Printing Requisitions in a Paperless Clinical Information System?

One of Connect Care's expected benefits is freedom from paper; and all the associated supply, mail, fax and storage costs. We've made progress! Already by Wave 3, paper-related expenses are dramatically reduced.

Connect Care clinicians may wonder why outpatient laboratory requisitions are printed when the Connect Care clinical information system supports both the clinician requesting a test and the laboratory performing the test.

In time, we hope to dispense with printed lab reqs altogether. However, until all sites have transitioned to  Connect Care, the following considerations can help prescribers ordering outpatient laboratory tests:

  • Labs not using Connect Care
    • Patients can present to any laboratory in Alberta to have samples drawn and tests performed. Some labs may currently use the Connect Care CIS while others may not. 
    • Printed reqs provided to outpatients can be considered a protective for patient choice until all labs use Connect Care.
  • Labs using Connect Care
    • If a patient presents to a laboratory collection site already using the Connect Care CIS, a printed requisition for Connect Care ordered tests is not absolutely necessary. 
    • With the patient's identity confirmed with government issued identification, laboratory staff can check Connect Care for open laboratory test orders.
    • A printed requisition can still be useful because it confirms patient awareness of the tests to be performed at a specific time (note that patients using MyAHS Connect see pending tests in a section called "Upcoming Tests and Procedures").


Attaching and Sharing Clinical Objects via Connect Care Charts

The Connect Care one-patient-one-record-one-system goal will be achieved when all clinicians participating in a patient's care have access to the same record of care. Until then, clinicians may need to attach external "objects" (e.g., documents, images, scans) from external systems to the Connect Care chart. These, as well as images of clinical findings, can be selected for the attention of other users when linked to communications (In Basket or Secure Chat).

Connect Care users seek tips about how to capture and attach documents or media, then share with colleagues. We have updated relevant sections of the Manual and its links:


Growing Awareness and Attention for "Mixed-Context" Prescribers

Prescribers who work where the Connect Care clinical information system (CIS) is the record of care and also work in at least one setting where the CIS is not the record of care (inside or outside of AHS facilities supported by paper or electronic medical records) are said to be working in a "mixed context". Connect Care's Wave 3 launch has brought more mixed-context providers to the CIS, with impacts on how results or reports ("results") may route to their non-Connect Care contexts. 

A detailed explanation of changes to result routing (lab and DI results) is available in Result Routing for Mixed-Context Prescribers. Additional resources related to result routing are available in the Clinician Manual sections on Mixed Contexts and Results Management

Routing of reports and communications (consultations, letters, etc.) is also impacted. Regardless of where a patient is seen (Connect Care or non-Connect Care context), some messages must route to the CIS In Basket for all Connect Care users. This lowers the risk of a privacy breach and allows reports to be correctly directed to the correct provider, even when the report does not contain information identifying a precise routing destination. 

All users with Connect Care CIS access will need to regularly monitor their In Basket for tasks, communications, results or reports that pertain to their work within Connect Care contexts, as well as for the same related to patients seen where Connect Care is not the record of care. Connect Care can be personalized to support email alerts, out of contact and other functions to help prescribers know when new In Basket content is ready for review, or to delegate some In Basket tasks to others (see Manual: Mixed Contexts).

Result and/or report routing to In Basket may not be ideal for some providers. A working group is working on further solutions to improve the routing of important messages and reports to a prescriber's preferred system. Additionally, new mitigations for mixed-context prescribers and their clinics are being created.  

In Basket is a core function of Connect Care. If a prescriber uses Connect Care in any capacity, regular In Basket review and management is required. 


Digital Dictation Optimization Sessions

Please join the digital dictation team to explore advanced Dragon Medical One functions that are available in Connect Care. 

These Zoom-delivered optimization sessions will include:

  • Step-by-step commands
  • Autotext vs. SmartPhrases
  • Manage vocabulary 
  • Anchor and release speech focus
  • Bring your questions and let us know what you’d like help with!

To register for a session on one of the dates below, click the relevant link:

More information:


Using RAAPID for Interfacility Transfers

Connect Care supports for the “Referral, Access, Advice, Placement, Information & Destination" (RAAPID) service facilitate prescriber actions for patients who may need transfer between sites or consultative advice about care at a current site. 

Use of RAAPID to coordinate interfacility transfers (IFTs) is not mandatory, but use of Connect Care functions is strongly encouraged as it helps to automate workflows and increase visibility for the transfers within the system. Specific circumstances under which prescribers should consider using RAAPID-specific workflows include:

  • Transfers to a higher level of care
    Consultation with a potentially receiving consultant is initiated with a RAAPID call. 
  • Transfers to a lower level of care
    Arrangements are facilitated by a "RAAPID Repatriation" order entered into Connect Care. 
  • Transfers for emergency care
    All ED to ED transfers must involve RAAPID. 

