2019-11-12

Connect Care Mobility Gaining Traction

Connect Care Mobility promotes use of Haiku for smartphones, Canto for iPads, Limerick for Apple Watches and Rover for smartphones. Many clinicians installed mobile apps during personalization workshops and many more will take the opportunity with personalization and optimization sessions to come.

Uptake has been impressive so early post-launch:
  • There are 2,121 physician devices successfully installed and actively used in the first week post launch. 
  • 1792 are smartphones (1431 iPhones and 361 Android) and 329 are iPads. 
  • About 1/5 of all Connect Care connections happen via mobile apps.
This represents enough of an installed base for us to shift more tips and just-in-time training to optimum use of mobile platforms.

2019-11-11

New series in Connect Care Physician Update blogs

It is great to hear Super Users report that questions have shifted from the basics to strategies for improving workflow efficiency.

To help, we've started a couple of new sub-channels within the Connect Care Physician Updates blogs:
  • Tippy (ahs-cis.ca/tippy) - daily fast tips that can quickly adopted with immediate workflow benefits
  • eSafety (ahs-cis.ca/eSafety) - alerts about clinical information system interactions requiring particular attention as we transition from paper to digital records.
Please send suggested content for either series to cmio@ahs.ca.

2019-11-10

Gratitude: Wave One, Week One

From Verna Yiu...

It’s hard to believe it’s already been a week since we launched Connect Care across Wave One.



We would like to thank the thousands of patients, staff, physicians and volunteers who helped welcome Connect Care to Alberta in the early hours of Sunday, November 3. We applaud the work of those at our Wave One sites including the hundreds of outpatient clinics and services across the Edmonton Zone, sites at the Walter C. Mackenzie Campus, the East Edmonton Health Centre, Pharmacy and Diagnostic Imaging sites in the Edmonton Zone, and Alberta Precision Laboratories in Edmonton and the North Zone, including the lab at the Cross Cancer Institute and DynaLIFE lab sites across Alberta.

We also recognize the team efforts of our partners in this launch – Covenant Health, DynaLIFE, Alberta Precision Laboratories, and the many post-secondary institutions who supported training for students. There were many individuals and teams from sites within Edmonton Zone and other zones in the province, who were not part of Wave One, but who supported as super users and in other roles. This help has been invaluable to the success of this launch. Epic, our technology partner, has also been an amazing support to our teams.

With a health system as complex and large as AHS is, we expected some challenges as we embark upon this provincial Connect Care journey. We anticipated there would many issues as we transition – some have been more urgent, while others are not. As issues arise we have a 24/7 command structure, super user teams and technical experts in place to address them and we are working to resolve them quickly.

Putting Connect Care fully in place will take time. Resolution times for issues will vary and we need to expect this. This is change on a massive scale and it won’t be seamless. We are committed to get to where we need to be over the weeks and months ahead. At the same time, we also recognize that overall, the launch has gone very well, especially considering the magnitude of this implementation. We have continued to provide high-quality patient care over this past week, and that is a tribute to AHS staff and physicians, who have worked so collaboratively to move forward.

We are incredibly proud of the collaboration and resilience our teams have demonstrated throughout the launch. We know this is a challenging time for our frontlines and support staff, and we are so inspired by you and your positivity. There is recognition that when Connect Care is fully in place, and teams are confident in using it, it will allow us to provide better patient care to Albertans.

Together, you have done amazing things this week. Thank you for all you are doing.

Sincerely,

Dr. Verna Yiu
AHS President & CEO

2019-11-09

First Week Yum-Yums

Exactly one week ago we were girding ourselves for the Wave 1 launch in the wee hours of the morning.

How much has changed!

We've tackled countless tweaks. Indeed, if nothing else, we've proved an ability to rapidly characterize issues, mobilize resources and get solutions implemented. This is our best reassurane for the waves that will follow... superlative collaborative problem-solving.

It is easy to miss how every well this launch has gone. Walking the wards, one hears positive, grateful and excited feedback. Just a few of the many comments:
  • no more tracking down a paper chart and fighting for access to it
  • all investigation and intervention data is in one place; no longer have to flip back and forth between paper and Netcare
  • learners notes are more coherent, without having to read chicken-scratch
  • lots of ways for attendings to work with the rest of the team, addending notes or when merited adding attending notes
  • routine orders can be entered anywhere, not just on the ward
  • billing is easier
  • dictation is now everywhere, anytime and available to any part of the chart; easy and fast
  • mobility is a game-changer, so much easier to review results from anywhere
  • team coordination and collaboration tools make it much easier to manage specialty groups and keep the work organized
  • morning rapid rounds are transformed, with rapid clarification and correction of team assignments and better sharing of discharge planning
... and many more. It is very encouraging to hear that the advantages of an integrated information system are already obvious to busy clinicians.

We are hearing about efficiency breakthroughs with personalization. Let's cycle back and invest as much as possible into personalization now that launch is behind us and optimization is our new opportunity!

2019-11-08

Surgery Personalization Inservices

Hollie Powers and Marc Shaw (Surgery Super Users) are holding special personalization in-services today, each able to accommodate up to 12 physicians. This offers a great opportunity to learn a bit more about surgery orders management, phases of care, and how to dramatically speed up workflows.

  • Location: 5G1.11
  • Time 1: Friday Nov 8, 2019,  1200-1400
  • Time 2: Saturday Nov 9, 2019, 0900-1100

Unpin from PIN

Alberta's Pharmacy Information Network (PIN) is linked to Connect Care, including an "external information" function and tools for PIN medication reconciliation. It is possible to select medications to import to the Connect Care chart.

Nice idea. Cool feature. Unfortunately, the PIN reconciliation tools are proving more hindrance than help.

First, PIN is not a comprehensive or trustworthy representation of what a patient should be taking. It is a partial record of dispensed, not prescribed, medications.

