2022-01-28

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:

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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. 

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2022-01-26

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:

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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 interpretation. The reader of a progress note needs to know what the writer thought and did for patient care.

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2022-01-25

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.

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2022-01-24

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.

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2022-01-23

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 blogs, tips, FAQs, Manual 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.
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2022-01-22

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 updates, tips, 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.

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2022-01-21

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2022-01-20

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.

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2022-01-14

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2022-01-13

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. 

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2022-01-11

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. 

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2022-01-10

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.
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2021-12-21

All User Bulletin - Connect Care Training and Play Environments Down

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

Connect Care Non-Production System Not Available

There is currently an unplanned outage of the Connect Care User Training (ACE) and Play (PLY) environments, which are used for independent learning and post-training practice. The Connect Care Technical Team is working on the issue, and we will update this notice when the system is fixed.

Update (2021-12-21, 11:25): Some ACE and PLY environments (ACE 11-18, PLY2) are now back online and are operating as expected. The remainder of the environments will be brought up online and worked on operationally throughout the day.

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2021-12-07

COVID-19 and Connect Care - Vaccine Orderset Adjustments

We've previously posted about updates to COVID-19 vaccination orders in Connect Care, reflecting things like changes in eligible populations, dosing intervals and boosters.

Further tweaks to these order sets, now in production, address the needs of newly eligible pediatric populations.

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2021-12-02

Prescriber Feedback: Survey on COVID-19–Related Terms in Connect Care

Prescribers providing direct care to COVID-19 patients are requested to participate in a voluntary survey to indicate the COVID-19–related terms that should remain active for Visit and Problem List diagnoses in Connect Care. This survey is open to both Connect Care and non-Connect Care users.

There are approximately 160 COVID-19–related terms for prescriber search and selection of Visit and Problem List diagnoses in Connect Care. A limited clinical review was recently completed under the direction of the Connect Care COVID-19 Working Group to reduce the number of front-facing COVID-19–related terms available to essential terms only. As a result of this review, the terms were grouped into two categories:

  1. Essential: Essential terms active in Connect Care for prescribers.
  2. Further clinical review: Terms requiring clinical review to determine if they should remain active in Connect Care.

Survey responses will be used to determine which of the terms in the "Further clinical review" category will remain active in Connect Care. The terms in the "Essential" category are viewable in the survey for reference only. Terms not selected will be removed from display for all prescribers. Changes will not be retroactive.

The survey is voluntary and takes about 8 to 10 minutes to complete. It will be open until end of day on Sunday, December 12, 2021. If additional terms are required or you have any questions, please contact clinicalterminologies@ahs.ca.

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2021-11-19

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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2021-11-05

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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2021-11-04

Prescriber Feedback: Use of Comments Within Laboratory Test Orders

The Connect Care laboratory medicine group seeks feedback about whether and why prescribers might use an available "comments" field when entering orders for laboratory tests in the Connect Care clinical information system. The following survey (closing November 11, 2021) can be used by any prescriber who enters orders for tests:

Survey feedback information will used to help optimize the design and use of order comments.  

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2021-11-03

Connect Care Waves 4 and 5 - Updated Launch Timelines

An important message from Dr. Francois Belanger, Chief Medical Officer, and Sean Chilton, Vice President Health Professions and Practice and Information Technology:

In September 2021, we made the difficult decision to delay the planned launch of Connect Care’s Wave 4 and subsequent waves, in order to support patients and healthcare teams as we faced an overwhelming wave four of the pandemic in Alberta. We thank all of you for your patience over this period of time, for your ongoing work to keep preparing for Connect Care, where it was possible, and for being redeployed into areas which desperately needed your help. 
 
Despite this recent delay, Connect Care remains an organizational priority. We promised we would update you with new timelines for launches as soon as we could. We feel we can now revisit Connect Care planning given there has been some reduction of pressure on the health system. Over the past weeks, Connect Care leaders collaborated with zone, provincial and executive leadership to determine our best path forward for the remaining six launches of Connect Care. 
 
The new plans for Connect Care have shifted the existing sequencing and scope for each wave six months into the future. This has extended the overall timelines for Connect Care, which will now be complete in 2024; however, the content of each wave remains the same. The next two waves are outlined below.
 