The benefits of using Connect Care with RAAPID include:

  • A pending admission at the receiving site is automatically generated, setting up the patient for immediate arrival and access to the Connect Care chart. 
  • RAAPID can send documents to involved providers, allowing for information transfer between care locations and seamless patient transitions.
  • RAAPID can document the patient’s transportation needs and arrangements (i.e., EMS) together with estimated arrival time, allowing the receiving site to better prepare.
  • From the RAAPID Patient Lists in Connect Care, all clinicians (e.g., Bed Planning, Managers, Charge Nurses) can track the progress details of a patient transfer, including physician acceptance, bed availability and patient appropriateness at/for the receiving site.

Further information about IFT workflows using RAAPID is available in the Clinician Manual.


Results Management for Emergency Departments

A number of prescribers spend at least some time contributing to emergency department (ED) services, where department-specific test result routing considerations may apply. These are summarized in a new section of the Connect Care Clinician Manual, with links to practical details in process and tip documents.


COVID-19 and Connect Care - Testing for VITT

Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) is an extraordinarily rare hematologic complication associated with COVID-19 vaccination. Symptoms may include persistent and severe headache, focal neurological findings, seizures, blurred vision, shortness of breath, chest or abdominal pain, swelling and redness in a limb or pallor and coldness in a limb. Onset may occur between 4-28 days after immunization (first or second vaccine). Laboratory findings may include thrombocytopenia, elevated D-dimer or imaging evidence of thrombosis.

In general, suspected VITT should be referred to a consulting Hematologist or Thrombosis physician who will oversee collection of required specimens in appropriate tubes, complete special laboratory requisitions and communicate with relevant reference laboratories. The consultant will take care of Connect Care orders (or will give the requesting physician specific instructions about which tests to order and how). 

In sum, the important action for Connect Care prescribers is to order a Hematology consult and speak directly with the consultant.


All Prescriber Bulletin - COVID-19 Vaccination Records

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

Documenting COVID-19 Immunizations in Connect Care

We've previously posted about how provincial immunization information systems interface to Connect Care, where the health record includes a patient's immunization history. 

There can be gaps. Patients may receive vaccinations at clinics, offices or other provinces that do not send data to Alberta's provincial records. In addition, if Connect Care does not yet have an order for a new vaccine (as is the case for COVID-19 for a period of time), documentation is not automatic.

Prescribers can use a simple manual process to record past patient vaccinations that have not been captured in Connect Care (be careful to work from an official record of administration, select the correct COVID-19 vaccine type, and note that in-hospital vaccination events will be independently recorded by vaccination staff):


Connect Care Mobility - Managing Expectations

Connect Care mobility continues to prove very popular with prescribers. As with Waves 1 and 2, uptake of speech recognition (Dragon Medical One for in-system dictation) has been almost instantaneous in Wave 3. Mobile applications that provide access to the health record (Haiku for smartphones and Canto for iPads) have also enjoyed rapid adoption.

While the enthusiasm is great, a bit of expectation management might be timely. 

We've posted some updates to the Manual, FAQs and Tips to remind about care needed when prescribers with multiple jobs use mobile apps, limits to the number of lab results accessible via mobile apps, and important differences between what the iOS and Android versions of Haiku are capable of:


Connect Care's Wave 1 Wins Health Quality Award

We are pleased to learn that Connect Care’s Wave 1 Implementation is the 2021 recipient of the Canadian College of Health Leaders’ 3M Health Care Quality Team Awards (Across A Health System). 

Connect Care had a successful first launch on November 3, 2019 at sites including the University of Alberta Hospital (UAH), Stollery Children’s Hospital, Kaye Edmonton Clinic, Mazankowski Alberta Heart Institute, over 500 outpatient clinics across Edmonton Zone, the East Edmonton Health Centre, pharmacy, lab and diagnostic imaging at UAH and the Cross Cancer Institute and DynaLIFE sites across Alberta.

This award recognizes the effort and dedication of the more than 22,000 frontline staff, including 3,000 physicians, who paved the way for Connect Care’s continuing success. 


Virtual Drop-in Centre Hours

With the first full week of Connect Care at the Wave 3 sites coming to a close, launch support via the Virtual Drop-in Centre (virtualhelp.connect-care.ca) will be scaled back to daytime hours. 

As of Monday, April 19, 2021, the Virtual Drop-in Centre will be open 07:30-23:00. If you require support outside these hours, please call the IT Service Desk & Solution Centre at 1-877-311-4300 (#1 for Connect Care) or visit help.connect-care.ca.

