Simpler Connect Care Referral Orders

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Change to Connect Care Referral Orders - Internal/External

Connect Care is making some changes to referral workflows, to ensure that closed loop communication is maintained. Prescribers will see some minor changes to referral (to ambulatory services) order composers starting January 21, 2021.

Previously, an "internal state" workflow was available to address situations in zones where some services are on Connect Care and others are not. This workflow is eliminated. It is simpler to think of just two workflows, one for referrals that are "internal" because both the order (request) and the response (outpatient service) occur where Connect Care is the record of care; and another for referrals that are "outgoing" because the receiving service is not on Connect Care. 

If the "Internal Referral" button is selected, the order composer adjusts to show only those services currently using Connect Care (no future wave sites). If the user does not find the desired service there, then the "Outgoing Referral" button can be selected to expose options for sending the referral to an external service.

Referral norms and processes are covered in the Connect Care Physician Manual:

• Manual: Referral Norms
• Manual: Referral Workflows

Co-sign Required for Pre-op Orders Placed by Surgical MOAs

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Second Signature for Pre-op Orders entered by Medical Office Assistants

In compliance with decisions made by Zone executive committees, a Connect Care delegated ordering workflow has been enhanced to assure surgeon validation of pre-operative orders entered by medical office assistants (MOAs), with the process summarized in the Connect Care Physician Manual:

• Manual: Delegated Orders

Trouble Subscribing to Connect Care Blogs

Problem: Some users report trouble subscribing to one or more Connect Care update blogs (bytes, tips, questions, support) for clinicians. They enter a valid email address in the "Follow (subscribe)" box to the right and click on "Submit", but then receive a message like this:

Considerations: Our blogging channels use Google's "FeedBurner" technology. This supports subscriptions for receiving new postings via email. The same technology underpins newsfeed (RSS) and Twitter feeds for the blogging channels.

If a user is logged on to another instance of Google's business productivity applications, the Internet browser may be using Google enterprise settings from that service. The other organization may not allow blog subscriptions for its own instances of Google blogging software.

The commonest conflict occurs when a user has an organizational instance of Google Mail (GMail) open within the Internet browser. Both the University of Alberta and the University of Calgary have enterprise GMail services.

Solution: The fix is usually easy. 

• Log out of any enterprise GMail (e.g., UofA or UofC webmail) within the browser. 
• Close all browser tabs. 
• Look to the browser menu and seek a command for clearing the browser "cache" or "history". 
• Sometimes it helps to close then reopen the browser. 
• Return to blogs.connect-care.ca before opening anything else. 
• Select the channel (e.g., bytes, tips, FAQ, Support; via top button bar) you wish to subscribe to.
• Enter your email in the "Subscribe" field in the right column and proceed.

How to manage mis-directed In Basket results

Problem: Laboratory results can occasionally get mis-directed. The affected prescriber may see 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 messages that link to patient health information should relate to patients with whom the receiving prescriber has, has had, or will have an approved relationship (circle of care, quality or research).

Test results may be delivered to a prescriber's In Basket "Results" folder because of an automated routing scheme, or because the recipient was explicitly copied on the result. Results may also be delivered if the receiving provider is:

• a member of the patient’s Care Team and configured to receive results,
• signed into a results review message pool,
• supervising a medical learner, or
• the most responsible provider at the time of discharge for results reporting after the time of discharge.

Results that are believed to have been received in error should be reviewed to determine if any of these conditions apply before taking action to flag a misdirected result.

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. 

• Not My Result

• Use this action if the result was misdirected and should not have been routed to the recipient's In Basket, even if the provider has participated in the patient's care at some point.
• The Result Note window will open and the provider will be required to complete two SmartLists (use F2 to find and use pick-list) to indicate why the result is being marked as received in error and what, if any, steps have been taken to remediate.
• If none of the available pick-list options fit,  select "other" and provide a brief comment to better explain the issue and what has been or should be done.
• Upon completing the two SmartLists and accepting the message, the result note will be re-routed to an internal results routing error pool for review and action.
• The associated In Basket message will disappear.