Second, PIN data is interfaced in a way that does not permit capture of form/route/dose/frequency information. So, "importing" a PIN med still requires manual entry of all this information. Personalizations do not come into play. Common default values are not available. Experience is showing that it takes more time to reconcile PIN medication information than to quickly enter the patients meds using Connect Care order-entry tools.

Finally, the PIN medication information capture workflow is escaping from all of the decision supports built into normal order-entry and so it is not immediately apparent, for example, that one is entering a duplicate.

And, to add inconvenience to inefficiency, PIN seems to struggle with recognition of a patient's existing meds and so re-presents the need to reconcile even after this has been done.

For all these reasons, we have decided to turn off the PIN external medication reconciliation feature; at least for now. We will revisit this functionality when it becomes possible to import all dispensing information, not just the medication name.

A full PIN list remains available in Netcare, which can be displayed in-context from within Connect Care. This allows PIN to be informative, not intrusive.


2019-11-07

Wave 1 Experiences

A message from Verna Yiu...

This week I had the wonderful opportunity to visit the University of Alberta Hospital and Stollery Children’s Hospital to meet with staff, physicians and volunteers, and hear about their early experiences with Connect Care. Wave 1 launched Sunday at 4 a.m. and the response has been remarkable. 


There is so much positivity at the site, even with a very steep learning curve to new work flows and new technology. I saw everyone's steadfast support of patients, families, and each other. I heard about some frustration but, most of all, I heard of teams coming together to solve challenges and move forward. I’m glad many people on my visit were willing to share their experiences with me. I also heard about the steady support people are receiving from our Super Users, as well as from our partners at Epic Systems. You can see the highlights from my visit in this five-minute video.

Phased by Phases?

Sorry about the title... one gets a bit punch(ed) drunk at this stage of a launch!

"Phases of Care" can send chills down the spine of Connect Care newbies. Stumbles with complex workflows often relate to a misstep somewhere along a Phases of Care continuum. Phase discipline is needed from surgeons and non-surgeons alike.

A new section in the Connect Care Physician Manual highlights a few high-value resources that can help physicians respect, but not fear, Phases of Care (a GREAT place to start is the excellent short demo recorded by Darren Hudson):

Physician Drop-in Centre Hours Change

Due to usage patterns, we are adjusting open hours for the Physician Drop-in Centre in WMC 4B1.39. 

Informal peer-to-peer help is available for clinical information system use, personalization and workflows, especially those not covered in basic training. 

Drop-in
Where:          WMC 4B1.39
When:           0700-2300
                      After 2300, refer to Super User call schedule in Manual
DMO Drop-in Sessions
Do you have questions about Dragon Medical One Dictation/Speech Recognition Software? Drop in:
Where:            WMC 4B1.39
When:             November 7 to 10, 0700-2300
                        November 11 to 18,  1000-1600

Water, water everywhere, Nor any drop to drink.

We are at a stage post-launch when users have desperate need for tips to help them navigate workflows. At the same time, there is such a flood of Connect Care change that users are drowning in information without finding a way to the bits that matter.

These blogs may not be helping. We're posting a lot more, in all channels (especially Tips, FAQs and peer Support). But our audience is so distracted that there is no easy way for them to connect with postings that could ease their way.

Best communication is in-person and just-in-time. We are flagging important posts to our Slack network that connects Super Users so that they are on-message with the latest changes and have support tools.

For what it's worth, we'll also post in this general interest blog about key topics appearing in the Manual and the other channels (linked in the above button-bar).

What's happening in the channels?

2019-11-06

Breaking Habits - Patient Lookup

Breaking Habit bulletins identify information behaviors that served well in Netcare but need to be broken to avoid confusion in Connect Care.

Patient Lookup - Context is Everything

The Netcare Electronic Health Record assembles information about patients' investigations and interventions. The context is the patient. Things like lab results are not linked to specific health care events or interactions. The first step in a Netcare workflow is to look up a specific patient chart... and that is our habit.

The Connect Care clinical information system (CIS) provides information about patients as well as information about the delivery of care to patients. Information and workflows are always presented in context. Therefore, our new habit needs to find the patient in a visit (outpatient), admission (inpatient) or connected sequence of events (episode).

EHR habits can hamper CIS workflows. This is especially true for Emergency and Inpatient interactions. Start with context, then seek the patient and task:

All Physician Bulletin - Consent Navigator

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Documenting Consent - just the basics...

Documenting patient consent to investigations or interventions does not have to be a hassle. But we've been hearing of a lot of frustration.

Connect Care provides an integrated Consent Navigator. It is best to launch this from the StoryBoard (we are aware of some problems when consents are linked from deep in workflows).

New physician-friendly instructions (and a very short demo) are in a new Consent topic in the Workflows section of the Connect Care Physician Manual:

A Tribute to IT

As physicians, it is natural to see the Connect Care launch through a clinical lens. This is good. We have mobilized leaders and informaticians with remarkable effect. But, caught up in the thrill of launch, it can be easy to miss how much technical problem-solving enables clinical problem-solving.

Connect Care is a massive, and massively complex, undertaking. Clinicians see the tip of an iceberg. We are grateful for fast fixes to the functions we see, but may not appreciate everything that has happened to make those functions possible in the first place. We don't see infinitely complicated foundational transitions: from a myriad of disparate systems to entirely new infrastructure and infostructure touching everything that supports health care across the continuum of care.

We are deeply grateful for the privilege of working with our IT partners. AHS has groomed an exceptionally capable, knowledgeable and resourceful IT team. Its leaders are, to a person, delightful to work with. They have grown strong and effective relationships with clinical and operational leaders. More importantly, their teams have nurtured a culture of service. As important as the speed of problem-solving, is the resilience, good nature and patient personae of those who solve problems. IT is at the focal point of countless stressors. But they work with us, listen to frustration, hear the underlying issues, and quietly get us to where we need to be. AHS is blessed with an IT capacity unmatched country wide. We are deeply grateful.

