2022-07-29

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:

Unique Workflows During Interim States

Connect Care is a fully integrated clinical information system. Nonetheless, it may depend upon other health information systems for core data while implementation progresses, launch-by-launch, across Alberta. 

Interim states occur when Connect Care interoperates with an external health information system (e.g., laboratory services, pharmacy services) that will be replaced by Connect Care functionality later. The (temporary) dependency may require workflows different from where Connect Care is fully deployed.

Considerations for prescribers are now linked in the Connect Care Clinician Manual:

2022-07-28

Connect Care Summative Documents - Mindful Signing

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

Mindful Signing of Summative Documents

Connect Care automatically shares key summative documents with the Alberta Netcare Portal electronic health record and with eDelivery-compatible electronic medical records (EMRs).

Automated sharing is triggered when an eligible note is signed (co-signed in the case of student-authored notes). If the same note is later edited and re-signed, a new copy is distributed to external systems. This can create a lot of work for providers using external EMRs. It is especially disruptive for community practices to sort through multiple copies of shared documents to determine which is definitive and what has changed. 

Summative document contributors should “pend” or “share” their work, saving "signing" for the most responsible prescriber after all reviews are complete. A document should be signed just once; and so shared just once.

2022-07-27

Connect Care to Netcare: Summative Document Sharing Update

Summative documents are high-value clinical notes that organize observations and offer goal-directed assessments and plans. Included are admission history and physicals, discharge summaries, consultation reports (inpatient and outpatient), operative reports, transfer summaries and emergency provider notes. 

Connect Care inpatient summative documents are automatically copied to the Netcare electronic health record, as well as compatible external electronic medical records via eDelivery. Outpatient communications are also copied to external systems if the author selects a Netcare-destined document template. 

Progress documents (which depend upon the rest of the chart for context) are not automatically shared with external systems.

A few best practices can help reduce incoming document management burdens for receiving providers:

2022-07-11

All User Bulletin: ED Provider Note Not Auto-copied to Author EMRs

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

ED Provider Notes No Longer Automatically Copied to External EMR of Authoring Providers

Connect Care prescribers may provide services where Connect Care is the record of care, and additionally provide follow-up services where a community electronic medical record (EMR) is the record of care. Physicians working in emergency departments, for example, may find themselves subject to "mixed-context" workflows. When these prescribers author summative documentation in Connect Care, copies are sent to their external EMR if it supports this type of eDelivery

Emergency Department Provider Notes are an exception. These are no longer copied to compatible external EMRs of authoring prescribers. Mixed-context prescribers who use these reports as part of externally managed (non-Connect Care) billing workflows can adopt other strategies for tracking billable ED events, as described in the following bulletin:

2022-07-05

All User Bulletin - Update: Ultrasound Reports for Referring Providers

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

Ultrasound Reports for Referring Providers via Astraia

[This post originally appeared in June, with subsequent updates indicated with strikeout and dark red font below.]

Astraia, a third-party specialized perinatal documentation system that is used in conjunction with Connect Care to provide comprehensive Maternal Fetal Medicine (MFM) assessment and consultation, provides highly specialized, in-depth MFM ultrasound reporting. Astraia generates detailed ultrasound reports for referring healthcare providers; these reports are available in Connect Care in text-only and full PDF versions:

  • Text-only: The text portion of the ultrasound report contains the consulting MFM physician’s summary, recommendations but does NOT contain the specific ultrasound measurements, anatomical assessments and graphs which includes fetal and maternal assessments. Currently the text-only report does not provide all fetal measurements and assessments. Critical results will be communicated to referring providers via a telephone call and facsimile of the full report. The text-only portion is displayed in Connect Care, and is also faxed to the referring healthcare provider. 
  • Full report: The complete report that includes specific ultrasound measurements, anatomical assessments and graphs is available as a PDF. Referring providers can find the PDF in the Chart Review activity:
    • Click the "Imaging" section. Select the target ultrasound, scroll down below the text to the section entitled "Order-Level Documents", and click on the hyperlink. 
    • Tip: To move the "Order-Level Documents" section to the top of your viewing screen, use the wrench tools on the top-right corner of the report window and drag this section to the top of the list.
                               