For further information about site and Virtual Drop-in Centre schedules, visit launchhelp.connect-care.ca. Also listed there are reminders about getting after-hours CMIO help for prescribers via Super Users, CMIO leader on call and help-cmio@ahs.ca.


All Prescriber Bulletin - Med Order Start Times

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

Take note of Medication Order Start Times

If an inpatient medication order is entered without an explicit start time, the default (standardized medication administration time, SMAT) can lead to unintended first dose timing, and possibly additional dose administration. 

The default when ordering an ongoing medication (e.g., furosemide 40 mg po daily) is for "As Scheduled" dose timing, which results in the first dose being given at a default time (e.g., 08:00, depending upon the medication). This works well most of the time. However, if an independent dose is ordered and given just before the continuing medication order, the clinician may want to explicitly set the "Starting" time to avoid two doses close together. This, of course, depends on intent.

Universal best practice: Take note of the starting time and the resulting anticipated initial schedule of dose times to confirm that this fits clinical need. 


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Admitting, Attending or Authorizing?

As Connect Care spreads, inpatient services new to digital workflows adapt processes for ensuring that provider-patient attachments are clear, current and validated. Distinctions between new uses of "admitting", "authorizing", "attending" and other names for accountable prescribers may not be obvious. 

The primary prescriber attachment for inpatients is the "Attending" prescriber (synonymous with "Most Responsible Healthcare Provider"). Each facility will need to firm-up processes for ensuring that this attending designation is updated as clinicians handover responsibilities from on-call, cross-coverage or rotation assignments. 

Support staff usually do this when patients move to and from wards. Prescribers participate by keeping a close eye on their patient and team patient lists, and being ready to adjust attending accountabilities as needed.

Tickets, Tickets, Tickets!

The Wave 3 launch has gone well, credit to the clinicians, leaders, trainers, Super Users and many others who have worked so hard to prepare.

Launch success is less about absence of problems and more about rapid attention to problems. In this, Wave 3 is doing extraordinarily well. Most issues are resolved quickly. Many stimulate improvements that benefit entire Connect Care community.

What's left are a few tricky problems. These are context-dependent. When a specific print fails, for example, the fault can be device-specific or, sometimes, an intersect of device, department, function and location.

Cleaning up tricky problems is a group effort. Our technical specialists need users to:


All Prescriber Bulletin - Tap Out or Log Off

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

Tap out or log off!

Some computer workstations are enabled for Tap-n-Go logons in high-flow settings. This is a great convenience because prescribers can sign-on to a workstation and get to Connect Care quickly by tapping an enabled ID card. 

Problems arise when prescribers do not "tap-out" upon leaving the workstation. Even if Connect Care is logged out, this can leave Windows open to the prescriber's session and expose that session to misuse by others. Tapping-in elsewhere else does not tap-out the prior workstation.

Most users do not notice this challenge because workstations in other clinical settings are often configured such that users only log on to Connect Care, with the Windows session automatically taken care of. 

Universal best practice: If you log on to Windows (keyboard, tap card, biometrics, or any other method) with a personal account, be sure to log off before leaving the device. 

Wave 3 Progress - A Great Start!

The Connect Care Wave 3 launch continues to progress well after a remarkably smooth and collaborative cutover. Most early problems are resolved and a few ongoing issues are explored by teams working to fine tune some of the more complex workflows.

Twice-daily physician huddles continue to triage any prescriber issues identified to Super Users, Medical Informatics Leads or the ticketing process. Rapid-response clinical system design and other task groups receive and work on issues during the day. Highlights of what is being worked on appear in a daily prescriber Support Update

Learning curves remain steep in the first week. New users are encouraged to continue to consult with Super Users, check the Connect Care Manual, and identify where new supports or clarifications could help (cmio-manual@ahs.ca). In addition, daily blog postings focus on the more common questions and challenges that we hear about:

Renewed thanks to all Wave 3 teams for their incredible work and resourcefulness through the launch period!

Connect Care to Netcare - Document Sharing

The Alberta Netcare Portal provides a cradle-to-grave, read-only view of patients' key health information for authorized providers. This electronic health record (EHR) includes summative documents shared from the Connect Care clinical information system (CIS). 

Summative documents are high-value clinical notes that review diverse information sources and interpret these at milestones. Included are admission history and physicals, discharge summaries, consultation reports (inpatient and outpatient), operative reports, transfer summaries and emergency department reports. 

