Choosing the Correct Blood Gas POCT Order

Problem: When ordering point of care test (POCT) blood gases, prescribers may be confused by the available options (arterial, venous, capillary) being listed with a "Type" of "Nursing". Although these test requests are sometimes fulfilled by nurses, they are often handled by other clinicians such as registered respiratory therapists (RRTs). Some prescribers have been selecting inappropriate Blood Gas POCT orders. 

Context: The below screenshot includes orders primarily handled by respiratory services. Though all orders are listed as a "Nursing" type order, and though they may be drawn by nursing or other disciplines, they are still managed by respiratory services. Therefore, for example, "Blood Gas Arterial POCT, Type - Nursing" is the correct order for an Arterial Blood Gas to be drawn and run by an RRT.


Solution: The "Type" classification cannot be changed to display the expected "Respiratory" or "Respiratory/Nursing", for a variety of reasons. However, once the correct Blood Gas POCT order is found, it can be saved as a favourite.

Android 11 OS Users - Unable to Connect to AHSRestrict Wireless Network

Problem: Prescribers using a smartphone with the Android 11 operating system (OS) may be unable to connect to the "AHSRestrict" wireless network in AHS facilities. 

Context: The AHSRestrict wireless network allows mobile (e.g., smartphones, tablets) and portable (e.g., laptops) computing devices to connect to the AHS intranet. The "HealthSpot" wireless network is also available in AHS facilities, providing public access akin to connecting from outside AHS. Both networks can be used to access Connect Care and otherwise stay connected, even in places where cellular signals are weak. 

Some users report difficulties connecting to AHSRestrict when using the latest version of Google’s Android 11 OS. 

Solution: The AHS IT network and mobility teams continue to investigate a feasible solution so that all Android devices are able to join the AHSRestrict wireless network. 

HealthSpot wireless network connections are not affected and so can be used as a short-term alternative until a solution has been confirmed. To report issues with network access, please contact the IT Service Desk & Solution Centre (1-877-311-4300).

Managing Virtual Visits Without MyAHS Connect

Problem: Volume-related delays in access to the MyHealth Records login portal can affect access to the Connect Care patient portal (MyAHS Connect, MAC), preventing patients from using MAC to initiate telehealth visits by that means.

Context: Connect Care supports secure virtual visits for patients through its patient portal (MAC) where patients select an appointment and activate the associated video visit from within the appointment encounter. If patients are unable to log in to MAC, they may have difficulty joining a virtual visit. Connect Care Hyperspace tools for clinician participation in virtual visits are not affected.

Solution: Clinic staff (and prescribers) can call patients directly to provide an alternate means of accessing their upcoming Connect Care video visit if MAC access is compromised. 

Connect Care automatically generates a Zoom link that can be sent to the patient outside of MAC. Email can be used as follows:
  1. Within an outpatient encounter "Pre-Charting" activity, use the "Start the Visit" button to make the "Rooming" activity available.
  2. Within the Rooming activity, find the "Connect" section and use the "Email Link to..." button to generate an email with the needed Zoom link to send to the patient.
  3. If the "Email Link to..." button is not available, use the "Demographics" activity (chart search) to add the patient's email to the chart.

Prescriber Trainee Login and Authorizing Provider Updates

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Trainee Login Job Consolidation 
  • Resident Authorizing Provider Changes
As of noon on August 17, 2021, two changes go live that affect prescriber trainees:
  • Trainee login job consolidation
    • Recent work in consolidating jobs with similar functionality has simplified and reduced the number of choices presented at login. 
    • Those trainees who have multiple Connect Care roles (typically PGY1 and PGY2 residents) will see an updated list of jobs when they login to Connect Care on or after August 17. 
    • For a summary of the changes and more information, see the Manual:
  • Resident authorizing provider changes
    • The "Authorizing Provider" button is now front-facing and easier to find for all users. It will also still be available from the "Options" drop-down menu.
    • For patients in the Emergency Department, when orders are being signed, the Authorizing Provider selection screen will appear automatically. 
    • For more information on Authorizing Providers, see the Manual:

PFT Discrete Data in Results Review

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Pulmonary Function Testing discrete data now in Results Review

As of July 5, 2021, the "Results Review" activity, available in Connect Care Hyperspace for charts opened to inpatient encounters, contains Pulmonary Function Testing (PFT) discrete data obtained from AHS Pulmonary Function Labs using the Sentry Suite PFT information system.

