. Because of you, we have accomplished so much in these last 30 days. I also want to thank and encourage those working on the combined Waves 2 and 3. There is much to learn from the first implementation and I appreciate all your efforts to get us ready for the next step.


Dr. Verna Yiu
AHS President and CEO


Recruiting Physician Area Trainers – Waves 2, 3 & 4

Connect Care continues to roll-out with Waves 2 & 3 in May 2020 and Wave 4 in November 2020. It's time to get ready!

There are opportunities for new physician Area Trainers, a role that proved exciting and rewarding to physicians who supported Wave 1. Area Trainers deliver Connect Care training while also promoting transformation and clinical improvement at launch.

previously posted about Physician Area Trainers. Interested clinicians benefit from exceptional clinical information system orientation and change management coaching. Stipend-supported, Area Trainers can use the role to supplement their usual clinical activities, play a pivotal role at Connect Care launch and positively impact health care in Alberta. Area Trainers are critical to the success of Connect Care, and will champion the initiative in their teams.  There will be an opportunity to extend the role for those who wish to continue beyond their assigned launch wave.

For more information:


Ordering for faster Workflows

We previously posted about cleaning Order clutter than can happen with complex inpatient pathways.

Better to prevent the clutter in the first place! Taking a bit of time, early on, to build Order preference lists may be the most important way to improve your efficiency while maintaining well-ordered Orders.

If you are struggling with Orders, chances are you need to take control and tweak them to your liking. Key skills include personalizing multiple versions of the same order based on diagnosis, timeframe and laterality. Examples include:
  • Multiple versions of a medication prescription based on the number days required, or different dosing schedules.
  • Multiple orders specific to x-rays of the left ankle, and the right ankle, left knee and right knee.
  • Multiple versions of interventions based on chief complaint (e.g. CT head to rule out CVA, CT head to rule our hemorrhage etc.)
Any time you have repetitive or similar ordering workflows to complete in Connect Care, there is a good chance they can be automated in some fashion to save you time.


deOrderizing Inpatient Charts

A variety of circumstances can lead to inpatient Order messiness. Complex transfers – to or from emergency, critical care, operating room, dialysis, inpatient and reactivation services – can generate Order litter in the form of duplicate, orphaned (not associated with a phase of care) or inactive Orders not cleared by prescribers on either side of a context shift. This disorder can make it harder to recognize and manage important Orders. It can also bloat summative documents, such as transfer reports.

Periodic “deOrderizing” should be done to find and remove inappropriate, unnecessary or misleading strays. Prescribers may be asked to do this by other health care team members who struggle to manage patients’ Orders. Today's Connect Care Optimization Clinic focused on this topic, supported by new aids for users:


Connect Care Optimization Clinic #1 - Orders Hygiene

The third phase of Connect Care training for physicians is called "Optimization", not to be confused with ongoing optimization of clinical content (documentation, decision and inquiry supports).

Among the many optimization options available to Connect Care physicians are a series of Optimization Clinics. These informal sessions are entirely voluntary and virtual, with no need to register, go somewhere, or work through MyLearningLink. There are no reading materials, eLearnings or other expectations.

Optimization clinics are delivered by peers, usually a clinician informatician or super user. But anyone can volunteer to facilitate a clinic.

Each clinic focuses on one or more challenging use or workflow(s). A short presentation of a proposed optimized practice is followed by questions, discussion and suggestions from participants. Any new key messages get posted to the Physician Manual or Physician Updates.

A first (pilot) optimization clinic occurs Wednesday November 27 at noon:
  • Topic: Orders Hygiene
  • Facilitator: Rob Hayward 
  • Time: November 27, 2019, 1200-1300
  • Audio: 780-801-2629, conference code 7070706
  • Video: clinic.connect-care.ca (please test and join between 1130-1200)


New Global Search for Connect Care Update Blogs

The Connect Care Physician Updates blogs include multiple "channels". These are listed across the top in a button bar (computers) or pick-list (mobile devices) and include:
  • Bytes - general interest updates
  • Bridges - posts of interest to those not using Connect Care as their record of care
  • Vlogs - short video blogs on general introductory topics
  • Informatics - more detailed or technical postings of interest to physician informaticians
  • Tips - brief explanations, demonstrations and practical pointers
  • FAQ - frequently asked questions about Connect Care functions
  • Support - common problems and solutions for Connect Care users
It has been possible to search for posts with title or text containing a term, or to search for posts tagged as belonging to a particular category (left column of all blog channels). 

