2022-01-14

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:

2022-01-13

Connect Care Clinical Documentation Deficiency Notices

Prior to Connect Care, clinical charting deficiencies were tracked and enforced through processes managed by Alberta Health Services (AHS) Health Information Management and zone Medical Affairs, with a focus on key summative documents required for all inpatient encounters. 

Minimum charting expectations are reinforced for Connect Care users through In Basket reminder messages that reflect Clinical Documentation Norms and Required Documentation. The reminders flag missing or incomplete History & Physical, Discharge, Operative or Emergency Provider notes, along with tools for rapidly addressing or redirecting deficiencies.

Starting mid-January 2022, Connect Care charting deficiency reports are additionally received and acted upon by zone Medical Affairs to ensure compliance with AHS Medical Staff Bylaws & Rules. Privilege curtailment warnings are addressed by each zone’s Medical Affairs office.

As charting deficiency reports include items dating back to the first Connect Care launch, many deficiencies may have accrued for users who have not attended to chart completion In Basket reminders. Prescribers can review and act on Connect Care charting deficiencies via the In Basket chart messages folder. 

2022-01-11

Connect Care Launch 4 Countdown

Our countdown timer has re-appeared again (see top of left column, just above the Search box)!

The Connect Care Launch 4 date is set for the early hours of Saturday, May 28, 2022. This wave will bring many sites into the Connect Care fold, including the following:
  • Calgary Zone: Alberta Children’s Hospital, Peter Lougheed Centre, Southern Alberta Forensic Psychiatric Centre (and associated forensic services), rural acute and combined acute and long-term care sites, Calgary Tuberculosis Clinic, Southern Alberta Clinic 
    • Urgent care: Sheldon M. Chumir Health Centre, South Calgary Health Centre, Airdrie, Okotoks, Cochrane
    • Addiction and Mental Health (AMH): Southern Alberta Forensic Psychiatric Centre (and associated forensic services), AMH urgent care centres, AMH rural and select urban ambulatory clinics
  • Edmonton Zone: Glenrose Rehabilitation Hospital, Lois Hole Hospital for Women, Royal Alexandra Hospital, AMH addiction/residential programs
  • Pharmacy and diagnostic imaging: Sites in Edmonton, Calgary including Central Production Pharmacy
  • Alberta Precision Laboratories: Sites in Edmonton including Glenrose Rehabilitation Hospital, Royal Alexandra Hospital, Grey Nuns Hospital (launching May 14), Misericordia Community Hospital (launching May 14)
We are within 150 days from Launch 4.

Having learned how important it is to avoid a last minute rush, our Countdown Checklist (checklist.connect-care.ca) will restart around 100 days prior to Launch 4. This checklist allows prescribers to ensure that requirements are met as they progress from registration through training, proficiency, personalization and launch-readiness. 

2022-01-10

Connect Care Launch 4 - Date Change

Given significantly increasing demands in Alberta Health Services facilities due to COVID-19, and the rapidly spreading Omicron variant, the date for Connect Care Launch 4 is adjusted. This will ensure that frontline and support teams have the time they need to prepare. 

Launch 4 will now take place May 28, 2022. Prescriber training will proceed as previously scheduled. 
  
Healthcare teams and patients come first in every decision AHS makes. As with previous periods of pandemic pressure, many of those who require training or who are involved in site preparations for Connect Care are redeployed to acute care areas, or to backfill positions for those who have been asked to support COVID-19 care. 

Once again, we want to emphasize that Connect Care is not being cancelled. It continues as one of AHS’ highest organizational priorities. Making these changes means we can allocate resources effectively while being respectful of the demands on our staff as they continue to protect the people of this province.

We acknowledge the disruptions this decision may cause, particularly for prescribers who may have made alternate clinical arrangements to support Launch 4.

2021-12-21

All User Bulletin - Connect Care Training and Play Environments Down

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

Connect Care Non-Production System Not Available

There is currently an unplanned outage of the Connect Care User Training (ACE) and Play (PLY) environments, which are used for independent learning and post-training practice. The Connect Care Technical Team is working on the issue, and we will update this notice when the system is fixed.

Update (2021-12-21, 11:25): Some ACE and PLY environments (ACE 11-18, PLY2) are now back online and are operating as expected. The remainder of the environments will be brought up online and worked on operationally throughout the day.

2021-12-08

Netcare Scheduled Outage - Thursday December 9, 2021, 21:00-03:00 Friday December 10, 2021

Alberta Netcare Portal will be unavailable Thursday, December 9, 2021 from 21:00 to 03:00 Friday, December 10, 2021. Connect Care will not be able to launch Netcare during this time. 

Users who are logged in during this time will be disconnected and will need to re-authenticate following the outage period. 

If urgent access to results is anticipated during these periods, please refer to and complete the ANP Downtime Contingency Kit in advance of the maintenance. 