    • Note: The complete report PDF can also be found in Netcare (click the diagnostic imaging section and find the target ultrasound report by date).

As of June 7, 2022, all text-only reports issued by Connect Care will contain the following statement to direct healthcare providers to the full PDF report:

This is the text portion (Consultation) of the Maternal Fetal Medicine ultrasound report. At the present time, Connect Care, Millennium, SCM and Impax are unable to accept the graphics portion of the report. For the entire report including graphs, please view this ultrasound report through the Alberta Netcare Portal (for access go to http://www.albertanetcare.ca/) or view through Connect Care by clicking on the Order-Level Documents PDF link found in the section below the imaging text result.”  

2022-06-27

Care Path Launch – Heart Failure and COPD

The Heart Failure and Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) Care Paths will launch in Connect Care on July 11, 2022. 

Who is the Care Path for?

Any patient admitted to hospital with a principal diagnosis of Heart Failure or COPD. While a patient can be placed on a Care Path at any point during the hospital stay, it is recommended to begin the Care Path on admission.

What is a Care Path and why use it?

    A Care Path is an advanced clinical decision support tool in Connect Care which summarizes relevant patient information, incorporates evidence, and builds multidisciplinary care into a single workflow path based on the patient’s primary diagnosis. Advantages include:
    • Automatically integrates evidence into care – Care Paths help providers to see summaries of diagnosis-specific care evidence in context of a patient’s relevant health information, enabling personalization of care decisions to optimize quality and safety of care.
    • Improves efficiency by summarizing relevant information – The Care Path Summary page consolidates patient information specific to the primary diagnosis into one view with quick links to relevant assessments, labs, vitals, medications, rapid rounds, expected date of discharge (EDD), and problem-oriented charting.
    • Provides specific guidance for phases of care – Care Paths includes imbedded Order Sets for hospital admission, as well as workflows to support managing day-to-day hospital care. Care paths also help to guide coordinated transitions between acute, primary and community-based care.
    Is there evidence to support Care Path use?
      Yes! The use of standard order sets and clinical pathways have been associated with improved patient outcomes including decreased length of stay, reduced hospital readmission rates, improved adherence to evidence, reduced healthcare costs, and even substantially reduced patient mortality. 

      What do you need to do?

      Care Paths are launching on July 11, 2022. Prior to that date, please watch the training video(s) below in My Learning Link (MLL). Benefits: learn how to use Care Paths efficiently to save time, and earn CME credits!

      • Unaccredited summary course: EPIC - Care Paths - Prescribers (20 min)
        • Note: This course is also inserted into the accredited modules listed below. 

      or 

      • Accredited course (Care Path-specific):
        • Heart Failure Disease Care Path Integration: Evidenced-Based Guideline Recommended Best Care 
          • RCPSC MOC 3 – SAP 1.5 hrs 
          • CFPC Mainpro+ 3-credits-per-hour for 1.5 hrs (4.5 credits)
        • Acute Exacerbation of Chronic Obstructive Pulmonary Disease Care Path Integration - Evidenced-Based Guideline Recommended Best Care 
          • RCPSC MOC 3 – SAP 1.0 hr 
          • CFPC Mainpro+ 3-credits-per-hour for 1.0 hr (3.0 credits) 

      For more information, see the updated Care Paths section of the Manual.

      2022-06-16

      Death Certification Still a Paper Process

      While it is great to see so many Connect Care users enjoying digital documentation -- and release from fussy forms -- there are some tasks that can only be completed on paper.

      One of these is death certification.

      The Province of Alberta is working on, but does not yet support, digital death certification. At this time, responsible physicians must complete a formal (paper) death certificate in the event of a patient death. These can be found at Emergency or Nursing Station forms stores. They can also be obtained from the facility admitting department and must be returned to medical records before a body can be released.

