Can't Find an Inpatient Provider Team

Problem: Clinicians must specify a destination "Provider Team" when admitting, transferring or consulting about a patient. What if they can't find an expected clinical team? How can the possibility of a "missing" team be checked, a provisional order be placed, and a correction requested for the Provider Team list?

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):

1. 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.
2. 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.
3. 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").

Haiku Logon Difficulties on Android Devices

Problem: Some physicians experience difficulty logging into Haiku on Android devices.  This is occasionally also seen on iOS devices running Haiku  or Canto.

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:

1. Switch phone to airplane mode and then switch back to Wifi (Wait 30 seconds after switching back).
2. Switch phone to cellular or Wifi depending on current network connection. (Wait 30 seconds after switching).
3. Cycle through different Wifi’s to re-establish a network connection. (Wait 30 seconds after switching).

COVID-19 IPC Alerts Live

Problem: Patients arriving from non-Wave-1 sites with positive COVID-19 NAT results were not triggering automated infection prevention and control (IPC) alerts.

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.

Emergency Visit Reports from non-Connect Care sites Available in Connect Care

Problem: Emergency room visits where Connect Care is the record of care are reported in a standardized way and shared with the Alberta Netcare Portal; but summaries of visits at non-Connect Care sites do not appear within Connect 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.

Printing at Remote Locations

Problem: The Connect Care Clinical Information System can be accessed from many locations. The “hyperspace” environment, however, is configured to route printed artefacts to locations appropriate for the logged-on department and task. This behavior can frustrate attempts to print when working remotely.

Solution: A one-page tip illustrates how to ensure that printing occurs locally at the intended device:

• Tip: Printing in Connect Care at Remote Locations

Change to location of 'External' Orders

Problem: When ordering interventions (e.g., referral) in an inpatient context, physicians need to remember to open a specific "External Orders" activity to access orders applicable in an outpatient context. This proved confusing and forced exit from one ordering workflow (inpatient) to find a different ordering workflow.

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.

Haiku and Canto problems post-upgrade

Problem: Haiku (SmartPhone) and Canto (iPad) users may have trouble opening their Connect Care mobile apps after the system upgrade of March 12, 2020. The following message may appear at attempted logon:

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.

Possible Problems Printing After Visit Summaries

Problem: There is a small possibility that attempts to print After Visit Summaries (AVS) for some patients may be associated with some formatting problems. This is not a known Connect Care problem but a (remotely) possible effect of the clinical system upgrade occuring March 12, 2020, in the early morning hours.

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.

Mobile Microsoft Outlook App no longer working with AHS email

Problem #1: Physicians who use personal mobile devices and the Microsoft Outlook mobile app for access to AHS email and calendars are noticing calendar gaps, lack of appointment reminders or apparent loss of emails.

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.

Patient Messages going to Clinic In-Basket Pools

Problem: Some patient communications appear to be inappropriately copied to clinic messaging pools when the patient and/or physician assumed that the exchange was exclusive to provider and patient.

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.

• FAQ: How can patient messages be restricted to patient-physician?

Automated Appointment Reminders - Are they Working?

Problem: An automated telephone appointment reminder system has been integrated with the Connect Care clinical information system and deployed at the end of January 2020. There will be growing pains. Physicians experiencing a no-show may wonder whether the patient received an appointment reminder but do not know how to do this within the Connect Care outpatient chart.

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.

• Tip: Auto-Appointment Reminder Calls
• Update: Auto-Appointment Reminder Calls - Jan 2020
• Update: Auto-Appointment Reminder Calls - Dec 2019
• Manual: Telephone Reminders

Why so much Scheduled Downtime?

Problem: Connect Care users wonder why they are alerted to a third scheduled downtime within the first 4 months post-launch. Scheduled downtimes for other systems that physicians use  have been less frequent (e.g., Netcare) or intrusive (e.g., eCLINICIAN).

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.

Inability to Launch Multiple Instances of Netcare within Connect Care

Problem: That the Netcare electronic health record can be launched in-context (opened to the same patient) within the Connect Care clinical information system is a great convenience. Netcare contains historical data going back further than Connect Care.

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.

Why are Professional Billing claims delayed?

Problem: Physicians using full Connect Care professional billing services may have noticed delays in reimbursement from Alberta Health during December 2019. Those in alternate reimbursement plans (including AMHSP) will have noticed less, as their "shadow" billings do not immediately impact personal reimbursements. Nonetheless, delays are a worry. What happened?

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.

Who can help Specialty Services adapt Referral processes for Connect Care?

