2021-01-31

Orders for Recurring Outpatient Therapies in Connect Care

Community prescribers who have Alberta Health Services (AHS) clinical privileges may refer patients into AHS Medical Outpatient Units (MOUs) or Emergency Departments (in smaller centres) for recurring therapies such as iron infusions, antimicrobials, blood products, etc. 

Once Connect Care goes live at a site and becomes the legal record of care, all orders for patient care must be entered into the Connect Care clinical information system, and only prescribers who are trained in the system can be selected as Authorizing Providers for orders. This has implications for sites anticipating Connect Care launch.

As a site prepares to launch Connect Care, existing (standing) paper orders for treatments that will be administered in MOUs or Emergency Departments must be entered into the system prior to each Connect Care launch wave. This ensures the orders can be activated when the patients arrive post-launch for their appointments. A single Connect Care Authorizing Provider must be designated for each therapy plan. Sites are encouraged to establish an approach for managing standing orders on which the ordering prescriber has not completed Connect Care training or does not have AHS clinical privileges. 

Recognizing possible practice variation from facility to facility and zone to zone, the Chief Medical Information Office (CMIO) is working with zone clinical leadership to implement an appropriate workflow to accommodate community prescribers who cannot be selected as Authorizing Providers during launch preparations. For more information, please see the below resources:

2021-01-24

Trainee Bulletin - Select Authorizing Provider when Ordering for Consulting Services

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

Specifying an Authorizing Provider for Consulting Services

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

A previous post outlines how authorizing provider identification is automated most of the time. 

Orders placed by services consulting in emergency (ED) or inpatient (IP) departments remain at risk for misdirection if trainees do not take care to explicitly identify the authorizing prescriber at the time of ordering. We experience ongoing issues with specialized tests returning to In Baskets of ED and IP physicians who did not order the test or take responsibility for follow-up. 

Fortunately, the process that trainees must use for specifying an appropriate consultant authorizing provider at the time of test ordering is straightforward, highlighted in the following:

2021-01-21

Connect Care Access to Calgary Historic Patient Data

Connect Care enables read-only access to external clinical information systems from within Hyperspace via an "Other Clinical Systems" section of the patient storyboard (left column of any open patient chart). Hovering reveals a pop-up listing linked external systems. Selecting a system's link opens a read-only viewer as an activity tab within the patient chart. 


Access to "Calgary Historic Patient Data" via a new embedded viewer is set to appear in Connect Care on January 21, 2021. More information is available in the Connect Care Manual:

2021-01-20

Great Time for Prescribers to Power-Up

A Power User is a clinician who uses Connect Care tools optimally. Physician Power User classes promote use of personalizations to improve users’ individual efficiency in ways that can be easily shared with colleagues. Training covers more than 140 tips and tricks for getting the most out of the Connect Care experience. 

The Power User training and qualification can be pursued by any physician wishing to get more out of Connect Care for themselves and their colleagues. Online courses are offered by Epic through self-directed online learning and webinars. 

Clinical departments and divisions may want to grow their Power User capacity, as this can boost quality improvement, clinical efficiency, physician satisfaction and other objectives.

2021-01-19

New Norms - Closed Loop Referral Management

Closed loop referral management is key to Alberta Health Services’ commitment to safe and effective referral processes for patients, their families and healthcare providers. Now that Connect Care is better established in launched clinics, it is important to clarify our expectations of one another when referring patients for health services.

Where effective change is a shared accountability, a clear statement of "norms" can be helpful. Information, Communication, Documentation, Ordering and Minimum Use norms already guide Connect Care users. 

Recognizing how much referrals depend upon coordinated workflows, we have recently drafted and released "Referral Norms" at the request of the Connect Care Executive Committee... and urge Connect Care community members to work together to assure closed loop referral management.

2021-01-14

COVID-19 and Connect Care - Accessing Public Health Act Forms

We continue to develop a section of the Connect Care Clinician Manual that focuses on workflows supporting care of patients with COVID-19 related illness.

Sometimes physicians need to comply with provisions of the Public Health Act relating to mandatory isolation or testing of non-compliant patients with active COVID-19. Workflows relating to the Mental Health Act are already in place and equivalent orders and flags for COVID-19 public health directives will be available soon.

Until the new orders make it to production, note that the Manual (available in Connect Care from the F1 key or help menu) provides links to instructions and forms:

2021-01-13

It's Official: North Zone Associate Chief Medical Information Officer, Dr. Marc Shaw

Dr. Marc Shaw, ACMIO, North Zone

We are pleased to announce that Dr. Marc Shaw will continue as Associate Chief Medical Information Officer (ACMIO) for Alberta Health Services (AHS) North Zone. Marc has been capably filling this role on an interim basis since September, and it is so nice to make it official.  

Marc has been part of the CMIO office since 2018. His contributions to Connect Care are significant: Provincial Physician Trainer, Surgery, Physician Master Builder, Area Trainer and Super User, Surgery for Wave 1/2. He provided valuable, on-site support for our Wave 1 and 2 Connect Care launches. 

Marc earned his MD at the University of Ottawa and completed his General Surgery Residency at Dalhousie University in Halifax, Nova Scotia. He is pursuing a Health Informatics certificate through Johns Hopkins University. 

Marc has practiced in Grande Prairie since 2006, and is a general surgeon with a special interest in oncoplastic breast cancer surgery. Marc is also an Assistant Clinical Professor in the Faculty of Medicine and Dentistry at the University of Alberta, and was awarded a Certificate of Teaching Excellence from Family Medicine Residents.  He also enjoys racing cars, hiking, and rowing. 