• Manual: Mis-directed Result Messages

Interfacility Emergency Department (ED) to ED Transfers

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Clarified ED to ED Interfacility Transfer Process

Transferring patients between emergency departments (EDs) is a relatively common workflow. With Wave 2 launch, ED to ED transfers can now involve two sites using Connect Care as the record of care. The RAAPID service, which facilitates ED to ED transitions, is also on Connect Care. Accordingly, there are a few key steps that ED prescribers should be aware of, especially the need to discharge a patient from one site before arriving the patient at a different ED. These considerations are summarized in updates to the Manual:

• Tip: ED to ED Transfer using RAAPID
• Manual: Interfacility ED to ED Transfers
  

Discharge from Leave of Absence Workflow

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Discharge from Leave of Absence Process

There are times when a patient on a Leave of Absence (LOA) does not return. The patient may require an admission at another site if, for example, on LOA for a procedure, but following the procedure requires further care at the procedural site. Once it has been determined that the patient will not be returning, the patient should be discharged from their LOA. 

Most of the associated workflow can be completed by nursing and ward clerks using their "Unit Manager" activity. Prescribers need to take care of discharge documentation, usually in the form of a discharge summary.

• Manual: Leave of Absence
• Tip: Discharge from LOA

Change to Post-Procedure Navigator - Short Stay

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Change to Post-Procedure Navigator - Short Stay

As of Thursday November 12, 2020, the admission order "Admit to Short Stay" is renamed "Admit to Mazankowski 5A7".

This order appears in post-procedure order sets viewed in the Post-procedure Navigator for surgical workflows. It shows for patients who do not have an admission order and was created to address some specific Wave 1 needs at one facility. The order does not apply elsewhere and is renamed to make it clear that only patients going to the Mazankowski Hospital short stay (Unit 5A7) should have this order placed.

All other patients requiring post-operative short stays should not receive an "Admit to Inpatient" order. The "Post-op" navigator should be used with the "Post-op to Discharge" tab.

Further work will be done to appropriately restrict the Mazankowski-specific order to appear only for the appropriate department. This name change is intended as an interim measure to avoid inadvertent ordering until departmental restrictions are in place.

Wave 2 Launch Support Hot Topics - Week 02

While this channel has highlighted post-launch needs identified in physician huddles, things have already stabilized and so this week 2 posting will be updated throughout the week. 

• Print Routing
• Further fixing of a few remaining printer mapping issues will require consistent helpdesk ticket submissions with order identifiers included.
• In Basket Cleanup
• Some providers experience large numbers of In Basket messages related to cutover activities for Wave 2. Tips to be posted this week to illustrate how to manage these in batch.
• Missed Cutover Admission Order & MedRec
• If an admission order was missed, or medication reconciliation was not completed at Wave 2 cutover, efforts to discharge the patient post-launch can be blocked.
• ✅Instructions are prepared and promoted, with a Support posting, updated Manual section and new Tip.
• Phases of Care
• A workgroup continues to investigate any reports of surgical orders not anchored to a phase of care. Solutions are emerging.
• ✅No technical or configuration problems have been found, with no evidence of a build issue. Resolution through training and workflow.
• Leave of Absence for Procedure
• Some providers have struggled with workflows associated with leave of absence for a procedure at another facility.
• ✅The Manual has been updated and a new Tip sheet provided with clear step-by-step guidance for prescribers.
• Duplicate Order Warnings related to Phase of Care
• A cause has been identified for some inappropriate duplicate orders warnings related to phases of care. 
• ✅A fix has been found and is implemented the afternoon of November 4, 2020.
• Order Management
• A SWAT team is assembled to investigate order use in complex teams and ensure that saved, pended and co-sign status for orders works optimally for nurses, trainees, hospitalists and consulting surgeons.
• ✅Affect teams have adapted order signing (save, pend, sign, held, etc.) to fit with needs of surgical teams with hospitalists where surgeon in consultant role
• Optimizing use of Treatment Teams
• Work continues to find an optimal use of principle care provider, attending and admitting designations in obstetrics at some sites.
• Bridging Medications
• A team is working on optimizing workflows for the provision of "bridging" medications needed during leave of absence and some transfers.
• Medication Reconciliation
• A workgroup with many experienced physicians continues to unpack cutover challenges with medication reconciliation in high-volume settings.
• Netcare eDelivery
• ✅Unintended automatic delivery of provider-authored progress notes is fixed in a Nov 4 upgrade.

