2020-12-22

COVID-19 and Connect Care - Facility-Based Codes Postponed to April 1, 2021

We previously posted about Connect Care professional billing modifications resulting from Alberta Health policy changes respecting overhead considerations. "Z codes" are a set of 13 facility-based health service codes that physicians use to submit claims for services performed in AHS facilities.

Expected changes are postponed to April 1, 2021.

Clinicians who record and submit professional billings through Connect Care need not make any changes at this time.
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2020-12-21

All User Bulletin - Change to Secure Chat Message Persistence

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

Change to Secure Chat Message Persistence

Secure Chat is a secure messaging service that allows users to send text and image messages to colleagues in real time. It is the preferred and approved tool for instant messaging within Connect Care. It is an appropriate communication channel for messaging involving personal health information.

To date, messages have been allowed to accrue indefinitely. This presents some users with large message collections. From January 14, 2021, messages older than 30 days will be automatically purged, even if part of a multi-message string. This is appropriate since messages are meant to support short-term communications that do not need to be part of the record of care. Once a message is purged, it cannot be recovered. 
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2020-12-13

COVID-19 and Connect Care - New Resources for Prescribers

Tippies can be quickly adopted with immediate workflow benefits...
  • Connect Care COVID-19 Resources for Prescribers
With prescribers re-assigned to address pandemic surge needs, some find themselves using Connect Care with inpatients for the first time at Wave 1 and 2 facilities in the Edmonton Zone. 

Many Connect Care enhancements have occurred since the pandemic began, with new and continually improving clinical content (e.g., flowsheets, order panels, order sets, documentation tools, navigators).

A new section of the Connect Care Manual organizes tips and guides to match COVID-19 workflows (with frequent additions), and a new series of "Tippies" shares simple actions that speed workflows.
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2020-12-11

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:

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2020-12-10

COVID-19 and Connect Care - Just-in-Time Training

The COVID-19 second wave brings rapidly increasing numbers of patients to our hospitals and critical care units. The Edmonton Zone is particularly hard hit, with most cases going to the University of Alberta Hospital (currently on Connect Care) and the Royal Alexandra Hospital. 

Many healthcare workers help by accepting clinical reassignments to serve COVID-19 inpatient units, or to free up other specialists by covering non-COVID units. Some prescribers are new to Connect Care and others encounter Connect Care modules (e.g., inpatient) that are new to them.  

The following steps are followed for prescribers needing just-in-time basic or additional Connect Care training:

  1. Edmonton Zone Medical Affairs is informed of the clinical assignment, confirming that privileges are in place, that training needs are clarified, Connect Care access is provisioned, and training instructions are provided: Edm.MedicalAffairs@ahs.ca.
  2. The provider's name is added to a training list and an appropriate pathway is provided for training and certification.
  3. Providers new to Connect Care will be contacted by the Edmonton Zone ACMIO team (cmio.ez@ahs.ca) to arrange virtual training.
  4. Prescribers who already have Connect Care training, and need to cross-train in another track, can access relevant Independent Learning on MyLearningLink by searching for "Independent". For example, those needing the inpatient tract would:
    • Search using "Independent" under "Courses & Registration". 
    • Look for "Epic-CMIO Inpatient Admitting Consulting Independent Learning".
    • Use the "Register" button to access the course.
    • Course elements can be completed at the user's pace and in multiple sittings.
  5. Independent learning is currently available for Critical Care, Inpatient, Emergency, Anesthesia, Pediatrics, Addictions and Mental Health, Ambulatory and Personalization.
  6. Further help with just-in-time training is available via help.cmio@ahs.ca.
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2020-12-08

COVID-19 and Connect Care - Mobile Device Advantage

We've previously warned that personal devices can act like fomites, and that users should take particular care with frequent cleaning. Device vendors have provided COVID-aware screen and keyboard cleaning recommendations.
Subsequent postings will look at inpatient workflows for physicians participating in the care of COVID-19 patients. These can change perspectives about the infection control risk of using personal devices relative to shared organizational devices. Use of hospital keyboards can pose personal risk if not cleaned between uses. Assignment of a device to an individual for an entire shift or use of a personal device with appropriate cleaning are alternatives. Indeed, if one can restrict oneself to dictation of quick draft notes on-ward and subsequent completion of notes off-ward, a mobile device can be used safely.