All Connect Care inpatient summative documents are copied to Netcare. Connect Care outpatient consultation letters are also copied to Netcare if the authoring prescriber selects a Netcare-compatible template. Progress notes (which depend upon the rest of the chart for context) are not shared with Netcare.

When generating an outpatient communication -- such as a letter to the referring physician or a report about an outpatient procedure -- the selected letter "template" determines whether the report will go to Netcare or not. Be sure to pick a template that includes "Netcare" in its name.


Prescriber Ordering Norms - Are Verbal Orders Allowed?

Computerized Provider Order Entry (CPOE) refers to the process of a medical prescriber entering orders electronically via a digital health record. 

CPOE involves much more than simply transcribing an order. The ordering process activates decision supports, patient safety protections and other aids to quality improvement. With a little practice, the CPOE process can also be much faster than written or verbal equivalents, as favourites, panels, personalizations and other automations come into play. In addition, Connect Care mobile apps make order entry immediately accessible from tablets and smartphones, any time, anywhere.  

It is a Minimum Use expectation for all prescribers that all tests, interventions and medications that can be ordered in Connect Care are ordered in Connect Care. Compliance is tracked in prescriber performance metrics. 

Very few exceptions to CPOE are acceptable, as summarized in Connect Care Ordering Norms.

Connect Care Communication Norms

Communication happens when one person or group relays information to another person or group, whereas documentation happens when information is managed to serve as a record.

Connect Care supports a wide range of communication tools, including voice, facsimile, commenting and secure messaging. Clinicians may wonder which tool to use for different communication needs, and how to use each to advantage.

Communication Norms are about what Connect Care users expect of one another for effective, efficient, safe and respectful information sharing within and between groups. Healthcare teams are encouraged to develop their own "communication compacts", clarifying how they will use different tools for different purposes. 

For example:
  • Chart "Sticky Note to Most Responsible Provider" can function like a "Doctor's To-Do clipboard" listing things to take care of on rounds. 
  • Secure messaging can be used for non-urgent reminders, such as the place and time of an upcoming team conference, that can be attended to within the next half-day (or so).
Urgent clinical communications should always be person-to-person, not relying on tools like sticky notes, secure messaging or In Basket.


Improving Issue Reports and Help Desk Interactions

Problem reports (help.connect-care.ca "tickets") have been well within expectations so far with the Wave 3 launch. Of course, more tickets are expected as clinical volumes ramp up with more outpatient activity. The good news is that tickets are resolved quickly, with critical tickets resolved within minutes to hours.

Helpdesk tickets route most efficiently when the user provides clear information at the right level of detail. See our tips for impactful issue reports:


Problem Power - A New Tips Series

Problem List management can seem daunting to new (and established!) clinicians. With a little effort, however, problem management can dramatically improve the Connect Care user experience, while significantly reducing personal and shared information burdens.

In tandem with the Wave 3 launch, a new Connect Care tips series will post daily, emphasizing little things that can have a big impact on the health record.

Just-in-Time Learning!

Our new Wave 3 Connect Care prescribers are on the steeper part of their learning curve. Help is available!

A powerful way to reinforce basic training, while busy with clinical work, is to consider one or two high-impact tips per day. To that end, we are posting daily "tippies" (tippy.connect-care.ca) on the Connect Care Tips channel (tips.connect-care.ca), starting with the simplest but most impactful suggestions. We'll progress to more advanced tips with time. 

The easiest way to follow these postings is to subscribe to the blog channel. A new emailed tip will arrive daily.

Also consider subscribing to both the FAQ (questions.connect-care.ca) and the Support (support.connect-care.ca) channels. We answer common questions on the former and provide important news about fixes and enhancements on the latter. 


All User Bulletin - Blood Product Information Services Restored

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

Blood Product Ordering Interface Restored

WellSky transfusion information systems and interfaces are restored to normal functions. Downtime procedures for blood product ordering are no longer required.

Prescriber Drop-In Centre Moving as of Sunday, April 11

As of Sunday morning, April 11, the in-person Drop-In Centre at the Grande Prairie Queen Elizabeth II Hospital is being moved to a more convenient location: room 2509-2510 (previously called 2-2 North), located just outside the physicians' lounge.

The Drop-In Centre will remain in this new location for the remainder of the scheduled launch support, but check the Launch Supports page for any further updates.

Wave 3: We are GO!

All Connect Care systems activated on time at 05:00! Interfaces to the WellSky blood product information system are expected to fully activate soon.

Today Connect Care welcomes many North Zone colleagues including those working in Peace Country Health Region, Fort Vermilion, High Level, La Crete and the many participating facilities and clinics. The first few days will be intense, but with lots of help at hand we are confident that progress will be fast. Cutover activities have been performed extraordinarily well... a great start.

