Problem: Connect Care users may experience an unexpected or unusual problem when using the clinical information system and wonder whether this is being experienced by others and will be resolved.
Context: Sometimes systems that Connect Care depends upon may unexpectedly go down or otherwise not function as needed. The clinical information system remains up but one or more dependencies (e.g., scanning, printing, dictation, wireless, etc.) may be affected. Such problems trigger a "major incident" which is managed by established team and protocol.
- Bulletin Banner at the top of the Connect Care Clinician Manual (bar with message appears at top of all pages).
- Alert popup visible during the Connect Care login process.
- Fan-out communications (email, fax) appropriate to the groups most affected.
- Update to Connect Care status page (status.connect-care.ca).
Context: Mobile apps are continually improved, just as desktop interfaces (Hyperspace) are improved through periodic updates and upgrades. Some upgrades may be significant enough that a recent version of the mobile app is needed to communicate with system servers. However, mobile applications on user devices are largely under user control. Not everyone configures for automatic updates. It is a good practice to update the mobile app(s) periodically. The best time to do this is immediately after a system upgrade (watch the blogs).
Solution: Although Haiku and Canto can be updated from iOS or Android app stores, best practice is to do a re-install from the Workspace One "Catalog" installed on user devices when Connect Care Mobility is first enabled (see Manual).
Open the "Catalog" app, look for the Haiku or Canto listing, and select the "Installed" or "Install" button. It does not matter that the app is already installed. Re-installing updates to the latest version compatible with Connect Care servers, while preserving important configuration settings.
Context: An All-user Bulletin alerts to the shift from an older "Provider Groups" to a more powerful "Provider Teams" functionality for managing the attachment of inpatients to clinically meaningful clinical services.
Solution: If a clinician is attempting to attach an inpatient to an existing inpatient service team and cannot find that team listed, then the following steps should be followed (after confirming understanding of the Provider Team Management tip sheet):
- Check the Provider Team Names Crib-Sheet to look for the needed team by browsing current specialties and services as commonly referred to. Failure to find a desired Provider Team may simply relate to recognition.
- If the desired team is not found or known, and the admission or transfer order mandates team selection (hard-stop), it is possible to select a "generic" provider team from the current Provider Team list and seek a correction later.
- Submit a request for adding, removing or editing a Provider Team name to help.connect-care.ca (use the request section entitled "I Have an Issue Related to How Connect Care Supports My Documentation, Orders, Decisions or Practice Improvement").
Context: Android devices may fail to recognize and use the virtual private network (VPN) "Tunnel" that needs to be active in order for Haiku to connect to its server. Re-setting the network connections (going into Airplane mode and then out again) can correct this lapse.
Tunnel failures happen very rarely with iOS, but the fix is the same: enter and then exit Airplane mode.
Solution: Each of these troubleshooting strategies can be tried:
- Switch phone to airplane mode and then switch back to Wifi (Wait 30 seconds after switching back).
- Switch phone to cellular or Wifi depending on current network connection. (Wait 30 seconds after switching).
- Cycle through different Wifi’s to re-establish a network connection. (Wait 30 seconds after switching).
Solution: The COVID-19 IPC Alert now auto-triggers in Connect Care, even for specimens collected outside of launched sites. This applies across all contexts, including ambulatory care.
Solution: On February 10, 2020, a data feed for emergency documents was activated in Connect Care. When a patient visits an Edmonton emergency department that has not implemented Connect Care, their documents are scanned and incorporated into Connect Care. This allows providers using Connect Care to view their patients’ emergency documents within the chart, rather than having to launch Netcare. Note that reports prior to February 10 are not converted.
Solution: A one-page tip illustrates how to ensure that printing occurs locally at the intended device:
Solution: Connect Care has been enhanced to bring all ordering within the same workflow. Now "External Orders" appears as a tab within the Inpatient Orders activity when a patient chart is open in an inpatient context. Prescribers are alerted to use this tab only for referrals or other post-discharge interventions.
Context: Connect Care upgraded its instance of Epic software, including the systems supporting mobile applications. The mobile applications also need updating. The version should be 9.2 (version information can be found by going to mobile system settings for "Haiku" or "Canto" and scrolling to view the version number) and should have been updated automatically. Some users may not have received the update.
Solution: Delete the mobile app from your mobile device. Reboot the device. Open the "Catalog" app that was installed when originally activating Connect Care mobile apps (see installing mobility in Connect Care Physician Manual). Re-install Canto or Haiku (even if the Catalog indicates that it is already installed). Remember to give the install a lot of time because configuration files are sent after the app itself is installed.
Context: The March 12 upgrade includes a new software component that renders the print-ready AVS. Some organizations have experienced rare difficulties. We have implemented preventive measures but want users to be vigilant when printing AVS reports so that any problems get promptly disclosed to the help desk (help.connect-care.ca).
Solution: AVS reports are helpful but not essential to outpatient care. Key content, such as medication lists, patient instructions or appointment details can be printed in other ways. And patients signed up to MyAHS Connect get their information by that route. Should any print formatting problems occur, please use the following troubleshooting pathway.
Context #1: A legacy AHS Communication Server supports email and calendar services. This is being upgraded. However, many physicians remain on the older server until a satisfactory physician configuration for the new server can be confirmed. Microsoft has recently changed its software in a way that blocks the ability of its current generation mobile app (Outlook for iOS and Android) to communicate with the older server (no longer supported).