In any case, it is important to be reminded about how to clean personal devices.
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2020-12-06

All User Bulletin - In Basket Change to "Not My Results" QuickAction

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

In Basket Change to "Not My Results" QuickAction

Sometimes physicians receive In Basket results messages in error. Once a prescriber confirms that the information is indeed inappropriately shared, an In Basket "QuickAction" can be used to flag the error and indicate, if known, to whom the message should be redirected. 

This workflow has been simplified. Previously there were options for "Not My Patient" and "Not My Result". The former is removed. The latter is enhanced with default response text that allows the recipient to quickly indicate why the test might have been misdirected and what action, if any, has been taken.
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2020-12-05

COVID-19 and Connect Care - Capacity Prediction

The prairie provinces, and Alberta in particular, emerge as COVID-19 second wave hotspots. Daily new case records invariably drive hospitalization records a few weeks hence. 

Our ability to compare pandemic phenomena across time and place has greatly improved, with international, national, provincial and organizational datasets proving invaluable for capacity planning. 

We have updated a shortlist of the best of these in the Connect Care Manual:
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2020-12-04

Trainee Bulletin - Change to Supervising Provider Workflow

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

Selecting a Supervising Prescriber no longer required at Login

Prescriber trainees, including medical students, residents and fellows, are supervised by fully licensed prescribers. These are “supervising” or “authorizing” prescribers. Unequivocal identification of the authorizing provider ensures that clinical documentation is appropriately attributed, and that critical and late-reporting results are appropriately routed. 

To avoid ambiguity, a requirement for "Supervising Provider" selection at login was introduced for Connect Care trainees in second quarter 2020. This led to practical difficulties for some trainees. The requirement is removed as of noon on December 8, 2020. 

Instead, a default authorizing prescriber is specific to each patient and encounter:
  • Emergency Departments
    1. Attending provider for the patient ED visit
    2. Current provider (trainee themselves, if they are an authorizing provider)
  • Inpatient Departments
    1. Attending provider for the patient admission
    2. Current provider (trainee themselves, if they are an authorizing provider)
  • Outpatient Departments
    1. Encounter provider for the patient visit
    2. Current provider (trainee themselves, if they are an authorizing provider)
If the authorizing provider cannot be deduced, then the trainee is prompted to select an authorizing provider at the time of ordering. 

The default assignment of an authorizing provider will work most of the time. However, it is important to know how to select an alternate authorizing provider if the default does not fit a specific patient interaction.
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2020-12-03

COVID-19 and Connect Care - New Posting Series

Many prescribers find their work changed in Alberta's second wave of the COVID-19 pandemic. Some redeployments require rapid Connect Care training. Most see already-trained prescribers learning new workflows for COVID care.

We resume frequent postings about tips and guidance for optimal use of Connect Care in the pandemic. These can be viewed together by using the COVID category in any of our blogging channels (see left column). A new link, covid.connect-care.ca, lists all the general Connect Care updates that relate to COVID care and is easy to bookmark.
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2020-12-02

Seasons Greetings from the Connect Care Team

 


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2020-12-01

All User Bulletin - Ordering Audiology Consults

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

Ordering Audiology Consults

As of Tuesday, December 1, 2020 at noon, specialty audiology exams that were previously available to be searched for and ordered by physicians will only be orderable by Audiology prescribers, who can best select a specific intervention appropriate to the clinical need.  
 
Going forward, physicians seeking specific audiology procedures should place an “Inpatient Consult to Audiology” order for inpatients or "Ambulatory Referral to Audiology" for outpatients. If a specific intervention is wanted, this can be added to the comments section of the consult/referral order. An Audiologist will then place the required procedure order(s) and make appropriate arrangements for assessment.

Entering "hearing" or "audiology" as term in the Order Search will bring up the consult or referral order options. 
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2020-11-30

All User Bulletin - Consulting for Interventional Neuroradiology Procedures

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

Consulting for Interventional Neuroradiology Procedures

A number of interventional neuroradiology procedures that were previously directly orderable by any prescriber are now ordered specifically by responsible radiologists. The appropriate ordering pathway is to request an interventional radiology referral or consultation. The diagnostic imaging team then confirms the best approach to address the clinical need while taking care of both orders and scheduling.  

Going forward, physicians seeking interventional neuroradiology exams should place a “Consult to Interventional Radiology” order for inpatients or an “Ambulatory Referral to Interventional Radiology” order for outpatients. This includes therapeutic stroke interventions and the following procedures:

  • IR Aneurysm Coiling 
  • IR Carotid Balloon Test Occlusion
  • IR Intracranial AVM Embolization
  • IR Head Neck Embolization
  • IR Spinal AVM Embolization
  • IR Intracranial Tumor Embolization
  • IR Spinal Tumor Embolization
  • IR Extracranial Stent Placement w Angioplasty
  • IR Intracranial Angioplasty
  • IR Intracranial Clot Retrieval
  • IR Epistaxis Embolization
  • IR Kyphoplasty One Level
  • IR Kyphoplasty Two or More Levels
  • IR Vertebroplasty
  • IR Vessel Occlusion Permanent
  • IR Nerve Root Ablation
The above orders are now treated as synonyms for IR Consult/Referral, which is the suggested order that will appear when searching.

As with all time-sensitive referrals and consultations, it is important to phone interventional radiology at the intended site to share details about the case, the clinical need and urgency considerations.

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2020-11-29

COVID-19 and Connect Care - COVID-19 and Respiratory Pathogen Testing for Inpatients

Alberta's laboratory medicine services continue spectacular work addressing extraordinary demands associated with the COVID-19 pandemic in its second wave. Strategic decisions are made to ensure that resources are focused on the most efficient way to help physicians diagnose patients presenting with infection-related respiratory symptoms.

Effective December 1, 2020, the COVID-19 and respiratory virus testing algorithm changes to improve test utilization in emergency room and inpatient settings. Key developments include:
  • Throat Swabs - Lack sensitivity for detecting non-COVID-19 respiratory viruses, and so will only be processed for COVID-19.
  • Nasopharyngeal (NP) Specimens - Can be tested for COVID-19 and other respiratory viruses.
  • Influenza Like Illness (ILI) NPs - For ED and inpatients, can be tested for COVID-19, influenza and RSV.
  • Full Respiratory Panel (RPP) - Testing should be restricted to patients presenting with ILI and immunocompromised, critical respiratory failure, flaccid paralysis, myocarditis or pericarditis; or for outbreak investigations under the direction of Public Health or Infection Prevention and Control (IPC).
  • Bulletin: COVID-19 and other respiratory virus testing changes
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2020-11-28

COVID-19 and Connect Care - Clinical Content

Clinical information systems (CIS) "content" includes standards (terminologies, lists, etc.), documentation tools (templates, flowsheets, automations, etc.), decision supports (references, advisories, order sets, etc.) and inquiry supports (performance indicators, quality measures, etc.), all designed to support best possible health services.

Connect Care clinical system design (CSD) has been drafting, building and implementing a wide range of clinical content to help clinicians care for patients with COVID-19 illness. We've previously posted about the release and revision of this content.

The burden of COVID-19 on the health care system increases as we struggle with a second wave of infections. The Connect Care updates will give priority to clinical content news, with practical guidance for Connect Care users about how best to use the CIS to reduce information burdens.

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2020-11-27

COVID-19 and Connect Care - Updates

With rapidly increasing COVID-19 cases, hospitalizations and intensive care admissions, this is a good time to refresh awareness about how Connect Care can make it easier to care for COVID-19 patients.

We will use this blogging channel (blogs.connect-care.ca - please consider subscribing) to update advice from earlier in the pandemic, while adding pointers about subsequent clinical information system (CIS) enhancements.

Connect Care prescribers can also review updates and resources using one or more of the following blogging channel themes. The Connect Care Manual remains a good single starting point, as it provides overviews with links to more detailed information:

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2020-11-26

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:

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2020-11-21

Practical Paranoia - Pandemic Phishing on the Rise

Hospitals are prime targets for cyberattacks and this is especially true during COVID-19. The consequences not only disrupt patient care but can be lethal. 


Hackers use phishing emails to trick healthcare workers into downloading ransomware, a type of malicious software that attacks computer systems when an infected link or attachment is opened. The ransomware logs out users and shuts off access to critical information until a "ransom" is paid by the organization.
 
Some recent examples:
  • Outpatient appointments were postponed in Quebec due to a recent cyberattack targeting health board members.
  • A recent ransomware attack in Germany meant that a patient had to be rerouted to a hospital 20 km farther away, delaying care and likely contributing to her death. 
  • An early morning cyberattack at Universal Health Services’ US facilities disabled multiple antivirus programs, logged off users and shut down system access. Affected hospitals had to redirect ambulances and relocate patients in need of surgery to other nearby hospitals. Universal Health Services operates in both the US and UK and is similar in size to AHS with more than 400 facilities and more than 90,000 employees providing healthcare services to about 3.5 million patients annually. 
You can help stop these attacks. 
  • Take note of AHS’ external email warning message. 
  • Don’t open unsolicited email attachments or click on links. 
  • Always report suspicious emails using the "Report Phishing" button on Outlook or forward to stop.spam@ahs.ca, then delete.
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.
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2020-11-20

Connect Care Kudos

From our Chief Medical Officer...

Connect Care Kudos

Following the roll out of Wave 2 on October 23, there have been many messages of thanks to the teams. We’d like to share a few to recognize the teams and tremendous work that went into a successful implementation of Wave 2 Connect Care.
 
Thank You Wave 2 Users: To the new Wave 2 Connect Care users, ​we want to thank you for all that you have done for this successful rollout of Wave 2. As part of this launch, you and your colleagues helped us achieve a 4/5 rating from Epic on the Wave 2 implementation. Under normal conditions this would be an extremely great achievement, never mind doing it under the current circumstances. Keep up the good work. ~ ​The AHS Board
 
Kudos to UAH Dialysis: I was a super user for Wave 1, and I must congratulate all individuals on the dialysis unit at UAH that were involved with the implementation of Wave 2. Staff are functioning at a week three level; they are very confident in opening the chart of the outpatients on dialysis, they calmly navigate through the record when looking for patient information.
 
Lessons learned and recommendation from Wave 1 have been implemented. The patients were well aware of the changes that were occurring; it's obvious the changes were shared with them. Physicians were present to support the staff. The therapy plans are complete, it is evident the success is due to a lot of hard work from all staff involved. I have been very impressed with the calm atmosphere: a real collaborative atmosphere!
 
Congratulations and Thank You: A huge congratulations and thank you to all the staff who have worked so hard on preparing for the Wave 2 launch! The use of Connect Care will positively impact your clinical practice for years to come. The preparation efforts that you have all made while responding to the pandemic at the same time are so incredibly impressive. Thank you!
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2020-11-16

Timing and Sequence of Upcoming Connect Care Waves

A message from Dr. Verna Yiu and Dr. Laura McDougall:

With the successful launch of Connect Care’s second wave on October 24, we are starting to look ahead to our next launches. We know each launch of Connect Care involves thousands of people and hours of preparation. We want to acknowledge the efforts you are making to make Connect Care a reality in your waves, zones and sites, especially with the added pressures of COVID-19.  

Wave 3 will launch on February 27, 2021, at 5 a.m. Teams are heavily involved in training and preparation for that launch, which will take place at 38 locations, including acute and combined acute/long-term care sites across the Calgary and North zones, and urgent care sites in Calgary Zone. This wave also includes related pharmacy and diagnostic imaging services, and Alberta Precision Labs (North Zone sites only) associated with these programs and services. The details of which sites are launching in Wave 3 can be found here. 

Recently, the Connect Care Executive Committee approved the launch timing for Waves 4 and 5, as follows:

  • Wave 4 will launch Saturday, June 5, 2021, at 5 a.m. in Calgary and Edmonton Zones, including:
    • the Alberta Children’s Hospital, Peter Lougheed Hospital, Glenrose Rehabilitation Hospital, Lois Hole Hospital for Women, Royal Alexandra Hospital and many Addiction and Mental Health programs and services in the Edmonton Zone. 
    • It incorporates related clinical support programs, including pharmacy, diagnostic imaging services, Alberta Precision Labs associated with these programs and services (Edmonton Zone sites only, plus genetics labs at Alberta Children’s Hospital), Health Information Management, Nutrition and Food Services, and other support areas.  

  • Wave 5 will launch Sunday, November 7, 2021, at 4 a.m. in various locations in all five zones. Major sites include:
    • the Foothills Medical Centre, Richmond Road Diagnostic and Treatment Centre, acute and combined acute/long-term care sites in Central Zone, the Centennial Centre for Mental Health and Brain Injury in Ponoka, Sylvan Lake Advanced Ambulatory Care Centre, Cancer Care, Screen Test and Alberta Kidney Care (Central, Calgary and South zones). 
    • It also incorporates all of the related clinical support programs, including pharmacy, diagnostic imaging services, and Alberta Precision Labs (Central Zone sites only) associated with some of these programs and services, Health Information Management, Nutrition and Food Services, and other programs.

Connect Care remains one of AHS’ highest priorities. It will give patients and their healthcare team a more complete picture of their health history, improved access to consistent information on best practices, and other resources at their fingertips. It will facilitate communication between patients and their healthcare providers, and among members of the healthcare team. 

Connect Care is being introduced to all AHS programs, facilities and many AHS partners in phases, which started in 2019 and will continue through 2023. The full implementation timelines and sequencing are available, here. 

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2020-11-13

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:

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2020-11-12

Wave 2 Stabilizing

The Connect Care Wave 2 launch continues to stabilize after a remarkably smooth and collaborative transition. Most problems have been resolved and a few ongoing issues are explored by teams working to better match a few workflows to clinical information system capabilities.

As the comfort and experience of users increases, twice daily physician huddles have been reduced to twice weekly. Rapid-response clinical system design and other task groups remain active, but switching from daily to ad hoc meetings as required. Accordingly, our Support Update postings retire and we resume communications in all blogging channels for prescribers in all Waves. 

Renewed thanks to all Wave 2 teams for their incredible work and resourcefulness through the launch period!

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2020-11-05

Results and Reports Routing - Updated Information

Prescribers (including physicians, medical trainees, nurse practitioners, clinical assistants and other health care professionals) order laboratory tests, imaging and other diagnostic interventions in the course of health care. Results or reports related to these interventions are returned to the prescriber for consideration. 

The recent Wave 2 launch has added many prescribers who serve where Connect Care is the record of care as well as where Connect Care is not the record of care. Some new resources can help address questions about results routing in these mixed contexts:

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2020-11-04

Netcare - eDelivery Adjustments

Connect Care's Wave 2 launch has onboarded a number of physicians who manage "hybrid" health record experiences. Some work (e.g., inpatient or emergency) is at sites where the Connect Care clinical information system (CIS) is the record of care and other work (e.g., office visits) is at locations where an electronic medical record is used.

Results and report delivery considerations can be complex during transitional periods. All routable test results and reports for work at a Connect Care venue deliver to In Basket. If the physician has requested eDelivery to their external Electronic Medical Record (EMR), there may be duplicative results routing. There are strategies to manage this, which we will re-post in the coming days.

In addition to laboratory test results and diagnostic imaging reports, providers may receive eDelivery of "summative" reports relating to their patients. These include admission histories, inpatient consults, operative reports, discharge summaries, labour & delivery reports and emergency room reports. 

Some providers have also received eDelivered inpatient progress notes that they authored for their patients in Connect Care. The automated eDelivery of non-summative documentation has been halted. As of November 4, 2020, only summative inpatient Connect Care documentation is eDelivered to external EMRs.

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2020-11-02

Happy Birthday Connect Care!

A year ago today, we were biting nails in anticipation of Connect Care's first launch at Wave 1 sites. 


So much has happened since! Most importantly, the Connect Care community has continued to grow in numbers and capacity. These strengths have enabled a successful Wave 2 launch and, no doubt, many launches to come!

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2020-10-31

On Other Channels...

Thank you for continuing to check (... ideally, subscribe to multiple channels; see instructions) the Connect Care Update blog for prescribers. One week into Wave 2 launch, there are many recent additions to this blog and its various channels to note:

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2020-10-30

Thanks for a great Wave 2 start!

A message of thanks from our Connect Care Triad:



Barb Kathol, Senior Program Officer, Connect Care; Penny Rae, Chief Information Officer; Stuart Rosser, Interim Chief Medical Information Officer
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2020-10-28

All Prescriber Bulletin - Test Patients in PRD

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

Keep Play in the Sandbox!

Demonstration patients are provided in the Production (PRD) environment to facilitate prescriber personalizations pre-launch. It is very important to limit use of these charts.

Never sign an order, communication or other action when working with a test patient. Strictly limit use to prepping order or documentation favourites or preferences. All system personalizations can be done without the use of test charts.

If practice with signing workflows is needed, do so in the PLY (play sandbox) environment.
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2020-10-27

Reminder: Personalization Power

Personalization is important for successful CIS adoption. Many groups benefit from having a few members create and share more advanced personalizations. Multiple pathways to proficiency are available:

Personalization Guides and Tips

The personalization section of the Clinician Manual gives a quick overview of key personalization tasks, opportunities and links. A number of enhancements are made to the Personalization Tips subsection to provide layered and specialty-aware advice about how to grow personalization skills.

Personalization Independent Learning

An online self-directed course, available via MyLearningLink (search for courses using "CMIO Personalization" keyword), covers a number of high-value personalizations for prescribers.

Power Personalization Workshops

A series of workshops are offered to help Connect Care prescribers leverage the power of personalization. Anyone is welcome. The focus will be on some of the more advanced adjustments that can dramatically speed up workflows. 

Personalization workshops are offered through the CMIO Virtual Drop-in Centre, repeated four times in the coming week:

  • October 27, 2020, 17:00-19:00 
  • October 29, 2020, 17:00-19:00 
  • November 3, 2020, 17:00-19:00 
  • November 5, 2020, 17:00-19:00 
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Getting More From Your Dragon

"If you want to conquer the world, you best have dragons."
George R.R. Martin, A Dance with Dragons, Game of Thrones

Looking to be slicker and faster (and happier!) with "Dragon Medical One" (DMO)?

Connect Care's in-system dictation solution consistently proves to be a physician's best friend. Dragon users can document with ease and automate repetitive workflows.

All Connect Care prescribers (current and previous waves) are encouraged to benefit from a DMO optimization session. These go beyond the basics, teaching how to do more with custom commands, hotkey shortcuts and dictation-triggered SmartText. 

All DMO optimization sessions are delivered via Zoom. This makes sessions easy to attend, and multiple time slots are available to choose from. Registration is requested, as group sizes are limited for a better learning experience. To register:
  • Visit My Learning Link (MLL)
  • Search for courses using “DMO Optimization” keyword
  • Select a session from among the available dates and times
    • Location: Zoom
    • Duration: 1 hour
    • Dates: November 3, 4, 5, 10, 10, 12
    • Times: 0700-0800, 1200-1300, 1700-1800
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