As the volume and value of postings has grown, our followers have requested a way to search multiple channels at once. We now have a rudimentary tool that does this.

Check out the new "Search" link in the button bar above or the "See Also" links to the right.


Chat with Care

Connect Care Secure Chat offers an approved way for users to share quick messages about their work. All other messaging services (e.g., iMessage, WhatsApp) must be avoided when identifiable health information is at risk.

While Chat can facilitate quick communication and collaboration, it does not replace usual communication for urgent matters, or In Basket for communications that belong in the record of care.

Prescribers should use Chat with care until the clinical information system (CIS) has fully deployed within a clinical area and new communication norms are widely understood. Early on, staff may forget that many matters still require face-to-face, pager or telephone communication. Secure chat should not be used to convey urgent information or to ask for urgent intervention from a colleague without person-to-person communication.

Initially, Secure Chat will be most useful for consenting clinical groups that commit to use it and agree about expected chat availability.


Drop-in Centre and Optimization Clinics

Having completed a full three weeks working with the Connect Care clinical information system, physician supports evolve to a model of embedded expertise. Please continue to follow this progression as changes are documented in the Connect Care Physician Manual (see the Support section and subsections, including Super User Schedules).

Drop-in Centre Schedules also adapt to changing needs:

Starting this week, we begin a series of Informatics Clinics for users wishing to optimize their Connect Care experience for specific workflows. More information will be posted to this blogs, but mark calendars for the first clinic this coming Wednesday November 27 at noon.


Transitioning to Sustainable Supports

As Connect Care users grow comfortable using the clinical information system, they become a valuable resource for their peers. Super Users will continue to be prominent in the workplace for a few weeks to come. However, they transition to embedded, not extraordinary, roles. Most divisions and departments have already set up clinical call schedules to ensure effective distribution of experienced and super users so that elbow-to-elbow support can continue.

If help is not close-at-hand, we encourage clinicians to make use of the Connect Care Solution Centre and Help Desk. These are available 24/7 with telephone, email and online chat channels.

The Solution Centre continues to have access to Super User, Trainer and other CMIO resources, who are on call to ensure continuity while we transition to sustainable embedded user supports.

Connect Care November 22, 2019 Newsletter Posted

The November 22, 2019, Connect Care Newsletter is available via the link below; covering 1) Connect Care successes, 2) Wave 1 launch, 3) Patient stories, and 4) Staff stories.


In-System Dictation (Dragon Medical One) Optimization Sessions

Looking to be slicker, faster (and happier!) with in-system dictation using Dragon Medical One (DMO)?

Attend a DMO Optimization sessions to learn how to use and create custom commands, hotkey shortcuts and dictation-triggered SmartText. Whatever your needs, optimization sessions can answer questions for a more personalized dictation toolkit.

To Register:
  • Visit My Learning Link (MLL) ;
  • Search “Dragon Medical One (DMO) Optimization”;
  • Select a session
    • Location: Kaye Edmonton Clinic (KEC) 3F.110
    • Duration: 1 Hour
    • Dates: November 25, 26, 28; December 3, 4, 6
    • Times: 0700-0800, 1200-1300, 1600-1700


From Launch to Optimization

Connect Care supports Alberta Health Service's (AHS) growth as a learning healthcare organization. This is an exciting time! With Wave 1 launch, we've broken through informational barriers to credible internal evidence about what works best for those we serve.

Now that care processes and outcomes are more accessible for informational improvement, it is essential that we transition from CIS break-in to optimization. We need to further streamline workflows while smoothing informational supports. There is every opportunity to help, not hinder, exceptional care.

Our launch preoccupation has been detecting and resolving technical problems. Concerns that might relate to clinical content (decision, documentation and inquiry supports) have been reviewed by rapid-action clinical system design supports from Content and Standards, Clinical Decision Support, Clinical Documentation and Clinical Inquiry Committees and, on behalf of Connect Care Council (CCC) and its Area Councils and Specialty Workgroups, the CCC Coordinating Support Unit.

This week the CCC holds its first full post-launch meeting, marking our transition to optimization. Area Councils will evaluate and prioritize issue-tickets not already closed. In addition, enhancement requests and “bright ideas” will be reviewed.