Solution #1: There is no way to reliably use Outlook mobile with the older communications server. Physicians can, however, use other mobile mail and calendar clients (e.g., Apple Mail, Spark, etc.). Instructions for connecting to AHS email with native iOS and Android clients are available.
Problem #2: Physicians who have used personal mobile devices for access to AHS email and calendars may notice sudden disruption of service.
Context #2: Although we are avoiding physician transitions to the new communications server, some physicians contracted to AHS have already been transitioned. There are new constraints that affect how mobile email and calendar access can work. The Microsoft Outlook app must be used (no other email or calendar apps will work with the new AHS configuration) and must be deployed through the same secure channel used for Connect Care mobile apps (Workspace ONE).
Solution #2: Affected physicians should receive instructions about installing and using Workspace ONE. This will allow Outlook to be used for mail and calendar access. The CMIO portfolio is working with AHS communications to prepare physicians for this change.
Context: Some physicians already take advantage of Connect Care secure messaging to communicate with their patients. When patients use MyAHS Connect (patient portal), they are able to report outcomes and seek guidance from their clinician between visits; helpful in chronic disease management. Although many interactions may be okay for copying to a clinic messaging pool, where support staff can screen messages for urgent issues and ensure timely connections with the right providers, the physician and/or physician may want to keep the communication loop closed.
Solution: Clinic-level incoming messaging pools are important for ensuring that patient communications are appropriately screened, triaged and directed to the right provider. Previously, the "Send patient reply to me" checkbox, appearing on all message composition screens for physician-to-patient communications, was not selected by default. Clinicians may not have noticed and may not have appreciated that the patient reply would copy to a clinic message pool. As of this week, this option is now selected by default.
Context: Automated reminders can free up clinic support staff for other important patient support activities. However, they do not work for all situations. Clinics managers can submit a request to opt-out, some areas have customized reminder scripts (coming soon), and some outpatient venues (e.g. procedures) will not be enabled until more experience accrues.
Solution: There is a way to get the patient appointment reminder status but it involves using the Department Appointments Report (DAR) functionality and editing the display columns to include one or more appointment status-related columns (e.g., "Patient Communication Preference", "Patient MyChart Status", "Confirmed Appointment", "Appointment Reminder Sent", "ES Phone Reminder Status"). Instructions for doing this are included in the tip linked below.
Easier is to open the “Appt” activity within a chart. This has a appointment reminder letter audit trail for each apt. We are looking for simpler ways to know of reminder status and are seeking addition of this information to the Appt chart activity.
Considerations: The Connect Care clinical information system (CIS) is much larger, more comprehensive, and wide-reaching than prior systems. A need to maintain or upgrade one part of the system could mandate restarting other servers to ensure that there is no break in the medical record. Alberta Health Services has committed to keeping the CIS software current and not falling behind the best that our partner (Epic) has to offer. This means upgrades can be adopted as frequently as quarterly. Maintenance work can also include urgent needs, like patching servers to respond to new security risks.
Solution: Connect Care has implemented a robust scheduled downtime process that ensures that the full and current medical record remains available throughout. Other tools allow things like orders to be captured and ordersets to be used. So, a scheduled downtime is less disruptive than downtimes experienced with other systems.
Downtime "windows" are scheduled monthly in the early hours of the morning. That does not mean that all windows will be used or that the full slot (usually 4 hours) will be used. Ensuring that there is monthly capability for any needed server update or maintenance also helps to maintain user awareness and competency; a good safety practice.
That Connect Care can manage multiple patient charts open at the same time is also convenient.
That Netcare can only be open in one Connect Care chart at a time is an annoyance. If Netcare has been opened within one Connect Care chart, then it must be closed before it can be opened in a second chart open within Connect Care at the same time that another chart is still open.
Considerations: Netcare launches within an internet browser control in Connect Care's hyperspace. Some slick informatics allows single-sign-on and automated patient lookup. However, Netcare is specifically designed to prevent more than one instance at a time. This is a safety measure. It prevents contamination of one Netcare chart display with information from a different chart.
Solution: The inability to open Netcare within more than one chart at a time is a 'feature' of the Netcare software. We do not anticipate this changing anytime soon. Prescribers wanting to open Netcare within Connect Care are advised to either open only one Connect Care chart at a time or to close Netcare before switching to a second opened Connect Care chart wherein Netcare is to be re-launched.
Solution: While it is true that 1) professional billing volumes may have been temporarily reduced by productivity impacts of launch activities, 2) physicians learning a new system may not record charges with all requisite information, and 3) the naming of some billing codes needed revision... these understandable transition challenges were not the primary cause of December payment delays.
Alberta Health (primary source of payments) experienced an unplanned downtime of its professional payment system, resulting in delays to payments that were not related to the Connect Care system.
All Connect Care factors steadily improve, claims acceptance rates have returned to pre-launch norms for most physicians, and the AH downtime is over.
Solution: Outpatient speciality services that use Connect Care as the record of care are "internal" referral resources. It is important that they have "receptor capacity" with appropriate use of referral intake messaging pools, work-queue tracking and triage processes. These clinics should reach out to the Connect Care Patient Access Team (ClinicalOperations-Patient.Access@ahs.ca) to confirm that they are referral-orders-ready.