All User Bulletin - Consulting for Interventional Neuroradiology Procedures

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

Consulting for Interventional Neuroradiology Procedures

A number of interventional neuroradiology procedures that were previously directly orderable by any prescriber are now ordered specifically by responsible radiologists. The appropriate ordering pathway is to request an interventional radiology referral or consultation. The diagnostic imaging team then confirms the best approach to address the clinical need while taking care of both orders and scheduling.  

Going forward, physicians seeking interventional neuroradiology exams should place a “Consult to Interventional Radiology” order for inpatients or an “Ambulatory Referral to Interventional Radiology” order for outpatients. This includes therapeutic stroke interventions and the following procedures:

• IR Aneurysm Coiling 
• IR Carotid Balloon Test Occlusion
• IR Intracranial AVM Embolization
• IR Head Neck Embolization
• IR Spinal AVM Embolization
• IR Intracranial Tumor Embolization
• IR Spinal Tumor Embolization
• IR Extracranial Stent Placement w Angioplasty
• IR Intracranial Angioplasty
• IR Intracranial Clot Retrieval
• IR Epistaxis Embolization
• IR Kyphoplasty One Level
• IR Kyphoplasty Two or More Levels
• IR Vertebroplasty
• IR Vessel Occlusion Permanent
• IR Nerve Root Ablation
  

The above orders are now treated as synonyms for IR Consult/Referral, which is the suggested order that will appear when searching.

As with all time-sensitive referrals and consultations, it is important to phone interventional radiology at the intended site to share details about the case, the clinical need and urgency considerations.

COVID-19 and Connect Care - COVID-19 and Respiratory Pathogen Testing for Inpatients

Alberta's laboratory medicine services continue spectacular work addressing extraordinary demands associated with the COVID-19 pandemic in its second wave. Strategic decisions are made to ensure that resources are focused on the most efficient way to help physicians diagnose patients presenting with infection-related respiratory symptoms.

Effective December 1, 2020, the COVID-19 and respiratory virus testing algorithm changes to improve test utilization in emergency room and inpatient settings. Key developments include:

• Throat Swabs - Lack sensitivity for detecting non-COVID-19 respiratory viruses, and so will only be processed for COVID-19.
• Nasopharyngeal (NP) Specimens - Can be tested for COVID-19 and other respiratory viruses.
• Influenza Like Illness (ILI) NPs - For ED and inpatients, can be tested for COVID-19, influenza and RSV.
• Full Respiratory Panel (RPP) - Testing should be restricted to patients presenting with ILI and immunocompromised, critical respiratory failure, flaccid paralysis, myocarditis or pericarditis; or for outbreak investigations under the direction of Public Health or Infection Prevention and Control (IPC).
• Bulletin: COVID-19 and other respiratory virus testing changes

COVID-19 and Connect Care - Clinical Content

Clinical information systems (CIS) "content" includes standards (terminologies, lists, etc.), documentation tools (templates, flowsheets, automations, etc.), decision supports (references, advisories, order sets, etc.) and inquiry supports (performance indicators, quality measures, etc.), all designed to support best possible health services.

Connect Care clinical system design (CSD) has been drafting, building and implementing a wide range of clinical content to help clinicians care for patients with COVID-19 illness. We've previously posted about the release and revision of this content.

The burden of COVID-19 on the health care system increases as we struggle with a second wave of infections. The Connect Care updates will give priority to clinical content news, with practical guidance for Connect Care users about how best to use the CIS to reduce information burdens.

• Manual: COVID-19 Clinical Content

COVID-19 and Connect Care - Updates

With rapidly increasing COVID-19 cases, hospitalizations and intensive care admissions, this is a good time to refresh awareness about how Connect Care can make it easier to care for COVID-19 patients.

We will use this blogging channel (blogs.connect-care.ca - please consider subscribing) to update advice from earlier in the pandemic, while adding pointers about subsequent clinical information system (CIS) enhancements.

Connect Care prescribers can also review updates and resources using one or more of the following blogging channel themes. The Connect Care Manual remains a good single starting point, as it provides overviews with links to more detailed information:

• Manual: COVID-19
• General Updates
• Tips
• Frequently Asked Questions
• Support Forum

On Other Channels...

Thank you for continuing to check (...ideally, subscribe to multiple channels; see instructions) the Connect Care Update blog for prescribers. Recent additions to this blog and its various channels:

• Blogs
• Timing and Sequence of Upcoming Connect Care Waves 
• Netcare Scheduled Downtime - Nov 19, 21:00-03:00 Nov 20 
• Connect Care Kudos 
• Practical Paranoia - Pandemic Phishing on the Rise 

• Tips
• Tippy Series
• Support
• Discharge from Leave of Absence Workflow 
• Interfacility Emergency Department (ED) to ED Transfers 
• Bridges
• Important Information for Primary Care and Community Providers related to the impact of Connect Care: Connect Care Identifiers 
• Informatics
• File Naming Norms Updated 
• Manual
• See What's New (many updates and additions)

Practical Paranoia - Pandemic Phishing on the Rise

Hospitals are prime targets for cyberattacks and this is especially true during COVID-19. The consequences not only disrupt patient care but can be lethal. 