Connect Care is not an IT project. We've always said that. However this is a good time to acknowledge that there would be no project without the very special AHS IT that makes Connect Care all that it can be. Thumbs up to our IT buddies today!

2019-11-05

More Progress

The physician community is doing remarkably well with major change. The prevailing tone is constructive helpfulness, with admirable forbearance while things get fixed. Reporting problems in sufficient detail remains the best support for continuing improvement.

Rough spots during break-in are inevitable. Our test is how quickly we identify and correct the break-in issues. We continue to make rapid progress improving orderables lookup, which we know to be a common current frustration. There are a number of accomplishments easy to miss because they unfold with little fanfare:
  • Mobility - great uptake with over 2,000 physician devices successfully activated for Haiku or Canto. We'll take a look at the typical uses about a week from now.
  • Dictation - in-system dictation (Dragon Medical One) is already taking off. Wonderful to see more in-system dictation, even large complex things like discharge summaries and procedure reports, than partial dictation (eScription) within the first days of launch. 
  • Ambulatory - all clinics fully launched at the beginning of the week.
  • MyAHS Connect - brisk uptake with 400 patients already active in the portal.
  • Lab processing - already case volumes are re-establisehed with 95% compliance with target reporting times.
  • Chemotherapy - no interruption and all on time.
  • Complex Cases - workflows and transfers continually improve, with multiple trauma, transplant and mass transfusions already managed in Connect Care.

2019-11-04

What a day!

Our second day in new Connect Care workspaces uncovered a number of rough spots needing attention. Continuing nimble trouble-shooting 24/7, physician informaticians effectively teamed up with operations, IT and Epic resources to push through problems and keep patients safe. Examples of important fixes appear in the Support Channel.

We (rightly) fret the frustrations, but we must remember that the overall experience is of remarkable success and rapid uptake. A few highlights:
  • Super User Community - our Super Users have rapidly established a vibrant Slack social network, with effective sharing of questions and solutions. There are 135 active members, 73 posting daily, with over 3000 messages exchanged. Lots of great tips, links and illustrations.
  • Access SWAT Team - working with some exceptionally helpful Epic resources, we moved just-in-time PRD trouble-shooting to the physician drop-in centre where issues were usually fixed within minutes. Much faster turn-around times begot happiness all round!
  • Drop-in Centre - hats off to the many clinical informatics leads, trainers and super users who have helped to keep physician drop-ins an excellent path to nimble help. The centre has been continually busy, and exceptionally effective. 
  • MyAHS Connect - the patient portal launched smoothly, with over 80 patients accessing and interacting in the first day.
  • Concierge - the Connect Care help portal has already served well, smoothly capturing > 600 tickets in the first day, with over half of those resolved within the first day.
  • Complex cases - multiple trauma cases challenged the ER in the first hours post-launch. Other complex surgical cases included three transplant operations. Everyone managed well, but also gained a lot of learnings about the importance of mastering phases of care and transfer handoffs.
  • Physician Handbook - usage has shot up from an average of ~100 uses per day to >500 users per day.
  • Early press - has been kind.
  • 4000 cups of coffee have been consumed!


All Physician Bulletin - Partial Dictation Workflows

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Partial Dictation Workflow Explained...

Partial (hybrid) dictation refers to use of a system outside Connect Care to capture, transcribe and edit dictated material which is then inserted into a documentation object (e.g. note, letter) within the clinical information system.

There are two ways for this to occur: 1) through AHS provincial "eScription", or 2) through a completely independent dictation service. eScription is familiar to physicians adopting Connect Care. Although the preferred Connect Care workflow is in-system dictation with Dragon Medical One, it remains possible to use eScription by following a workflow that specifies where the transcribed material is to go.

It is very important to do this using a precise workflow that allows the dictated material to get to the right spot. Follow instructions in the Connect Care Physician Manual:

All Physician Bulletin - Logon Departments

All-physician-bulletins highlight stumbling blocks, and solutions, that all physicians need to be aware of when starting to use the Connect Care clinical information system.

Choose the correct "department" at logon.

When logging on to the Connect Care clinical information system (CIS) Hyperspace environment, one needs to indicate a "Department" (context) that one will be working within. The word "Department" is not used in the way we think of a clinical division, speciality, department or section. Rather, "department" is simply a way for the Connect Care ecosystem to be divided up in ways that might better shape the users' CIS experience.

An individual physician may work in multiple contexts and need to switch between these from time to time. Trainees will often change contexts when they change rotations.

Those accustomed to the prior eCLINICIAN system, will know very specific departments. These do not exist in the Connect Care space. Rather, physicians should seek the highest level (broadest) department to match the specialty they work in within one of Alberta's zones.

The easiest way to get this right for wave 1 physicians is to search for the right department with "Edmonton Zone X" where X is the specialty or clinical area (broadest available) of interest.


Do not be alarmed that nurses and other health professionals may have a different workflow and select very specific departments, like an individual unit. Physicians go broad!

2019-11-03

Launch on time at 0400

After a few tense minutes waiting for linked information services to connect after decommissioning legacy systems, we launched Connect Care at exactly 0400 as planned.

The day has been full of work, rapid problem-solving and intense adaptation. Throughout, excellence of care has been sustained and adoption has progressed with a generous spirit that has been a marvel to witness.

Things will get a bit harder before we start to enjoy the ease of familiarity.... but we are off to a great start!

We are GO!

All interfaces and all other dependencies were cleared on time. We've launched on time at 0400!



Now off to the wards to be part of better health, powered by information!

Physicians, please make use of the drop-in centre at WMC 4B1.39. We have pulled in extra resources to deal with any remaining access or role problems.

2019-11-02

Hours Away!

From our CEO, Verna Yiu...

We are in the homestretch and in the final hours before we launch Wave 1 of Connect Care. I’m full of gratitude for all the effort and work that’s led us to this point. Where else in Canada are we going to be able to do something like this? We are, in essence, making healthcare history.

