Connect Care Direction Setting 1 Finishes Well!

The first of three direction setting conferences concluded today, with excellent results and feedback.

A warm thank you to all participants for taking time in from busy schedules to attend and contribute. It can be exceptionally difficult to protect so much time on such short notice. Some will have begged colleagues to cross-cover: please extend our thanks to them. Others will have had the inconvenience of changed clinic, attending or procedure arrangements. Again, extended thanks.

Having so many clinicians active in early Connect Care build activities has been invaluable. Trust that “parking lot” content will find its way to Connect Care Committees, Councils, Workgroups and future direction-setting, validation and clinical system design sessions. Please reach with questions or recommendations.

AHS is most grateful for all the interest in and support for this transformative project. Reposted here is our CEO's Vlog marking the launch of Connect Care build.

Connect Care Kick-off

More than 2,400 Alberta Health Services (AHS) staff, physicians and volunteers gathered in Edmonton today for the first of three Direction Setting sessions. The event also gave opportunity to celebrate the start of the Connect Care journey. We were thrilled to have deputy minister of health Milton Sussman and AHS CEO Verna Yiu ground our efforts with a strong sense of purpose and value.

A massive conference, with countless sessions intricately streamed, the true impact may have less to do with direction setting and more to do with direction sharing. One feels that AHS has matured as a provincial organization, fully able to rally around a common intent and shared commitment. There will be many challenges along the way -- and success is far from assured -- but today one felt fuel for progress!

One of our Fort McMurray colleagues, Dr. Mayank Singal, captured the spirit well:
“We’re on the first day of the Direction Setting sessions, and it was a very encouraging and exciting morning. And I am amazed by the potential that we have here. I really do believe that in 5 to 10 years from now we will have the most amazing infrastructure in Canada, and perhaps the world.”

• Byte: What is Direction-Setting?​​​​

Why does Connect Care matter?

The foundation of Connect Care is a clinical information system (CIS) that will transform how we use and access information. Building the CIS is a huge undertaking. Ten build principles - about how CIS design should reflect, not set, our values - emerged from extensive stakeholder consultation. Theses are summarized in a document and explained in the presentation below.

• CIS Build Principles

What is Connect Care Groundwork?

Groundwork occurs during the first phase (year 1) of Clinical Information System (CIS) implementation. It is a major Connect Care activity, alongside Direction-Setting, Validation and Clinical System Design.

Groundwork is about discovery. Groundwork analysis helps Epic get to know Alberta Health Services (AHS) and how its goals set the scope and expectations for a CIS. The Groundwork process reciprocally helps AHS explore Epic capabilities, so that early decisions can be made about where the CIS will enable existing practices and where it will be designed for post-transformation practices.

Groundwork is also about commitment. Groundwork decisions, primarily made by Connect Care leadership, recognize requirements for success, define Connect Care's scope, empower oversight structures, affirm decision-making principles, and set bounds for the CIS foundation build.

• ​Byte: Groundwork
• Connect Care Build Activities and Timeline
• February Calendar​

Connect Care Update: Requirements for Success

To help Connect Care move forward, the Connect Care Executive Committee recently identified several requirements for success. These reflect the needs of patients and healthcare providers, preparing to respond consistency and efficiency throughout AHS. Committing to high-level requirements is important because the decisions provide a foundation for designing the Connect Care clinical information system. Six key requirements were recently approved:

1. AHS will seek HIMSS Stage 6 Certification
2. AHS will adopt digital identification tools
3. AHS will adopt digital identities (signatures)
4. AHS will promote use of in-system documentation tools
5. AHS will promote use of a Connect Care Provider Portal
6. AHS will support flexible bed planning at the level of sites, programs, zones, and the province

​For more information:

• February 8 2018 Connect Care Update
• Connect Care Scope: Requirements #2

Building the Connect Care CIS

Connect Care 2018 builds the clinical information system (CIS) that will be tested in 2019 and deployed in 2020 through 2022. During the critically important design period, Alberta Health Services (AHS) configures a foundation build and continually improves it to become the technology platform for clinical transformation.  Complementary activities inform the build:

• Groundwork is about discovery. Epic and Alberta Health Services (AHS) exchange information about how teams deliver care across Alberta.
• Direction Setting is about workflow, or how AHS does what it does. This includes how patients move from service to service, how practitioner roles interact, and how processes need to adapt in specific settings.
• Clinical System Design is about populating the CIS with documentation, decision support, order entry and improvement support tools to ease best practices.
• Validation is about getting it right. Subject matter experts review how the CIS takes shape to ensure that information flows support workflows.