Wave 4: May 14, 2022

With 57 sites in the Edmonton and Calgary Zones, Wave 4 will be our biggest launch to date. It includes:
  • Calgary Zone: 
    • Alberta Children’s Hospital, Peter Lougheed Centre, Southern Alberta Forensic Psychiatric Centre (and associated forensic services), Calgary Correctional Centre, Calgary Tuberculosis Clinic
    • Urgent Care Centres: Sheldon M. Chumir Health Centre, South Calgary Health Centre, Airdrie, Okotoks and Cochrane, including Addictions and Mental Health Urgent Care sites and rural ambulatory clinics
    • Calgary Zone rural and acute care combined sites, including Airdrie Community Health Centre and Provincial Building, Banff Community Health Centre, Mineral Springs Hospital (Banff), Canmore General Hospital, Claresholm General Hospital, Willow Creek Continuing Care Centre (Claresholm), Chestermere Health Centre, Cochrane Community Health Centre, Didsbury District Health Services, High River General Hospital, Lake Louise Medical Clinic, Nanton Community Health Centre, Oilfields General Hospital (Black Diamond), Okotoks Health and Wellness Centre, Strathmore District Health Centre, Vulcan Community Hospital  
  • Edmonton Zone: Glenrose Rehabilitation Hospital, Lois Hole Hospital for Women, Royal Alexandra Hospital, Addictions and Mental Health Addictions and Residential programs
  • Pharmacy and Diagnostic Imaging: Sites in Calgary and Edmonton, including Central Production Pharmacy
  • Alberta Precision Labs: Alberta Children’s Hospital Genetics Services South Lab, Edmonton, including Glenrose Rehabilitation Hospital, Royal Alexandra Hospital, Grey Nuns Hospital and Misericordia Community Hospital
Wave 5: November 6, 2022
  • Calgary Zone: Foothills Medical Centre (including associated clinics at Richmond Road Diagnostic and Treatment Centre)
  • Central Zone: Acute and combined acute and long-term care sites from the former David Thompson Health Region, including the Centennial Centre for Mental Health and Brain Injury, Sylvan Lake Advanced Ambulatory Care Service, Addictions and Mental Health services in the former David Thompson Health Region, Continuing Care (intake and transition services)
  • North Zone: Addictions and Mental Health ambulatory sites from the former Peace County Health Region, Fort Vermillion, High Level, La Crete, Paddle Prairie and Rainbow Lake
  • Provincial Programs: CancerCare Alberta North and South, Kidney Care South
  • Pharmacy and Diagnostic Imaging: Sites in Calgary and the former David Thompson Health Region
  • Alberta Precision Labs: Sites in the former David Thompson Health Region
For more details on launch sequencing, please visit Insite.
 
As we move forward, Connect Care teams will be working with site and zone operational leaders to schedule required training in early to late November. The training will commence in January 2022. 
 
Connect Care team members redeployed to support the pandemic response will be released from those roles as capacity and demand decreases across the organization. We expect these team members will be returned to their Connect Care roles no later than the beginning of January.  
 
We are thankful for all the work done to prepare us for these next launches by teams across the organization. Your work has set us up for success as we move forward.  
 
We also want to thank you for your patience as we altered our plans to address the urgent needs of Albertans and the healthcare system. 
 
We look forward to these upcoming launches and continuing to improve the care we provide to Albertans through Connect Care. 
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2021-10-30

COVID-19 and Connect Care - Hospital Co-vaccinations

The flu season is soon upon us, with opportunistic immunization important for at-risk patients during hospitalizations.

Previously, the COVID-19 vaccination instructions and documentation suggested that COVID-19 immunization not be considered within 14 days of any other immunization event. The evidence, and guidance, is now clear that co-vaccinations are both safe and appropriate. The Connect Care order set and associated clinician documentation reflects this change.

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2021-10-29

COVID-19 and Connect Care - Documenting Historical Vaccinations

We've previously posted about how to review COVID-19 immunization information in Netcare and Connect Care and how, if indicated, to add information about an otherwise undocumented vaccination as a historical immunization when patients present with formal documentation of non-Alberta immunizations.

Recent audits have uncovered some inappropriate (even fraudulent) instances of what appear to be formal external documents. Alberta's provincial COVID-19 vaccination validation service is resourced to assess and validate external vaccine documents. It is easily accessed and used by patients online.

Connect Care providers should direct patients to submit their external documents for approval and possible addition to the provincial registry, and should avoid manual entry of historical COVID-19 vaccine administrations into Connect Care. The provincial registry information is automatically copied into Connect Care when validated.