 We know it’s going to be a little bit bumpy. No doubt about that. But we also know that we have the resources and supports in place to help us address any issues we come across. Some of the issues will be resolved very quickly and others may take a bit more time. But, again, we know we have the resources and supports in place to help us deal with any issue.

   

We are all full of gratitude for all the work and amount of effort that you’ve put into getting us to this point. Hang in there as we prepare to launch and know you have the support of AHS behind you.
 Remember that, ultimately, we’re doing this because we want to improve patient quality and safety of care — and that, ultimately, this is going to transform the way that we provide healthcare in Alberta.

Countdown Checklist L-00

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 0 days from now...
  • Drop In 
This ends our countdown checklist. We hope all goes well at 0400! Of course that's only the start. We'll have a working system but we'll need to grow it, and grow with it, to fulfill its potential.
  • The Physician Drop-in Centre has proved popular at WMC 4B1.39. Please do drop-in. We have informatics specialists, Super Users and physician informatics leads eager to help.
  • This becomes the grand-central for physician support. 
  • We are trilled to enjoy generous support from Epic, who provides additional experts to help in the Drop-In centre during the busy early days.

In the News

Connect Care has beavered away for years without much in the way of media attention. On the eve of our Wave 1 launch, that's changing in a big way.

Let's brace ourselves. There will be lots of press coverage in the days to come. Of course this will be a vector for some anxieties. Good news is rarely newsworthy.

Nice to see a positive lead from the Edmonton Journal! We'll update this posting with links as they appear. Also, continue to follow our other blogging channels, our ahs_cmio twitter feed, and the #connectcare hashtag.

2019-11-01

Countdown Checklist L-01

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 1 days from now...
  • Share and Learn! 
No more checklist. We are down to the final day. Any preparations that could be have been. Now we must turn to one another and share the next steps in a spirit of adventure.

SuperUsers are widely distributed. Look for yellow and orange. Don't struggle. Ask for help.
  • Late breaking tips and gap-fillers will be added to the Connect Care Physician Manual.
  • The Connect Care Physician Updates will focus on pointers to new material, key developments, tips, tricks and FAQs. Use the buttons at the top, especially Tips, FAQ and Support.
  • Record your non-urgent needs, ideas and suggestions at help.connect-care.ca
  • Call the IT Service Desk with urgent needs: 1-877- 311-4300
  • Use the Physician Drop-in Centre at WMC 4B1.39 (open 24 hours a day)
  • Super Users are using a community forum to rapidly share learnings so they can be widely applied... ask them for help.

Prescriber Drop-in Room has Moved! Now in WMC 4B1.39

Due to the popularity of our drop-in training and support we have moved to a bigger room -- you can now find us in WMC 4B1.39. 

Informal peer-to-peer help will be available for clinical information system use, personalization and workflows, especially those not covered in basic training. You can also complete a "login lab" to verify that you can access the system.


Drop-in
Have you taken basic training? Do you have questions about personalization, mobility apps or how to effectively work in Connect Care?  Drop in:
Where:          WMC 4B1.39
When:           November 1 & 2, 0700-2300
                      November 3 to 10, 24 hours
                      November 11 to 18, 0700-2300
DMO Drop-in Sessions
Do you have questions about Dragon Medical One Dictation/Speech Recognition Software? Drop in:
Where:            WMC 4B1.39
When:             November 3 to 10, 24 hours
                        November 11 to 18,  1000-1600

2019-10-30

Countdown Checklist L-03

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 3 days from now...
  • Unburden 
With just a few days to launch, we have our last opportunity to prepare for the smoothest possible transition on the weekend.
  • Do everything possible on inpatient services to expedite discharges and decrease occupancy. 
  • Community services, rehabilitation and respite care are all aware of our need. Leverage whatever resources can be mobilized.
  • Look for repatriation opportunities, as our community hospitals are committed to help us with the coming challenge.
  • Lighten ambulatory loads in any way possible for next week.
  • Ensure that any possible clinician reserves are mobilized.
  • Above all, make sure that you have the Connect Care access you need.

More Onsite Resources for Clinicians

In addition to the physician drop-in centre and dictation drop-in sessions, new in-person supports are available from today at the Walter Mackenzie Centre:
  • Physician Training Drop-in (open to all questions)
    • October 29 - November 1
      • WMC 5G1.11 (5th floor northeast)
      • 0700-2300
    • November 2 - November 10
      • WMC 4B1.39
      • 24 hours availability
    • November 11 forward
      • WMC 4B1.39
      • 0700-2300
  • Mobile Device Support
    • WMC 4th Floor Atrium
    • Monday-Friday, 0700-1500
    • October 29 - November 15, 2019
  • Point of Care (Ward & Clinic) Scanner Support
    • Medical Records Conference Room, WMC 0E1.25
    • Wed, Thurs, Fri, 0800-1700
    • October 30 - November 1, 2019

2019-10-29

Countdown Checklist L-04

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 4 days from now...
  • Access, Access, Access! 
Do you, or could you, have clinical duties November 3, 2019, at a Wave 1 Site (University Hospital, Mazinkowski Center, Stollery Hospital, any eCLINICIAN clinic, and others)? If so, it is essential that you confirm NOW that you have access to the AHS Network, to the Unified Access Portal (myapps.ahs.ca) and to Production (PRD) Connect Care.
We know that there have been problems with the MyLearningLink system. Alternate ways to confirm requirements for gaining access to PRD are provided. A SWAT team is working non-stop to support clinicians reporting problems. 

We can help with technical access issues but cannot help if clinicians have not completed their InfoCare module or taken training. If you are not ready for practice on November 3, make sure that you find someone to cover your clinical service!

