Connecting for Continuity

Continuity of Care is about a patient and provider healthcare experience that is coherent, connected, coordinated and consistent with patient goals.

Connect Care will go a long way towards bringing continuity to healthcare in Alberta. Its integrated clinical information system (CIS) will replace most of the >1,300 health information systems currently in place across Alberta Health Services (AHS) and affiliated organizations. When fully implemented in late 2022, the CIS will be used by all providers where AHS is accountable for the record of care.

A variety of Electronic Medical Records (EMRs) facilitate primary and specialty healthcare where Connect Care is not the record of care. Without ways to bridge these information spaces (CIS and EMR), continuity is broken.

One bridge is provided by Alberta's provincial Electronic Health Record, Netcare, which aggregates key health information and makes it available to authorized providers. Netcare is improved when Connect Care deploys because it gains a wider range of information from a single, standards-based, CIS source.

Another bridge is provided through "eDelivery" of health information from Connect Care and Netcare to Alberta EMRs. This too is improved with Connect Care. More information in a more consistent format is easier for EMRs to capture and organize.

Two new initiatives promise even better connections. AHS, the Alberta Medical Association and Alberta Health are promoting two-way health information sharing between EMRs and Netcare through "Community Information Integration" (CII) and a "Central Patient Attachment Registry" (CPAR). These allow patients to be linked to a medical home, and for that home to share information with Netcare. The CII will extend sharing to include the CIS in 2020 and CPAR will both inform and be informed by what happens where Connect Care is the record of care.

Working together, Alberta's CIS, EHR, EMR, CII and CPAR help to defragment the health information space; bringing continuity to Albertans' experience of healthcare.

90 Day Launch Readiness Assessment Today

Among many preparations for the 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 to problem-solve impediments. This taking-the-temperature is invaluable for nimble adjustments and collaborative coordination.

An important 90 day LRA occurs today, July 30, in the Bernard Snell Hall (Walter Mackenzie Health Sciences Centre in Edmonton) starting at 0830. Connect Care team members and Wave 1 leaders and participants, will review all streams of work for progress, risks and launch readiness.

• Insite: Connect Care Readiness Activities
• Edmonton Zone Readiness Resources: edmonton.connect-care.ca

Clinical Operations 2 Minute Updates

Clinicians work as a team. Connect Care both increases and leverages our interdependence. There will be many opportunities for the professions to help one another by reducing duplicative documentation, improving handover, coordinating communications and keeping all aligned with patient goals.

While Bytes blog has a prescriber (physicians, medical trainees, pharmacists, clinician assistants, nurse practitioners, etc.) focus, our interests often overlap those of non-prescribers. A basic awareness of colleague's Connect Care efforts is important.

The clinical operations team maintains an excellent "2 Minute Update" approximately weekly. This summarizes key happenings and priorities for non-prescriber colleagues; lots relevant to prescribers.

• Newsletter: Clinical Operations 2 Minute Updates
• Update: 2 Minute Update - July 29, 2019

Mandatory Privacy Awareness Training

All physicians must complete privacy awareness training prior to gaining Connect Care access. This can be done independently and online by completing “InfoCare: On Our Best Behaviours” through MyLearningLink.ahs.ca (MLL). A search in “Courses & Registration” for “Infocare” will bring up the module. Note that it must be completed in full to expose a final attestation which must be completed before full Connect Care access is granted.

MLL has a “Required Courses” menu item and section. Note that the many courses listed are not required of physicians, with the exception of InfoCare. Physicians will receive explicit instructions in their training packages about which modules fit their needs.

• Tip: MyLearningLink for Physicians

MyLearningLink for Physicians

Most Connect Care courses are managed through MyLearningLink.ahs.ca (MLL), which is accessed using an Alberta Health Services (AHS) username and password.

Many physicians will seek access from outside AHS facilities, likely with computer types different from standard AHS issue. For example, users of Apple computers are advised to use the Chrome browser. A tip sheet gives practical advice about how to configure for MLL success outside of AHS facilities.

• Tip: MyLearningLink for Physicians

Wave 1 Training - Important to Sign Up for Scheduling!

Good training, supplemented with effective personalization, is a best predictor of physician satisfaction with clinical information system (CIS) use. We can't avoid CIS adoption -- it is now an essential clinical skill -- but we can avoid lacklustre training.

Connect Care physicians are offered personalized, workflow-sensitive, training tracks delivered by those who understand their needs: other physicians. Moreover, the curriculum is designed to help physicians acquire essential competencies while getting valuable continuing education credits.

A wide range of times and locations are offered, in addition to flexible self-directed e-learning modules. Inevitably, the necessary in-person training sessions have limits and so it is essential that all Wave-1 physicians submit their scheduling preference surveys as soon as possible! The survey link appears in emails, and email reminders, sent via medical affairs.

We are pleased that over 80% of eligible physicians have submitted preferences and most are receiving assigned dates and times. Nonetheless, the longer one procrastinates, the fewer training slots available to pick from. And, in the end, the training cannot be avoided.

Physicians who believe they should receive, but have not received, a training preferences survey should contact wave1-connectcare.physiciantraining@ahs.ca.

Yet another review - How does this affect Connect Care?

In a previous post we commented on reports of an external review to be launched by Alberta's provincial government, with intent to explore how information system assets could be coordinated to public advantage.

Another review has hit the press. A contract awarded to Ernst & Young supports a general review of Alberta Health Services, the province's public corporation responsible for integrated care across the continuum of care.

It is important to appreciate that Connect Care is not in scope for the general AHS review. Also important to re-iterate that support for Connect Care is not in scope for the health information systems review. Rather, the focus is on optimization and opportunity. Alberta has leading-edge Electronic Health Record (EHR), Electronic Medical Record (EMR) and Clinical Information System (CIS) initiatives.

• Key Concepts: Digital Health Records

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:

• FAQ: AHS Secure Clinical Email

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.

• Infographic: Wave 1 Activities and Timelines

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.

• Key Messages: Clinical Data Conversion
• Byte: Data Conversion
• FAQ: Data Conversion

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 2019 Calendar

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.

• Connect Care Newsletter - July 5, 2019

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:

• Tip: Clinical Email 
• InfoCare: Email Encryption and Decryption Instructions

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:

• Byte: Physician Training
• Key Messages: Physician Training
• Principles: Physician Training
• FAQ: Physician Training
• Norm: Physician Training Compensation
• Backgrounder: Physician Training Compensation

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.

Before Connect Care, MLL focused on education needs of AHS staff working in AHS facilities on AHS-provisioned systems. Courses are optimized for Internet Explorer or Edge browsers running under Windows 10 on AHS desktop computers. But Connect Care users need to train at non-AHS locations on non-AHS computers.

Fortunately, MLL presently works on networks both inside and outside of the AHS “intranet”. Testing and support for users of Apple operating systems is adapted by the CMIO portfolio for prescribers.

A tip offers 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 cmio-manual@ahs.ca.

• Tip: MyLearningLink for Connect Care