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2021-10-22

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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2021-10-15

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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2021-10-11

BBHR: Charting Efficiencies - Sidebar Aids for Transition Planning

Building a Better Health Record (BBHR)
Charting Efficiencies - Sidebar Aids for Transition Planning

Improvements to the Hyperspace inpatient chart Sidebar include aids for quickly finding, displaying and editing information in either the main (central), Sidebar (right) or pop-up chart spaces. The first set of tools appear by default when the inpatient Sidebar opens to its "Index & checklists" view. These nicely illustrate how the Sidebar can help users quickly access and update chart data that otherwise would require more familiarity with less-used parts of the chart.

The focus of the checklists view is on transition planning, whether that relates to discharge, transfer or a move to a different level of care (click on icon to view screenshot; numbers below refer to numbers in screenshot). 

  1. If not already displayed, select the top-left "Index & checklists" link to display the "Checklists" and "Transition Planning" Sidebar tools.
  2. Daily, Admission and Discharge Checklists are presented. These function like task managers, reflecting important unfinished tasks and changing to completion status when the relevant work is done. The few highlighted tasks closely match Connect Care minimum use norms.
  3. Checklist items are "active". When selected, the user is taken to a relevant documentation or ordering tool directly relevant to the listed task.
  4. The Transition Planning section summarizes relevant information, including expected transition and discharge dates, social supports, community care needs and patient goals. Where information is missing or incomplete, the title or bracketing text appears in a (dark) blue font, indicating that it can be selected to activate data entry tools in-context where the associated information can be updated. Use the Sidebar "refresh" icon (top left of Sidebar) to update the display if this does not happen automatically.

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2021-10-08

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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2021-10-01

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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2021-09-30

BBHR: Charting Efficiencies - Other Clinical Systems Sidebar Views

Building a Better Health Record (BBHR)
Charting Efficiencies - Using Other Clinical Systems Sidebar Views

New patient assessments offer important opportunities to initiate core clinical data in the patient chart. This decreases the work of documentation thereafter, when clinicians can revise or validate information already entered. 

Sidebar tools can help clinicians when they review information from other clinical information systems (e.g., Netcare) or from prior unstructured Connect Care documentation (dictated notes that, for example, did not include updated problem lists). The user needs to review and document at the same time, ideally without jumping back and forth between different windows. 

The Sidebar can help in two ways, either when used to review information that informs documentation performed with main panel tools, or when used to enter information gleaned from the main panel. 

Sidebar views of other clinical information system content are especially helpful when doing problem, adverse reaction or medication reconciliation, as explained in a recent Manual addition.

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2021-09-29

All User Bulletin - Inpatient Sidebar Enhancements

All-user-bulletins highlight information that all prescribers can benefit from when using the Connect Care clinical information system.

Inpatient Hyperspace Sidebar Enhancements

Users may notice changes to the "Sidebar" (rightmost panel appearing when a patient chart is opened to an inpatient encounter in Hyperspace) starting noon September 30, 2021. The best way to learn about new functions is to select the embedded help link to gain access to a quick overview.

All the same Sidebar information is available. However, many Sidebar views have been enhanced with better clinical summaries. The Sidebar index now uses information about the current provider, patient and clinical setting to conditionally display the most relevant information. In addition, new features make it easier to use the Sidebar to access charting tools that complement what one may be using in Hyperspace's main (centre) panel. 

The biggest change relates to how the Sidebar summary index works. The index will always appear at the top of Sidebar views (default "Index" tab) and can be used to jump between different views. Index items have three parts:

  1. Clicking on a left arrow will open relevant information in the main Hyperspace panel.
  2. Clicking on the index title will open a Sidebar summary view with information matching the title topic.
  3. Clicking on a right arrow (when present) will open a charting tool (with data-entry capabilities) in the Sidebar itself.
The enhanced Sidebar better supports a number of charting needs, including:
  • Quickly find a tool not among one's defaults (and so not having to seek in menus).
  • Enter and update problem lists within the Sidebar while reviewing past notes in the main Hyperspace panel.
  • Gain rapid access to discharge planning tools.
  • Find and use supports for problem-oriented charting.

Time-saving charting efficiencies become possible with effective use of Sidebar tools. We will post tips and tricks in the Building a Better Health Record series of this blog.

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