COVID-19: The Calgary Zone Story

COVID-19 clinical burdens have been unevenly distributed in Alberta, with the Calgary Zone handling the majority of cases. An excellent infographic summarizes the Wave 1 experience to date:


Practical Paranoia - COVID-19 Cyber Attacks Continue

Exercise caution in handling any email with a COVID-19-related subject line, attachment, or hyperlink, and be wary of any COVID-19 related social media plea, text, or phone call.

Cyber criminals and hackers are taking advantage of the heightened anxiety around COVID-19 by sending emails with malicious attachments or links to fraudulent websites to trick victims into revealing sensitive business or personal information or donating to fraudulent charities or fake causes. Please take the following precautions:
  • Watch for AHS’ external email warning – it signals greater risk.
  • Beware of unsolicited emails and avoid clicking on links or opening attachments.
  • Do not respond to email solicitations asking you to reveal business, personal or financial information.
  • Use only trusted sources for up-to-date fact-based COVID-19 information.
  • Always verify a charity’s authenticity before donating by checking out their official website and always look for the secure browser ‘lock’ icon before making donations.  
Learn more about some of the common tricks cybercriminals use to access your information by viewing Don’t be fooled by Scammers and visit InfoCare on AHS Insite for information on all privacy and information security matters.


Alberta Health introduces Secure Messaging Service during Pandemic

Alberta Health is sponsoring a new voluntary service that can help physicians securely message with patients during the COVID-19 pandemic.  BrightSquid is the selected provider for "MHR Secure Mail" and Alberta Health is making it available at no cost to participating physicians until July 31, 2020.

While any Canadian physician can sign up, the target audience for the Alberta Health promotion is physicians who do not already have a patient portal or other secure communication service available to their patients. There is no requirement to use MHR Secure Mail, or to use it in preference to other secure communication tools.

Physicians sign up for the BrightSquid service and invite their patients to participate. A link to BrightSquid is available via MyHealthRecords, which is also where patients can launch MyAHS Connect for secure communications with physicians who use Connect Care as their record of care.

Physicians using AHS information systems should continue to use the secure clinical messaging services provided by AHS, with priority given to communication tools integrated with clinical information systems. Future postings (or in our FAQ Channel) will address questions about how Connect Care physicians can support patients seeking clarity about secure clinical communications in Alberta.


Alberta Health Health Information Systems Review Posted

We've previously posted about reviews contracted to Ernst and Young respecting Alberta Health Services performance and Health Information System strategy.

The second of these reports, "Review of Connect Care, Alberta Netcare and MyHealth Records: final report", is released by government for public access today:
The report recommendations will be considered by Alberta's health informatics stakeholders as the province emerges from the first wave of COVID-19 and works to reinvigorate informatics coordination on multiple fronts.

Physicians may not identify with all of the report assumptions or findings but these are matters of detail and the focus moving forward needs to be on high-level recommendations. The CMIO portfolio would welcome reflections or suggestions via cmio@ahs.ca.


All Prescriber Bulletin: Diet & Nourishment Orders - Default Frequency

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

Diet & Nutrition Order - Start and Frequency Parameters
As of 1200 Thursday, May 21, 2020, all inpatient users of Connect Care will see a small change in diet and nourishment orders. The default frequency button, “Effective Now”, will be replaced by “Now or Specify Date/Time.” This reflects new functionality to more precisely set  time-dependent changes to a patient’s diet. This also supports the entry of multiple linked diet orders and a layered approach to progression along a nutrition plan.

For example, for patients expecting an NPO interruption to their usual diet, the expected series of diet orders can be placed all at once. This is done by using the starting date, time, and (if required) conditions to be met. All orders will appear in the active orders, with clear reflection of the starting date,  time and duration for each.

This update could affect personalizations. System-level ordering tools such as Preference lists, Therapy Plans, Treatment Plans, and Order Sets will be automatically updated. Personalized order lists, panels or plans that include diet orders using "Effective Now" will experience a hard-stop during ordering, alerting to the need to update the personalization to specify the new parameters.


Virtual Care - Recording Zoom Virtual Visits

Alberta Health Services is working on security features that will satisfy privacy protections needed in order for clinical Zoom sessions to be recorded (even in part).

Until such tools are available, in-Zoom recording functions have been disabled for all AHS accounts. Similarly, Zoom’s Live streaming tools for social media are disabled. Work is underway to support special requests for Zoom recording, where this is the best way to meet a specific and important clinical need.

Current requests for local recording can only be considered for Zoom meetings which do not expose personal health information, such as non-clinical administrative and educational sessions. Any recordings are saved to local storage temporarily, en-route to secure AHS storage (e.g., SharePoint). The temporary storage device must be encrypted and compliant with AHS security policies.

Please contact ahszoom@ahs.ca for more information.