Virtual Login Lab - Very Important for Wave 1 Physicians

We thank all Wave 1 physicians for their patience, resourcefulness and continuing support getting ready for Connect Care. Launch is very close. We ask that all Wave 1 medical staff confirm that they have the working access to the Production (PRD) version of the Connect Care clinical information system (CIS). The following "virtual login lab" allows physicians to take advantage of supports newly put in place.

To ensure your access is live take these steps:
  1. Logon to the access portal with your AHS username and password --> myapps.ahs.ca 
  2. Ensure that the Connect Care "PRD" icon is available
  3. Logon to PRD with your username and password
  4. Confirm that you have the expected Connect Care tools for your role(s)
If all 4 steps work, you are ready to go! 

If any step fails, report the problem with a quick online report --> ahs-cis.ca/check

A login trouble-shooting team will contact you within 24 hours of report submission. If you have not heard from the team within 24 hours, please  call 780-735-1600. Phones will be active from 0700- 1700.

There is currently a prescribers’ Drop-In Centre at WMC 5G1.11, available from 0700-2300, where login help is available.  This will continue through go live but will be open 24 hours a day from November 2-12 at a location TBD. Pre-emptive testing will ensure we have the opportunity to correct any deficiencies thereby preventing further disruption on November 3 when Connect Care launches.

2019-10-28

Countdown Checklist L-05

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 5 days from now...
  • Get Ready for Cutover 
Key for attendings, residents and medical learners presently serving Wave 1 inpatient or consultation services is work to make transition easier at launch. Key for physicians active at Wave 1 outpatient sites is to make sure that schedules and charts are ready for next week.
  • Inpatient: Make sure that all dictations are complete and signed. Use dictation (eScription) for all admissions, transfers and consults this week (so that transition notes at launch can refer to the documentation in Netcare).
  • Outpatient: Make sure that all eCLINICIAN documentation is complete, signed and routed; while also taking care of any open encounters.
  • Complex patient care: consider pre-launch problem list documentation to support easy transition note generation at launch.
Key resources:

Physicians' Role in Cutover

Cut-over is a process through which key pieces of information about admitted inpatients are entered into the Connect Care clinical information system (CIS) in the 48 hours prior to launch. Cutover includes both technical and clinical elements.

The primary concern for physicians will be the management of medication and non-medication orders, and the translation of important information about patients’ clinical status from a paper record to an electronic one.

Physicians facilitate five tasks as part of cutover processes:
  1. validating continuing medications to be entered by pharmacists,
  2. documenting continuing non-medication orders to be entered by the cutover nurses,
  3. optionally entering or validating patient-level health information for patients with complex problems,
  4. validating entered orders on the launch morning, and
  5. providing a brief summary note of the patient’s status at launch.
The following resources can help physicians understand and participate in cutover activities:

2019-10-27

Countdown Checklist L-06

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 6 days from now...
  • Take advantage of MD Drop-in Centres 
Many physicians, residents and medical learners have participated in personalization workshops. A major benefit is ensuring that personal mobile devices are set to take advantage of Haiku (smartphone) and/or Canto (iPad) applications; plus PowerMic Mobile to tap the considerable power of in-system dictation. Having mobility ready for launch can be a powerful aid to adoption.

Drop-in Centres are open to help physicians with mobility and dictation, 0700-2300, all of the final pre-launch week. Take advantage of this opportunity for one-on-one help!

Filling Workflow Gaps

Workflow is about how a series of tasks are organized, assigned and accomplished to serve a specific purpose. Clinical workflow serves a clinical purpose. Connect Care workflow focuses upon how the organization, assignment and accomplishment of tasks is optimized to take advantage of clinical information system (CIS) features and functions.

Most workflows are explored during Connect Care training and readiness activities. Some gaps remain. Some workflows are complex. Some differ significantly from paper-enabled processes. A workflow section of the Connect Care Physician Manual grows with tips, guides and demos that address particularly challenging or complex workflows. The sections are short; more guides to support materials for those who find a workflow that matters to their work.

Keep an eye on the manual this week, as new workflow sections appear addressing professional billing, consent management, handoff reports, medication reconciliation and triplicate prescriptions. Recent additions include:

2019-10-26

Countdown Checklist L-07

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 7 days from now...
  • Dictate any pre-launch inpatient admission or transfer notes 
Wave 1 inpatient facilities (University Hospital, Stollery Childrens Hospital, Mazinkowski Alberta Health Institute) are all supported for dictation of admission histories, transfer notes, and even consultation reports. This is done through the provincial eScription service. These dictations appear in the Netcare electronic health record, and will be available to refer to in Connect Care when it launches. Accordingly, succinct initial progress notes  become possible in Connect Care on November 3 if they can refer to an existing digital admission or transfer record and simply note changes since. The same applies for Consults performed in the coming week for patients expected to still be in-hospital post-launch.
  • Take advantage ot eScription to facilitate easier Connect Care cutover next weekend!

Connect Care Physician Manual - Updates

The Connect Care Physician Manual (manual.connect-care.ca) gathers tips, guides, resources and norms for prescribers using the Connect Care clinical information system (CIS). The focus is essential information addressing the particular needs of physicians and other prescribers.

The Manual grows with the needs of the time. The current emphasis is on personalization tips, filling gaps between training and production CIS, finding supports, and introducing the norms that will help us help one another after launch.

Note that the buttons at the bottom of all Manual pages now include a link to the new Connect Care Concierge.

Recent updates include:

2019-10-25

Countdown Checklist L-08

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 8 days from now...
  • Report any missed Wireless Gaps 
As part of Wave 1 launch readiness efforts, the Wireless networks in all sites have been upgraded to clinical-grade (high-density, high-performance) WiFi. Teams have walked the wards to confirm that Wireless connectivity is universally present and up to the needs of providers and patients.

Coverage seems to be complete. Please help the wireless team by checking for signal and connection to AHSRESTRICT in all your workspots at the University Hospital, Stollery Hospital, Mazinkowski Centre, Kaye Edmonton Clinic and other Wave 1 sites. Please report any gaps to Bart.Mielczarek@ahs.ca directly. Be precise about location.