For any questions or concerns, AHS employees please contact 1-877-311-4300, while Community Alberta Netcare users (outside AHS) can contact the Provincial Helpdesk at 1-877-931-1638.

2021-12-07

COVID-19 and Connect Care - Vaccine Orderset Adjustments

We've previously posted about updates to COVID-19 vaccination orders in Connect Care, reflecting things like changes in eligible populations, dosing intervals and boosters.

Further tweaks to these order sets, now in production, address the needs of newly eligible pediatric populations.

2021-12-02

Prescriber Feedback: Survey on COVID-19–Related Terms in Connect Care

Prescribers providing direct care to COVID-19 patients are requested to participate in a voluntary survey to indicate the COVID-19related terms that should remain active for Visit and Problem List diagnoses in Connect Care. This survey is open to both Connect Care and non-Connect Care users.

There are approximately 160 COVID-19related terms for prescriber search and selection of Visit and Problem List diagnoses in Connect Care. A limited clinical review was recently completed under the direction of the Connect Care COVID-19 Working Group to reduce the number of front-facing COVID-19related terms available to essential terms only. As a result of this review, the terms were grouped into two categories:

  1. Essential: Essential terms active in Connect Care for prescribers.
  2. Further clinical review: Terms requiring clinical review to determine if they should remain active in Connect Care.

Survey responses will be used to determine which of the terms in the "Further clinical review" category will remain active in Connect Care. The terms in the "Essential" category are viewable in the survey for reference only. Terms not selected will be removed from display for all prescribers. Changes will not be retroactive.

The survey is voluntary and takes about 8 to 10 minutes to complete. It will be open until end of day on Sunday, December 12, 2021. If additional terms are required or you have any questions, please contact clinicalterminologies@ahs.ca.

2021-11-04

Prescriber Feedback: Use of Comments Within Laboratory Test Orders

The Connect Care laboratory medicine group seeks feedback about whether and why prescribers might use an available "comments" field when entering orders for laboratory tests in the Connect Care clinical information system. The following survey (closing November 11, 2021) can be used by any prescriber who enters orders for tests:

Survey feedback information will used to help optimize the design and use of order comments.  

2021-11-03

Connect Care Waves 4 and 5 - Updated Launch Timelines

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


In September 2021, we made the difficult decision to delay the planned launch of Connect Care’s Wave 4 and subsequent waves, in order to support patients and healthcare teams as we faced an overwhelming wave four of the pandemic in Alberta. We thank all of you for your patience over this period of time, for your ongoing work to keep preparing for Connect Care, where it was possible, and for being redeployed into areas which desperately needed your help. 
 
Despite this recent delay, Connect Care remains an organizational priority. We promised we would update you with new timelines for launches as soon as we could. We feel we can now revisit Connect Care planning given there has been some reduction of pressure on the health system. Over the past weeks, Connect Care leaders collaborated with zone, provincial and executive leadership to determine our best path forward for the remaining six launches of Connect Care. 
 
The new plans for Connect Care have shifted the existing sequencing and scope for each wave six months into the future. This has extended the overall timelines for Connect Care, which will now be complete in 2024; however, the content of each wave remains the same. The next two waves are outlined below.
 
Wave 4: May 14, 2022

With 57 sites in the Edmonton and Calgary Zones, Wave 4 will be our biggest launch to date. It includes:
  • Calgary Zone
    • Alberta Children’s Hospital, Peter Lougheed Centre, Southern Alberta Forensic Psychiatric Centre (and associated forensic services), Calgary Correctional Centre, Calgary Tuberculosis Clinic
    • Urgent Care Centres: Sheldon M. Chumir Health Centre, South Calgary Health Centre, Airdrie, Okotoks and Cochrane, including Addictions and Mental Health Urgent Care sites and rural ambulatory clinics
    • Calgary Zone rural and acute care combined sites, including Airdrie Community Health Centre and Provincial Building, Banff Community Health Centre, Mineral Springs Hospital (Banff), Canmore General Hospital, Claresholm General Hospital, Willow Creek Continuing Care Centre (Claresholm), Chestermere Health Centre, Cochrane Community Health Centre, Didsbury District Health Services, High River General Hospital, Lake Louise Medical Clinic, Nanton Community Health Centre, Oilfields General Hospital (Black Diamond), Okotoks Health and Wellness Centre, Strathmore District Health Centre, Vulcan Community Hospital  
  • Edmonton Zone: Glenrose Rehabilitation Hospital, Lois Hole Hospital for Women, Royal Alexandra Hospital, Addictions and Mental Health Addictions and Residential programs
  • Pharmacy and Diagnostic Imaging: Sites in Calgary and Edmonton, including Central Production Pharmacy
  • Alberta Precision Labs: Alberta Children’s Hospital Genetics Services South Lab, Edmonton, including Glenrose Rehabilitation Hospital, Royal Alexandra Hospital, Grey Nuns Hospital and Misericordia Community Hospital
Wave 5: November 6, 2022
  • Calgary Zone: Foothills Medical Centre (including associated clinics at Richmond Road Diagnostic and Treatment Centre)
  • Central Zone: Acute and combined acute and long-term care sites from the former David Thompson Health Region, including the Centennial Centre for Mental Health and Brain Injury, Sylvan Lake Advanced Ambulatory Care Service, Addictions and Mental Health services in the former David Thompson Health Region, Continuing Care (intake and transition services)
  • North Zone: Addictions and Mental Health ambulatory sites from the former Peace County Health Region, Fort Vermillion, High Level, La Crete, Paddle Prairie and Rainbow Lake
  • Provincial Programs: CancerCare Alberta North and South, Kidney Care South
  • Pharmacy and Diagnostic Imaging: Sites in Calgary and the former David Thompson Health Region
  • Alberta Precision Labs: Sites in the former David Thompson Health Region
For more details on launch sequencing, please visit Insite.
 