Hackers use phishing emails to trick healthcare workers into downloading ransomware, a type of malicious software that attacks computer systems when an infected link or attachment is opened. The ransomware logs out users and shuts off access to critical information until a "ransom" is paid by the organization.

 

Some recent examples:

• Outpatient appointments were postponed in Quebec due to a recent cyberattack targeting health board members.
• A recent ransomware attack in Germany meant that a patient had to be rerouted to a hospital 20 km farther away, delaying care and likely contributing to her death. 
• An early morning cyberattack at Universal Health Services’ US facilities disabled multiple antivirus programs, logged off users and shut down system access. Affected hospitals had to redirect ambulances and relocate patients in need of surgery to other nearby hospitals. Universal Health Services operates in both the US and UK and is similar in size to AHS with more than 400 facilities and more than 90,000 employees providing healthcare services to about 3.5 million patients annually. 

You can help stop these attacks. 

• Take note of AHS’ external email warning message. 
• Don’t open unsolicited email attachments or click on links. 
• Always report suspicious emails using the "Report Phishing" button on Outlook or forward to stop.spam@ahs.ca, then delete.

Learn more about some of the common tricks cybercriminals use to access your information by viewing Don’t be fooled by Scammers and visit InfoCare on AHS Insite for information on all privacy and information security matters.

Connect Care Kudos

From our Chief Medical Officer...

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Connect Care Kudos

Following the roll out of Wave 2 on October 23, there have been many messages of thanks to the teams. We’d like to share a few to recognize the teams and tremendous work that went into a successful implementation of Wave 2 Connect Care.

 

Thank You Wave 2 Users: To the new Wave 2 Connect Care users, ​we want to thank you for all that you have done for this successful rollout of Wave 2. As part of this launch, you and your colleagues helped us achieve a 4/5 rating from Epic on the Wave 2 implementation. Under normal conditions this would be an extremely great achievement, never mind doing it under the current circumstances. Keep up the good work. ~ ​The AHS Board

 

Kudos to UAH Dialysis: I was a super user for Wave 1, and I must congratulate all individuals on the dialysis unit at UAH that were involved with the implementation of Wave 2. Staff are functioning at a week three level; they are very confident in opening the chart of the outpatients on dialysis, they calmly navigate through the record when looking for patient information.

 

Lessons learned and recommendation from Wave 1 have been implemented. The patients were well aware of the changes that were occurring; it's obvious the changes were shared with them. Physicians were present to support the staff. The therapy plans are complete, it is evident the success is due to a lot of hard work from all staff involved. I have been very impressed with the calm atmosphere: a real collaborative atmosphere!

 

Congratulations and Thank You: A huge congratulations and thank you to all the staff who have worked so hard on preparing for the Wave 2 launch! The use of Connect Care will positively impact your clinical practice for years to come. The preparation efforts that you have all made while responding to the pandemic at the same time are so incredibly impressive. Thank you!

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Timing and Sequence of Upcoming Connect Care Waves

A message from Dr. Verna Yiu and Dr. Laura McDougall:

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With the successful launch of Connect Care’s second wave on October 24, we are starting to look ahead to our next launches. We know each launch of Connect Care involves thousands of people and hours of preparation. We want to acknowledge the efforts you are making to make Connect Care a reality in your waves, zones and sites, especially with the added pressures of COVID-19.  

Wave 3 will launch on February 27, 2021, at 5 a.m. Teams are heavily involved in training and preparation for that launch, which will take place at 38 locations, including acute and combined acute/long-term care sites across the Calgary and North zones, and urgent care sites in Calgary Zone. This wave also includes related pharmacy and diagnostic imaging services, and Alberta Precision Labs (North Zone sites only) associated with these programs and services. The details of which sites are launching in Wave 3 can be found here. 

Recently, the Connect Care Executive Committee approved the launch timing for Waves 4 and 5, as follows:

• Wave 4 will launch Saturday, June 5, 2021, at 5 a.m. in Calgary and Edmonton Zones, including:
• the Alberta Children’s Hospital, Peter Lougheed Hospital, Glenrose Rehabilitation Hospital, Lois Hole Hospital for Women, Royal Alexandra Hospital and many Addiction and Mental Health programs and services in the Edmonton Zone. 
• It incorporates related clinical support programs, including pharmacy, diagnostic imaging services, Alberta Precision Labs associated with these programs and services (Edmonton Zone sites only, plus genetics labs at Alberta Children’s Hospital), Health Information Management, Nutrition and Food Services, and other support areas.  
  
