On Other Channels...

Thank you for continuing to check the Connect Care update blog for prescribers (ideally, subscribe to multiple channels; see instructions). Recent additions to this blog and its various channels:

Submitting Issues and Ideas Even Easier

We've previously posted about how Connect Care users can report problems and submit suggestions. A recent enhancement makes the Connect Care Concierge even easier to find and use within Connect Care workflows.

Submitting a suggestion (suggest.connect-care.ca) is done using the same form that is used for non-urgent support requests (help.connect-care.ca). Although the form reads like a problem-reporting tool, it is intended for both issues and ideas.

The blogs' "Help" button (above) and the Clinician Manual's "Concierge" button (bottom of all pages) are available when the blog or Manual are opened from within Connect Care. In addition, the Connect Care "Help" menu (sub-menu of Epic menu at top left of Hyperspace) has a "Connect Care Support" item (click icon to view screenshot): 

and pressing the "F1" key anywhere within Connect Care brings up a pop-up with "Connect Care Support" at the top of its "Prescriber Resources" section (top of middle column):

Finally, entering "connect care" in chart search makes it easy to jump to the support page:

Generating a help or suggestion "ticket" ensures attention to the issue or idea. It also provides a reference number that can be used when seeking advocacy through medical informatics or other leaders. 


COVID-19 and Connect Care - Virtual Care Billing Update

We've previously posted about changes to the Alberta Health fee schedule that accommodate pandemic-compatible clinical workflows.

From January 1, 2022, prescribers providing telehealth care can use a wider range of fee codes and modifiers to better reflect the duration and complexity of patient visits. 

The new complex modifiers (CMXV15, CMXV20, CMXV30, etc.) have been incorporated into Connect Care professional billing supports. Prescribers may need to update personalized charge lists to reflect the new options.

The Alberta Medical Association offers a webinar about updated virtual fee codes:

BBHR: Bloat Busters - Interpret, don't Replicate

Building a Better Health Record (BBHR)

"Note bloat" is a health record affliction that decreases the signal-to-noise ratio of clinical documentation and frustrates clinical decision-makers. As part of our documentation quality improvement initiative, we promote practical ways for clinicians to promote succinct, clear and actionable charting.

Bloat Busters - Interpretation >> Replication

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 related to clinical progress) multiplied by interpretation (application of clinical expertise to advance understanding and support decision-making):

Digital health records make it easy to amplify noise in progress documentation. Copy-paste and text automations ("SmartStuff") pull data blocks (e.g., lab result flowsheets) into a note. These can bring signal at the cost of excess noise. Authors can be lulled into thinking that documentation is done; but the note has little clinically helpful interpretationThe reader of a progress note needs to know what the writer thought and did for patient care.


Building a Better Health Record: Where's the Bloat?

Building a Better Health Record (BBHR)
Bloat Busters - 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. 

Clinicians reviewing others' notes 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 focus on 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" (click the icon to view screenshot):

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.

Better still? Provide feedback to the author that their documentation of important changes might be clearer if they were to focus progress notes on what's new and use tools like the Hospital Course or links to other notes to reference what is stable.


Updates to AHS Email Access - Multi-Factor Authentication

On January 27, 2022, Alberta Health Services (AHS) expands use of Multi-Factor Authentication (MFA) for medical staff, further protecting clinicians from growing cyber security threats.

When logging in to Microsoft Outlook Web Access to gain access to AHS email on a personal device, users will need to verify their identity with a code number obtained by either:

  • using an authenticator app on a smartphone or tablet;
  • receiving a text message to a mobile number of their choice; or
  • receiving a phone call to either a cellphone or landline of their choice.

User name and passwords alone will no longer be sufficient to gain access to AHS email from non-AHS computers not connected to the AHS network.

Instructions about setting up MFA will be mailed prior to January 27, and can be followed at any time using an AHS MRA user guide:

These MFA requirements for prescribers currently apply to Outlook Web Access on  non-AHS laptops or desktop computers.  This MFA solution will not be required for Outlook Application on mobile devices managed by Workspace ONE.


Building a Better Health Record (BBHR)

BBHR: Building a Better Health Record

Well into our Connect Care journey, it is time to take stock. 

We've successfully launched hundreds of sites with thousands of users using a powerful clinical information system (CIS) supporting patient care in diverse settings. We've seen widespread adoption of innovations like mobile-access and in-system dictation. 

However, there are indications that we may need to do more to protect ourselves from potential digital health records harms (mostly identified pre-launch). Indeed, misuse of the Connect Care CIS could make it more difficult for us to quickly discover what is important in a patient's experience. 

Connect Care continues a documentation quality improvement initiative (DQI). This started with background work to optimize charting tools, express provincial documentation standards, clarify documentation norms and find workflows that decrease clinicians' informational burdens. Early products of this work were evaluated with volunteers in late 2021 and then improved and implemented in 2022. 

Wider DQI awareness is supported with a series of blogstipsFAQsManual update and StreetSmart Training modules. Documentation quality indicators can help front-line users benefit from more efficient and effective charting tools. These appear in minimum use and meaningful use dashboards.


COVID-19 and Connect Care - Updated Resources

All COVID-19 workflow, clinical content and resources pages have been updated in the Connect Care Clinician Manual (manual.connect-care.ca). 

With our inpatient facilities bearing a heavy burden of care, we are also posting new updatestips, FAQs and support forum materials in the Connect Care blogging channels (blogs.connect-care.ca) to help clinicians get the most out of Connect Care for COVID-19 care.


COVID-19 and Connect Care - Workflow Supports

As a wider range of clinicians find themselves caring for patients hospitalized because of or with COVID-19, some may have less experience with Connect Care tools developed to facilitate the care of persons with COVID-19 related illness.

The Connect Care Manual (manual.connect-care.ca) has a wealth of information about COVID-19 decision, documentation and inquiry supports. These can be browsed by exploring outline sections nested below a "COVID-19" title in the main "Home" section. Using the search tool (magnifying glass icon, top right) with "COVID-19" plus concept terms will rapidly expose specific details.

We've recently added a "COVID-19 Workflows" section that helps clinicians learn about Connect Care COVID-19 tools in light of the daily tasks that they ease. An "Inpatient Workflows" subsection is ready for review, while we continue work on subsections for emergency, critical care and outpatient contexts.


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:


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. 


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. 


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.