Presentation of values for measures like FVC and FEV1 will allow for trending of PFT discreet data. Also, PFT data becomes easier to access for a wider range of users.

A PFT synopsis view is also newly available. "Synopsis" is an activity that streamlines the presentation of quantitative clinical data. The activity can be selected from any patient chart opened to an inpatient or outpatient encounter. 

Connect Care Mobility Cannot Find a Network Connection

Problem: Users of Connect Care mobility (Haiku, Canto) may receive messages that the mobile application ("app") cannot establish a network connection, possibly after a system upgrade.

Context: The Connect Care mobile apps (Haiku for smartphones and Canto for iPads) are managed by another application called "Workspace One" from vmWare. This includes a "Tunnel" app that takes care of establishing a secure virtual private network (VPN) for clinical apps to use when communicating with their server. 

The Tunnel app may update automatically, and an update may include a new copyright or privacy notice. Users who are unaware of this may try to use Connect Care mobile apps without realizing that the VPN is not activated. The mobile app will fail to logon, giving a message to the effect that a network connection to its server cannot be established.

The Tunnel VPN may also fail if the user's device is already connected to a personal or enterprise VPN, as there can be a conflict.

Solution: When confronted with a network connection error message when trying to login to Haiku or Canto, be sure to open the Tunnel app and take care of any alerts or messages there. Also consider whether an independent VPN service needs to be turned off in order for the Connect Care VPN to activate.

Spinal Precautions Order Panel

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Spinal Precautions now ordered via Spinal Precautions Panel
As of June 29, 2021, spinal precautions are ordered exclusively through the Spinal Precautions Panel:
  • To order, with the patient's chart open, in the "Orders" activity, search for "spinal" and select "Spinal Precautions Panel". Relevant linked patient care orders can be selected within this panel. 
  • To clear spinal precautions, two steps are needed:
    1. Discontinue the order: In the "Orders" activity, under "Active Orders">>"Precautions & Restraints">>"Spinal Precautions", click "Discontinue".
    2. Document the clearance: In the "Notes" activity, create a new note and indicate the "Type" as "Spinal Clearance" (search for "spinal") to bring up the Spinal Clearance Documentation SmartText.
      • Note: Recently cleared precautions can be seen in the "Summary">>"Overview" activity tab.
For more information, see the new tip sheet:

Inpatient Consult Order Minor Changes

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Change to Inpatient Consult Orders
A minor change to the order composer for inpatient consult requests is part of the Connect Care Spring 2021 Upgrade. This impacts no features or functions, but involves a slight layout adjustment that users will notice. Inpatient consult order entry workflows do not change. 

Previously, contact particulars for the requesting (from) and receiving (to) provider were accessed via an icon:


Presently, contact particulars appear in an information field to the right of the selected provider:


Typically, inpatient consultation requests go to a particular inpatient provider team. This continues to be the most important field as it ensures that the consult request appears in the patient list for the desired service.

If a specific consultant is desired, the "To Provider" field should be completed. The address information helps confirm that the appropriate location was chosen for providers attached to more than one facility.

Wave 3 Launch Support Hot Topics - Week 2

While this channel has highlighted post-launch needs identified in physician huddles, the launch has gone well and things have stabilized. This combined Wave 3 Week 2 posting is updated throughout the week, accumulating any new issues while also indicating issue resolution. 

