Physician Training - First Month - By the Numbers

Our prescriber training team, lead by Dr Vanessa Maclean, moves mountains!

The number and complexity of Connect Care courses, all heeding our prescribers-training-prescribers commitment, is truly staggering. We thank all leaders, trainers, super-users, informaticians and many other supports for making Connect Care adoption possible. Training and personalization are the strongest predictors of clinician satisfaction.

Of the 1885 physicians who need to be readied for Wave 1 launch in November:

• 85% are registered and allocated to training slots
• 37% have completed basic training
• 13% have completed competency assessments 
• 82% are set up for personalization labs

We are learning, and getting better, all the time. Thank you to all training participants for being patient and growing with us!

Connect Care Continues to Move Forward

Excerpt from today's message from our Alberta Health Services President and CEO, Dr Verna Yiu...

Teams  across the province are actively engaged in bringing the Connect Care program to life. I want to say thank you to everyone involved and supporting this important launch.

As expected, the Government of Alberta on Thursday announced they are reviewing the provincial health information systems: Alberta Netcare, MyHealth Records and the Connect Care clinical information system, with a specific deliverable to ensure digital health information is used effectively to deliver more coordinated services and better results for patients, without duplication. We will participate fully in this review and look forward to its findings. 

This does not affect our work in preparing for Connect Care, and I want to reassure you that we are moving forward.

We know that Connect Care will have a positive impact on Alberta’s healthcare system, and lead to improved efficiencies and better patient care. We are committed to seeing it through to completion. 

We are so very grateful for the contribution and commitment of teams across Alberta, both inside and beyond our organization, who have been hard at work preparing AHS and our partners for Connect Care. Thousands of people have contributed thousands of hours to build, design and pave the way to better healthcare for Albertans. We thank you for all you are doing, especially as you are reaching peak activities to support this program. 

Full steam ahead, with deep gratitude for all our teams have done to get us ready for launch!

Save the date! How do we do Impossible?

The Edmonton Zone Medical Staff Society, University of Alberta and Alberta Health Services are pleased to invite all Connect Care stakeholders to the next Leadership Lecture Series presentation. Cameron Chell will explore "How we do Impossible?" in collaboration with medical leaders and special guests David and Teri Price.

This promises to be an exiting and engaging session; well timed and highly relevant for our first Connect Care launch.

Attend in person at the Bernard Snell Hall Theatre between 0700-0900 on Friday October 4, 2019 or via videoconference locations listed at:

• www.ualberta.ca/department-of-medicine/leadershiplecture

Reinforcing Connect Care Training through Practice

There are already more physicians through basic Connect Care training than ever were trained  for eCLINICIAN use! And the pace of training continues to accelerate. Yet launch is still 2 months from now. That is a long time for busy clinicians to retain new information.

Personalization training will provide opportunity for reinforcement between 2 and 4 weeks pre-launch. It is vitally important, not only for learning new things like mobile Connect Care access, but also for tweaking the system to better suit personal preferences. Still, prescribers need ongoing system access for practice and consolidation of basic training.

We are gratified that so many physicians are asking for ongoing access to some form of Connect Care, anywhere they may have opportunity for practice and exploration. Everyone should have access to a "play" (PLY) environment where one can practice interacting with the clinical information system. Of course there is no real patient data . And one must be change-tolerant as clinical content continues to grow.

Simple internet shortcuts are provided to ease access. We can change the links behind these shortcuts as the full Connect Care production environments emerge. To access Connect Care, note whether your computer is on the Intranet (AHSRestrict network) or Extranet (all other networks).

• Intranet: ahs-cis.ca/cisinternal
• Extranet: ahs-cis.ca/cisexternal
• Tip: Accessing Connect Care Hyperspace

The MacKinnon Report and Connect Care

The Government of Alberta today released its "Blue Ribbon Panel" review of the province's financial perils and prospects. The panel, chaired by former Saskatchewan finance minister Janice MacKinnon, flagged the healthcare system for high expenditures not matched by high performance.

Many of the panel recommendations hinge on inter-provincial comparisons of per-capital spending, using aggregate measures. Of necessity, this is more about where we've been than where we are going. And there is little assessment of the health processes or outcomes that Albertans may value most for their loved ones.