Secure Clinical Messaging for users of AHS Clinical Information Systems

As tempting as it is to send clinical queries via email, this can risk a privacy breach. Alberta Health services (AHS) provides clinicians with tools for secure transmission of clinical information via email, including encrypted email to external (non-AHS) addresses. These should be used in all health service contexts where AHS has responsibility for the legal record of care. Such records can be paper-based,  AHS supported Electronic Medical Records or any of the AHS clinical information systems (CIS).

Transitory communications (e.g. request to meet) do not require secure transmission if they do not contain information that might identify a patient. Non-transitory communications about patients and the care they receive (e.g., patient instructions) must be protected and recorded or referenced in the record of care. 

Clinicians interacting with patients via email or messaging systems should use the most secure and integrated system available:
  • Connect Care Messaging
    • Use messaging solutions within Connect Care when both sender and recipient have access. This includes clinicians who do not use Connect Care as the record of care but have access to the Provider Portal. 
  • AHS Secure E-Mail
    • If both sender and receiver have AHS email addresses (@albertahealthservices.ca or @ahs.ca or @covenanthealth.ca or @albertapprecisionlabs.ca), then clinical communications can be securely sent and received using AHS email.
    • If the sender has an AHS email address but the receiver does not, then add “!Private” to the subject line so the email message is encrypted. 
  • External Approved Solution
    • If none of the above are appropriate for clinical communication, consider use of an external clinical secure messaging solution that meets Health Information Act requirements. Some have been approved for use with AHS records, to be replaced when Connect Care and its patient portal are fully implemented province-wide. 
    • An instance of the BrightSquid secure messaging system, "MHR Secure Mail", is available to Alberta physicians during the COVID-19 pandemic at no cost and can be used when no other AHS-provisioned system is available or appropriate.
We will update the Connect Care physician manual as secure communication options evolve in Alberta.


COVID-19 and Connect Care #18 - Recent Progress

Connect Care clinical system design (CSD) continues to prepare new documentation, decision and inquiry supports for upcoming implementation waves, while optimizing supports already launched. Recently, clinical content needs driven by our COVID-19 pandemic response take priority. Impressive progress has included the following categories of new and adapted content:

  • Documentation Supports
    • COVID-19 nursing documentation tools are released to facilitate tracking of symptoms, signs and progress.
    • Documentation of virtual care consent tools and scripts (Manual)
  • Decision Supports

  • Inquiry Supports

Other COVID-19 related developments have more to do with change-management and workflow optimization:

  • Patient Messaging Pools - these are important for patient support through the MyAHS Connect portal. Increased virtual care increases the need for all clinics to have incoming message screening and triage processes understood and operationalized. The deadline for pool consolidation is May 29, 2020.
  • Appointment Request Workqueues - modified to accommodate virtual care options and procedure appointment requests.


Practical Paranoia - Protecting Personal Devices

Personal computing devices (laptop, notebook, tablet, desktop) may support clinical work when physicians take call from remote sites, or otherwise participate in the provision of healthcare services outside AHS facilities. 

Because identifiable personal health information could appear on data storage devices which, if stolen, could risk a privacy breach, it is essential that personal devices be configured in compliance with AHS policy and legislative requirement, including:
  • Password protection with a strong and well maintained code
  • Inactivity timeouts that re-challenge for a device password after automatic system suspend or sleep states
  • Hard drive encryption
  • Firewall protection
  • File sharing off or appropriately protected
Encryption is a method of protecting information by converting it to a format that's unreadable by anyone except those with a special key (usually a very long password). All Windows operating system devices must have native hard drive encryption enabled (BitLocker). All Macintosh operating system devices must also have native hard drive encryption enabled (FileVault).


Virtual Health Office Hours - Connect Care Zoom Integration

The Virtual Health team will be holding Office Hours again on Monday, May 19, 2020 from 12:00-13:00.

The session will focus on how AHS Enterprise Zoom teleconferencing is integrated with the Connect Care clinical information system. There will be a live demo to illustrate virtual encounter scheduling and visits, also featuring the patient experience and how it can be facilitated by MyAHS Connect. Experienced panelists will be available for Q&A. Please use the registration link to sign up:


Emergent Blood Product Administration Attestation

Complex title! New tips and demos cover some essential knowledge (and Connect Care skills) that all who order unmatched blood products can benefit from.

Emergency blood product administration bears extraordinary risk. The related workflow includes:
  • a phone call to the blood bank to initiate product preparation;
  • a "Transfuse Emergent Blood Product" order entered by the provider;
  • an attestation note completed by the ordering provider. 
These actions allow the work of lab and nursing staff to proceed. The attestation confirms that the use of un-crossmatched blood is clinically necessary for patient care. 


COVID-19 and Connect Care #17 - Connect Care COVID-19 Reports

We've previously posted about excellent provincial COVID-19 reports maintained by AHS Data & Analytics as Tableau visualizations, and about how those can be accessed through links in the Connect Care Physician Manual and, within Connect Care, Learning Home Dashboards. The Tableau visualizations combine data abstracted from the CIS and and data from other AHS sources.