Troubleshooting Patient Discharges for Wave 2 Cutover Patients

Problem: Some inpatients at Wave 2 sites were admitted before Wave 2 launch. Key information was transferred to Connect Care charts as part of a cutover process. This information was then validated by prescribers immediately after launch. If an admission order was missed, or medication reconciliation was not completed, efforts to discharge the patient post-launch can be blocked. 

Context: When experiencing discharge challenges, an important first check should be for a valid admission order. Next, confirm that medication reconciliation has been completed. Patient transfers and discharges require a completed medication reconciliation so that accurate medication information follows the patient. Unattended admission order or MedRec work will be flagged in the "Sidebar Summary" that appears in the right sidebar of an open chart.

Solution: Attending to the following two checks should resolve most discharge blocks:

1. Check for an Admission Order by looking in the "Order History" section of the "Orders" activity, and add an admission order if found missing.
• Tip: Finding Inpatient Admission Status
2. Ensure completion of key parts of Admission Medication Reconciliation:
• Open the Admission navigator (tab) with the chart open in the current inpatient encounter.
• Select the "Admission Orders" section (bottom of the navigator left column).
• Select "Review Home Medications":
• Ensure this list includes all medications that the patient was taking prior to admission. 
  
  
  
  
  
• This step may already have been completed by nursing or pharmacy, as indicated by the "Med List Status" at the bottom of the listing.
  
  
  
  
  
  
• Select "Reconcile Home Medications" (must be done by prescriber):
• Complete documentation of reconciliation decisions by selecting "Don't Order" for any medications that were already ordered as part of cutover.
• If all home medications listed were already ordered for cutover, use the "Mark unreconciled Don't Order" button at the top of the screen for convenience.
• Review the new reconciliation actions and then Sign at the bottom of the right sidebar.

Improvement to External Orders for Imaging at another Facility

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Improved Order Composer for External DI Procedures

A prior FAQ outlines how inpatient prescribers should order diagnostic imaging procedures to be performed at a different facility.

The associated order composer has been enhanced to automate printing paper requisitions when those are required by a destination facility that is not on Connect Care.

A prescriber tip is updated.

Finding Order Numbers to use when Reporting Printing Problems

Problem: Faulty printer mappings are hard to track down without knowledge of the order triggering the printing.

Context: We continue in a "hybrid" state for a while, where most functions are digital but some require printing in order to work with other parts of the health care system. Common examples are printed prescriptions and requisitions destined for locations not yet on Connect Care.

Some printing functions automatically route to where action needs to be taken. A few configuration problems can turn up in the early post-launch period and are easily fixed. The catch is that the specific patient-provider-location-function intersect needs to be tracked down. All required information can be found using an "order number".

Solution: Include order numbers when reporting possible printer problems. To quickly find an order number:

• Inpatient
• Active Orders: Go to the "Orders" activity and hover over an order in the "Active Orders" tab to get an order report icon (📃) at the top right of the row for that order. Click on this icon to get a popup with information about the order. The order number is in brackets or parentheses.
• External Orders: Note the list of external orders at the bottom of the "External Orders" tab, and click on an order of interest to get a popup that includes the order number (in parentheses).
• Outpatient
• Encounter Orders: If encounter orders have been signed, click on the order icon (📋) just to the left of the bottom right "Sign Encounter" button. Then, click on the individual order of interest, and note the order number in the Order Report.
• All contexts
• With a patient's chart open, use the Search function (top right of hyperspace or within StoryBoard) to find the "Order Review" activity.
• This can be used to list all orders for a specified time period (default is last 72 hours). 
• Clicking on an order will reveal the Order Report (usually bottom half of screen) with the order number in it.

Wave 2 Launch Support Hot Topics - Day 09

While this channel has highlighted post-launch needs identified in physician huddles, things have already stabilized and so we will no longer post daily. 

• Fall Back Downtime
• The autumn time change downtime went smoothly, with no issues reported by prescriber groups.
• Congratulations to all. Preparation was excellent.
• Phases of Care
• A workgroup continues to investigate any reports of surgical orders not anchored to a phase of care. Solutions are emerging.
• Order Accountability
• Wave 2 uncovers some unique team care relationships, with shared accountability for surgical orders. 
• A SWAT team is assembled to investigate the need and ensure that use of saved, pending and co-sign status for orders works optimally for nurses, trainees, hospitalists and consulting surgeons.
• Netcare Adjustments
• We reported earlier that adoption of provincial naming conventions for facilities, teams and locations resulted in some duplicate entries for services in Netcare.
• This has been fixed.
• Optimizing Use of Treatment Teams
• Work continues to find an optimal use of principal care provider, attending and admitting designations in obstetrics at some sites, with the next problem-solving meeting tomorrow.
• Dialysis
• The adoption of Therapy Plan encounters for managing dialysis care of patients with renal failure may require some additional communication and training for prescribers, to ensure that they know how to review the content of the Therapy Plan and consider any implications for ongoing inpatient and outpatient care. 
• Particular attention is given to dialysis sessions that involve blood product administration.

Wave 2 Launch Support Hot Topics - Day 08

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Fall Back Downtime
• The clock will go back an hour at 02:00 tomorrow morning, November 1, 2020.
• Scheduled downtime procedures will be in place, as explained with links to resources on our blog posting.
• Physicians seeking access to patient records during the downtime will use the PRDSRO environment (icon on workstation screens and MyApps) and will record orders on sheets from Downtime Toolkits available in all facilities and clinics.
• Duplicate Orders
• Some prescribers do not appear to be taking full advantage of the decision supports embedded in the clinical information system (CIS). In particular, possible duplicate laboratory tests are recognized by visual cues during ordering and possible duplicate meds are flagged with alerts.
• This is an important CIS protective to heed.
• Quick Fixes
• Some discrepancies in the labelling of a few tests in orders and elsewhere in the chart (e.g., "creatinine, serum" and "creatinine") are resolved.
• A tricky workflow to print DI requisitions for patients going on an LOA for procedure to non-Connect Care sites has been improved and will be in production (with automated printing) Monday.
• In the Works
• Phases of Care
• Some surgery-related orders are not being associated with an appropriate phase of care.
• A workgroup is formed and examining the misalignments.
• The Clinical Decision Support and Components Committees are looking for any possible association with order sets and order panels.

Wave 2 Launch Support Hot Topics - Day 07

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Physician Order Entry
• Some practice venues adapt to digital workflows while re-negotiating how teams collaborate to ensure smooth order management. 
• There are clear ordering norms and exception application processes, now re-surfacing as Wave 2 workflows start to stabilize. Areas of concern are being explored through facility medical leadership.
• The Manual explains ordering norms, with links to FAQ and Norms documents.
• Mobile Order Entry
• It is great to find rapid uptake of Connect Care mobile solutions. The ability to enter routine orders at a distance is appreciated. However, we also appreciate that some users might need more support, as the existing mobility help is focused on getting devices activated.
• A pool of experienced physician Haiku users will be identified and organized to increase back-up for our Super Users and trainers.
• Quick Fixes
• Referral Workflows
• A few outpatient specialty services have been found that got missed when building lists of referral services in Connect Care. These are added (fixed) as soon as reported. Please continue to use ticket submissions at help.connect-care. ca.
• In the Works
• Phases of Care
• Some surgery-related orders are not being associated with an appropriate phase of care.
• A workgroup is formed and examining the misalignments.
• The Clinical Decision Support and Components Committees are looking for any possible association with order sets and order panels.
• Provider Teams and Women's Health group
• A multi-stakeholder workgroup met to learn more about the challenges obstetrics experiences with designating attending providers that change every 12 hours. 
• The functional needs are better understood and are being mapped to available Connect Care treatment teams functionality.
• The workgroup reassembles Monday to consider alternative solutions.
• Printing Routing Issues
• Computer workstations appear to be routing print jobs to the wrong locations.
• A SWAT team is formed and cases are investigated to identify devices needing re-configuration. Will report back.
• Instructions for physicians to force prescription or requisition printing to a device of choice will be highlighted.

Wave 2 Launch Support Hot Topics - Day 06

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Internal vs. Outgoing Referrals
• Outpatient services that use Connect Care as the record of care are "internal" referral resources. Outpatient services that are not on Connect Care are "outgoing". The distinction is  important because it triggers a reminder to print/fax the request to external clinics.
• The Manual has been revised to be more explicit about this branch-point in referral orders.
• Consult vs. Referrals from ER
• Some ER prescribers have been uncertain whether to "consult" or "refer" when seeking specialty assistance.
• Consult orders relate to assessments to be done within the current encounter, and are entered from inpatient and emergency Orders activities (search for "consult").
• Referral orders relate to assessments that will be done outside or after the current inpatient or emergency encounter, and are entered using the "External Orders" tab of Orders activities (see Tip). 
• External Orders for Inpatients
• Some clinicians struggle when seeking orders that they cannot find in the inpatient order catalogue. Usually they are trying to line up actions (e.g., procedure at another facility or follow up to occur at a clinic) that occur outside of the current admission facility.
• Reinforce the difference between internal and external orders, as covered in today's Tippy and explained in the Manual.
• Home Care Orders from Inpatient Facilities
• Continuing Care Access services launch with Connect Care Wave 2, shifting home care coordination from a paper-based to digital process. Physicians may see new requests for order co-signs.
• A new section has been added to the Manual to clarify physician accountabilities.
• Quick Fixes
• Wave 2 support appears to be working well. High-priority tickets are sorted within 3 hours, and ¾ of all tickets (any priority level) are already resolved.
• In the Works
• ECG workflows
• Some problems with device interfaces are being worked on.
• Protocoled orders
• Some Wave 2 sites have solid use cases for protocoled orders but are new to how this can work in Connect Care.
• CMIO leads are working with the teams to facilitate registration of a protocol and sharing personalizations to enable the needed team-entered orders.
• Ordering Norms pertain.
• Rapid Attending Changes
• We are encountering some Wave 2 clinical contexts (e.g., Obstetrics) where attending physicians take over from one another as often as every 12 hours.
• Fast-flipping provider schedules present challenges making sure that the "attending provider" designation is always correct, and that the right staff are attending to attending changes.
• ➔ Workgroup activated to look into technical and change-management solutions.
• Medication reconciliation
• MedRec is required but not always well resourced. Information burdens increase transiently when most patients are new to Connect Care and need home medications entered and validated.
• ➔ Workgroup activated to look into dissemination of best tricks for speeding information entry while working on organizational support options.

Wave 2 Launch Support Hot Topics - Day 05

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Login Department for Long Term Care
• Physicians providing care for patients at Long Term Care (LTC) settings on Connect Care should log on using a LTC virtual department (e.g., "Edmonton Zone Long Term Care").
• The default Summary Overview that shows when LTC inpatient charts are opened has been enhanced to include the communication tools (e.g., MRHP and Team sticky notes) and information displays most important to LTC. The fix is applied to LTC and Rural MD virtual departments.
• Tap Out - Log Out
• Very important to log off of multi-user computer workstations if one has logged on with a Windows account.
• This is a universal precaution and also applies when a tap card is used.
• Keep Play to the Sandbox
• Demonstration patients were provided in the Production (PRD) environment to facilitate prescriber personalizations pre-launch. It is very important to limit use of these charts to creating personalizations.
• Never sign an order, communication or other action when working with a demo patient. Strictly limit use to saving lined up orders or draft documentation as personal favourites or preferences.
• If practice with order signing workflows is needed, do so in the PLY (play sandbox) environment.
  
• Quick Fixes
• Medical student editing rights for labour and delivery documentation → fixed.
• Alert on MAR to continuous medication administration end time → fix approved, going into PRD.
• In the Works
• Best workflow and CIS support for providing bridging medications for patient on pass or in transfer to Long Term Care → workgroup on this.
• ECG best practices at Wave 2 sites → workgroup on this.

