2021-09-30

BBHR: Charting Efficiencies - Other Clinical Systems Sidebar Views

Building a Better Health Record (BBHR)
Charting Efficiencies - Using Other Clinical Systems Sidebar Views

New patient assessments offer important opportunities to initiate core clinical data in the patient chart. This decreases the work of documentation thereafter, when clinicians can revise or validate information already entered. 

Sidebar tools can help clinicians when they review information from other clinical information systems (e.g., Netcare) or from prior unstructured Connect Care documentation (dictated notes that, for example, did not include updated problem lists). The user needs to review and document at the same time, ideally without jumping back and forth between different windows. 

The Sidebar can help in two ways, either when used to review information that informs documentation performed with main panel tools, or when used to enter information gleaned from the main panel. 

Sidebar views of other clinical information system content are especially helpful when doing problem, adverse reaction or medication reconciliation, as explained in a recent Manual addition.

2021-09-29

All User Bulletin - Inpatient Sidebar Enhancements

All-user-bulletins highlight information that all prescribers can benefit from when using the Connect Care clinical information system.

Inpatient Hyperspace Sidebar Enhancements

Users may notice changes to the "Sidebar" (rightmost panel appearing when a patient chart is opened to an inpatient encounter in Hyperspace) starting noon September 30, 2021. The best way to learn about new functions is to select the embedded help link to gain access to a quick overview: 

All the same Sidebar information is available. However, many Sidebar views have been enhanced with better clinical summaries. The Sidebar index now uses information about the current provider, patient and clinical setting to conditionally display the most relevant information. In addition, new features make it easier to use the Sidebar to access charting tools that complement what one may be using in Hyperspace's main (centre) panel. 

The biggest change relates to how the Sidebar summary index works. The index will always appear at the top of Sidebar views (default "Index" tab) and can be used to jump between different views. Index items have three parts:

  1. Clicking on a left arrow will open relevant information in the main Hyperspace panel.
  2. Clicking on the index title will open a Sidebar summary view with information matching the title topic.
  3. Clicking on a right arrow (when present) will open a charting tool (with data-entry capabilities) in the Sidebar itself.
The enhanced Sidebar better supports a number of charting needs, including:
  • Quickly find a tool not among one's defaults (and so not having to seek in menus).
  • Enter and update problem lists within the Sidebar while reviewing past notes in the main Hyperspace panel.
  • Gain rapid access to discharge planning tools.
  • Find and use supports for problem-oriented charting.

Time-saving charting efficiencies become possible with effective use of Sidebar tools. We will post tips and tricks in the Building a Better Health Record series of this blog.

2021-09-28

BBHR: Bloat Busters #06 - Avoid Superfluous Data

Building a Better Health Record (BBHR)
Bloat Busters #6 - Avoid Superfluous Data

Our Bloat Busters series can help clinicians prevent "note bloat", a digital health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. 

It can be difficult to break paper-appropriate habits when going paperless. A number of data elements -- such as patient names, birthdates and identifiers -- are important to insert on physical pages because these can be disrupted. Embedded identifying data helps restore pages to the correct chart and location.

Connect Care notes do not get such benefit from embedded identifiers. Clinical information system notes are digitally anchored. More importantly, any act of printing, copying or otherwise moving information causes headers and footers to be generated with unequivocal patient, encounter and event identifiers. This includes the date and time of documentation and other situating information. 

No need to replicate!

2021-09-26

BBHR: Bloat Busters #05 - Interpretation >> Replication

Building a Better Health Record (BBHR)
Bloat Busters #5 - Interpretation Over Replication

Our Bloat Busters series can help clinicians prevent "note bloat", a digital health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. 

The clinical value of progress (non-summative) documentation relates to a ratio of signal (clinically important new information reflecting developments in a patient's experience) to noise (information related to the patient, but not directly relevant to clinical progress) multiplied by interpretation (application of clinical expertise to information to advance understanding and support decision-making):

Digital health records make it easy to amplify noise in progress documentation. Copy-paste of prior documentation and some text automations ("SmartStuff") pull data blocks (e.g., vitals and laboratory flowsheets) into a note, adding signal, but often in company of a lot of noise. Authors can be lulled into thinking that documentation is done, while the note remains lean on clinically helpful interpretationThe reader of a progress note needs to know clearly what the writer thought and did for patient care.

The Connect Care Documentation Quality Improvement initiative ("Building a Better Health Record") introduces a number of new text automations, templates and other documentation aids that can help authors replicate chart data more selectively, while also being explicit about the clinical meaning of observations. Continue to follow this thread as we describe how to use the tools to your advantage.

2021-09-25

Next Connect Care Scheduled Downtime Window Will NOT Be Used

The September 30th downtime for Connect Care will not be taken as scheduled.
 
The decision was made with Clinical Leadership based on the significant capacity issues the frontline is currently facing with COVID-19 workloads.
 
A new date for scheduled Connect Care system maintenance has not been confirmed but will be communicated well in advance.

2021-09-22

BBHR: Bloat Busters #04 - Link, Don't Copy

Building a Better Health Record (BBHR)
Bloat Busters #4 - Link, Don't Copy

Our Bloat Busters series can help clinicians prevent "note bloat", a digital health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. 

Connect Care users have not escaped a big "bloater" – copy-paste excess. On average, about a quarter of all notes contain content copied from elsewhere (other notes), with about a fifth of all note content duplicating other documentation. Understandable, since clinicians may think that, as with paper-based records, it is a service to use a progress note like a scrapbook, sparing the reader from having to flip through dense records.

Unfortunately, digital notes laden with copied-forward, then saved or edited, content make it unnecessarily difficult for the clinical reader to figure out what's new, current, trending or important. Connect Care documentation norms promote referencing prior documentation in preference to copying into current documentation. The current note should highlight, not obfuscate, change.

There is a workflow that helps! Progress notes can refer to prior notes (being specific about the note type, service and date; e.g., "see GIM Consult from 2021-09-20"). Even better is the ability to create an automated link to the prior documentation that will allow users to quickly see it in context.

2021-09-21

BBHR: Bloat Busters #03 - Clinical Note Provenance

Building a Better Health Record (BBHR)
Bloat Busters #3 - Where did a note's content come from?

Our Bloat Busters series can help clinicians prevent "note bloat", a digital health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. 

Clinicians reviewing the clinical documentation of others may not always appreciate who authored the parts used to assemble the note, or how those parts were generated. It can be important to know, for example, that content was facilitated by text automations (e.g., SmartPhrases).  

There is a documentation tool that helps! 

When a documentation object (e.g., progress note) is open for review, look to the top right of the note display to find a hovering option menu with checkboxes for "Hide copied text" and "Hover for details":


Select the "Hover for details" checkbox, position the pointer over a piece of text and note how blocks of text are highlighted with a superimposed descriptor indicating how the text was generated, by whom and when. The personalization icon can be used to have this feature persistently enabled.

2021-09-20

BBHR: Bloat Busters #02 - Where's the Bloat?

Building a Better Health Record (BBHR)
Bloat Busters #2 - Where's the Bloat?

Our Bloat Busters series can help clinicians prevent "note bloat", a digital health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. 

Clinicians reviewing the clinical documentation of others may not always appreciate how much of it is copied from elsewhere and how much is original to the current note. The author may have copied-forward a prior note and then edited it to reflect current state and saved it as a new note. But the reader's interest may be less in a note as a snapshot for a point in time, and more in how the patient's condition is changing or progressing. 

There is a documentation tool that helps! 

When a documentation object (e.g., progress note) is open for review, look to the top right of the note display to find a hovering option menu with checkboxes for "Hide copied text" and "Hover for details":

Select the "Hide copied text" checkbox and note how content copied from elsewhere is greyed. This helps the reader get a quick sense of what is newly authored in the current note. The personalization icon can be used to have this feature persistently enabled.

2021-09-16

All User Bulletin - Patient Portal Access Update #2

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

Patient Portals Access Workaround for MyAHS Connect

We previously reported access problems affecting the MyAHS Connect (MAC) patient portal. Due to the long queue lines experienced by many Albertans trying to log in to the Alberta Health MyHealth Records (MHR) patient portal, which uses the same authentication portal as MAC, patients faced delays or, in some cases, were not able to log in to MAC. 

A new Internet link has been created that allows current users to directly access MAC, avoiding the current queue process. Prescribers can now advise their patients to log in to MAC using one of the following options:

  • Try the MyChart app (the mobile version of MAC).
  • Use a browser to access MAC directly via this Internet link ahs.ca/mac (suggest that this be saved to their browser "favourites" for future use). 

Note that patients looking to access MHR immunization records will still need to go through the MHR queue process. It remains possible for patients to access their Connect Care immunization record through MAC.

Technical teams continue to work round-the-clock to increase MHR capacity and reduce any queues. We will keep you updated about access to MAC as additional information becomes available.  

2021-09-15

All User Bulletin - Patient Portal Access Update

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

Patient Portals Access Constraints

We previously reported access problems affecting the MyAHS Connect patient portal. Patients faced delays or, in some cases, were not able to log in. 

The Alberta Health MyHealth Records (MHR) patient portal is experiencing an increased number of Albertans trying to access their immunization records. As a result, many Albertans trying to log in to MyHealth Records are experiencing long queue lines. 

The Alberta Health Services MyAHS Connect (MAC) Connect Care patient portal uses the same authentication portal as MHR. Consequently, patients also face delays or loss of access to MAC. The MAC mobile apps (SmartPhones and Apple Watches) are likewise affected. To be clear, Connect Care Hyperspace is not impacted and the MAC servers are functioning normally.  