Area Councils will again take the lead in refining clinical content and determining what should be built next within their specialty. They continue to be supported by Area Council Support Units that bring together Build Teams, cORE Leads and Clinical Informatics Leads to develop, build, validate and implement clinical content.

We look forward to leveraging a great launch through even greater optimization.


Ordering without Ordering

Some of our more complex clinical information system (CIS) challenges relate to Orders.

Duplicate and stray orders accumulated in the early days post-launch. Since then, workgroups have clarified how to prevent these through workflow adaptation and CIS adjustment. We are getting better moving tasks with the patient for actioning by the right providers in the right sequence.

At the same time, we may dredge up interprofessional irritants.

The common meaning of "Order" is to "give an authoritative direction or instruction to do something". This can trigger PTSD about who gets to tell who to do what and when, with presumption of differential priorities.

Indeed, it is unfortunate that Connect Care even uses the term "Order." In truth, CIS "Orders" are multi-facetted task-management tools that have more to do with collaborative coordination than directive instructing.

Connect Care order-management will falter without excellence in communication and consideration. Orders should not be "dropped" without ensuring that those who must pick them up are aware and ready. And it is essential that we talk with one another about what needs doing, even more than we did pre-launch.

Connect Care does not prohibit protocolized, verbal or telephone orders. But it does expect teams to adopt norms that promote order transparency, coordination and iterative improvement. Any proxy order-entry needs to be done in a way that leverages the available decision supports.


Physician Resource Updates

With Connect Care Wave 1 now well underway, clinical information system (CIS) users start to enjoy experiential learning, growing comfort, and personalization-driven productivity.

Information needs change. There is growing readiness for coaching about better workflows. But the help needed for post-launch growth can be hard to sift from burgeoning content in Learning Home Dashboards,  the Physician Manual, Physician Update Blogs, Tip Sheet collections and Slack community notes.

Some recent innovations can help:


Connect Care Research Supports Productive

At the two-week mark, Connect Care already supports the research information management needs of almost 3,000 patients registered in clinical studies. This reflects a very successful cutover, getting existing protocols registered and all associated treatment plans entered and activated.

Research super users support investigators and study support staff.

We have added a section to the Connect Care Physician Manual to summarize launch-supports for investigators and upcoming training opportunities.

All Physician Bulletin - Prevent Chart Locking

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Prevent Chart Locking...

While the Epic software underlying Connect Care allows multiple health care providers to work with the same patient chart, there are limits. Were two providers to be editing exactly the same progress note at the same time, for example, conflicts could occur. Errors are prevented by limiting the users working on exactly the same task at the same time.

Unfortunately, protecting the integrity of the chart also demands good manners of users: do not lock out other users inappropriately or for longer than absolutely necessary. As a general protective, always close charts when finished with them and NEVER walk away from a terminal with a chart left open.

Chart activities that can lock, and what to do when blocked:


Practical Paranoia - Don't Click on Links in Emails!

We've frequently emphasized the place of practical paranoia as an essential privacy protection and clinical skill.

The Connect Care initiative benefits from robust technical privacy protections. As important are the behavioural privacy protections promoted through InfoCare, which all Connect Care users must participate in.

Neurons, not networks, remain our biggest risk. AHS continues to be targeted by phishing attacks, as previously explained. The size of our target may be bigger because of the publicity Connect Care has attracted.

Be especially vigilant about email messages. Seemingly familiar communications can contain links that install hacker software. Safest to practice universal precautions and never click on hyperlinks in emails (even those from internal AHS email addresses).

The CMIO portfolio is changing its approach to email communications. We will spell out internet links so the user can copy and paste to a browser, rather than clicking the link. By knowing the exact location of the link, take care to only use links where the "domain" or root is recognized and trusted ("ahs.ca", "albertahealthservices.ca", "connect-care.ca", "ahs-cis.ca", "ahs-cmio.ca", "bytesblog.ca").

Physician Drop-in Centre Opening Hours Change

Continuing to respond to usage patterns, Physician Drop-in Centre (WMC 4B1.39) opening hours are adjusted as follows: 
  • November 16, 17: 0700-2300
  • November 18 and following: 0800-2000
The service desk (1-877-311-4300) and online help (help.connect-care.ca) remain available throughout day and night.
Informal peer-to-peer help is available for clinical information system use, personalization and workflows, especially those not covered in basic training. 


Still have your Back!

As Connect Care approaches the end of its second week post-launch, two realizations compete.