  
  • Clarify Options for Reflecting On-call Coverage in Connect Care
    • Responding to user requests, new supports have been developed to highlight how Connect Care tools can be used to reflect changes in attending and on-call prescriber status, with a new Manual section, Tip sheet and FAQ.
  • Documenting COVID-19 Immunizations
    • As the order build for COVID-19 immunizations is currently in progress, documentation in Connect Care is not yet automatic. 
    • On the process for manually recording past vaccinations not captured in Connect Care, see a new bulletintip, and Manual section.
  • Mobility Apps: Haiku and Canto
    • The Haiku app on Android mobile devices lacks some of the functionality available on iOS mobile devices, particularly for inpatient quick order tools. Also, ordering from iOS devices is limited to preference lists. See this FAQ for considerations when selecting a mobile device that will best fit your clinical needs.
    • The job type you can log in to in Hyperspace can be affected by whether there is a simultaneously open Haiku or Canto session, as explained in a new FAQ.
    • Not all lab results are available to Haiku or Canto. A default lookback period (2 years for outpatient labs; 1 week for inpatient labs) ensures that the apps remain quickly responsive, even on slow networks, while not consuming too much of a user's mobile data allowance. A working group is investigating whether the lookback periods should be modified post-Wave 3, as explained in a FAQ and a general blog.
  • Virtual Drop-in Centre Hours
    • Now that we're in the second week, launch support via the Virtual Drop-in Centre is scaled back to daytime hours.
    • The schedule and information about after-hours CMIO support is available in a post and in the Manual.
  • Handoff Tool
    • Resources are being developed to highlight how Connect Care's Handoff tool is used to support patient handovers between providers.
  • Requesting Therapy Plans in Other Facilities
    • For a prescriber to request a therapy plan at a facility where they do not have privileges (especially in EDs that may not have appointment scheduling capacity or a clear most responsible provider), there needs to be direct communication between the prescriber and responsible provider at the facility that will enact a therapy plan.
    • Facility-specific workflows may be determined in collaboration with a Zone Medical Director.
    • Planning is underway for longer-term (post-Wave 3) solutions to accommodate variances in where and by whom therapy plans can be ordered and enacted.
  • Taking Care When Ordering Tests
    • Some prescribers may struggle when finding the right test for a specific clinical purpose, while being mindful of what may be locally available.
    • A new FAQ offers some advice.
  • Pocket Card Handouts for CMIO User Supports
    • A handout-ready card has been prepared that Super Users, Medical Informatics Leads, Trainers and others can use to remind Wave 3 initiates about where to get help.
  • Results Routing at Discharge
    • Specific questions are raised about how results for tests ordered at discharge, where the intent is that the test be performed AFTER discharge. A Manual section is updated.
  • Medication Start Times
    • A bulletin has been posted to remind inpatient prescribers of the importance of medication start times.
  • Patient Lists
    • An updated list of Provider Teams has been added to the Manual, organized by Wave.

Dragon Medical One Upgrades

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Dragon Medical One upgrades
A recent Dragon Medical One (DMO) upgrade brings in a few new features:
  • Dynamic microphone selection: You no longer need to exit and relaunch DMO to choose a new audio input. To switch microphones while using DMO, use the Dragon "flame" menu. 


  • Access online learning videos within DMO: Using the verbal command "open training" or "show training" will bring up a catalogue of short demonstration videos. Topics include:
    • Getting Started
    • Increasing Productivity
    • Additional Features
    • Administrative Tools
  • Spelling mode: Following the use of the verbal command "spell out", users can then spell unusual terms or acronyms, uncommon names, or special characters. The characters can be spoken using either standard letter pronunciation or the NATO phonetic alphabet (e.g., Alpha, Bravo).

For more information:

Wave 3 Launch Support Hot Topics - Day 7

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).