For more information about how these activities are timed and relate to one another:

• Connect Care Build Activities and Timeline
• February Calendar - Build Activities

Connect Care Build Launch - Telehealth Invitation

As Alberta Health Services (AHS) Connect Care (connect-care.ca) builds momentum, important Direction-Setting work is about to begin in Edmonton. For those who cannot make the opening session, telehealth links are available province-wide (see links).

From February 13 - 15, 2018, AHS healthcare providers and staff from across Alberta gather in Edmonton to start to design the Connect Care Clinical Information System (CIS).  Direction-Setting sessions focus on workflows, which are the series of tasks that take place as patient care is provided. We will be looking at how tasks are accomplished, in what order, and by which care provider, to determine how the CIS can support and improve the way we work. From 09:30 - 11:30 we hold the official launch of Connect Care design and build. AHS leaders, clinicians and teams can view the launch via Telehealth links provided throughout AHS and partner facilities.

• Telehealth Site Instructions
• Direction-Setting 1-pager

What are Connect Care, CIS and Epic to one another?

What is Connect Care Direction-Setting?

Direction-Setting is one of the major activities occurring during design of the Connect Care (CC) Clinical Information System (CIS). Other activities include Groundwork, Validation & Adoption and Clinical System Design.

Where Groundwork helps the Epic team learn about AHS as an organization, Direction Setting explores how AHS does its work and how the CIS will work for AHS. The purpose of Direction-Setting is to prepare for a CIS foundation build that it supports further work, rather than getting in the way. Clinical System Design digs deeper, tuning the CIS to support specific healthcare lines of service.​

• ​Byte: What is Direction-Setting?
• FAQ: Physician Participation in Direction-Setting
• Resources: Direction-Setting​

What is a SME?

​There is a lot of talk about SMEs (Subject Matter Experts) in Connect Care right now. Unfortunately, the timing of this talk may contribute to confusion, since conversations about SMEs and 'Direction-Setting Sessions' are happening at the same time. Some worry that not participating in Direction-Setting equates to not giving direction to Connect Care, and not being recognized for perspectives that Connect Care should accommodate.

In fact, a wide range of contributions are made through diverse design activities across the entire Connect Care journey. Follow the link to learn more about what a SME does, and all the times and places where SMEs do.

• What does a SME do?
• How does a SME contribute?

Important Transformations Beyond our Reach

​Just read an Economist article that nicely summarizes sea-changes in how health data is gathered and used.... all outside the reach of the conventional health care sector. More data accrues in personal devices than in electronic health records, fastest growth is in virtual consults, and micro-medical devices are proliferating. Worth the skim...

• Economist article 

Primary Health Care Program Update

The Alberta Health Services (AHS) Primary Health Care Program (PHC) promotes collaboration of community, practitioners and AHS partners to enhance the healthcare system through sustainable high-performing primary care services. Current attention focuses on medical homes, medical neighborhoods and medical communities.

The PHC vision and strategic efforts are nicely summarized in a February 2018 update, as linked.

• PHC Update
• PHC Contact

Connect Care Town Hall - North Zone

All Alberta Health Services North Zone physicians are encouraged to join a virtual Town Hall hosted by Dr. Hendrik van der Watt, the new Associate Chief Medical Information Officer for the zone. Follow the link for more information about how to join the February 9, 2018, 0715-0745 event. An overview of the initiative will be shared to set the stage for questions and answers.

• Poster
• Videoconference

Epic Ratings High

​Epic Systems Corporation has attained 'best in KLAS' for the 8th year in a row.

KLAS is a Utah Based Health Informatics research company that "helps healthcare providers make informed technology decisions by offering accurate, honest, and impartial vendor performance information." The company has been collecting ratings on healthcare industry software since 1997. There are 9 award categories and Epic placed highest in a number of them and overall.