Connect Care Weekly Review - October 25, 2019

A big thank you to all the physicians groups who have welcomed us to special meetings to help with last-minute planning (and a tinge of panic?). It is always good to meet directly with colleagues. We have great capacity. We will rise to the Connect Care challenge. And we will do our best to fit in more just-in-time meetings this week. Contact cmio@ahs.ca.

Some highlights from the week past:
  • Connect Care Newsletter
    The latest is linked.
  • Physician Training
    ~99 % of Wave 1 physicians have registered for basic and personalization training. ~3,000 physicians, residents, students and nurse practitioners have already attending basic training. The classes are working at full capacity. Still, don't get missed! We will find a way to get all who need training ready to work in Connect Care for launch. Priority is given to those with clinical duties in the first days/weeks.
  • Physician Production System Readiness
    About 2,700 physicians have completed of privacy awareness training (InfoCare) and 1,900 have completed competency assessments (EUPA). Both milestones must be met in order to gain access to the full Connect Care clinical information system. We understand that the MyLearningLink system has failed to record many completions, and so have provided an attestation equivalency. Despite these efforts, we fear many clinicians are not aware that they have not been credited for having completed these milestones. We are contacting affected physicians and expediting attestations. Please contact ConnectCare.PhysicianTraining@ahs.ca if you don't know why you do not have PRD access.
  • Dictation
    Some technical problems with the Dragon Medical One in-system dictation tool have been tracked down and resolved. The system is now working efficiently.
  • Drop-In Centre
    Drop-in Centres have opened at the University Hospital and have been well attended. 
  • Drop-In Dictation Support
    Supplemental dictation workshops have also been appreciated.
  • Connect Care Concierge Launches
    A user help portal (one of many ways to gain support) has launched and is ready to receive non-urgent problem reports and feature requests.

2019-10-24

Countdown Checklist L-09

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 9 days from now...
  • Meet your Connect Care Concierge! 
A unified intake portal for Connect Care user support, the "Concierge", is up and at your service!

Check it out and familiarize yourself with methods for seeking help when you need it.

A unified intake process allows user needs to be captured, channeled and tracked. All users, super users and helpers can enter requests and suggestions. The Connect Care “Concierge” service offers a single point of capture for help, feedback, and requests (help.connect-care.ca, concierge.connect-care.ca, insite.ahs.ca/ccsupport all go to the same place).

Locating Connect Care Downtime Plans

A Clinical information system (CIS) can suffer performance degradation, or even a complete "downtime", affecting one or more functions. Service interruptions can be planned (maintenance) or unplanned.

Of course we don't want, or expect, unplanned downtimes. But it would be silly to not prepare for the possibility. Business continuity relates to support of clinical and administrative workflows when CIS functions are compromised.

Connect Care has implemented a robust cloud-based Recovery Planner (RPX) to support business continuity, provide a common front for downtime plans, and be resilient to local technical or software failures. We'll post more information about RPX as it deploys.

For now, through downtime and recovery procedure information is available at downtime.connect-care.ca (insite). If the website should become unavailable, contact the IT Service Desk and Solution Centre (1-877-311-4300) to get copies of downtime guides.

2019-10-23

Countdown Checklist L-10

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 10 days from now...
  • Check your PRD (Production) Access
All physicians who have completed their InfoCare training and Connect Care Proficiency Assessment (EUPA), should be able to log on to the full production version of Connect Care (PRD) by now. We know that there have been issues with SuperUser and other physicians losing access. This is being fixed. Everyone should have access by Oct 27.

Please do the following from within an AHS network (AHSRESTRICT) or from outside with the aid of a RSA security fob or token:
  1. Go to myapps.ahs.ca and log on with your AHS username and password. Can't get in? See "Access Problems" in the Physician Manual.
  2. Once logged on to myapps.ahs.ca, ensure that the PRD (production) Connect Care icon is available. If not, see "CIS Access" in the Manual.
  3. Open PRD and log on with your AHS username and password. Can't get in? Contact ConnectCare.SupportTeam.Security@ahs.ca or cmio@ahs.ca. We are trying to identify the users who somehow got missed. Do not expect access if InfoCare or EUPA is not complete.

Upcoming Connect Care Presentations

A couple of presentations are of interest to the Connect Care community on the eve of Wave 1 launch.

Connect Care Go-Live
  • Friday November 1, 2019, 0700-0900, Bernard Snell Theatre, University of Alberta Hospital
  • Sponsored by: Alberta Health Services; Faculty of Medicine & Dentistry; Medical Staff Society
  • Welcoming all interested clinicians and Wave 1 stakeholders
  • Open forum, questions and answers, with panel of Connect Care clinical and operational leaders
  • Poster: Connect Care Go-Live
Connect(ed) Care
  • Tuesday October 29, 2019, 1200-1300 Webinar 
  • Register at https://is.gd/pfccweek or patient.engagement@ahs.ca
  • How can a clinical information system positively impact patients and families? How can the provider-patient relationship be protected and enhanced?
  • Poster: Connect(ed) Care

2019-10-22

Countdown Checklist L-11

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 11 days from now...
  • Anticipate and Manage Launch Clinical Burdens
Many inpatient services have very limited ability to control patient census or clinical workloads. However, this is the time to make every effort to prepare for launch by:

  • readying for discharge as many patients as possible, especially where rehabilitation or other community services not in Wave 1 might be available. 
  • transfer all patients who could be repatriated to community hospitals within the pre-launch week, wherever possible. These hospitals are informed and primed to maximize their capacity. 
  • identify and list complex continuing patients who may need more cutover attention during the week pre-launch. 
  • Use sick roster backup and any other resources that can be leveraged to increase physician supports at launch.

Every team has different circumstances and will make different preparations. But do prepare!