Wave 2 Launch Support Hot Topics - Day 04

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Inpatient DI Orders to be Performed at another Facility
• Wave 2 sites present more situations where a patient needs a specific imaging intervention, but the procedure needs to be performed at a different site. A specific external orders workflow is required.
• A new FAQ (with Tip Sheet), linked to the Manual, illustrates the process.
• Personalization Power
• Lots of interest (and benefit opportunity) arising for personalization.
• Tips and resources have been updated in the Manual and a blog posting highlights the many different ways that prescribers can grow their personalization skills.
• Therapy Plans for Dialysis
• Inpatient dialysis at the UAH site is among the Wave 2 programs learning new digital workflows.
• Early experience is showing that an alternate approach to orders organization is needed and therapy plans are being adapted for this purpose. 
• Those needing the plans are aware, using interim workflows while training, and anticipate smoother order supports soon.
• Netcare Program Lists Configuration
• Wave 2 physicians are reporting empty or incomplete "Program Lists" in Netcare for sites that have just launched with Connect Care Wave 2.
• The underlying cause is related to one we reported for "Physician Lists" and has a similar fix described in a new Support Posting.

Problems with Physicians' Program List in Netcare

Problem: Wave 2 physicians accustomed to Netcare's "Program" lists (configurable to show inpatient, outpatient or other groups where a service group has assigned patients) may find that a Program list is inappropriately empty or incomplete after the associated site transitions to Wave 2.

A related issue affecting lists of patients associated with a Provider is addressed in a separate posting.

Context: With Wave 2 launch, some facilities take on new site names and new names for clinical service groups. If Netcare continues to seek Program patient panels with the older names, lists will be empty or incomplete.

Solution: In most cases, Netcare Program lists can be restored by correctly selecting the "Site" using new Connect Care naming conventions. Note in the image below that there is both a site called "University of Alberta Hospital" (pre-Connect Care naming convention) and a site called "EDM WMC University of Alberta Hospital" (post-launch Connect Care naming convention). 

UPDATE (20201101): duplication of programs in Netcare lists has been fixed. It is still important to re-to confirm selection of the intended program in personal settings.

Be sure to select Connect Care sites using the new Connect Care site name. This will correctly populate searches for Program affiliated patients. The same care must be taken when editing "User Settings" to configure a default inpatient or outpatient program for lists.

Wave 2 Launch Support Hot Topics - Day 03

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Sensitive Notes
• We have had questions about the circumstances in which an entire patient chart may be "confidential" and accessible only via "Break-the-Glass" and also about when and how "Sensitive Notes" are to be used.
• We've updated the Manual section on this topic to provide clearer and more specific guidance for physicians.
• Long Term Care Chart Summary Views
• Some physicians caring for LTC patients report opening the chart to the long term care encounter to find the chart "Summary" activity defaulting to a view other than the intended standard "Overview".
• The default Summary view is affected by one's login department. Fixes are in the works today for login departments (e.g., rural physician) that are not displaying the correct default.
• An immediate mitigation is for physicians providing long term care to select "Edmonton Zone Long Term Care" virtual department when logging on.
• Connecting to Virtual Drop-in Sessions
• Virtual Drop-in Centre support is available for all Wave 2 prescribers 24 hours a day through to November 2, after which the centres continue in daytime hours. See launchhelp.connect-care.ca for more information and use virtualhelp.connect-care.ca to connect to the virtual centre.
• Users are finding that typical AHS devices are not able to support the Zoom audio. 
• We recommend using the "call me" option presented when joining the virtual centre. This allows the audio part to flow through one's own mobile phone.
• Poster: Wave 2 Launch Supports
• Better Problem Reports
• Thankfully, problem report volumes are much less than experienced with Wave 1.
• Problems are resolved fastest when the original submission has the right level of detail, as described in an updated Manual section.
• Inter-Facility Transfers
• Wave 2 sites deal with a wider range of transfer situations than encountered in Wave 1, stimulating further revisions of user supports.
• New tip sheets have been prepared that are specific to what physicians need to do, all linked in a further updated Manual section.

Wave 2 Launch Support Hot Topics - Day 02

Daily postings on this channel address needs identified in physician huddles. A posting may be updated with new material multiple times in a day. Consider looking back at the previous day's posting.

• Netcare 'My Patients' List problems
• A number of Wave 2 physicians note that Netcare no longer lists their patients (e.g., inpatients) in its My Patients display, which is often the default display at logon.
• While Connect Care investigates a definitive fix, there is a work-around described in the Support Forum.
• Connect Care Provider Teams
• Provider Teams reflect the clinical services within a facility and are populated when patients are admitted, transferred or consulted.
• There were a few missed teams at launch. This is fixed.
• Some teams were not fully populated by the work of cutover. Super Users worked on Day 1 to manually compensate.
• A list of call Provider Teams at all Wave 2 sites was added to the relevant section of the Manual.
• Interfacility Transfers (IFT)
• With the advent of Wave 2, we have more transfers occurring to and from Connect Care sites and from Wave 2 sites to tertiary care Connect Care sites. We have found that prior instructions were not clear enough about what providers need to do to ensure smooth transfers.
• The relevant Clinician Manual Section has been updated and all IFT tip sheets for physicians. New tip sheets provide more precise reminders for Connect Care emergency physicians transferring patients to Connect Care and non-Connect Care sites.

Problems with Physicians' Patient List in Netcare

Problem: Wave 2 physicians accustomed to Netcare's "My patients" list (configurable to show admitted, outpatient and other care relationships) find that the list is empty or incomplete even though they have active patient responsibilities at a Wave 2 site.

Context: Unlike Wave 1 sites, some facilities launching with Wave 2 have different admission, discharge, transfer (ADT registration information) systems that inter-operate with Netcare differently.

Solution: In most cases, Netcare provider lists can be restored by re-configuring "User Settings" in Netcare. Go to the "Patient Lists" section and re-select the "My Provider" value. Note that the "Provider Popup Search" tool may find more than one match for the intended provider name.

Select the row that includes "[Connect Care]". This should restore Netcare's "My Patients" list to include patients served in Wave 2 facilities.

Wave 2 Launch Support Hot Topics - Day 01

Daily postings on this channel address needs raised in physicians huddles, with links to helpful information. A posting may be updated with new material multiple times in a day, with content locked in at 22:00. Consider looking back at the previous day's posting.

• Finding Departments
• Many users struggle at first when seeking the right login department for their immediate needs.
• New support information has been added to the Manual and a new FAQ lists some helpful resources.
• The site-specific support pages (linked to launchhelp.connect-care.ca) now have the most helpful facility acronyms to use when seeking departments relevant to a particular Wave 2 site.
• Access Problems
• Issues with roles (jobs), departments and permissions are common in the first days post-launch.
• Use the Virtual Login Lab and help.connect-care.ca to resolve (use telephone if an urgent access issue).
• Note that the Drop-In Centres (site and virtual) have extra resources to help with access issues in early days.

Problems with External WiFi Access and iOS 14

Problem: Some users may experience dropped WiFi connections after upgrading to Apple iOS 14. Has something happened?

Context: Apple has committed to protecting the privacy of its users. With the recent release of iOS 14, a unique MAC address (device identifier) is generated for each network that a user might connect with. This defeats common methods for un-consented tracking of user movements. 

Unfortunately, the Apple privacy protection may interfere with the device management strategy in use by some home or institutional networks (especially with mesh network extenders) and some virtual private networks. Symptoms include the mobile device reverting to cellular data use, even when an approved WiFi signal is strong. 

Solution: Users experiencing problems can turn off private MAC addresses by going to network settings on their mobile device, selecting the affected WiFi network, viewing its properties, then turning off the "Private Address" feature. 

Improvement to F1 Universal Connect Care Help Function

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• F1 Universal Help Enhanced to Include Prescriber Resources

Pressing the F1 key from anywhere in Hyperspace will open a popup window containing links to helpful Connect Care resources, tips, guides and instructions.

The "Universal Connect Care Links and Information" has a new section at the top of the middle column. Entitled "Prescriber Connect Care Resources", it has links to the Clinician Manual, Tips and other aids to prescribers learning best practices in Connect Care.

Interfacility Transfer Navigator, LOA for Procedure Improvements

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Improved Inter-facility Transfer and Procedure LOA Workflows

A new consolidated Inter-Facility Transfer (IFT) navigator appears in Connect Care starting October 13, 2020. This addresses concerns of both sending and receiving sites, improving the quality of communication and documentation. 

The prior "IFT to Connect Care Site" and "IFT to Non-Connect Care Site" navigators are combined to a single IFT navigator. This provides a consistent experience while guiding providers about the specific orders documentation required for different transfer scenarios. In particular, medication reconciliation and recommended orders are summarized in a standardized IFT Note for receiving non-Connect Care sites.