• News article

Clinician Information Sharing Compact

For Connect Care to achieve its goals, it is essential that health information be appropriately captured, documented, shared, disclosed and used. These are matters of information sharing. They touch the core of health care professionalism and change as clinicians move from siloed paper records to shared digital records.

In order to address the need for new information sharing norms, and to account for professional obligations and legislative imperatives, a Clinical Information Sharing Compact has been developed by AHS in collaboration with healthcare professionals. Its adoption can promote effective information sharing in clinical information systems.

A compact is clear statement of reciprocal expectations and accountabilities between two groups. It is not a legal contract but is a matter of public accountability. Compacts emerge from  collaborative efforts to understand shared interests. They leverage common goals – such as improving care for patients and populations – to discover how stakeholder interests can be best aligned.

• Clinical Information Sharing Approach
• Clinical Information Sharing Compact
• CISA Principles

Precision Health and Connect Care

The Alberta Academic Health Network, linking Alberta Health Services with Alberta's researh institutions, has initiated work on an Alberta Precision Health Strategy. This anticipates powerful new capabilities associated with a fully integrated clinical information system supporting the province-wide Connect Care initiative. There will be entirely new opportunities to learn from how health care works in Alberta... or best 'internal' evidence that can be matched to best 'external' evidence produced by clinical research about the effects of health interventions in other populations. Knowing more about the exact characteristics of persons who react differently to the same treatmetns can help practitioners craft care plans that more precisely arrest disease processes while rallying patients' own disease defences. The Connect Care team will collaborate with Precision Health Alberta to make the most of in-system analytics and clinical inquiry supports.

• More Information
• precisionhealth@aahn.ca​

Ottawa Healthcare Facilities Adopt Information Integration Strategy

A number of Ottawa facilities, including the regional pediatric hospital, community hospitals and academic health centres, gather in a growing 'cluster' sharing a common clinical information system. This expands adoption of Epic Systems in Eastern Ontario where costs are shared working from a common build. Patients benefit when multiple providers and facilities work from a shared record.

Connect Care has already built liaison bridges to Ontario groups on or adopting Epic-enabled integrated health systems. A Canadian user group is formed and will seek opportunities to further extend collaboration and sharing of evidence-informed content.

• Canadian Healthcare Technology

Apple Announces Mobile Health Records Application

Apple's next release of its 'iOS' operating system for mobility (iPhone, iPad)​ is now in beta testing. A new feature, called 'Health Records' extends many incremental developments (HealthKit, ResearchKit, CareKit, Activity App, Health App) to pull everything together in a personally managed health record. More importantly, this is standards-based 'Health Record' app adheres to the HL-7 FHIR standard, allowing incorporation of content gathered from full digital health record run by healthcare organizations.

Of relevance to Connect Care, the soon-to-be-released app works with Epicare and will release ready to interface with clients like Johns Hopkins Medicine. In any case, Apple's foray into personal health records is sure to stir things up!

• HealthITNews
• CNBC News

Clinical Telehealth becomes Virtual Health Services

​The Alberta Health Service (AHS) Clinical Telehealth program is newly reorganized as "Virtual Health Services" (VHS) under the dyad leadership of Dr. Jonathan Choy (medical) and Catherine Keenan (operational), with oversight through the Chief Medical Office portfolio.

VHS is responsible for the introduction, adoption, promotion and monitoring of processes and technology enabling high quality and effective patient care anywhere. Services include traditional video conferencing, as well as electronic consultations, store and forward, secure messaging and remote patient monitoring. The vision for VHS is closely coupled with that for Connect Care and will leverage the many tools and processes afforded by a fully integrated digital health record.

A new, Connect Care aware, VHS strategy is in the works. Interested stakeholders are encouraged to assist with direction setting. Contact Jonathan (jonathan.choy@ahs.ca) or Catherine (catherine.keenan@ahs.ca) for more information.