  
  • Keep Calm and Navigate
    • Navigators help prescribers navigate multi-step workflows where it is otherwise easy to forget key requirements. Admission, transfer and discharge navigators are particularly important.
    • Using the Discharge Navigator simplifies prescriber work, ensuring that orders, medication reconciliation, documentation and follow-up tasks are coordinated.
    •  A Manual page gives a brief orientation to navigators, including tip sheets that are being updated.
  • Start Times for Med Orders
    • If a med order is entered without a start time, the default (standardized medication administration time, SMAT) can lead to inadvertent timing of dose administration.
    • Super Users and other Wave 3 supports for prescribers are encouraged to reinforce awareness of this, and a posting will be prepared for weekend release.
  • Control Over Print Location for Discharge Prescriptions
    • Earlier this week, physicians expressed frustration with lack of control over the print location for discharge medication prescriptions generated when using the discharge navigator and discharge order. We posted a workaround.
    • Build work was reviewed and approved today by the Clinical Documentation Committee to add discharge prescription reprinting (with print location control) to the other printable discharge documents. This should get into production early next week.
  • Special Mobility Considerations for Multi-job Prescribers
    • Some prescribers have multiple roles ("Jobs", e.g., emergency physician and rural family physician) that they select from when logging in to Connect Care. This ensures that they see the correct module (e.g., ASAP) and tools. 
    • Connect Care is designed to ensure that the same user is not logged in to Connect Care in the same way at two different devices simultaneously... with the exception of mobile devices (which can be open while Hyperspace is open).
    • The catch is that a prescriber who has a mobile session (e.g., Haiku) open under one job cannot then open Hyperspace under another job. It is essential that multi-job prescribers take care to fully log off of mobility (Haiku or Canto) before logging on to Hyperspace in a different job. Otherwise, a session lock can be encountered.
    • Communications and Manual support will be developed to address this situation.

Wave 3 Launch Support Hot Topics - Day 6

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).

  • Nursing Communication Orders for Rapid Response
    • Some Wave 3 sites continue to work out how their Rapid Response nursing protocols can reflect most responsible provider engagement and endorsement.
    • While the processes need to be worked out as matters of norms and change management, this situation illustrates a possible use of "communication orders" to support initiation of protocolized actions. 
    • A new Manual section and FAQ relate.  
  • Finding Upcoming Encounters
    • Some prescribers have reported difficulty finding encounters of interest. 
    • tip is developed, a FAQ posted and both and linked to comments newly added to the Manual.
  • Setting Up a My Consults List
    • Some users do not have a "My Consults" patient list in the personal lists area of the Patient Lists activity. A method used to set up a custom list was not working.
    • Instructions are posted respecting the safest way to track one's patient attachments of the "consult" type... and to set up a My Consults folder.
    • The Patient Lists section of the Manual is updated.
  • Prescription Refill Workflows
    • There are frustrations in the early days post-launch for outpatient prescribers managing large volumes of prescription refill requests from pharmacies.
    • Prior guidance about the need to record a prescription refill in Connect Care is reinforced, while posting a FAQ reassuring that pharmacy-provided refill forms can be signed and returned (avoiding a print-sign-scan-fax workflow).
  • Need for Local Scanner/PDF-Attach Support in Consent Navigator
    • Some surgical office assistants have struggled with remote addition of scanned consent documents to the chart. 
    • A meeting of stakeholders was held to illustrate any challenges. The technology is working but there are opportunities to emphasize a few tips that will address challenges. Training is aware.
  • Attaching Media (documents, images) to Patient Charts
    • A related user request sought simple prescriber-friendly guidance about how to capture and attach documents to patient charts, or insert clinical images directly into notes.
    • The Manual entry for attaching documents/objects to patient charts is updated to highlight prescriber-friendly workflows for scanning, importing or otherwise working with Media Manager. A relevant Tippy is updated and re-posted.
  • Generating Reports Specific to a Provider's Activities During a Defined Period
    • Already Wave 3 users express interest in how they might use Connect Care to generate a report of their patient-related activities for a defined period.
    • We may turn specific request(s) into examples that others can emulate.
    • For now, a section of the Manual has been updated.
  • Results Routing for Locum Prescribers
    • Challenges with different options for locum prescribers to receive or delegate test results related to a specific work assignment are being explored, with intent to produce a simplified summary of issues and options.
  • Orders for Specific Rapid COVID-19 Testing
    • Some Wave 3 prescribers wish to order a new Rapid-testing assay newly available but not on their facility list. 
    • The Components committee is looking at options for extending the current integrated testing order panel.

Wave 3 Launch Support Hot Topics - Day 5

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).