Problem: Specialty outpatient clinics may use Connect Care as their record of care without fully implementing referral management processes that use the clinical information system. This is a problem if the clinic has indicated that it is "internal" for referrals but has not set up intake messaging pools, assigned staff to work-queue monitoring, or coordinated staff and physician contributions. Referring prescribers will generate referral orders that do not achieve the intended result.

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.

How to manage mis-directed In-Basket results.

Problem: Laboratory results, intervention reports, clinical notes or other patient information can occasionally get mis-directed. The affected prescriber may see Connect Care In-Basket notifications about patients that are not within the prescriber's circle of care. Indeed, reviewing this information inappropriately could constitute a privacy breach. What to do?

Considerations: In-Basket or Chat messages that link to patient health information should relate to patients with whom the receiving prescriber has, has had, or will have a care relationship (circle of care).

Mis-directed messages may relate to mis-identification (another provider selects the wrong physician to copy results to), mis-registration (clinic or admitting process incorrectly associates the patient with the wrong physician as an admitting, responsible, consulting, ordering or authorizing prescriber), mis-codification (use of incorrect physician ID, given recent introduction of new identifiers for laboratory results). Sometimes other physicians will copy colleagues as a professional courtesy (e.g., copying results of a family member); a practice that is no longer acceptable.

Solution: The Connect Care In-Basket has a "QuickActions" tool that allows prescribers to manage results received in error.

Select (click on) the In-Basket result notification and then look to the button bar at the top of the result display. The "QuickActions" pick-list is in the left-most position. There are two options:

1. Not My Patient - if the result relates to a patient outside one's circle of care (as above).
2. Not My Result - if the result relates to a patient that the receiving provider has had a care relationship with (in the circle of care) but the result should not have been routed to the Connect Care In-Basket (e.g., inpatient test result or otherwise should have been directed to a more responsible provider).

Clicking on either option will cause the In-Basket message to disappear. Medical records staff receive a notification so that a correction can be put in place and future mis-direction can be prevented. In addition, the physician is protected because privacy audits will take note and document that the physician did not review clinical material for a patient outside one's circle of care. 

Connect Care Fixes Review - December 19, 2019

By this point (almost 2 months post-launch), there are countless fixes and optimizations already in place. A few highlights are listed (and added to from time to time) here...

• MAR Access: It was discovered that some Connect Care user groups, mainly trainees, have the ability to order medications but lack access to the Medication Administration Record (MAR) to review when which medications have been received by a patient. Medication review, including reorders and discontinuations, requires precise knowledge of the time and frequency of medication use. By applying a general principle --- that anyone who prescribes should have MAR access -- we believe that the trainee and other missed groups have been taken care of.
• Spiritual Health and Indigenous Health Consults: Support is added to enable inpatient requests for spiritual care consults and indigenous health consults. The ordering process is analogous to requests for other health professional engagement. Documentation can also be filtered by contributions from these health care team members.
• Notes from Clinical Staff: In addition to personal sticky notes and specialty notes, Notes to Clinical Staff can be useful for non-urgent prompts between teams (e.g., consider downgrading the vitals monitoring intensity). These are now prominently display on the Vitals flowsheet as well as the chart summary display.

Why is the Service Code Navigator showing stray Lab charges?

Problem: Many wave 1 Connect Care prescribers have noticed stray (not related to professional billing) "charges" appearing in the Service Code Navigator. It is not clear what these mean or if they will affect legitimate professional billing claims.

Solution: This configuration problem has been fixed with the December 12 system update. Please report any stray charges that appear after this date. Note that the prior charges had no impact on professional billings and required no action on the part of the prescriber.

Getting Ready for Downtime

As posted elsewhere, scheduled downtimes are required for quarterly clinical information system (CIS) updates. These are normally set for the early hours of the morning but can still affect clinical activities.

It is good practice to anticipate downtimes and ensure that one has access to the tools that allow continuity of care during and after a downtime. Take a few moments to check that a "PRDSRO" Connect Care icon is available via myapps.ahs.ca and use this to log on to Connect Care in read-only mode. This is how patient information will be accessed when the full CIS (PRD) is not available.

Unscheduled downtimes may involve loss of access to Connect Care servers. A business continuity application can be opened via an icon on clinical workstation desktops.

Try logging on to this as well, noting how it is possible to view patient chart summaries and other downtime tools.

For more information:

• FAQ: Downtime Information for Physicians

More Mobility Management Alerts

A number of iOS mobility users have recently received the following message on their device:

No worry. This message is safe and does not represent anything more than the alert that mobility management is in place; the same alert that occurred during the installation process for Haiku or Canto. Click 'Cancel' and all will continue as before.