Epic Announces Option for Small Practices and Facilities

First described at the 2017 Epic User Group meeting attended by some of our physician leads, Epic has formally announced 'Sonnet', a stripped down variant of its digital health record software optimized for small hospitals, clinics and physician practices. It's workflows are streamlined and standardized, coupled with a quick-install methodology and ready-to-use designs.

In is uncertain how long before this kind of offering might become available in Canada. Sonnet could bring affordable options to smaller practices wanting to connect with fully integrated clinical information systems.

• HealthcareITNews

Epicare 2017 Software now in-Province for further Development

​We are thrilled to learn that all 6 non-production Epic 2017 environments are now installed and functioning in Alberta in support of Connect Care! This is a key milestone, timed exactly right (and on time), as we prepare clinicians and support staff for intense direction-setting and design activities over the next months.

The foundation build will be upgraded to Epic's 2018 software in March. This will be the environment that most trainees, designers, deveopers and testers work with. Important clinical repository interfacing can now proceed with key databases and codesets up and running.

Connect care has the first elements of its technology foundation!

Connect Care Physician Information Resources

As Connect Care ramps up and speeds up, communications increase exponentially. It can be difficult for stakeholders to track what affects them the most. The AHS CMIO will continue to advocate for clinician interests and will work with physician and other practitioner groups to customize and optimize communication strategies.

For now, general Connect Care information is readily available via an open public website (see links). Focused project information is available to Connect Care participants via an internal AHS website and comprehensive Connect Care activity supports are managed via an internal SharePoint site (see links).

Physician users of Connect Care services can also access a Connect Care Physician Handbook. This handbook provides guides and tips, largely prepared by clinicians for clinicians. The Handbook is intended as a form of peer-to-peer mentoring and support. It can be accessed directly with its web link or as part of the Clinical Improvement Collaboratory.

If you believe you should be able to access one of these sites, but are unable to do so, please contact cmio@ahs.ca.

• Connect Care External website: connect-care.ca
• Connect Care Internal website: ahs-cis.ca/insite
• Connect Care Internal SharePoint: ahs-cis.ca/sharepoint
• Connect Care Physician Handbook: handbook.ahs-cis.ca
• Clinical Improvement Collaboratory: clinicalimprovement.ca

US Regulatory Agency Rules on Use of Clinical Text Messaging

​The Centers for Medicare and Medicaid Services (CMS) in the United States may have brought some clarity to whether text messaging can be used to communicate clinical information supporting health care. CMS has confirmed that in order to be compliant with conditions for reimbursement coverage, providers must use messaging systems that are secure, encrypted and maintained for privacy and confidentiality protections. Messaging integral to a Clinical Information System would comply. Separate non-integrated systems must meet discrete security standards. This reinforces our commitment to enable unified and integrated secure clinical messaging as an integral part of the Connect Care ecosystem.

• HealthCareITNews article: li.ahs-cmio.ca/20180108a

New Connect Care Physician Design Lead

​Dr. Alan Sobey joins Connect Care as its new Physician Design Lead. Dr. Sobey brings over 20 years of experience to the role, highly regarded as a surgeon and intensivist. He received his MD from the University of Alberta and will soon complete his Masters of Science in Health Information Science at the University of Victoria. In addition to his Design Lead role, Dr. Sobey will continue contributions as a Clinical Knowledge Lead, and remains clinically grounded in the Department of Critical Care at the University of Alberta. Dr. Sobey is the proud father of three and grandfather of two. He loves to cook, read, cycle and swim and has started to play the guitar (no tours in the offing!).

• CMIO Physician Leads: ahs-cmio.ca/contacts

Alberta Clinical Trials Registry Online

Alberta’s universities, working with Alberta Health Services and the Northern Alberta Clinical Trials and Research Centre, now support an online database of clinical trials registered or active in Alberta. “Be The Cure” intends value for patients seeking information about possible new treatments, and for researchers planning new studies or recruiting for ongoing studies. Follow the link for more information. The link has also been added to the Clinical Improvement Collaboratory (clinicalimprovement.ca).​

• More info:
  BeTheCure.ca
• Trial registry:
  bethecure.ca/find-a-clinical-trial

Connect Care - Giving Direction

For clinical improvement to follow Connect Care (CC) implementation, it is vitally important that physicians integrate new informational tools into daily workflows in a meaningful way. For this to happen, they must also be directly involved in decisions about how the CC Clinical Information System (CIS) is designed and configured. A system adapted to Alberta’s front-line opportunities and constraints has the best chance of success.