2021-01-12

MyHealth Records: More Lab Results Released to Patients via My Personal Records

The following information is provided by Alberta Health respecting some important changes to the My Health Records service:


In 2021, Albertans will be able to view more laboratory test results in "My Health Records" (MHR), the integrated access point for Albertans’ personal health information. These lab results will be viewable through the "My Personal Records" (MPR) application. This change is being made to provide Albertans with more access to their health information, and as an additional safety net for patient care within the system. These results will be viewable as soon as they are released by laboratory services:

  • About 95% of the most commonly-ordered (by volume) lab test results will be viewable by Feb 1, 2021. 
  • All remaining lab tests, including more complex results in microbiology, pathology and genetics, will be available in MPR by July 1, 2021.

Lab results ordered from all sites in Alberta, including labs ordered during inpatient and emergency visits will be included in MPR. Once the changes are in place, new users will see an 18-month retrospective view of any lab results slated for release. Existing users will not have labs added retroactively, but they will be able to see the expanded lab results moving forward. 

After the changes, patients will have immediate access to more of their own information. Providers may notice some changes in their patterns of work, and may need to consider giving patients more information about the implications of different results when initially ordering a test. Physicians and other providers will continue to have access to results information through their usual channels, including Alberta Netcare.

To support Albertans, Alberta has created the MyHealth.Alberta.ca Web site, a trusted source of health information, and MyHealth Records Support is available at 1-844-401-4016, 24 hours daily. Technical assistance is available between 8:15 a.m. and 4:30 p.m. (MT), Monday to Friday, but a connection to 811 for health-related inquiries, including test results, is available at all times.

For more information about lab results online, please visit:

The Alberta Medical Association and Alberta Health Services will be hosting webinars for providers: 

Webinar: Real Time Release of Labs to Patients: What This Means to Your Practice
Speakers: Dr. Allen Ausford, Dr. Brad Bahler, Dr. Jay Easaw, Dr. Rob Hayward, Dr. Nigel Flook

Date: Wednesday January 20, 2021
Time: 12:00 PM

Moderator: Dr. Heidi Fell, Informatics Chair, Alberta Medical Association
Register: https://albertadoctors.zoom.us/meeting/register/tJEuduqqqjgsGtDTMnZy0HftCmbufOJQlxft

Date: Wednesday January 27, 2021
Time: 5:00 PM

Moderator: Dr. Stuart Rosser, Interim Chief Medical Information Officer, Alberta Health Services
Register: http://ahs-cis.ca/mhrwebinar   


Wave 3 Training Update

AHS leadership recently announced that Connect Care Wave 3 will now launch in North Zone in former Peace Country Health Region, Fort Vermilion, High Level and La Crete on April 10, 2021. 

Connect Care prescriber training in the North Zone has been rescheduled and new registration dates are now open. Once Wave 3 prescribers register for the new rescheduled Wave 3 classes, they will receive new calendar invitations with the updated information.

Please delete any original calendar invitations if registered in those classes before January 5, 2021. The older invitations will not work for the rescheduled classes, and they cannot be remotely removed from calendars.


2021-01-11

Connect Care Wave 3 Countdown

Our countdown timer has re-appeared (see top of left column, just above the Search box) again!

After some COVID-19 adjustments, the Connect Care launch schedule resumes with the Wave 3 launch date set for early hours of the morning of Saturday April 10, 2021. This will bring the following sites into the Connect Care fold:
  • Peace Country Health Region
  • Fort Vermilion
  • High Level
  • La Crete
We are within 90 days from the Wave 3 launch.

Having learned how important it is to avoid a last minute rush, our Countdown Checklist (checklist.connect-care.ca) restarts for Wave 3. This allows physicians to ensure that requirements are met as they progress from registration through training, proficiency, personalization and launch-readiness.

2021-01-08

All User Bulletin - Immunization Records and Connect Care

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

Immunization Records and Connect Care

Immunization data for provincially funded and privately purchased vaccines are recorded in the provincial immunization repository called "ImmARI" (Immunization and Adverse Reaction to Immunization). Authorized healthcare workers use a web app called "IDSM" (Immunization Direct Submission Mechanism) to submit immunization information to ImmARI. 

A letter from Alberta Health was recently sent to some healthcare providers stating that all immunization records need to be entered into ImmARI or IDSM. 

For prescribers who use Connect Care, use of ImmARI or IDSM is not required. Immunization orders for administration of immunizations automatically trigger documentation uploaded to ImmARI – no additional steps are required. 

Questions can be directed to: Health.Imm@gov.ab.ca.

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:

2021-01-04

Connect Care - Change in Timing for Wave 3



The impact of COVID-19 on our health system has been carefully evaluated and a decision made to change the timing and scope of upcoming Connect Care launch waves. Given the increasing demands of COVID-19 on frontline staff, physicians, programs and services, it is prudent to delay the next wave of Connect Care, originally scheduled for February 2021. 

Wave 3 of Connect Care will launch in two parts: 
  1. The portion planned for North Zone will launch April 10, 2021
  2. The Calgary Zone portion will be further reviewed in consultation with zone leaders and teams. 
AHS remains committed to keeping the full Connect Care implementation within the originally-planned timeframe. Dates for future launches will be communicated as pandemic adjustments are firmed up. 

Despite the change in Wave timing, the bulk of Connect Care preparations continue, including:
  • Infrastructure and technology work, including WIFI upgrades, facility preparations, and device deployment and testing
  • Continued support for Waves 1 and 2 to aid the stabilization of those sites and programs
  • Building and validation work for Waves 3-7
  • Building and preparing training support, leadership teams and other roles necessary for upcoming launches.  

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.

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. 

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.

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.

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.

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.

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:

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.

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.

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. 

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.

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

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.