Physicians, please make use of the drop-in centre and other launch supports (launchhelp.connect-care.ca). 

A welcome from our CEO:

All User Bulletin - Blood Product Ordering

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

Downtime Procedures for Blood Product Ordering

There was a scheduled outage for the WellSky Transfusion System as part of the Connect Care Wave 3 launch preparations earlier this morning (April 10, 2021). The transfusion information system is not yet restored.

This outage affects only the transfusion functions for Connect Care. The main impact for prescribers is that requests for blood products require paper process. Blood product downtime procedures should continued to be followed until the problem is resolved:


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Wave 3 Launch Support: Virtual Health Update

AHS Virtual Health Services has published a newsletter with important information for Connect Care Wave 3 clinicians and staff:

Enhancements to Isolation Discontinuation Orders for COVID-19

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

Discontinuation of Isolation Orders

Patients can be placed on contact and/or droplet and/or airborne precautions by means of an "Initiate Isolation" order. A different order is required to remove isolation precautions already in place. 

Starting April 9, 2021, “Discontinue Isolation” orders have some new properties that reflect COVID-19 policies. These illustrate how just-in-time instruction, guidance and documentation can be supported with an integrated workflow. 

The discontinue isolation order is unchanged for most exposures. If the order relates to COVID-19 risks, exposure or disease, then the order must be supplemented with documentation of compliance with COVID-19 protocols. This is accomplished with a linked note, automatically created from within the discontinue isolation order:

Connect Care WellSky (Transfusion System) Scheduled Outage - Friday April 9, 2021, 23:00-03:30 Saturday April 10, 2021

Components in the Connect Care clinical information system need periodic maintenance. There will be a scheduled outage for the WellSky Transfusion System (in preparation for Connect Care Wave 3) starting at 23:00 Friday April 9, 2021, with services resuming by 03:30 Saturday morning. 

This outage affects only the transfusion functions for Connect Care. Blood product downtime procedures should be followed:


Connect Care Wave 3 Launches April 10, 2021

Connect Care's third wave launches in just a few days, primarily in North Zone areas. Systematic preparations are already a great accomplishment. Capable teams will continue to work hard to support all stakeholders this coming weekend.


All User Bulletin - Dose Range Medication Orders

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

Dosing Ranges and Connect Care

When prescribers order a single scheduled medication with ranged dosing, system restrictions (such orders cannot work with decision supports) cause delays as extra pharmacist resources are required to interpret the prescriber's intent. 

With rare exceptions, dose range requests should be handled through two separate (but linked) orders. The first sets a regular baseline dose at consistent intervals. The second specifies an as-needed (PRN) dose that can supplement the baseline, possibly at a different administration frequency. 


Meditech Considerations for Connect Care Wave 3 Launch

As not all locations in the Peace Country Meditech Ring are going live in Wave 3, North Zone prescribers (both in Connect Care Wave 3 and those remaining on Meditech) may be affected at launch.

Meditech encounters (i.e., a case or visit in a pre-registered, waitlisted, scheduled or active state) converted to Connect Care will still appear in Meditech. They will be in either a discharged or open state.

Other important considerations for Wave 3 prescribers:

  • As previously posted, it is very important to complete and close legacy charts by April 9, 2021. 
  • After 05:00 on April 10, 2021, all charting should take place in Connect Care. 
  • After launch, Connect Care users can expect read-only access to Meditech records. Some users, previously identified by their leaders, will have continued read and write access. 
  • For North Zone prescribers who are not part of Wave 3 and are remaining on Meditech, orders should not be sent in Meditech to locations that have transitioned to Connect Care. Netcare can be checked when needing patient information for departments that have transitioned to Connect Care.
  • There will be a scheduled Meditech downtime for Northern Lights and Peace Country from April 9, 2021 23:30 to 05:00 April 10, 2021.


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:


Improved Support for RAAPID Consultations

The Alberta Health Services "Referral, Access, Advice, Placement, Information & Destination" (RAAPID) service facilitates physician access to consulting services for patients who may need transfer between sites or additional advice about care at a current site. Typically, participating emergency and specialty physicians generate separate "Telephone" encounters to document their interactions through a RAAPID consultation.

RAAPID is now fully enabled by Connect Care. A new "Intake" encounter type supports RAAPID activities. This provides an easier workflow for consulting. 

The RAAPID encounter navigator streamlines documentation and communication throughout a patient transfer event, while also making the information easily accessible in any resulting inpatient encounter. Instructions are provided about how to handle any orders that may be required.

RAAPID workflows using the Intake encounters are explained in brief tip sheets: