2022-02-26

Professional Billing - Mitigation for temporary problem with RAAPID encounters

Some clinicians provide consultative and triage services through RAAPID workflows. 

Professional billing (charge capture) normally happens within encounters, including RAAPID encounters that open when consulting physicians open charts from a patient list of RAAPID requests. 

RAAPID encounters have a unique configuration that allows RAAPID staff to manage both referral and transfer actions. Unfortunately, this also means that physicians do not "sign" the encounters. This has recently been found to be interfering with charge submissions. The problem is being addressed and will be fixed.

Until a fix is announced, physicians are advised to open an "Orders-Only" encounter after serving a patient as part of a RAAPID triage. The charge capture ("service codes") activity is available in orders-only encounters and can be used to submit claims. Be sure to sign and close the encounter.

2022-02-25

On Other Channels...

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

2022-02-19

All User Bulletin - Laboratory Blood Collection Tubes Shortage

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

Laboratory Test Supply Shortage

Supply levels of blood collection tubes are constrained globally due to ongoing shortages of medical-grade plastics, with the greatest local impact on tubes used across Alberta for CBC, Hemoglobin A1C, and Type and Screen. Use of these tubes is being prioritized for Acute Care settings and for acute clinical management at this time.

All clinicians are asked to defer non-acute and non-urgent CBC, CBC with diff, HbA1C, Type and Screen and other tests requiring a K2 EDTA tube.

2022-02-17

BBHR: Bloat Busters - Avoid Superfluous Data

Building a Better Health Record (BBHR)

"Note bloat" is a 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 promote practical ways for clinicians to promote succinct, clear and actionable charting

Bloat Busters - Avoid Superfluous Data

It can be difficult to break paper-based habits when going paperless. A number of data elements -- such as patient names, birthdates and identifiers -- are important to insert on physical pages because embedded identifiers helps lost pages get back to the right chart and location.

It's okay to let Connect Care take care of this!

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

2022-02-16

BBHR: Bloat Busters - Link, Don't Copy

Building a Better Health Record (BBHR)

"Note bloat" is a 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 promote practical ways for clinicians to promote succinct, clear and actionable charting.

Bloat Busters - Link, Don't Copy

Copy-paste excess is a big bloater. 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, notes cluttered with copied-forward content make it unnecessarily difficult for the clinical reader to figure out what's new, trending or important. Connect Care documentation norms emphasize 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 a popup window without losing context.

2022-02-15

BBHR: Bloat Busters - Expose Note Sources

Building a Better Health Record (BBHR)

"Note bloat" is a 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 promote practical ways for clinicians to promote succinct, clear and actionable charting.

Bloat Busters - Where did a note's content come from?

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.

2022-02-14

All User Bulletin - Comments in Laboratory Test Orders

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

Using Comments in Laboratory Test Orders

The "Comments" field of a lab test order allows prescribers to offer additional information that may be relevant to an order. It should be used carefully.

In particular, the comments field should not be used to give instruction to laboratory service personnel. Depending upon the type of test requested, it is possible that laboratory staff may not see prescriber comments.

Clinicians should remember that lab test order comments are visible to patients when test requisitions are printed. They may appear in patient portals (e.g., via the My Personal Records application of Alberta Health's MyHealth Records).  

Prescribers should be mindful of local communication norms when using the "Comments" field. Comments should be concise, focused and clinically relevant.

To avoid laboratory test processing issues, including missed labs and misrouted results, comments should NOT include test-specific instructions for common, high-volume tests. They should not be used to request add-on assays and must not be used to request, copies, communications or specific results routing (delivery).

To avoid privacy breaches, comments should NOT include Personally Identifiable Information or Protected Healthcare Information for patients. Personally identifiable refers to the patient and anyone else in their circle of care.

Clinically important information should be documented or communicated via the appropriate Connect Care tools (e.g., Progress Note, Sticky Notes, MyAHS Connect result note).

2022-02-13

Prescriber Feedback Dashboard: Minimum Use Norms

Connect Care's minimum use norms define a set of practices that all clinicians must follow in order to preserve the integrity of the health record while not unduly burdening other Connect Care users. The norms, together with practical compliance tips, appear in:

Feedback about personal compliance can help clinicians identify workflow challenges and consider options for optimizing both their experience and the quality of the health record. 

Workgroups overseen by the CMIO portfolio and the Connect Care Clinical Improvement Support Committee have examined metrics that reflect compliance with minimum use norms. The first of these relate to adverse reaction, medication and problem list review expectations of all Connect Care prescribers.

Assembled in a new Connect Care dashboard, the minimum use norms metrics are ready for use, and iterative improvement (please send feedback!):

2022-02-12

BBHR: Bloat Busters - Use Interval H&P Notes

Building a Better Health Record (BBHR)

"Note bloat" is a 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 promote practical ways for clinicians to promote succinct, clear and actionable charting.

Bloat Busters - Use Interval H&P Notes

A common "bloater" is unnecessarily duplication of clinical documents. For example, a patient may be seen by a consultation service in the emergency department, where a consult note is completed. A decision is made to admit and the consult note includes relevant information that might otherwise be placed in an admitting history and physical (H&P) note. 

Given a requirement that all inpatient encounters have an admitting H&P, the admitting service may be tempted to copy the consult note into a separate H&P note, 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), creating unhelpful duplication beyond Connect Care.

There is a workflow to avoid this! 

An "Interval H&P" note can be created to point to a source document (e.g., Consult note) that takes the place of a H&P note. This avoids duplicate documentation while satisfying a documentation requirement.

2022-02-11

2022-02-07

Connect Care Supports for Locum Prescribers

As more sites across the province launch Connect Care, locum prescribers increasingly take assignments where Connect Care is the record of care. These prescribers need to ensure that they have the necessary training, access and permissions for the departments where their patients receive care. 

A new section has been added to the Clinician Manual to summarize preparations and supports relevant to locum rotations.