In any case, the panel deliberations already fuel political debate about how the health care system should achieve more with less. Operational recommendations for Alberta Health Services will surface in a separate review expected later this year.

Notably absent is discussion about the role of health information transformation in creating the conditions for iterative, evidence-informed, improvement attuned to Alberta's circumstances, values and aspirations. This is good. There is nothing in the report to discourage us from striving to fulfill our vision for Connect Care. Our transformation agenda is a necessary condition for continuing improvement... including Alberta's competitive positioning among provinces.

A very important report, which physicians should be aware of:

• Report: Blue Ribbon Panel on Alberta's Finances

Wave 1 Incomplete Charting - a Chore worth Completing

September 1st conjures vacation's end and school's start (of toil). More PTSD this September as we escalate preparation for Connect Care launch on November 3, 2019!

An important readiness chore is to make sure -- now -- that all legacy pre-Connect Care clinical documentation is complete. Now, because transfer from systems like eCLINICIAN and Netcare is happening now.  Data conversion, chart abstraction and documentation cutover must be completed pre-launch.

What's to do? Start with ensuring that all Wave 1 site (University of Alberta Hospital, Mazinkowski Alberta Heart Institute, Stollery Children's Hospital, Kaye Edmonton Clinic, eCLINICIAN clinics) consult and discharge summary dictations are complete and signed.

It is to physician advantage to complete outstanding deficiencies (inpatients and day surgery) prior to November 3, 2019, eliminating the need to work in two systems.

Wave 1 physicians can contact Health Records (780-407-7638) to obtain a list of incomplete charts and have these pulled for dictation, correction and/or signing.

Readiness Activities in Full Swing

Summer's over! With the start of September, the shift from design-build-validation to training-readiness-implementation is daunting... but also exhilarating!

We have already trained more Edmonton Wave 1 physicians that ever were trained to use the former eCLINICIAN system. Multiples parallel streams of classes run all-day, all-week. At the same time, there is a flurry of iterative tweaking as clinicians view and validate the decision, documentation and inquiry supports they helped design. And practitioners of all types dig deeper into readiness activities. There are many this month:

• 60 day Launch Readiness assessment
  taking stock of all that has to happen to be ready for launch; this time with the clinical information system users taking the lead.
• Shadow Charting
  where complex, high-impact and high-volume documentation workflows are tried alongside real patient encounters in order to smooth any rough workflows before launch.
• Patient Movement Day
  when transitions and handoffs are tested to ensure that modules and clinical domains can work together across a complex patient journey.
• First personalization labs
  when clinicians learn how to shape the CIS to better suit their needs and style.

We'll keep posting!

Connect Care September 2019 Calendar

A summary of key Connect Care happenings in September 2019 has been posted to the Alberta Health Services (AHS) internal Connect Care website, linked below.

• Connect Care September 2019 Calendar

What is a CIS "Environment"?

It is exciting to get ever more exposure to what the Connect Care clinical information system (CIS) will look like at launch. Along the way, we are called upon to work in a variety of CIS "environments". Each has a specific purpose, and properties suited to that purpose.

Our eHealth Glossary has been updated to include definitions of all the CIS environments that may be encountered by clinical informaticians. Each acronym (e.g., PRD, SBX, PLY, etc.) is defined together with information about the groups who have access, and under what conditions. The following link pulls environment definitions from the glossary:

• Environment definitions: glossary.connect-care.ca/?=environments

How will current eHealth initiatives enhance continuity of care?

[repost from AMA MD Scope]

Continuity of care is about a patient and provider health care experience that is coherent, connected, coordinated and consistent with patient goals.

Connect Care, community EMRs, Netcare, and the Community Information Integration (CII) and Central Patient Attachment Registry (CPAR) will build connectivity to defragment the health information space and increase access to it; bringing continuity to Albertans' experience of health care.

• News article: Alberta Medical Association MD Scope

How can Connect Care connect with you?

In November 2019, Connect Care will begin launching at Wave 1 sites and programs, with the rest of Alberta Health Services (AHS) and its partners launching by the end of 2022.

Connect Care is becoming very real, very quickly, for all those clinicians not yet directly involved. This is a large and busy group. We want to make sure that all stakeholders are able to get the information they need via the channels that work best. Can you help us make sure you are getting the information you want, when and how you want it?