As we move forward, Connect Care teams will be working with site and zone operational leaders to schedule required training in early to late November. The training will commence in January 2022. 
 
Connect Care team members redeployed to support the pandemic response will be released from those roles as capacity and demand decreases across the organization. We expect these team members will be returned to their Connect Care roles no later than the beginning of January.  
 
We are thankful for all the work done to prepare us for these next launches by teams across the organization. Your work has set us up for success as we move forward.  
 
We also want to thank you for your patience as we altered our plans to address the urgent needs of Albertans and the healthcare system. 
 
We look forward to these upcoming launches and continuing to improve the care we provide to Albertans through Connect Care. 

2021-10-30

COVID-19 and Connect Care - Hospital Co-vaccinations

The flu season is soon upon us, with opportunistic immunization important for at-risk patients during hospitalizations.

Previously, the COVID-19 vaccination instructions and documentation suggested that COVID-19 immunization not be considered within 14 days of any other immunization event. The evidence, and guidance, is now clear that co-vaccinations are both safe and appropriate. The Connect Care order set and associated clinician documentation reflects this change.

2021-10-29

COVID-19 and Connect Care - Documenting Historical Vaccinations

We've previously posted about how to review COVID-19 immunization information in Netcare and Connect Care and how, if indicated, to add information about an otherwise undocumented vaccination as a historical immunization when patients present with formal documentation of non-Alberta immunizations.

Recent audits have uncovered some inappropriate (even fraudulent) instances of what appear to be formal external documents. Alberta's provincial COVID-19 vaccination validation service is resourced to assess and validate external vaccine documents. It is easily accessed and used by patients online.

Connect Care providers should direct patients to submit their external documents for approval and possible addition to the provincial registry, and should avoid manual entry of historical COVID-19 vaccine administrations into Connect Care. The provincial registry information is automatically copied into Connect Care when validated.

2021-10-25

Therapy Plan Resources

A series of webinars on therapy plans, to be hosted by the CMIO portfolio, had previously been advertised as occurring this fall. With the delay of Wave 4, these supplementary sessions will be deferred to a later date and rescheduled after a launch date is confirmed. 

The rescheduled webinars will explain how therapy plans work, how they are used and how prior paper-based plans can be converted in readiness for launch. All Connect Care prescribers are welcome, as many may benefit from a refresher on ordering ongoing therapies. 

Watch this space for information on the rescheduled webinars. In the meantime, users can access existing therapy plan resources:

2021-10-11

BBHR: Charting Efficiencies - Sidebar Aids for Transition Planning

Building a Better Health Record (BBHR)
Charting Efficiencies - Sidebar Aids for Transition Planning

Improvements to the Hyperspace inpatient chart Sidebar include aids for quickly finding, displaying and editing information in either the main (central), Sidebar (right) or pop-up chart spaces. The first set of tools appear by default when the inpatient Sidebar opens to its "Index & checklists" view. These nicely illustrate how the Sidebar can help users quickly access and update chart data that otherwise would require more familiarity with less-used parts of the chart.

The focus of the checklists view is on transition planning, whether that relates to discharge, transfer or a move to a different level of care. 

  1. If not already displayed, select the top-left "Index & checklists" link to display the "Checklists" and "Transition Planning" Sidebar tools.
  2. Daily, Admission and Discharge Checklists are presented. These function like task managers, reflecting important unfinished tasks and changing to completion status when the relevant work is done. The few highlighted tasks closely match Connect Care minimum use norms.
  3. Checklist items are "active". When selected, the user is taken to a relevant documentation or ordering tool directly relevant to the listed task.
  4. The Transition Planning section summarizes relevant information, including expected transition and discharge dates, social supports, community care needs and patient goals. Where information is missing or incomplete, the title or bracketing text appears in a (dark) blue font, indicating that it can be selected to activate data entry tools in-context where the associated information can be updated. Use the Sidebar "refresh" icon (top left of Sidebar) to update the display if this does not happen automatically.

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.