  
• Wave 5 will launch Sunday, November 7, 2021, at 4 a.m. in various locations in all five zones. Major sites include:
• the Foothills Medical Centre, Richmond Road Diagnostic and Treatment Centre, acute and combined acute/long-term care sites in Central Zone, the Centennial Centre for Mental Health and Brain Injury in Ponoka, Sylvan Lake Advanced Ambulatory Care Centre, Cancer Care, Screen Test and Alberta Kidney Care (Central, Calgary and South zones). 
• It also incorporates all of the related clinical support programs, including pharmacy, diagnostic imaging services, and Alberta Precision Labs (Central Zone sites only) associated with some of these programs and services, Health Information Management, Nutrition and Food Services, and other programs.

Connect Care remains one of AHS’ highest priorities. It will give patients and their healthcare team a more complete picture of their health history, improved access to consistent information on best practices, and other resources at their fingertips. It will facilitate communication between patients and their healthcare providers, and among members of the healthcare team. 

Connect Care is being introduced to all AHS programs, facilities and many AHS partners in phases, which started in 2019 and will continue through 2023. The full implementation timelines and sequencing are available, here. 

On Other Channels...

Thank you for continuing to check (... ideally, subscribe to multiple channels; see instructions) the Connect Care Update blog for prescribers. Recent additions to this blog and its various channels:

• Blogs
• Tickets, Tickets, Tickets!
• Happy Birthday Connect Care!
• Netcare Scheduled Downtime (Nov 5-6)
• Netcare - eDelivery Adjustments 
• Results and Reports Routing - Updated Information
• Wave 2 Stabilizing

• Tips
• New Tippy Series
• Questions
• How is "COVID-19-related MIS" added to Problem Lists?
• How can AHS Outlook 365 Calendars be Viewed in Other Calendar Applications?
• Support
• Wave 2 Launch Support Hot Topics - Week 02
• Finding Order Numbers to use when Reporting Printing Problems 
• Improvement to External Orders for Imaging at another Facility 
• Troubleshooting Patient Discharges for Wave 2 Cutover Patients 
• Change to Post-Procedure Navigator - Short Stay Order
• Informatics
• Super Users seeking CMIO Lead on Call - new number 
• Manual
• See What's New (many updates and additions)

Wave 2 Stabilizing

The Connect Care Wave 2 launch continues to stabilize after a remarkably smooth and collaborative transition. Most problems have been resolved and a few ongoing issues are explored by teams working to better match a few workflows to clinical information system capabilities.

As the comfort and experience of users increases, twice daily physician huddles have been reduced to twice weekly. Rapid-response clinical system design and other task groups remain active, but switching from daily to ad hoc meetings as required. Accordingly, our Support Update postings retire and we resume communications in all blogging channels for prescribers in all Waves. 

Renewed thanks to all Wave 2 teams for their incredible work and resourcefulness through the launch period!

Results and Reports Routing - Updated Information

Prescribers (including physicians, medical trainees, nurse practitioners, clinical assistants and other health care professionals) order laboratory tests, imaging and other diagnostic interventions in the course of health care. Results or reports related to these interventions are returned to the prescriber for consideration. 

The recent Wave 2 launch has added many prescribers who serve where Connect Care is the record of care as well as where Connect Care is not the record of care. Some new resources can help address questions about results routing in these mixed contexts:

• Manual: Results and Reports Routing
• FAQ: Results Routing for Mixed Context Prescribers

Netcare - eDelivery Adjustments

Connect Care's Wave 2 launch has onboarded a number of physicians who manage "hybrid" health record experiences. Some work (e.g., inpatient or emergency) is at sites where the Connect Care clinical information system (CIS) is the record of care and other work (e.g., office visits) is at locations where an electronic medical record is used.

Results and report delivery considerations can be complex during transitional periods. All routable test results and reports for work at a Connect Care venue deliver to In Basket. If the physician has requested eDelivery to their external Electronic Medical Record (EMR), there may be duplicative results routing. There are strategies to manage this, which we will re-post in the coming days.

In addition to laboratory test results and diagnostic imaging reports, providers may receive eDelivery of "summative" reports relating to their patients. These include admission histories, inpatient consults, operative reports, discharge summaries, labour & delivery reports and emergency room reports. 

Some providers have also received eDelivered inpatient progress notes that they authored for their patients in Connect Care. The automated eDelivery of non-summative documentation has been halted. As of November 4, 2020, only summative inpatient Connect Care documentation is eDelivered to external EMRs.

Happy Birthday Connect Care!

A year ago today, we were biting nails in anticipation of Connect Care's first launch at Wave 1 sites. 

So much has happened since! Most importantly, the Connect Care community has continued to grow in numbers and capacity. These strengths have enabled a successful Wave 2 launch and, no doubt, many launches to come!