      2022-06-13

      Dictated Textual Radiology Results Issue - Resolved

      On the afternoon of Sunday June 12, 2022, there was an issue preventing flow of newly dictated textual radiology results to Connect Care. During this time, critical results were reported verbally. The flow of results was disrupted for approximately three hours, from 12:47 until 15:48, and was in effect province-wide. The issue is now resolved, and all textual results have been posted to Connect Care. There is no further action required at this time. 

      2022-06-10

      Connect Care Launch 4 - Electronic Documents and Results Delivery to Community Providers

      AHS uses a system called "eDelivery" to electronically deliver patient information to providers and physicians at their private community practices. With Connect Care Launch 4, there have been changes to the information distributed to providers. Providers who work at AHS facilities using Connect Care as well as at private clinics/offices in the community will want to understand these changes. 

      These changes affect the six types of Connect Care summative notes as well as results for lab, diagnostic imaging (DI) and other investigations. A memo summarizes the changes for the delivery of this information from Connect Care to community providers; the key messages are:

      • All providers will receive copies of summative notes in their external electronic medical record (EMR) when they are identified as the Primary Care Provider (PCP) for a patient; sometimes you may receive information for a patient not associated with you or your clinic – you can follow up with AHS to remediate this situation. 
      • Authoring providers in Connect Care will receive copies of summative notes they author at AHS facilities in their external EMR. 
      • Mixed-context providers (working in AHS facilities as well as at private clinics/offices in the community) may receive some community DI reports twice (in their Connect Care In Basket as well as at their non-AHS locations).
        • Additional information specific to DI report delivery for mixed-context providers is available in an earlier memo.
      • All summative notes and results are available in Netcare.

      For more information, please review the full memo:

      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:

      2022-05-31

      Launch 4 Progress - A Great Start!

      Connect Care Launch 4 continues to progress well after a remarkably smooth weekend. 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 prescriber 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 Hot Topics

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

      Renewed thanks to all Launch 4 teams for their incredible work and resourcefulness through the launch period!

      2022-05-28

      Launch 4: We are GO!

      All Connect Care systems activated on time at 05:00! 

      Today, Connect Care welcomes 57 Edmonton and Calgary sites into the family. The first few days will be intense, but with lots of help at hand we are confident that progress will be fast. 

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

      A message to Connect Care Launch 4 teams from Interim President and CEO Mauro Chies:


      The Alberta Medical Association (AMA) published a letter from the President advocating for physician and patient interests during the Launch 4 Connect Care rollout:


      2022-05-26

      Connect Care Submit Help Ticket Button

      We previously posted about a new path to Connect Care Help Desk Ticket submissions, directly from within Connect Care. A "Connect Care - Submit Help Ticket" button has now been added to the top of the screen, making the link easy to access (click on below icon to view screenshot). The link can also still be found via the main menu (Help subsection), chart search, and the universal learning home dashboard (F1 key).

      This button should be used to report non-urgent problems or suggestions about Connect Care. Once the button is clicked on, a form will pop-up for the user to fill in details while still in Connect Care. The ticket created from this form will then automatically be routed to the relevant support team.

      2022-05-24

      Removal of Outdated eCLINICIAN Medication-checks from Connect Care

      Most clinicians have noticed "Medications from outside sources..." alerts in Connect Care charts (click below icon to view screenshot).


      These prod the user to open the "Reconcile Outside Information" activity and either import or delete information from an external health information system. Judging by the large numbers of unmanaged alerts, it appears that most users do not find them helpful. 

      A review of the reconcile outside medication prompts reveals that they relate to imports from the eCLINICIAN outpatient health record, which was replaced by Connect Care in 2019. Years have passed, the information is old and the prompts have little remaining value. 

      As part of ongoing efforts to minimize unnecessary alerts, all unreconciled eCLINICIAN medication triggers older than 2 years will be archived; thus removing distracting prompts. 