AHS Community Engagement and Communications wants to better understand the best ways to keep clinicians involved and informed about Connect Care. A short online survey (<2 min) remains open until 11:59 p.m. Sept. 3, 2019.

And, as always, please feel free to share feedback directly or through your physician informatics leads.

• Survey: Connect Care Communication Needs
• Feedback: connectcare@ahs.ca
• Physician Contacts: CMIO portfolio

Wave 1 Patient Movement Day - September 18, 2019

Patient Movement Day (PMD) offers a unique opportunity for clinicians to take a practical look at what in-patient journeys will look like in Connect Care.

All physicians, prescribers, nurses, allied health and other staff are encouraged to attend. They can see and learn about how complex patient movements are coordinated with clinical information system (CIS) tools and workflows. Morning demonstrations illustrate how Connect Care will facilitate the sequence of events that must occur for patients to flow safely and efficiently from emergency to ward, critical care, surgery, diagnostic imaging and other investigation and intervention venues. In the afternoon, drop-in practice centers (including a physician practice center) allow participants to dig deeper, view more specific workflows, ask questions and practice different patient movement scenarios.

Wave 1 Patient Movement Day occurs Wednesday September 18, 2019 from 08:30 to 16:00, with scenario explorations and demonstrations in the morning and practice activities in the afternoon. A more detailed agenda will follow, allowing physicians to focus on the transitions most relevant to their practice.

• Byte: Patient Movement Day

Training Milestone - First MD Cohort Completes Basic Training

We are delighted to see the first group of Wave-1 physicians complete their basic training!

12 paediatricians worked with a physician trainer and 2 physician super users to progress through a curriculum customized to their typical workday, work setting and clinical tasks. The training environment worked well and everyone was able to progress through the planned tasks. All participants were appropriately allocated the right Connect Care applications. And it was clear that physicians training physicians is appreciated.

Of course, we noted ways in which the experience could be improved. The trainers' learnings are summarized, shared and used to tweak the next set of training sessions.

In particular, we are very aware of some challenges with the MyLearningLink learning management system. The recommended self-directed modules are not filtering correctly, with the result that physicians see all possible modules when checking "Required Courses", not the ones that pertain to their track. We are putting together supplementary QuickStart guides to help the next wave of trainees to pick out what matters most.

Huge thanks to our first participants, and to the Connect Care training team. We're finding our stride!

Connect Care Clinical Inquiry Newsletter

We've previously posted about how Connect Care in-system inquiry tools can help AHS grow as a learning healthcare organization.

The Connect Care Clinical Inquiry Newsletter offers an excellent way for those interested to keep updated about developing capabilities, supports and processes related to clinical inquiry. There are many applications, including personal practice reviews, quality assurance, quality improvement, clinical research and process optimization.

The Newsletter releases monthly. For those interested in the same content via shorter but more frequent communications, subscribe the Clinical Inquiry Blog. 

With our current emphasis on training, change management and readiness, the Newsletter is full of great information about courses, webinars and emerging key contacts.

Physician Resources Listing Updated

Befitting the size and complexity of Connect Care, the volume and variety of communications grows exponentially as launch grows closer. Not all are of direct relevance to prescribers.

This (bytes.connect-care.ca) and other Connect Care communication channels for physicians can help. We highlight new and important topics, briefly, daily. Those who want to know more can link-out to single-page summaries ("Byte") and, from there, more detailed resources.

Not all physicians have the same Connect Care needs. Focused communication channels can help. Accordingly, we have started messaging for different listening styles and contexts. One new channel focuses on the needs of physicians who will not be using Connect Care as their record of care. Another focuses on physicians pursuing informatics opportunities.

A user-to-user peer support forum is part of our launch plans. We've set this up and are figuring out how to make it work well for those who value that kind of interaction. And we continue to work on a new physician manual to make key user-oriented documents readily available on mobile platforms. The physician handbook will focus on the more detailed information needs of super users, trainers, power users, builders and designers.

We will continue to summarize current and emerging links at resources.connect-care.ca (recently updated).

Connect Care for outside Connect Care

The Connect Care "Non-AHS Community Physician Advisory Group" gathers together stakeholders interested in Connect Care but not anticipating using Connect Care as their record of care. NACPAG has been active for a number of months and has already facilitated impactful analyses, consultations and recommendations. Above all, they have worked to improve communications about how Connect Care links with diverse provincial health informatics initiatives.

NACPAG supports its own blogging channel (bridges.connect-care.ca), where a newsletter series has been initiated. We encourage interested physicians to subscribe by following the instructions linked on the blog home page.

• Blog: Connect Care Bridges
• Newsletter: Connect Care Community Provider Update (August 2019)
• FAQ: Connect Care outside Connect Care
• Web: Connect Care Community Provider Resources

Medical Error - How big is the problem?

We approach the 10 year anniversary of publication of the Institute of Medicine's report, "To Err is Human: Building a Safer Health System," with growing awareness that health information systems can both prevent and contribute to medical error.

Where Safety relates to freedom from unacceptable risk, eSafety relates to freedom from unacceptable risk associated with the development, implementation and use of health information systems.

There have been great advances in our understanding of health safety, with many Canadian Patient Safety Institute facilitated initiatives now protective in health care facilities. We are also more measured in our understanding of patient safety, even recognizing that we may have over-estimated some risks. A recent healthydebate article explores the thinking.

What is Connect Care doing about patient safety and eSafety?

• eSafety Framework
• Clinical System Design (CSD) is informed by an eSafety Framework developed and adopted at the beginning of Connect Care. 
• User Interface Review
• Emerging clinical content is tested against an eSafety Checklist to avoid known interface and informational risks. Experienced human factors specialists facilitate this work.
• Workflow Review
• Human Factors also facilitates a detailed, click-by-click, review of common and complex workflows to ensure that no new interface, information or interaction flaws increase risks.
• Safety Incident Reporting
• The AHS safety reporting system is integrated with Connect Care, enabling users to report near-misses and other events without breaking workflows.
• eSafety Tracking
• Safety incident reporting and tracking now includes specific characterizations for errors directly or indirectly related to information system use.
• Embedded Problem Reporting
• Users are able to report, from within Connect Care information flows, aspects of their Connect Care experience that might contribute to error or safety.

We'll share more specifics as clinicians make their way through training and enhance our eSafety vigilance.

Connecting for Continuity

Continuity of Care is about a patient and provider healthcare experience that is coherent, connected, coordinated and consistent with patient goals.

Connect Care will go a long way towards bringing continuity to healthcare in Alberta. Its integrated clinical information system (CIS) will replace most of the >1,300 health information systems currently in place across Alberta Health Services (AHS) and affiliated organizations. When fully implemented in late 2022, the CIS will be used by all providers where AHS is accountable for the record of care.

A variety of Electronic Medical Records (EMRs) facilitate primary and specialty healthcare where Connect Care is not the record of care. Without ways to bridge these information spaces (CIS and EMR), continuity is broken.

One bridge is provided by Alberta's provincial Electronic Health Record, Netcare, which aggregates key health information and makes it available to authorized providers. Netcare is improved when Connect Care deploys because it gains a wider range of information from a single, standards-based, CIS source.

Another bridge is provided through "eDelivery" of health information from Connect Care and Netcare to Alberta EMRs. This too is improved with Connect Care. More information in a more consistent format is easier for EMRs to capture and organize.

Two new initiatives promise even better connections. AHS, the Alberta Medical Association and Alberta Health are promoting two-way health information sharing between EMRs and Netcare through "Community Information Integration" (CII) and a "Central Patient Attachment Registry" (CPAR). These allow patients to be linked to a medical home, and for that home to share information with Netcare. The CII will extend sharing to include the CIS in 2020 and CPAR will both inform and be informed by what happens where Connect Care is the record of care.

Working together, Alberta's CIS, EHR, EMR, CII and CPAR help to defragment the health information space; bringing continuity to Albertans' experience of healthcare.

90 Day Launch Readiness Assessment Today

Among many preparations for the Connect Care launch later this year are Launch Readiness Assessments (LRA). These bring together all participants in the Connect Care initiative to  report on progress and to problem-solve impediments. This taking-the-temperature is invaluable for nimble adjustments and collaborative coordination.

An important 90 day LRA occurs today, July 30, in the Bernard Snell Hall (Walter Mackenzie Health Sciences Centre in Edmonton) starting at 0830. Connect Care team members and Wave 1 leaders and participants, will review all streams of work for progress, risks and launch readiness.

• Insite: Connect Care Readiness Activities
• Edmonton Zone Readiness Resources: edmonton.connect-care.ca

Clinical Operations 2 Minute Updates

Clinicians work as a team. Connect Care both increases and leverages our interdependence. There will be many opportunities for the professions to help one another by reducing duplicative documentation, improving handover, coordinating communications and keeping all aligned with patient goals.

While Bytes blog has a prescriber (physicians, medical trainees, pharmacists, clinician assistants, nurse practitioners, etc.) focus, our interests often overlap those of non-prescribers. A basic awareness of colleague's Connect Care efforts is important.

The clinical operations team maintains an excellent "2 Minute Update" approximately weekly. This summarizes key happenings and priorities for non-prescriber colleagues; lots relevant to prescribers.

• Newsletter: Clinical Operations 2 Minute Updates
• Update: 2 Minute Update - July 29, 2019

Mandatory Privacy Awareness Training

All physicians must complete privacy awareness training prior to gaining Connect Care access. This can be done independently and online by completing “InfoCare: On Our Best Behaviours” through MyLearningLink.ahs.ca (MLL). A search in “Courses & Registration” for “Infocare” will bring up the module. Note that it must be completed in full to expose a final attestation which must be completed before full Connect Care access is granted.

MLL has a “Required Courses” menu item and section. Note that the many courses listed are not required of physicians, with the exception of InfoCare. Physicians will receive explicit instructions in their training packages about which modules fit their needs.

• Tip: MyLearningLink for Physicians

MyLearningLink for Physicians

Most Connect Care courses are managed through MyLearningLink.ahs.ca (MLL), which is accessed using an Alberta Health Services (AHS) username and password.

Many physicians will seek access from outside AHS facilities, likely with computer types different from standard AHS issue. For example, users of Apple computers are advised to use the Chrome browser. A tip sheet gives practical advice about how to configure for MLL success outside of AHS facilities.

• Tip: MyLearningLink for Physicians

Wave 1 Training - Important to Sign Up for Scheduling!

Good training, supplemented with effective personalization, is a best predictor of physician satisfaction with clinical information system (CIS) use. We can't avoid CIS adoption -- it is now an essential clinical skill -- but we can avoid lacklustre training.

Connect Care physicians are offered personalized, workflow-sensitive, training tracks delivered by those who understand their needs: other physicians. Moreover, the curriculum is designed to help physicians acquire essential competencies while getting valuable continuing education credits.

A wide range of times and locations are offered, in addition to flexible self-directed e-learning modules. Inevitably, the necessary in-person training sessions have limits and so it is essential that all Wave-1 physicians submit their scheduling preference surveys as soon as possible! The survey link appears in emails, and email reminders, sent via medical affairs.

We are pleased that over 80% of eligible physicians have submitted preferences and most are receiving assigned dates and times. Nonetheless, the longer one procrastinates, the fewer training slots available to pick from. And, in the end, the training cannot be avoided.

Physicians who believe they should receive, but have not received, a training preferences survey should contact wave1-connectcare.physiciantraining@ahs.ca.

Yet another review - How does this affect Connect Care?

In a previous post we commented on reports of an external review to be launched by Alberta's provincial government, with intent to explore how information system assets could be coordinated to public advantage.

Another review has hit the press. A contract awarded to Ernst & Young supports a general review of Alberta Health Services, the province's public corporation responsible for integrated care across the continuum of care.

It is important to appreciate that Connect Care is not in scope for the general AHS review. Also important to re-iterate that support for Connect Care is not in scope for the health information systems review. Rather, the focus is on optimization and opportunity. Alberta has leading-edge Electronic Health Record (EHR), Electronic Medical Record (EMR) and Clinical Information System (CIS) initiatives.

• Key Concepts: Digital Health Records

Practical Paranoia - Why Use AHS Secure Email?

We've previously posted about warranted worry when using email for clinical purposes.

Alberta health Services (AHS) offers a secure email solution that can support sending identifiable patient health information between AHS email and, with "!Private" in the subject line, to non-AHS email addresses.

Clinicians have raised a number of questions. Hopefully, this FAQ helps:

• FAQ: AHS Secure Clinical Email

Is Connect Care at risk in new provincial review?

Connect Care participants have expressed concern about recent news reports of a provincial government review of Alberta's health information systems. Is Connect Care at risk?

The review, fulfilling a pre-election promise of the new provincial government, does not reflect second thoughts, or any lack of support, for the Connect Care initiative. Rather, there are information services that Connect Care can offer patients and physicians that may overlap with other provincial offerings, like the provincial electronic health record and public service patient portal. The intent of the review is to consider the most efficient strategy for leveraging Alberta's considerable opportunities. A request for proposals from potential reviewers has been posted and review results are not anticipated until 2020.

The Connect Care initiative continues with unequivocal commitment to its first launch in November 2019, and beyond.

Connect Care Wave 1 - What's Up?

Anyone associated with Connect Care is no stranger to immense complexity! And the number of simultaneously accelerating activities increases week by week. It can be hard to appreciate all that is happening.

A new Wave 1 Activities Timeline can help stakeholders keep up with accomplishments, needs and milestones.

With all clinical content (decision, documentation and inquiry supports) designed, the new priorities relate to content build and validation. It is especially important to re-rally clinical experts to ensure that what is built is what was intended. All levels of training continue to ramp up, with the bulk of end-user training starting just weeks from now. Other immediate happenings relate to device (medical and non-medical) installation, testing and validation.

• Infographic: Wave 1 Activities and Timelines

How much past health data will make it into Connect Care?

Data conversion is about how historical health information is selected and managed for transfer from legacy information systems to the Connect Care clinical information system (CIS). We've previously explained the principles and processes that determine which, and how much, health information will be available in Connect Care at launch.

Wave 1 launch rapidly approaches and we can answer data conversion questions with more certainty.

In most cases, laboratory and diagnostic imaging results will be complete back to June 1, 2017; bringing over two years of important clinical information into Connect Care. In addition, most vaccination records, genetic data and legacy clinical information system (e.g., eCLINICIAN) data will transfer. Paper records will not be transcribed or copied. However, they may inform chart abstraction (outpatient) or cutover data entry (inpatient) near launch.

Clinicians can be reassured that key health information remains available in the Alberta Netcare Portal; an important safety net during transitions to Connect Care.

In addition to previously shared conversion summaries, take a quick look at the Key Messages for a quick summary of our latest expectations.

• Key Messages: Clinical Data Conversion
• Byte: Data Conversion
• FAQ: Data Conversion

More Power to Connect Care Users

Building capacity in clinician communities remains a pillar of the Connect Care physician readiness strategy. Capacity grows at many levels. Our training program emphasizes empowerment of end-users, especially to leverage personalizations that can make the clinical information system (CIS) experience efficient, even enjoyable.

We've previously blogged about building capacity at other levels. Physician Super Users, Power Users, Builders, Analysts, Knowledge Leads and Medical Informatics Leads have already proved invaluable to our clinical system design and build efforts. We are benefiting from skilling-up before launch, which is not typical for other CIS implementations.

One option for physicians seeking more advanced information management skills is the Power User pathway. We've facilitated this opportunity for medical informatics leaders embedded in zones and specialty areas. It is exciting to witness how many have taken advantage of excellent course offerings from Epic. 17 Power Users are certified (completed 8 courses), 66 have started the pathway and 58 have at least two courses completed.

Thanks to all who prepare for CIS mastery... to better help the rest of us avoid being enslaved by the CIS!

Wave 1 Physician Training - Registration Progress

We've previously posted about getting Wave 1 physicians ready for and scheduled into Connect Care training.

A big thank you to all who have heeded the call and submitted preferences for personalized training! We are grateful to have over 1,300 physicians (73% of Wave 1 cohort) already getting lined up for basic training.

Follow-up communications are going out to those who have not yet registered preferences. It is very important that all physicians respond and get matched to acceptable tracks and timelines. Delays reduce options!

The Area Trainers guiding physicians through training are themselves trained, with about 60% completing key preparations this week. Super Users are also key to effective facilitation. About 40% will have finished their own training this week.

Our unique Connect Care training program continues to unfold. We are excited to see, as much as possible, the prospect of clinicians training clinicians coming to fruition. It remains for users to seize the opportunities offered. Taking training seriously is one of the best predictors of satisfaction with a new clinical information system.