First, we cannot sustain the intensity, effort and energy that has carried us through the immediate peri-launch period. Second, emergent multi-disciplinary and multi-dimensional problems require a lot of attention! To sort out complex workflows, we need sustained focus and support.

There is no arbitrary support withdrawal just because a second-week milestone has been reached. However, there is need to rejig support. As drop-in centre attendance drops, for example, we can shift trainers and physician informaticians to things like patient movement workgroups.

The daily physician huddles continue, but with more attention to Connect Care as how we do our work, rather than Connect Care as a big piece of work.


Second Week Yum Yums

Connect Care has progressed nicely through its second week. There are many promising indicators. Mobile application use and in-system dictation continue to grow. Many patients have been both admitted and discharged with Connect Care as the record of care. Outpatient clinics continue to increase productivity and the hospital is rapidly returning to typical case and complexity burdens. The emergency and critical care device issues are largely resolved.

We continue to see the number of closed support 'tickets' exceed the number opened, demonstrating catch-up from the post-launch rush.

We experience early transition from technical to change-management challenges. Accordingly, problem-solving takes longer and involves a wider range of stakeholders. Major areas of progress in week two address complex challenges:
  • Patient transitions - a workgroup directly observes and analyzes phase of care, transfer order and other difficulties associated with complex patient transitions (direct admit from clinic, direct consult to specialty in ER, direct to OR, OR to and from ICU, etc.). The root causes of things like duplicate orders are being exposed and a combination of configuration, education and change management interventions are taking hold.
  • Consent navigator - difficulties with changing or evolving consents are addressed by a new capability for addenda to signed consents.
  • Order entry norms - increasing prescriber exposure to clinical decision supports requires full CPOC (computerized prescriber order entry) and clearly understood exceptions when protocolized, verbal or telephone orders may be appropriate.


Glenrose, Royal Alexandra and Lois Hole Drop-in Training Centre

Do you have questions regarding ambulatory workflows, personalization, mobility apps or how to effectively work in Connect Care? A few moments at a Connect Care prescribers' Drop-In Centre might be just the thing!

Prescribers (physicians, residents, medical students, nurse practitioners and other prescribers)
Informal peer-to-peer help with general ambulatory questions (i.e. clinical information system use, personalization and workflows).
Community Services Centre, 237-2
November 14 to 15, 2019, 9 a.m. to 3 p.m.

Please do drop-in. We will have informatics specialists, Super Users and physician informatics leads eager to help.


Connect Care Mobility Gaining Traction

Connect Care Mobility promotes use of Haiku for smartphones, Canto for iPads, Limerick for Apple Watches and Rover for smartphones. Many clinicians installed mobile apps during personalization workshops and many more will take the opportunity with personalization and optimization sessions to come.

Uptake has been impressive so early post-launch:
  • There are 2,121 physician devices successfully installed and actively used in the first week post launch. 
  • 1792 are smartphones (1431 iPhones and 361 Android) and 329 are iPads. 
  • About 1/5 of all Connect Care connections happen via mobile apps.
This represents enough of an installed base for us to shift more tips and just-in-time training to optimum use of mobile platforms.


New series in Connect Care Physician Update blogs

It is great to hear Super Users report that questions have shifted from the basics to strategies for improving workflow efficiency.

To help, we've started a couple of new sub-channels within the Connect Care Physician Updates blogs:
  • Tippy (ahs-cis.ca/tippy) - daily fast tips that can quickly adopted with immediate workflow benefits
  • eSafety (ahs-cis.ca/eSafety) - alerts about clinical information system interactions requiring particular attention as we transition from paper to digital records.
Please send suggested content for either series to cmio@ahs.ca.


Gratitude: Wave One, Week One

From Verna Yiu...

It’s hard to believe it’s already been a week since we launched Connect Care across Wave One.

We would like to thank the thousands of patients, staff, physicians and volunteers who helped welcome Connect Care to Alberta in the early hours of Sunday, November 3. We applaud the work of those at our Wave One sites including the hundreds of outpatient clinics and services across the Edmonton Zone, sites at the Walter C. Mackenzie Campus, the East Edmonton Health Centre, Pharmacy and Diagnostic Imaging sites in the Edmonton Zone, and Alberta Precision Laboratories in Edmonton and the North Zone, including the lab at the Cross Cancer Institute and DynaLIFE lab sites across Alberta.