We are investigating why the message appears now; possibly related to mobile device or mobility software updates.

Downtime Procedures for Physicians

A Clinical information system (CIS) can suffer performance degradation, or even a complete "downtime", affecting one or more of its critical functions. "Business continuity" relates to support of clinical and administrative workflows when CIS functions are compromised.

Connect Care downtime and recovery information is currently maintained at downtime.connect-care.ca where a downtime procedures manual is maintained.

The Connect Care Physician Manual support section about downtime procedures is recently updated, including an overview and FAQ about physician impacts.

• Overview: Downtime Procedures for Physicians
• FAQ: Downtime Procedures for Physicians

Decimal Precision for Oral Medication Measurements

Problem: Some Connect Care users expressed concern that the volume of liquid oral medications is rounded to 2 decimal places if less than one millilitre but to 1 decimal place for volumes greater than 1 millimetre.

Considerations: The concern has been reviewed by multiple provincial area councils pre-launch. Medication margins of error, measurement confidence intervals, decision-support dependencies, reconfiguration-burden and validation and practices elsewhere were considered. Worries about narrow therapeutic windows were explored.

Solution: Pharmacy, Critical Care and Child Health stakeholders carefully considered the issues and Wave 1 clinical system design review pathways were activated. A decision is made to:

1. Continue with two digit rounding for volumes of liquid oral medications <1ml; and one digit rounding for volumes >1ml
2. Monitor a list of 22 liquid oral medications flagged for possible administration problems
3. Make available a work-around that simulates two-digit rounding with linked orders, while limiting its use because of clinical decision support impacts.
4. Review and reconsider after 6-8 weeks experience with the current build.

Connect Care Fixes Review - Week 2

There are way too many responses to user requests (some of which are fixes) to keep up! Some recent highlights...

• Laboratory Test Orders Add-On Default:The clinical information system (CIS) had been configured to default to using prior blood draws, if within 1 day and sample still available in the lab; a sensible effort to decrease phlebotomies. Even though some settings and test types were excluded, we've noted unhelpful confusion among providers. Accordingly, clinical system design oversight decided to turn this default off for all tests. The CIS continues to allow prescribers to optionally click the button to add a test to a prior draw, and decision supports suggest this when a potentially reasonable action.
• Cutover Pre-Op Orders:
  Transcription of some pre-op orders from paper to CIS pre-surgical plans did not happen. A workgroup has been formed and appropriate preparations and pre-ordering is being implemented by CMIO and other resources.
• Result Review Test Ordering:
  The results review activity is taking shape in a way that is more recognizable for former eCLINICIAN and Netcare users. A number of technical and clinical resources are collaborating to ensure that the folder structure fits Alberta norms and that all tests are appropriated allocated and order. Sufficient progress has been made to activate the clinical grouping today. Many physicians participate in the validation process.
• Computers on Wheels in Surgery:
  Hearing that there may not be sufficient device-density in the operating room area, computers on wheels have been redeployed to address the need.
• Phone Book Access:
  Some trainees and a few prescribers lacked access to the Connect Care phone book, where it is important to confirm one's contact particulars for professional communications. The correct template settings are now applied and all should be able to use this tool.

Results Review - Alphabetic vs Categorical Sorting

Problem: Clinicians value tabular displays of laboratory test results. This helps appreciate a lot of information at once. However, if table rows are not ordered as expected, visual scanning does not perform as expected.

The Connect Care results review activity is organizing table rows (within sections) alphabetically, which differs from clinical convention. The elements of an electrolyte panel, for example, should be ordered by meaning (e.g., sodium, potassium, chloride, bicarb), not first letter of the test name.

Solution: The results review row order was set to alphabetical to match a Netcare provincial flowsheet. This was not as intended and needs to be reversed. A team is working to restore the clinically meaningful results ordering that physicians expect. The change should appear before Nov 14.

Trouble Finding Orders

Problem: We've received feedback from prescribers that it is difficult to find specific orders when entering common non-medication order names in both inpatient and outpatient order lookup tools.

The order catalogue that Connect Care uses is a first. A product of years of work, it is a provincial compendium of orderables that reflects a lot of effort to harmonize and standardize. Unfortunately, the actual names of order items is sometimes not intuitive to physicians.