A key first opportunity for input comes during “Direction-Setting” sessions scheduled for early 2018. These tap into clinician perspectives to guide basic choices about how common workflows will be supported by Connect Care. Physicians participating in Direction-Setting will:

• review groundwork information about common workflows and practices;
• guide translation of optimized processes into Connect Care workflows;
• ensure that proposed workflows align with AHS goals and policies.

We need your help! Please check out the FAQ link: 

• handbook.ahs-cis.ca/?=12780

Recognizing AHS Secure Emails

The AHS Connect Care initiative will support unified clinical communications, all securely integrated with the legal record of care. Until Connect Care is deployed, Alberta Health services (AHS) provides health care providers with the opportunity to transmit clinical information via secure email, including encrypted email to external addresses. This is enbled with an add-on to AHS Microsoft Exchange email services. Clinicians receiving encrypted emails sent to non-AHS email addresses may not recognize the source or type of communication; and might rightly suspect a phishing or hacking attempt. Emails from an AHS address that contain “You have received an email message secured by Private Post” in the body, and bear an “Encrypted_Message.htm” attachment, are okay to open and review.​

Clinical Secure Messaging:
stq.ahs-cis.ca/?=12153

AHS Secure Email Guide:handbook.ahs-cis.ca/?=12164

What do Clinicians want from Connect Care?

The Alberta Health Services (AHS) Connect Care initiative aspires to improved health outcomes through use of a one-person-one-record-one-system support for clinical improvement. For improvement to follow implementation, it is vitally important that pCIS users integrate new informational supports into daily workflows in a meaningful way. And that requires meaningful engagement.

Engagement is facilitated when stakeholders understand the purpose of Connect Care, what it means for patients, what benefits users can expect, and how AHS can collaborate with users to promote benefits and avoid harms. The mission, values, goals and core principles of the initiative must make sense, be easily understand, and be compelling.

Users must also be highly motivated. They must be able to see, in a very practical way, how Connect Care will help them to do their work. These are matters of detail, often intimate, and inseparable from the messiness of frontline practice.

So, what do clinicians want from Connect Care? We have summarized impressions gained from interviews, meetings and focus. Follow the link to learn how users prioritize matters of convenience, connection, adaptation, integration and agency.

• Consultation summary:
  handbook.ahs-cmio.ca/?=12722

Connect Care Technology Partner Confirmed

Alberta Health Services and Epic Systems Corporation have finalized and signed a contract engaging Epic as the technology partner for AHS’s Connect Care initiative. Effective the beginning of October, 2017, this clears the final hurdle to embarking on a transformative journey that will integrate health information systems across all AHS lines of service and the continuum of care.

Work begins in earnest to align AHS preparations with Epic’s approach for bringing large complex projects like Connect Care to successful implementation.

• Journal Article:
  li.ahs-cmio.ca/20171005a

• eMessenger Article:
  li.ahs-cmio.ca/20171005b

• AHS CEO Announcement:
  li.ahs-cmio.ca/20171005d

Meeting Less, Doing More

Among many preparations for the formal kick-off to Alberta Health Services’ (AHS) Provincial Clinical Information System (CIS) has been establishing effective governance and oversight. New committees are struck, terms of reference are approved, meetings are scheduled and day timers filled. The need to rationalize old and new structures is the subject an upcoming governance workshop that will try to resolve issues of overlap and accountability.

Emergence of a systematic approach to formal governance matters to Connect Care stakeholders. We also need, and are working on, an approach to informal channels of influence, oversight and accountability; including User Group coordination and collaboration.

Is this our opportunity for a re-think? A recent Guardian editorial (see link) summarizes evidence that typical organizational meetings accomplish little, kill productivity and are even a health hazard. We can’t escape meetings, but maybe we can moderate their quantity and maximize their quality.

• Guardian editorial:
  li.ahs-cmio.ca/meetings
• Feedback/suggestions:
  cmio@ahs.ca