We also recognize the team efforts of our partners in this launch – Covenant Health, DynaLIFE, Alberta Precision Laboratories, and the many post-secondary institutions who supported training for students. There were many individuals and teams from sites within Edmonton Zone and other zones in the province, who were not part of Wave One, but who supported as super users and in other roles. This help has been invaluable to the success of this launch. Epic, our technology partner, has also been an amazing support to our teams.

With a health system as complex and large as AHS is, we expected some challenges as we embark upon this provincial Connect Care journey. We anticipated there would many issues as we transition – some have been more urgent, while others are not. As issues arise we have a 24/7 command structure, super user teams and technical experts in place to address them and we are working to resolve them quickly.

Putting Connect Care fully in place will take time. Resolution times for issues will vary and we need to expect this. This is change on a massive scale and it won’t be seamless. We are committed to get to where we need to be over the weeks and months ahead. At the same time, we also recognize that overall, the launch has gone very well, especially considering the magnitude of this implementation. We have continued to provide high-quality patient care over this past week, and that is a tribute to AHS staff and physicians, who have worked so collaboratively to move forward.

We are incredibly proud of the collaboration and resilience our teams have demonstrated throughout the launch. We know this is a challenging time for our frontlines and support staff, and we are so inspired by you and your positivity. There is recognition that when Connect Care is fully in place, and teams are confident in using it, it will allow us to provide better patient care to Albertans.

Together, you have done amazing things this week. Thank you for all you are doing.


Dr. Verna Yiu
AHS President & CEO


First Week Yum-Yums

Exactly one week ago we were girding ourselves for the Wave 1 launch in the wee hours of the morning.

How much has changed!

We've tackled countless tweaks. Indeed, if nothing else, we've proved an ability to rapidly characterize issues, mobilize resources and get solutions implemented. This is our best reassurane for the waves that follow... collaborative problem-solving.

It is easy to miss how well this launch has gone. Walking the wards, one hears positive, grateful and excited feedback. Just a few of the many comments:
  • no more tracking down a paper chart and fighting for access to it
  • all investigation and intervention data is in one place; no longer have to flip back and forth between paper and Netcare
  • learners notes are more coherent, without having to read chicken-scratch
  • lots of ways for attending physicians to work with the rest of the team, addending notes or when merited adding attending notes
  • routine orders can be entered anywhere, not just on the ward
  • billing is easier
  • dictation is now everywhere, anytime and available to any part of the chart; easy and fast
  • mobility is a game-changer, so much easier to review results from anywhere
  • team coordination and collaboration tools make it much easier to manage specialty groups and keep the work organized
  • morning rapid rounds are transformed, with rapid clarification and correction of team assignments and better sharing of discharge planning
... and many more. It is very encouraging to hear that the advantages of an integrated information system are already obvious to busy clinicians.

We are hearing about efficiency breakthroughs with personalization. Let's cycle back and invest as much as possible into personalization now that launch is behind us and optimization is our new opportunity!


Surgery Personalization Inservices

Hollie Powers and Marc Shaw (Surgery Super Users) are holding special personalization in-services today, each able to accommodate up to 12 physicians. This offers a great opportunity to learn a bit more about surgery orders management, phases of care, and how to dramatically speed up workflows.

  • Location: 5G1.11
  • Time 1: Friday Nov 8, 2019,  1200-1400
  • Time 2: Saturday Nov 9, 2019, 0900-1100

Unpin from PIN

Alberta's Pharmacy Information Network (PIN) is linked to Connect Care, including an "external information" function and tools for PIN medication reconciliation. It is possible to select medications to import to the Connect Care chart.

Nice idea. Cool feature. Unfortunately, the PIN reconciliation tools are proving more hindrance than help.

First, PIN is not a comprehensive or trustworthy representation of what a patient should be taking. It is a partial record of dispensed, not prescribed, medications.

Second, PIN data is interfaced in a way that does not permit capture of form/route/dose/frequency information. So, "importing" a PIN med still requires manual entry of all this information. Personalizations do not come into play. Common default values are not available. Experience is showing that it takes more time to reconcile PIN medication information than to quickly enter the patients meds using Connect Care order-entry tools.

Finally, the PIN medication information capture workflow is escaping from all of the decision supports built into normal order-entry and so it is not immediately apparent, for example, that one is entering a duplicate.

And, to add inconvenience to inefficiency, PIN seems to struggle with recognition of a patient's existing meds and so re-presents the need to reconcile even after this has been done.

For all these reasons, we have decided to turn off the PIN external medication reconciliation feature; at least for now. We will revisit this functionality when it becomes possible to import all dispensing information, not just the medication name.

A full PIN list remains available in Netcare, which can be displayed in-context from within Connect Care. This allows PIN to be informative, not intrusive.


Wave 1 Experiences

A message from Verna Yiu...

This week I had the wonderful opportunity to visit the University of Alberta Hospital and Stollery Children’s Hospital to meet with staff, physicians and volunteers, and hear about their early experiences with Connect Care. Wave 1 launched Sunday at 4 a.m. and the response has been remarkable. 

There is so much positivity at the site, even with a very steep learning curve to new work flows and new technology. I saw everyone's steadfast support of patients, families, and each other. I heard about some frustration but, most of all, I heard of teams coming together to solve challenges and move forward. I’m glad many people on my visit were willing to share their experiences with me. I also heard about the steady support people are receiving from our Super Users, as well as from our partners at Epic Systems. You can see the highlights from my visit in this five-minute video.

Phased by Phases?

Sorry about the title... one gets a bit punch(ed) drunk at this stage of a launch!

"Phases of Care" can send chills down the spine of Connect Care newbies. Stumbles with complex workflows often relate to a misstep somewhere along a Phases of Care continuum. Phase discipline is needed from surgeons and non-surgeons alike.

A new section in the Connect Care Physician Manual highlights a few high-value resources that can help physicians respect, but not fear, Phases of Care (a GREAT place to start is the excellent short demo recorded by Darren Hudson):

Physician Drop-in Centre Hours Change

Due to usage patterns, we are adjusting open hours for the Physician Drop-in Centre in WMC 4B1.39. 

Informal peer-to-peer help is available for clinical information system use, personalization and workflows, especially those not covered in basic training. 

Where:          WMC 4B1.39
When:           0700-2300
                      After 2300, refer to Super User call schedule in Manual
DMO Drop-in Sessions
Do you have questions about Dragon Medical One Dictation/Speech Recognition Software? Drop in:
Where:            WMC 4B1.39
When:             November 7 to 10, 0700-2300
                        November 11 to 18,  1000-1600

Water, water everywhere, Nor any drop to drink.

We are at a stage post-launch when users have desperate need for tips to help them navigate workflows. At the same time, there is such a flood of Connect Care change that users are drowning in information without finding a way to the bits that matter.

These blogs may not be helping. We're posting a lot more, in all channels (especially Tips, FAQs and peer Support). But our audience is so distracted that there is no easy way for them to connect with postings that could ease their way.

Best communication is in-person and just-in-time. We are flagging important posts to our Slack network that connects Super Users so that they are on-message with the latest changes and have support tools.

For what it's worth, we'll also post in this general interest blog about key topics appearing in the Manual and the other channels (linked in the above button-bar).

What's happening in the channels?


Breaking Habits - Patient Lookup

Breaking Habit bulletins identify information behaviors that served well in Netcare but need to be broken to avoid confusion in Connect Care.

Patient Lookup - Context is Everything

The Netcare Electronic Health Record assembles information about patients' investigations and interventions. The context is the patient. Things like lab results are not linked to specific health care events or interactions. The first step in a Netcare workflow is to look up a specific patient chart... and that is our habit.

The Connect Care clinical information system (CIS) provides information about patients as well as information about the delivery of care to patients. Information and workflows are always presented in context. Therefore, our new habit needs to find the patient in a visit (outpatient), admission (inpatient) or connected sequence of events (episode).

EHR habits can hamper CIS workflows. This is especially true for Emergency and Inpatient interactions. Start with context, then seek the patient and task:

All Physician Bulletin - Consent Navigator

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Documenting Consent - just the basics...

Documenting patient consent to investigations or interventions does not have to be a hassle. But we've been hearing of a lot of frustration.

Connect Care provides an integrated Consent Navigator. It is best to launch this from the StoryBoard (we are aware of some problems when consents are linked from deep in workflows).

New physician-friendly instructions (and a very short demo) are in a new Consent topic in the Workflows section of the Connect Care Physician Manual:

A Tribute to IT

As physicians, it is natural to see the Connect Care launch through a clinical lens. This is good. We have mobilized leaders and informaticians with remarkable effect. But, caught up in the thrill of launch, it can be easy to miss how much technical problem-solving enables clinical problem-solving.