Workflow QuickSteps - Consultation and Referral

We know that a number of important tasks were not adequately exposed in basic or personalization training. Sometimes functions or tools that had not made it to the training environments or curricula. Other times build was not quite signed off by clinical colleagues.

We've promised to provide simple guidance backed by short demos (<3min) that can be copied, practiced and personalized. Our first Workflow "QuickStep" relates to referral management. This has been the subject of a huge effort at rationalization and standardization. Now we can turn our attention to the essential skills that clinicians need to master.

For each Workflow QuickStep, we provide a high level summary in the physician manual, one or more tip sheets, a FAQ if needed, and a few quick demos. Check out the referral and consultation QuickStep! The manual provides links to all related materials:

2019-10-21

Countdown Checklist L-12

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 12 days from now...
  • Ambidextrous? Let us know! 
Most physicians work within a primary care or specialty service and are well served by the Connect Care department, role and user template assigned to them. Some physicians work in multiple facilities or specialties (e.g. Nephrology and General Internal Medicine); still served well by their Connect Care toolset and the ability to change departments (contexts) on the fly. 

Some physicians work in two or more specialty areas that have quite different clinical information system (CIS) modules. The emergency module (ASAP), for example, is not like the critical care user interface. If one needs to switch between different modules for different roles (e.g. ER physician and Critical Care physician), then more than one "sub-template" needs to be added to one's Connect Care physician record.

Connect Care has made these configuration changes for dual-role physicians already known. If you think you may have been missed, likely because you do not see a module you need, get in touch with Medical Affairs to request adjustments to your profile.

Drop-In Dictation (Dragon) Sessions

Intrigued by the possibilities of Connect Care speech recognition and in-system dictation? But intimidated about how to get started?

Consider learning and sharing with peers at a DMO (Dragon Medical One) drop-in Session!

Who:Prescribers (physicians, residents, medical students, dentist, nurse practitioner, clinical associate, etc.) anticipating use of DMO in Connect Care workflows
What:Informal peer-to-peer help with PowerMic Mobile set up, high-value voice commands and efficient documentation tricks.
Where:WMC 5G1.11 and WMC 0C2.59 (University Hospital)
When:Oct 21-25, 2019, 1015-1215 and 1745-1945 at WMC 5G1.11
Oct 26, 2019, 1015-1215 at WMC 0C2.59

2019-10-20

Countdown Checklist L-13

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 13 days from now...
  • Complete that InfoCare!
There is no way round this one. No InfoCare == No Connect Care == No privileges == No work.

InfoCare is the name of the privacy awareness training that every physician must complete in order to comply with medical staff bylaws and be allowed to work with the legal record of care. This is a legislative and professional expectation... not Connect Care trying to make your life difficult. 

Log on to MyLearningLink.ahs.ca (MLL) with your AHS username and password. Search the available courses using "InfoCare". Anticipate spending about 15 minutes. At the end of the module, there are some questions, attesting that you will protect personal health information. Complete these, submit and be done! You should receive a confirmatory email.

What if MyLearningLink does not "credit" you with InfoCare completion? This can happen; especially with computers common among physicians. Physicians who complete InfoCare training but find that MLL does not credit them for completion should report completion at: ahs-cis.ca/check 


Drop-in Training & Personalization Support

Feeling anxious? Want some last-minute help? Want to trade strategies with peers? A few moments at a Connect Care prescribers' Drop-In Centre might be just the thing!

Who:Prescribers (physicians, residents, medical students, dentist, nurse practitioner, clinical associate, etc.)
What:Informal peer-to-peer help with clinical information system use, personalization and workflows, especially those not covered in basic training.
Where:WMC 5G1.11 (University Hospital, Fifth floor NE)
When:Oct 22 to Nov 1, 2019, 0700-2300
Nov 2-12, 2019, 24 hours a day (location TBD)
Nov 13-18, 2019, 0800-2300 (location TBD)

Even if you have taken your Connect Care training, you may still have questions about personalization, mobility apps or how to effectively work in Connect Care.  The CMIO training team will be available each day from now until after launch to lend a hand... and learn from you!

2019-10-19

Countdown Checklist L-14

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 14 days from now...
  • Complete that EUPA!
EUPA = "End User Proficiency Assessment". This becomes available in MyLearningLink as soon as basic training has been completed. The assessment is done online. It is not hard and you can refer to your training environment (TRN or EXAM) while completing the assessment (open book, open system). 

Don't procrastinate! It is better to take the EUPA, not get the needed 80%, and then re-take. Delaying only keeps one from progressing to personalization. And there is no access to the full production Connect Care system unless both InfoCare and EUPA are complete.

After completing the EUPA, check to see if a PASS confirmation arrives via email. If this does not happen, don't worry! We know that the MLL system has problems confirming completion for some of the computers or browsers used by physicians. Don't waste time trying to re-do the EUPA. Instead use the following link to answer a few questions and you will be moved to pass.



Connect Care Weekly Review - October 18, 2019

The pace quickens! Thank you to all of the physicians who have stepped forward to participate in a wide range of readiness and implementation activities. Thank  you also to all our colleagues who are following the countdown checklists and getting personally ready for launch.