Connect Care users can also access a wide range of relevant reports internal to the Connect Care CIS. These include a "Connect Care COVID-19 Pulse" dashboard (open Dashboards activity) and a number of other operational reports and dashboards (visualizations).

After opening the Dashboard activity, conduct a "Catalogue" search for all reports, components and dashboards containing the keyword "COVID". Not all reports are open to all users. Those who currently work where Connect Care is the record of care will value details about bed and ventilator capacity, hospitalization and ICU rates, test positive and pending trends, etc., etc.
  • From Connect Care Hyperspace: go to the Dashboards activity within Connect Care landing page and select the drop-down menu just to the right of the title of the dashboard that appears by default. This gives access to a search interface. Search for all items matching "COVID".


Summative Connect Care Documents to Netcare - Types Released

We previously posted about efforts to ensure that clinically useful summative documents transfer from Connect Care to the the Alberta Netcare Portal. All emergency, inpatient and outpatient adjustments will be fully operational mid-June when a needed Netcare software update is activated. This update is important for outpatient consultation letters, which will start transferring thereafter.

To avoid confusion, the following summative documents will copy from Connect Care to Netcare (ultimately, retrospective to the launch of Connect Care as teams work to resubmit older documents):
  • Emergency
    • Emergency Department Provider Note (summary of ED encounter)
  • Inpatient
    • Admitting History and Physical
    • Labour and Delivery Report
    • Operative Report
    • Consultation Report
    • Discharge Summary (including those using Deceased template)
  • Outpatient
    • Letter to Referring Physician (Communication)


Virtual Care and Collaboration - By the Charts

We've previously posted about rapid uptake of new virtual collaboration and care supports, clearly of value as clinicians adapt to COVID-19 pandemic challenges.

Videoconferencing using AHS's secure enterprise instance of Zoom continues to grow, with meeting and virtual visit volumes following an anticipated word-week pattern. The number of active users (repeat videoconference use) also continues to grow.

We'll soon have sharable tracking tools, additionally revealing how advanced account update and Connect Care integrated video visits progress.

Congratulations to AHS communications and virtual health teams for being so nimble and responsive to rapidly changing needs!


Blood Product Orders

The Connect Care clinical information system (CIS) has Epic's integration engine interfaced with a WellSky system for blood product management. Related workflows accommodate this integration while also addressing safety, accreditation and Canadian Blood Services requirements.

Physicians sometimes struggle with transfusion orders. We've updated Manual, Guide and Demo supports to help:


Supervising Prescriber Selection for Trainees - Optimizing Workflows

We previously posted about a Connect Care change needed to ensure that orders, results and documentation are appropriately linked to responsible physicians when trainees participate in healthcare.

The tweaked logon workflow brings Connect Care in line with expected practice, while ensuring that the right physicians get the right information when test results report late or documentation requires co-signature. Explicit supervisor declaration is mandated by medical staff bylaws, professional regulation and residency training program requirements.

Some trainees have struggled with this change, especially when working in high-volume clinics where they have more than one supervising prescriber. Tips and demos can help:

Note: selection of a Supervising Provider ceased to be part of trainee logons as of December 8, 2020. Please see the Manual for information about how this workflow is largely automated. The rest of this posting still applies.


Virtual Health Office Hours Update

We've previously posted about a helpful series of webinars and open discussion sessions hosted by AHS Virtual Health services. Registration is available for the next set of sessions.

Register for upcoming Zoom for Virtual Care Office Hours by clicking the link for session(s) of interest in the list below. These continue to run every Tuesday and Thursday from 12:00 p.m. to 13:00 p.m. (check the  Virtual Health Insite page for last-minute changes):


Time to Promote MyAHS Connect

Clinicians continue to adapt to social distancing. In addition to expanded use of Virtual Care for patient support at-a-distance, Connect Care providers can leverage communication tools in the MyAHS Connect patient portal. We'll be posting more about this in the coming weeks.

Any patient who interacts with a facility or provider where Connect Care is in play can be invited to use MyAHS Connect. For patients who activate, some capabilities can help with clinical communication:
  • Secure Messaging - clinicians can communicate with patient portal users and can take advantage of messaging pools to quickly screen incoming messages.
  • Results Messaging - results released through the patient portal can be annotated as a form of quick and targeted communication.
  • Video Visits - teleconferencing integrated with the patient portal can be easier for patients and providers to use.
For now, check out a growing list of postings in our FAQ channel:


Summative Connect Care Documents to Netcare - Good News Update

We previously posted about correcting a gap in summative document (e.g., consult, discharge summary, operative note, etc.) sharing with the Alberta Netcare Portal. There were situations where documents initially authored by trainees were not exchanging as expected. The fix became effective April 24, 2020.

We are now pleased to note that all gaps going back to November 3, 2019 when Connect Care first launched, have been filled.