Connect Care is a massive, and massively complex, undertaking. Clinicians see the tip of an iceberg. We are grateful for fast fixes to the functions we see, but may not appreciate everything that has happened to make those functions possible in the first place. We don't see infinitely complicated foundational transitions: from a myriad of disparate systems to entirely new infrastructure and infostructure touching everything that supports health care across the continuum of care.

We are deeply grateful for the privilege of working with our IT partners. AHS has groomed an exceptionally capable, knowledgeable and resourceful IT team. Its leaders are, to a person, delightful to work with. They have grown strong and effective relationships with clinical and operational leaders. More importantly, their teams have nurtured a culture of service. As important as the speed of problem-solving, is the resilience, good nature and patient personae of those who solve problems. IT is at the focal point of countless stressors. But they work with us, listen to frustration, hear the underlying issues, and quietly get us to where we need to be. AHS is blessed with an IT capacity unmatched country wide. We are deeply grateful.

Connect Care is not an IT project. We've always said that. However this is a good time to acknowledge that there would be no project without the very special AHS IT that makes Connect Care all that it can be. Thumbs up to our IT buddies today!


More Progress

The physician community is doing remarkably well with major change. The prevailing tone is constructive helpfulness, with admirable forbearance while things get fixed. Reporting problems in sufficient detail remains the best support for continuing improvement.

Rough spots during break-in are inevitable. Our test is how quickly we identify and correct the break-in issues. We continue to make rapid progress improving orderables lookup, which we know to be a common current frustration. There are a number of accomplishments easy to miss because they unfold with little fanfare:
  • Mobility - great uptake with over 2,000 physician devices successfully activated for Haiku or Canto. We'll take a look at the typical uses about a week from now.
  • Dictation - in-system dictation (Dragon Medical One) is already taking off. Wonderful to see more in-system dictation, even large complex things like discharge summaries and procedure reports, than partial dictation (eScription) within the first days of launch. 
  • Ambulatory - all clinics fully launched at the beginning of the week.
  • MyAHS Connect - brisk uptake with 400 patients already active in the portal.
  • Lab processing - already case volumes are re-establisehed with 95% compliance with target reporting times.
  • Chemotherapy - no interruption and all on time.
  • Complex Cases - workflows and transfers continually improve, with multiple trauma, transplant and mass transfusions already managed in Connect Care.


What a day!

Our second day in new Connect Care workspaces uncovered a number of rough spots needing attention. Continuing nimble trouble-shooting 24/7, physician informaticians effectively teamed up with operations, IT and Epic resources to push through problems and keep patients safe. Examples of important fixes appear in the Support Channel.

We (rightly) fret the frustrations, but we must remember that the overall experience is of remarkable success and rapid uptake. A few highlights:
  • Super User Community - our Super Users have rapidly established a vibrant Slack social network, with effective sharing of questions and solutions. There are 135 active members, 73 posting daily, with over 3000 messages exchanged. Lots of great tips, links and illustrations.
  • Access SWAT Team - working with some exceptionally helpful Epic resources, we moved just-in-time PRD trouble-shooting to the physician drop-in centre where issues were usually fixed within minutes. Much faster turn-around times begot happiness all round!
  • Drop-in Centre - hats off to the many clinical informatics leads, trainers and super users who have helped to keep physician drop-ins an excellent path to nimble help. The centre has been continually busy, and exceptionally effective. 
  • MyAHS Connect - the patient portal launched smoothly, with over 80 patients accessing and interacting in the first day.
  • Concierge - the Connect Care help portal has already served well, smoothly capturing > 600 tickets in the first day, with over half of those resolved within the first day.
  • Complex cases - multiple trauma cases challenged the ER in the first hours post-launch. Other complex surgical cases included three transplant operations. Everyone managed well, but also gained a lot of learnings about the importance of mastering phases of care and transfer handoffs.
  • Physician Handbook - usage has shot up from an average of ~100 uses per day to >500 users per day.
  • Early press - has been kind.
  • 4000 cups of coffee have been consumed!

All Physician Bulletin - Partial Dictation Workflows

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Note: Partial (hybrid) dictation workflow supports are removed from Connect Care as of first quarter 2021 and so the following posting is no longer valid (but retained below for archival purposes).

Partial Dictation Workflow Explained...

Partial (hybrid) dictation refers to use of a system outside Connect Care to capture, transcribe and edit dictated material which is then inserted into a documentation object (e.g. note, letter) within the clinical information system.