It is uncertain how long it will be before this issue is resolved. We will keep you updated about access to MyAHS Connect as more information becomes available.  

At present, patients will experience longer wait times, and possibly other challenges, when trying to connect to MAC via computer or mobile devices. This can affect scheduling, information access, communications with providers and embedded telehealth services.

BBHR: Bloat Busters #01 - Using Interval H&P Notes

Building a Better Health Record (BBHR)
Bloat Busters #1 - Using Interval H&P Notes

"Note bloat" is a digital health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. 

As part of our documentation quality improvement initiative, we will share practical ways for clinicians to benefit from Connect Care documentation norms that promote succinct, clear and actionable charting.

A common "bloater" is unnecessarily duplication of clinical documents. A patient may be seen by a consultation service in the emergency department, where a consult note is completed and a decision is made to admit to an inpatient facility. The consult may have anticipated admission and included all information that might otherwise be placed in an admitting history and physical (H&P). 

Given the requirement that all inpatient encounters have an admitting H&P, the admitting service may be tempted to copy the consult into a separate H&P, or to place a comment in the H&P referencing the consult. However, both the Consult Note and the H&P are shared with external systems (e.g., Alberta Netcare) and so extend unhelpful duplication beyond Connect Care.

There is a workflow to avoid this! An "Interval H&P" note can be created to point to the source document (e.g., Consult Note), avoid copy-paste and also avoid duplicate shares with external systems.

2021-09-14

All User Bulletin - Patient Portal Access Down

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

Patient Portals Access Down

Access to MyHealth Records started slowing mid-day September 14, likely related to public demand for vaccination information. By mid-afternoon, access stopped. 

Access to MyAHS Connect (Connect Care patient portal) has been bound to the same MyAlberta Digital Identity sign-on used by MyHealth Records. Consequently, MyAHS Connect access is also affected.

We will update this notice when information about service restoration becomes available.

2021-09-10

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:

2021-09-03

COVID-19 and Connect Care - Waves 4-5 Delay

An important message from Dr. Francois Belanger, Chief Medical Officer, and Sean Chilton, Vice President Health Professions and Practice and Information Technology:


Our healthcare teams and patients come first in every decision we make. Given the significantly increasing demands on acute and critical care areas, frontline staff, physicians, programs and services, and the increased health risks our patient and healthcare teams are facing due to COVID-19, we do not feel it would be prudent to launch the next wave of Connect Care in November 2021.

Our immediate priority is to support Alberta’s on-going COVID-19 response. We know that each Connect Care launch requires significant training and preparation by frontline teams, those who support behind the scenes and leadership. Delaying our Connect Care launches helps ensure our staff, physicians and leaders are able to focus on delivering care to patients who need acute and critical care at this time. 

We are currently assessing the situation in order to determine our new wave rollout plan. Firm dates for subsequent launches will be shared as we have them.

To be very clear, Connect Care is not being cancelled: Connect Care continues to be one of our highest organizational priorities. In fact, even with this delay to the upcoming launches, some Connect Care work will still continue to support the needs of the organization, the pandemic, and to prepare for the next launches. Work that can still continue because it is less impacted by COVID-19 includes:
  • Infrastructure and technology work, including WIFI upgrades, facility preparations, and device deployment and testing
  • Continued support for Waves 1, 2 and 3 to aid the stabilization of those sites and programs
  • Building and validation work for Waves 4-7
  • Building and preparing training support, leadership teams and other roles necessary for future launches. 
We are thankful for all the work done to launch our three previous waves so successfully, including the incredible support from the Edmonton and North zones, and from sites and programs across the province. We also want to recognize the preparations undertaken for our next launches by Connect Care teams, site and program teams and our leadership. 

When it is safe and prudent to move ahead with our future launches, we will be ready. In the meantime, making these changes means we can be strategic with resources and respectful of the demands on our staff and physicians, as they continue to protect the people of this province.  

2021-09-02

COVID-19 and Connect Care - Additional Dose and Moderna Changes

As of September 1, 2021, an additional (third or booster) dose of the COVID-19 vaccine is available for eligible groups:

  • immunocompromised individuals 12 years of age and older with specific conditions, 8 weeks after their second dose; 
  • residents of seniors’ supportive living facilities, 5 months after their second dose; and 
  • travelers to jurisdictions where AstraZeneca/Covishield or mixed doses are not recognized, 4 weeks after their second dose.
Also as of September 1, 2021, the Moderna (COVMODmRNA) vaccination has been approved for ages 12 years and older.

To support the expanded criteria for vaccinations, the COVID-19 vaccine inpatient order set is enhanced in Connect Care:

  • An "Additional Dose" section has been added to the order set to support those eligible for additional doses (as described above).
  • Moderna (COVMODmRNA) is now available for everyone born 2009 and earlier.

For more information: