Summative Clinical Documents: Connect Care to Netcare

The Alberta Netcare Portal provides a cradle-to-grave, read-only, aggregated view of information from multiple databases about key health events in an individual’s life; information that any health care provider may need in order to serve an individual. Key to this electronic health record (EHR) function is capture of key "summative" documents from a clinical information system (CIS) like Connect Care. 

Summative documents are high-value clinical notes that analyze diverse information sources and interpret these at healthcare milestones, such as outpatient visits or inpatient admissions. Included are discharge summaries, consultation reports, operative reports and transfer summaries.

While Connect Care has been sending summative documents to Netcare since launch, some gaps emerged. Summaries prepared by trainees (e.g., medical students, residents) were not transferring if bearing a "Cosign Needed" status. This departed from how such records were handled previously through provincial eScription. 

As of April 24, 2020, all summative Connect Care documents (in approved categories) transfer to Netcare, even when a final signature is pending. As previously, the document is released to facilitate clinical communication and gets re-released with any updates or when the responsible physician has fully signed-off. Work has begun to apply this same rule to any summative notes that missed transfer to Netcare between launch (November 3, 2019) and April 24, 2020.


COVID-19 and Connect Care #16 - Provincial COVID Reports

The AHS Data & Analytics team has produced a number of excellent interactive reports. These explore Alberta Health Service's (AHS) emerging experience with the COVID-19 pandemic and provide valuable information about case, hospitalization and critical care loads provincially.

The associated "Tableau" dashboards can be accessed from within the AHS intranet or with use of an AHS security Token from outside AHS locations. Key dashboards are available to all AHS clinicians. Some require special permissions.

We list provincial COVID-19 report access points in the Connect Care Physician Manual, which appears on all Connect Care learning home dashboards for physicians. At this point, two simple ways to track this work:
  • From the Manual: Follow Report links listed in the COVID-19 sections in the Home area of the Manual.
  • From Connect Care: go to your specialty's learning home dashboard (Dashboards activity within Connect Care landing page), look for a group of COVID-19 links at the top left, open the Manual, then the COVID-19 Content section and then click on one of the listed Reports links.


COVID-19 and Connect Care #15 - Professional Billing Reversions

We previously posted about Connect Care professional billing changes resulting from Alberta Health policy changes. Changes affected complex modifiers and built-in overhead considerations.

This area is proving volatile. Policy has shifted and changes required for April 1, 2020, are now pushed back to later in the year (October 1, 2020); together with some other changes.

While the addition of "z-codes" (at this moment not financially different from prior codes) is live in Connect Care, clinicians need not worry as their claims will be automatically corrected before submission. It is still wise to update billing personalizations to reflect the Z addition if working in a publically funded facility, as these appear destined to stay.


Virtual Health Webinars and Office Hours

AHS Virtual Health offers a variety of services that can help clinicians trying to provide health care when physically distanced from their patients.

The current pandemic has dramatically increased the numbers of both patients and providers in self-isolation or otherwise unable or ill-advised to attend AHS clinics. The current and enduring goal is to support quality virtual care, anytime, anywhere. AHS staff, clinicians in all disciplines, and physicians can visit ahs.ca/virtualhealth for more information and resources.

Starting April 28, AHS Virtual Health will host regular virtual webinars and office hours for those seeking just-in-time learning, problem-solving or tips related to virtual care. These occur Tuesday and Thursday from 12:00 p.m. to 13:00 p.m., until further notice.

Details will be updated on the Virtual Health insite page. Upcoming topics include:
  • AHS Zoom for beginners
  • Scheduling Virtual Appointments
  • Protecting Patient Privacy
  • Making the Most of Basic Accounts
  • AHS Zoom Integration with Connect Care
  • Group Sessions for Multidisciplinary Teams
  • Ad Hoc, On-Demand, Videoconference Sessions
  • Clinical Best Practices for Virtual Care


Practical Paranoia - Important message from our CEO

We've previously posted about additive privacy and security challenges emerging in the context of a pandemic.

Dr. Verna Yiu reminds us about the vigilance needed to avoid situations where our pandemic activities increase the risk of privacy breaches:

Dear AHS staff, physicians and volunteers,

Protecting privacy and ensuring that patient information remains confidential is as important now as it has ever been.

During this state of emergency, our obligations to our patients have not changed. The Health Information Act (HIA), the Freedom of Information and Protection of Privacy Act (FOIP), AHS’ privacy policy and best practices still apply.

We each have a duty to protect the information entrusted to us. We can only collect, use, access, and disclose the information needed to perform our AHS job, duties, and responsibilities. As healthcare professionals, our patients trust us to appropriately access and safeguard their health and personal information. We must always remain fully committed to ensuring this trust is never broken through inappropriate collection, access, use, or disclosure.

Under no circumstances should staff or physicians access or disclose health records of individuals they are not providing a health care service to. For example accessing information outside of your role – even if your reason is concern for colleagues, friends, neighbours or loved ones – is a privacy breach.

A privacy breach occurs when there is an unauthorized collection, use, disclosure, access to, or disposal of personal or health information. It’s a serious matter that will be investigated by our Privacy team and could result in potential workplace disciplinary action, college sanctions, fines, and/or criminal charges. It is your individual responsibility to report any breach you discover, even if it did not originate from you. Report privacy breaches here.

I encourage each of you to be vigilant and advocate for patient privacy and the confidentiality of our information. If you need support or are unsure what information you can and cannot access in your AHS role, speak with your manager or contact infocare@ahs.ca. More information is available on the InfoCare Insite pages.

Dr. Verna Yiu
AHS President and CEO


COVID-19 Guidance from AHS Scientific Advisory Committee

Part of Alberta Health Services' COVID-19 pandemic response involves rapid collection and analysis of guidance for clinicians, staff and patients. A Scientific Advisory Group (SAG), reporting to the Emergency Coordination Centre (ECC), connects clinicians, operations, researchers and other experts to review, synthesize and interpret emerging evidence about management of COVID-related phenomena at population and patient levels.

Rapid Response Reports examine recommendations from provincial, national and international bodies, considering the supporting evidence and purported impacts. The reports back recommendations for AHS policy and practice. A helpful byproduct is an inventory of emerging evidence, recommendations and analyses.

SAG clinical guidance, together with recommendations emerging from Strategic Clinical Networks, Provincial Advisory Groups, Clinical Area Councils and other collaboratives, inform the production of decision, documentation and inquiry supports for clinical information systems (including Connect Care). Such "clinical content" provides clinicians with actionalbe aids to applying recommendations at the point of decision-making. Examples include order sets, documentation templates, calculators, flowsheets and reports; expressed in clinical information system and paper formats.

SAG recommendations and supporting reports are gathered online at a new AHS website:


Physician Trainee Bulletin - Selecting a Supervisor

All-user-bulletins highlight developments physicians need to be aware of when using the Connect Care clinical information system.

Selecting a Supervising Prescriber
Prescriber Trainees, including medical students, residents and fellows, are “supervised” by a fully licensed prescriber who must co-sign or attest to at least some Trainee activities in the Connect Care Clinical Information System (CIS).

From April 17, 2020, Trainees must identify a “default” Supervising Prescriber when logging on to the CIS. This Supervisor is automatically notified, when required, about documentation or orders requiring co-sign, while also receiving results of trainee-ordered tests when those are routed to In-Baskets.

Inpatient workflows remain largely unchanged: Trainees can still select the “co-sign” checkbox when they seek review of orders or documentation. All mandated co-signs (e.g., discharge summaries), and any laboratory results reported post-discharge, are routed to the In-Basket of the appropriate Attending Prescriber.

Outpatient workflows are also affected, as mandated co-signs (e.g., outpatient notes, consultation Communications Letters, etc.) are routed to the Supervising Prescriber.
Note: selection of a Supervising Provider ceased to be part of trainee logons as of December 8, 2020. Please see the Manual for information about how this workflow is largely automated. The rest of this posting still applies.


COVID-19 and Connect Care #14 - Training Progress

We've previously posted about the move to virtual training methods to avoid tight gatherings in computer training labs.

Kudos to the Connect Care Training and eLearning teams for their fabulous work designing, developing then delivering online learning! Nimble, responsive and quick!

Many groups of physicians are recruited, re-deployed or otherwise placed in positions where they need to master new skills to work at sites where Connect Care is the record of care.

Basic and personalization training is provided in a mix of self-directed and instructor facilitated virtual learning. Many of these courses are already completed, moving physicians to competency in priority areas; including emergency, critical care, inpatient medicine/pediatrics/surgery. Supports are provided to learners 0700-2100 7 days week.


Medical Students Step-up for Connect Care

Alberta's 3rd and 4th year medical students -- off-ward during the COVID-19 pandemic -- make invaluable contributions to our pandemic response; including contact tracing, patient education and direct supports to front-line physicians.

In addition, University of Alberta medical students have rallied to help to Connect Care clinicians at Wave 1 sites in the Edmonton Zone. Many pandemic-response providers are newly trained, or re-trained for new roles, as part of staff redeployment. For these clinicians, COVID challenges can be complicated by unfamiliar Connect Care workflows.

Medical students are tooling up to serve as super-users. They will help clinicians who may struggle with new ways of ordering, documenting and communicating. Other clinical informatics roles expand our clinical system design and testing capacity, while fanning-out practical tips for busy physicians.

Student contributions reflect a lot of work! Super users complete advanced learning modules in multiple tracks (e.g., surgery, emergency, inpatient, critical are), while mastering virtual user-support technologies. Medical student leaders also organize scheduling so that supports are available at all times.

A big thank-you to our medical learners and education leaders! Their initiative helps clinicians stay on task.


Virtual Collaboration and Care - By the Numbers

We've previously posted about supports for virtual collaboration and care, rapidly expanded to address COVID-19 needs.

Uptake has been impressive, suggesting that self-registration for basic AHS Zoom access has worked well. Scalable processes for allocating advanced accounts are firming up. And deep integration with the Connect Care clinical information system will be available soon.

As of early April, 2020:
  • ~8700 registered  basic users
  • ~830 registered advanced users
  • > 9,000 virtual meetings or visits
  • >1,007,400 meeting/visit minutes
  • > 38,000 meeting participants
  • ~40 full webinars
In addition, associated webinar technologies have assured our Connect Care training programs continued maximal productivity as new groups of clinicians are prepared to work where Connect Care is the record of care.

Congratulations to AHS communications and virtual health teams for being so nimble and responsive to rapidly changing needs!


COVID-19 and Connect Care #13 - In-system Dictation Supports

The Connect Care clinical information system (CIS) integrates "Dragon Medical One" (DMO) within desktop and mobility (Haiku, Canto) environments. Support for high-fidelity clinical speech recognition has proved very popular.

With COVID-19 terms now routine in clinical documentation (e.g., COVID risk and screening status), some clinicians have stumbled, needing to personalize these terms for custom recognition.

The Connect Care instance of DMO is enhanced today with a "COVID-19 Content Pack". Users will notice that "COVID-19" and related terms are recognized without need for personalization. In addition, a number of new Autotexts are supported.


Virtual Collaboration and Care - Zoom Concerns?

We've previously posted about secure virtual collaboration and care supports provided to AHS clinicians, recently extended as part of our COVID-19 response.

Clinicians may worry about reports of possible security problems with videoconferencing services. Hijacking (e.g., "ZoomBombing") is reported with a variety of meeting technologies, more now that use is massively increased as part of social distancing and remote work.

AHS clinicians making use of AHS Zoom can be reassured. The enterprise version of Zoom licensed and deployed by AHS differs from the (free) public instance. AHS Zoom has passed a detailed internal security review and satisfies Canadian and international security standards, federal legislation and best practices for business and healthcare. AHS is an experienced enterprise health Zoom user.

Currently, AHS Zoom supports clinician-clinician and clinician-patient communication. Recording is not allowed, "meetings" are closed by default, and no information is stored or exchanged with other systems. AHS Zoom will be integrated with the Connect Care clinical information system; subject to further privacy reviews and protections.

It is important for clinician-users to appreciate and take advantage of provided protections:
  • Do not use public (free) Zoom accounts for clinical purpose; instead use the AHS Zoom private service or another AHS-approved service (e.g., Skype for Business, Telehealth).
  • Do not publish meeting links or IDs and do not use personal IDs for open meetings.
  • Limit meeting identifier sharing to planned participant(s) who are informed via AHS secure email or an equivalently private means (e.g., direct communication with patient).
  • Do not include identifiable patient information in meeting invitations, however communicated.
  • Confirm attendees and identities when commencing a meeting.
  • Limit screen-sharing and video-sharing to the presenter/host or person(s) explicitly approved by the presenter/host.
  • When running larger meetings, take advantage of scheduling features like forced registration, required logon, meeting locks, or waiting rooms to confirm intended attendees.
  • Adhere to secure communications legislation, organizational policies, communication normsbest practices and tips


All User Bulletin: Test Order Optimization

All-user-bulletins highlight stumbling blocks that all physicians need to be aware of when using the Connect Care clinical information system.

Rationalize Test Ordering Please!
Alberta's laboratories are under intense pressure as the COVID-19 pandemic unfolds. Human and physical resources (e.g. reagents) are prioritized for assays that most help most patients. As patient volumes and complexity increase, we will hit a test capacity "wall" that will mandate implementation of laboratory test restrictions. This has always been part of pandemic planning.

The likelihood of implementing essential test restrictions, and the timing, is affected by decisions that all physicians make right now.

For every laboratory test, and every patient, ask:
  • Is this test, or this test frequency, essential to patient care at this time?
  • Will anticipated test results significantly affect care choices at this time?
  • Can sequential (ordering tests, rather than 'shotgunning') testing reduce the overall test burden?
  • Can tests be deferred to a future date (e.g. tests done for surveillance or chronic disease management)?
Above all, check the "Orders" tab at every patient encounter, and at every rounding, looking for tests that can be removed or rationalized.