Some highlights from the week past:
  • Appointment conversion
    Many clinicians review data conversion from eCLINICIAN to Connect Care of upcoming clinic appointments. The mapping is tricking because of different classifications of visit types but mitigations are in place and the work will be done on time. The conversion weekend progressed through >70,000 referral conversions, ~120,000 appointment conversion in the first 24h, with just a handful of errors found. A a great success that gives confidence in our appointment types and department mappings.
  • Launch Supports and Command Structure Communications about how users will be supported at and after launch start to circulate, while the schedule of Command Structure activities is being finalized for the first 4-6 weeks post-launch. Already some launch supports are in play. Watch for openings of drop-in centres!
  • Cut-over Dry RunInpatient cut-over occurs in the two days immediately prior to launch day. Current patients are registered in the CIS and their charts are seeded with essential information about orders, medications and clinical history. A dry run successfully tested the health information interfaces that need to activate at the same time. Tools for chart extracts are developed and tested.
  • Medical Therapy Plan ConversionPatients whose treatment extends over person, time and place are on "Therapy Plans" for complex outpatient therapies. Existing plan conversion into Connect Care progresses now.
  • Medical Outpatient Unit OrdersMedical outpatient units function somewhere between inpatient and outpatient norms. Special preparations are made to ensure that their investigations and interventions are supported at launch. Conversions are underway, to finish November 1.
  • Oncology Protocol ConversionPatients currently on Oncology treatment protocols need to have their information and stage of treatment converted into Connect Care. This work is underway.
  • Outpatient Chart AbstractionClinics moving from eCLINICIAN benefit from extensive data conversion. Still some old chart content may need to be abstracted into new charts so that scheduled patients will have a sufficient record when seen at launch. Over 1000 charts are already abstracted.
  • Research ConversionHere again, patients on current research protocol treatment plans need to have their information, orders and recurring tests entered to Connect Care so there is continuity of research at launch. Over 200 studies are supported.
  • Shadow ChartingThese real-time simulations have continued and continue to prove invaluable for orientation, training and discovering tweaks needed before launch. User feedback is very positive. Within resource limits, a few more sessions are being planned to address readiness needs of complex areas.
  • Physician Training
    We continue to progress with 99% of physicians registered for basic and personalization training (seems like ~20 docs have gone walkabout!), 2,920 physicians are finished basic training and all medical learners are trained.
  • Medical Office Assistant TrainingIt has proved challenging to identify medical office assistants in independent clinics who need Connect Care access and training. ~150 are registered to training tracks.
  • Mobility
    As of last week, we have >1,125 mobile devices successfully installed with Haiku or Canto. A new physician portal has opened and lots of mobility tips are flowing in.

2019-10-18

Countdown Checklist L-15

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 15 days from now...
  • Consider a Personal Device for Connect Care Use
Many of us will come to prefer doing common clinical information system (CIS) tasks on mobile or personal computing devices. These are set up to our liking, move with us, and will work well with wireless in Connect Care facilities and clinics. This is a good time to check whether what we have is what we'll want to use. For those interested in new Apple iPads, Macbooks or Macbook Pros, a Connect Care physician purchase portal is now open. The available devices are CIS-appropriate and backed by extended enterprise AppleCare.

Apple Purchase Portal for Connect Care Physicians

We previously posted about things to consider when selecting a personal mobile device for physician use with the Connect Care clinical information system (CIS). We also posted about a new arrangement between Apple and Alberta Health Services to provide enterprise support for clinicians using Apple devices with the CIS.

We are now pleased to confirm availability of a physician purchase portal for Apple devices. The available devices are selected for their fit to rounding and other workflows where personal computing can be most helpful. An exception is iPhones, since both pricing and support is better had through one's mobile phone and wireless services provider.

CIS-ready tablet and notebook computers purchased through the portal are backed by extended enterprise AppleCare support at no additional cost.

2019-10-17

Countdown Checklist L-16

Continuing our list of essential actions for Wave 1 physicians facing Connect Care Launch 16 days from now...
  • Connect to Launch Supports
This is a good time to check that you and clinical colleagues know who the Super Users, Medical Informatics Leads or other peer-resources are for your clinical group, division, subspecialty or clinic. They can facilitate pre-launch personalization activities. They will be present and a great resource during the pressures of launch. 

Clinical groups (divisions, units, clinics, etc.) should plan for their own start and end-of-day meetings to take the pulse of their implementation and flag issues to forward to launch supports.

This is also a good time to note where User Supports are described in the  Connect Care Physician Manual. This information will be updated with more specifics about how to find and use human, online and telephone supports for help with Connect Care on-boarding.

Got your Back!

There is a lot of (anxiety-tinged) excitement as we close in on Connect Care's Wave 1 launch. Everyone is impacted; even those at Zone sites that do not yet implement the clinical information system (CIS). Naturally, we wonder about the who and how of end-user support. We also need to know how unexpected issues will be identified, reported, understood and resolved. 

Medical and Operational Leaders work together in a launch "Command Structure” that coordinates user-supports and problem-solving during launch and for a number of weeks afterwards. This operates 24/7, constantly receiving concerns from clinical groups, managers and leaders. There will be "ears to the ground" everywhere; using rounds, divisional meetings, unit scrums, Super User reports,  and drop-in conversations to capture issues, then channel these to the Connect Care Service Desk & Solution Centre. Throughout the day, diverse Command teams will meet to discuss and resolve issues. Updates will be shared Zone-wide on a regular basis. 

Wave 1 launch deploys the Connect Care CIS to specific facilities and clinics. But the entire Zone monitors clinical impacts, ready to redirect service loads where and when needed.  The Command Structure will dovetail with a Zone Emergency Operations Centre (ZEOC) to ensure an integrated and coordinated approach to addressing service loads, protecting patient safety, and communicating to stakeholders. 

Those putting hands to keyboards (or mouths to microphones!) in early November will have diverse supports:  
  • Super Users will be “at-the-elbow” to guide clinicians (be sure to identify and work with your own Super User, who will help solve problems and log issues and requests). 
  • The CIS Learning Home Dashboards will update guides about how to support workflows with CIS tools.
  • The Connect Care Physician Manual (manual.connect-care.ca) will be updated regularly, reflecting the essential knowledge and skills needed for physicians to make headway with Connect Care.
  • The Connect Care Physician Blogs (blogs.connect-care.ca) have channels for peer-to-peer tips, FAQs and supports. Check daily (or subscribe) for help with unique informational needs of physicians.
Don't be shy! Reach out early and often. A solution or mitigation is likely just a call away.