Solution: This is an important problem receiving priority attention. Multiple remediations are underway:

• Consistency: Diagnostic imaging orders were identified as a particular problem. These used intervention abbreviations in some cases (e.g., "US") and full names in others (e.g., "Ultrasound"). This problem has been (mostly) rectified. The orders group will continue to review lists to find and fix inconsistent names.
• Forgiving Search: Epic has a "fuzzy logic" search enhancement that detects and corrects for misspellings and other user-term problems that may degrade search performance. This has been activated for Connect Care.
• Synonyms: Common names given to many orderables may not match standard terminology used by those who make lists. We have assembled a history of synonyms that have proved most useful in other Alberta health information system implementations. These are being added to the Connect Care order catalogue. A synonym will allow different search terms to get to the same order (e.g. searching for "normal saline" will find both the iv saline order and the iv fluids order panel).
• Experience: We are most grateful to all prescribers who take time to report an unrewarding order search. This will allow the orders team to focus on the most important categories of orders for synonym work, which otherwise is very time consuming.

Connect Care Day 005 Fixes

Continuing our daily tally of illustrative (selected) fixes...

• Problem identification and resolution - physician leader huddles continue twice a day. These focus on issue identification and assignment. Most days the issue is resolved before the afternoon huddle. As we approach the end of first week post-launch, we are seeing fewer technical or configuration issues and more matters of training and norms. All problems are carefully logged and tracked. Accordingly, we'll stand down this daily report of high-level fixes. Specific challenges will continue to be documented and guided in the Tips, FAQ and Support channels.
• When to call - physicians should be reminded to call the help desk for all pressing problems, especially anything affecting access or patient care. The online concierge is good for ensuring that less urgent matters get noted and worked on (after the high-priority tasks).
• We have reached the 'happy' place where more tickets are closed than entered!

Cutover Provider Mis-Assignments

Problem: As part of the launch cutover process of the Connect Care clinical information system (CIS), a default responsible provider was attached to new inpatient charts. Sometimes, this assigned provider did not reflect the attending (most responsible provider, MRP) at the time of post-launch morning rounds. Some teams, or patient locations, changed during the 48-hour cutover period. Such mis-assignments were not recognized for a few days.

Solution: A support synopsis explains possible effects (none serious), mitigation and permanent fix:

• Support: Cutover Provider Mis-assignments

Connect Care Day 004 Fixes

Continuing our daily tally of illustrative (selected) fixes...

• Ticket Resolution - breaking in a complex system, implemented on a large scale in very different clinical contexts, brings forth an impressive number of 'tickets'. These range from trivial matters to substantive optimization requests to high-priority items that could directly affect patient care. Understandably, there are many duplicates. Based on raw, unfiltered, numbers, 50% of ~8,000 tickets got closed with 100% of critical tickets closed and 83% of important tickets closed in the same day. 
• Cutover provider mis-assignment - a temporary default most responsible provider assignment has affected a small number of charts. With a fix made, and the problem not recurring, any inaccuracies are being corrected.
• Pharmacy Information Network - efforts to integrate PIN into medication reconciliation activities have proved frustrating in practice and so the interface is disabled until more discrete drug information can be transferred.
• Session stealing - adjustments to Windows logon configurations appear to have resolved most of the Citrix session loss problems experienced in some settings.
• ER printing - printer and label maker mappings in the emergency room appear to be sorted.
• and lots of other adjustments...

Connect Care Day 003 Fixes

Continuing our daily tally of illustrative (selected) fixes...

• Ticket Resolution - many hundreds of "tickets" are processed daily; as ticket volumes peak (expected at this time), please understand that the most pressing (affecting safety) tickets are prioritized for first attention.
• Insulin Management - Connect Care launched with glucose management tools befitting provincial guidelines and best practice, but found this incurring a difficult change burden; continuous IV insulin ordersets were built to help bridge us to full BBIT compliance.
• Finding Order Items - many have expressed concern about difficulty finding orderable items (medications, tests, procedures) using common search terms. A number of improvements are made: 1) search engine improvement to use "fuzzy logic" to deal with things like spelling errors, 2) turn off feature that auto-selects single-hit search results, 3) addition of many synonyms to improve the completeness of search results. 
• Medication details - a very large number of tweaks have improved the manner in which medications can be set for exactly the delivery methods needed in specialized contexts. Ongoing focus on issues unique to critical care.
• Ultrasound DI Names - a problem with inconsistent naming of some diagnostic imaging tests has been fixed. Also, making orders very clear about location of test (POC vs DI).
• and lots of other adjustments...

Training for Complex Workflows

Recognizing that some workflows involve more change and challenge than others, some focused training opportunities give 30 minute refreshers for affected staff over the next few days. Two of the topics may be of interest to some physicians:

• Phases of Care
• WMC 0C2.59
• 0900, 1100, 1300, 1500, 1700, 1900
• Blood Administration
• WMC 0.C2.60
• 0900, 1100, 1300, 1500, 1700, 1900