      Other potentially high-value information continues to flow from active external systems (e.g., allergies and adverse reactions). These may prompt clinicians to consider incorporating any new information into Connect Care charts.

      2022-04-21

      Toronto University Health Network Joins the Club

      The University Health Network in Toronto is about to go live with its "Synapse" implementation of Epic Systems' digital health record. This brings a number of additional hospitals, including the Toronto General Hospital, Toronto Western Hospital, Princess Margaret Hospital and others, into the Canadian Epic community. More opportunity to share and learn!

      2022-04-07

      New Path to Connect Care Help Ticket Submissions

      The Connect Care Concierge (help.connect-care.ca) service connects users with resources so that problems can be addressed efficiently. Sometimes, issue reports or requests involve submitting a "Help Desk Ticket" via the Concierge website.

      A new enhancement facilitates streamlined ticket submissions directly from within Connect Care. The embedded process spares users entering some details (Connect Care passes the information to the ticketing system automatically) while making it easier to simultaneously submit screen shots that might illustrate a problem.

      "Connect Care Help Ticket" submissions within Connect Care can be initiated from the main menu (help subsection), chart search and the universal learning home dashboard (F1 key).

      2022-04-03

      Connect Care Provider Portal

      With Connect Care growing in Alberta, physicians not using the Connect Care clinical information system (CIS) wonder about how they can follow their patients where Connect Care is the record of care. 

      A key tool is the Connect Care Provider Portal (CCPP). This connects external providers to the Connect Care CIS, allowing them to request consults, schedule appointments, securely communicate, place orders, and exchange secure messages with colleagues. They can receive notifications about important patient events (e.g., admission, transfer, discharge) and view updates about lab, imaging, test and procedure results. They can also request and follow consultations. The clinical content of the Connect Care health record, including images, care plans, notes, letters and documents can be viewed.

      A portals committee oversees CCPP design and deployment and welcomes input from interested providers.

      2022-04-02

      Updates to Isolation Discontinuation Orders for COVID-19

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

      Discontinuation of Isolation Orders

      Inpatient and emergency 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. 

      Since April 9, 2021, “Discontinue Isolation” orders have had properties that reflect COVID-19 policies. These were updated March 28, 2022, to simplify workflows while providing relevant clinical information within the ordering workflow. 

      The discontinue isolation order is unchanged for most exposures. It is no longer necessary to independently document reasons for discontinuation in COVID-19 contexts. Rather, ordering prescribers are provided with links to the latest discontinuation criteria together with links to information that can help decide if the criteria are met.

      2022-04-01

      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:

      Launch 4 OBIX Perinatal Online Education & Training (P.O.E.T.) Begins April 4

      OBIX Perinatal Interface Software is a provincial bedside solution which automates the delivery of fetal health information from the electronic fetal monitor (EFM) to the electronic health record (EHR) in Connect Care. During Connect Care Launch 4 on May 28, 2022, all Labour and Delivery (L&D) and non-L&D sites that have an EFM and are launching Connect Care will implement OBIX. The implementation of OBIX Perinatal Interface Software allows electronic sharing of the fetal heart rate (FHR) from the EFM to the Connect Care EHR for obstetrical patients, and makes this information available at bedside, on central monitors and via devices at other locations throughout Alberta. As it expands throughout Alberta, the provincial OBIX network supports better outcomes for maternal and newborn patients in Alberta. 

      OBIX training will allow providers to become familiar with the interface. The training is additional to Connect Care launch training, is delivered entirely online, and takes about 30 minutes for physicians, medical learners and nurse practitioners. On April 4, you will receive an email to your AHS email from OBIX Perinatal Online Education and Training (P.O.E.T.) with instructions for how to access your OBIX training. To be prepared for the launch, please complete your training before May 20, 2022. Care can still be provided prior to completing OBIX training by managing the patient in Connect Care and viewing EFM records at the bedside if they are not on the chart.