The new navigator has embedded instructions. Additional or updated guidance appears in the Manual and in linked Tips and Demos, which should be referred to the first few times that a prescriber uses the IFT or Procedure LOA workflows:

• Tip: IFT to Connect Care Site
• Demo: IFT to Connect Care Site
• Tip: IFT to non-Connect Care Site
• Demo: IFT to non-Connect Care Site
• Tip: Leave of Absence for Procedure
• Demo: Leave of Absence for Procedure
• Tip: Transfer to Continuing Care
• Manual: Inter-Facility Transfers
• Manual: Leave of Absence

Schedulable Orders Enhancement

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Schedulable Orders Enhancement

Schedulable orders allow prescribers to request health care interventions to be performed sometime in the future by another group that makes scheduling and other arrangements. Examples include requests for pulmonary function testing and phototherapy.

Schedulable orders usually relate to the outpatient context and so are encountered within ambulatory orders or "external orders" for inpatients.  These are not simple laboratory tests that can be ordered for future dates, or a series of recurring dates.

Like many cardiology and diagnostic imaging orders, more than one location may be able to do the work. The key distinction is whether the intervention will be performed at a facility that uses Connect Care, allowing for digital information flows, or an external facility, requiring printed requisitions.

Schedulable Orders emulate Cardiology and Imaging orders by asking prescribers to choose between a Connect Care fulfillment location (default) or a Non-Connect Care location. If Connect Care, then the actual location must be selected. The order will route electronically and the chosen location will proceed with scheduling.


To expedite the ordering process for prescribers who typically order procedures for the same preferred site, it is possible to personalize schedulable orders. 

• If an order has typical properties entered, select the "Accept" button, then be sure to select the star symbol to mark a personal preference. 
• An "Add to Preference List" dialog (popup) will appear. Confirm the order parameters and be sure to select the "Copy from Order" link.
• Give the personalized order an appropriate name (e.g., OP PFT at KEC Lung Lab). 
• Alternately, use the Preference List Composer to create a personalized Schedulable Order from scratch.

Point of Care Blood Gas Order Improvement

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Point of Care Arterial Blood Gas Order Enhancement

Prior "Blood Gas Arterial POCT", also known as Arterial Blood Gas (ABG), orders were missing a few key items needed to inform the collection workflow, including what level of oxygen supplementation should be used at the time the test is drawn. Clarity is required for accurate interpretation of test results.

Prescribers who order these tests need to indicate whether a patient is "On Current Therapy" (default, no further action required), "On Room Air", or "On Oxygen". If the third button is selected, then a field appears to indicate the oxygen amount and route at the time of testing:

Recognizing Major Incidents

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. 

Solution: Connect Care users who witness what might be an unrecognized problem should immediately contact helpdesk (help.connect-care.ca or 1-877-311-4300) to submit the concern. Indicate suspected major incident. 

Problems already recognized will be acknowledged (with mitigation instructions) for all users by one or more of the following channels:

• 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).

Connect Care Concierge (Help) Improvements

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Concierge Enhancements

The Connect Care Concierge (help.connect-care.ca) is an online help-desk that provides information about how to get immediate attention for urgent problems and how to request help for non-urgent problems.

The Concierge request-entry process is streamlined, with improvements to the fields that inform a "ticket" in the request management system.

The improvements are intuitive. Physicians will notice a simpler landing page with clearer distinctions between urgent and non-urgent issues.

Physicians may also notice new mandatory fields for specifying an alternate contact and contact number. This reflects difficulties analysts have had contacting persons submitting requests. Such contact is often needed when gathering details about the clinical need and context. If an independent physician does not have an obvious alternate contact, it is fine to enter one's own information twice.

• Manual: Support
• Manual: Who to Call
• Concierge: help.connect-care.ca

Handoff Report Enhancement - Summary Section

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...

• Handoff Report Enhancement - Summary Section

The 'Handoff' report can be accessed from patient lists, within opened charts and when using Canto to facilitate patient rounds. Each speciality has its own content. The Handoff tools can support safer information transfer to on-call clinicians and when clinicians transfer teams.
 
As of September 29, 2020 the 'Summary' section will no longer default to RAWS headings. This change responds to user feedback, acknowledging that other sections of the Handoff report can be used for content like "what to watch out for" and that many specialties have preferred SmartPhrases developed for the Summary section.