There are two ways for this to occur: 1) through AHS provincial "eScription", or 2) through a completely independent dictation service. eScription is familiar to physicians adopting Connect Care. Although the preferred Connect Care workflow is in-system dictation with Dragon Medical One, it remains possible to use eScription by following a workflow that specifies where the transcribed material is to go.

It is very important to do this using a precise workflow that allows the dictated material to get to the right spot. Follow instructions in the Connect Care Physician Manual:

All Physician Bulletin - Logon Departments

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Choose the correct "department" at logon.

When logging on to the Connect Care clinical information system (CIS) Hyperspace environment, one needs to indicate a "Department" (context) that one will be working within. The word "Department" is not used in the way we think of a clinical division, speciality, department or section. Rather, "department" is simply a way for the Connect Care ecosystem to be divided up in ways that might better shape the users' CIS experience.

An individual physician may work in multiple contexts and need to switch between these from time to time. Trainees will often change contexts when they change rotations.

Those accustomed to the prior eCLINICIAN system, will know very specific departments. These do not exist in the Connect Care space. Rather, physicians should seek the highest level (broadest) department to match the specialty they work in within one of Alberta's zones.

The easiest way to get this right for wave 1 physicians is to search for the right department with "Edmonton Zone X" where X is the specialty or clinical area (broadest available) of interest.

Do not be alarmed that nurses and other health professionals may have a different workflow and select very specific departments, like an individual unit. Physicians go broad!


Launch on time at 0400

After a few tense minutes waiting for linked information services to connect after decommissioning legacy systems, we launched Connect Care at exactly 0400 as planned.

The day has been full of work, rapid problem-solving and intense adaptation. Throughout, excellence of care has been sustained and adoption has progressed with a generous spirit that has been a marvel to witness.

Things will get a bit harder before we start to enjoy the ease of familiarity.... but we are off to a great start!

We are GO!

All interfaces and all other dependencies were cleared on time. We've launched on time at 0400!

Now off to the wards to be part of better health, powered by information!

Physicians, please make use of the drop-in centre at WMC 4B1.39. We have pulled in extra resources to deal with any remaining access or role problems.


Hours Away!

From our CEO, Verna Yiu...

We are in the homestretch and in the final hours before we launch Wave 1 of Connect Care. I’m full of gratitude for all the effort and work that’s led us to this point. Where else in Canada are we going to be able to do something like this? We are, in essence, making healthcare history.

 We know it’s going to be a little bit bumpy. No doubt about that. But we also know that we have the resources and supports in place to help us address any issues we come across. Some of the issues will be resolved very quickly and others may take a bit more time. But, again, we know we have the resources and supports in place to help us deal with any issue.


We are all full of gratitude for all the work and amount of effort that you’ve put into getting us to this point. Hang in there as we prepare to launch and know you have the support of AHS behind you.
 Remember that, ultimately, we’re doing this because we want to improve patient quality and safety of care — and that, ultimately, this is going to transform the way that we provide healthcare in Alberta.

In the News

Connect Care has beavered away for years without much in the way of media attention. On the eve of our Wave 1 launch, that's changing in a big way.

Let's brace ourselves. There will be lots of press coverage in the days to come. Of course this will be a vector for some anxieties. Good news is rarely newsworthy.

Nice to see a positive lead from the Edmonton Journal! We'll update this posting with links as they appear. Also, continue to follow our other blogging channels, our ahs_cmio twitter feed, and the #connectcare hashtag.


Connect Care November 2019 Calendar

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

Prescriber Drop-in Room has Moved! Now in WMC 4B1.39

Due to the popularity of our drop-in training and support we have moved to a bigger room -- you can now find us in WMC 4B1.39. 

Informal peer-to-peer help will be available for clinical information system use, personalization and workflows, especially those not covered in basic training. You can also complete a "login lab" to verify that you can access the system.

Have you taken basic training? Do you have questions about personalization, mobility apps or how to effectively work in Connect Care?  Drop in:
Where:          WMC 4B1.39
When:           November 1 & 2, 0700-2300
                      November 3 to 10, 24 hours
                      November 11 to 18, 0700-2300
DMO Drop-in Sessions
Do you have questions about Dragon Medical One Dictation/Speech Recognition Software? Drop in:
Where:            WMC 4B1.39
When:             November 3 to 10, 24 hours
                        November 11 to 18,  1000-1600