  • Login for Shared Clinical Workstations
    • It is very important to ALWAYS log in to an AHS computer workstation (and then Connect Care) with one's own unique credentials (user name and password), and then to log off of both Connect Care and the workstation before leaving the device. This prevents "session stealing" and other information system challenges. "Generic" logins should not be used. 
    • An updated FAQ addresses the previous practice of using generic logins, and a bulletin details logging off/tapping out.  
  • Post-Admission Alerts when ED organizes Admission
    • Workflows for emergency physicians who organize and implement admissions (more common at Wave 3 sites) expressed concern about intrusive alerts.
    • The associated workflow is being simplified to avoid a superfluous popup.
  • Admitting vs. Attending vs. Authorizing Prescriber
    • Wave 3 inpatient services are getting used to a variety of admission workflows, including those where an ED prescriber does an admission overnight that a hospitalist takes responsibility for in the morning.
    • It is important to recognize the primary importance of the "Attending" (Most Responsible Healthcare Provider) prescriber attachment to a patient and to firm-up processes for ensuring that this status is updated as clinicians handover. An enhanced Manual section is released today along with a linked tip.
  • Finding Upcoming Encounters
    • Some prescribers have reported difficulty finding past encounters of interest. 
    • A tip is developed and linked to comments newly added to the Manual.
  • Sticky Notes
    • Reminder that Sticky Notes do not form part of the chart and should not be used for orders or care notes/documentation. They can be very useful for multidisciplinary team, most responsible provider and specialty reminders.
    • See yesterday's posting on communication norms for more information and note the Manual section about Sticky Notes.
  • Virtual Drop-In Support
    • The Virtual Drop-in Centre is available, to both end users and Super Users requiring additional support, 24/7 for the first post-launch week. To access, go to virtualhelp.connect-care.ca using a computer or smartphone or via the QR code found on the Launch Supports poster up in sites (or the Manual) using a smartphone camera for audio-only help. 
  • Connect Care to Netcare
    • Some Wave 3 users have asked about how to tell if a Connect Care documentation object (e.g., progress note) will be shared with Netcare.
    • A general blog posting reminds about how Connect Care to Netcare document sharing works.

Wave 3 Launch Support Hot Topics - Day 4

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).

  • Ordering Therapy Plan Treatments in EDs
    • Therapy plan treatments may require visits scheduled in emergency departments (EDs), a workflow more common Wave 3. However, the best way to facilitate scheduling differs from site to site.
    • A tip sheet has been published, linked to an addition to the Manual and a new FAQ posting.
  • Virtual Drop-In Support
    • The Virtual Drop-in Centre is available, to both end users and Super Users requiring additional support, 24/7 for the first post-launch week. To access, go to virtualhelp.connect-care.ca using a computer or smartphone or via the QR code found on the Launch Supports poster up in sites (or the Manual) using a smartphone camera for audio-only help. 
  • Entering Orders on Behalf of Another Provider
    • If a provider must enter an order on behalf of the Ordering Provider, the correct Authorizing Provider must be selected via the Options >> Providers drop-down menu (in the Orders sidebar) to avoid incorrect results routing.
    • Note that entering an order for another provider is not recommended as a routine practice, particularly if the providers have different login departments. 
    • New FAQ posted.
  • ED Prescriber Admitting to a Different Site
  • Tweaks to Discharge Report for Community Pharmacy
  • Ordering Norms
  • Communication Norms
    • A new blog posting emphasizes that secure messaging should not be used as a surrogate for order entry. If one can secure-message, one can and should do CPOE. Secure messaging is not an appropriate communications tool for "verbal" orders.
  • Connect Care to Netcare
    • Some Wave 3 users have asked about how to tell if a Connect Care documentation object (e.g., progress note) will be shared with Netcare.
    • The April 14 general blog posting reminds about how Connect Care to Netcare document sharing works.
  • Connect Care to Community EMR
    • Wave 3 users have also asked about whether and how Connect Care documentation can be shared with Community Electronic Medical Records served by "eDelivery".
    • This is an area where important new capabilities are soon to be released. What and how to communicate is under consideration. Prior messaging needs to be updated.

Wave 3 Launch Support Hot Topics - Day 3

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).

  • ED Prescriber Admitting to a Different Site
    • An emerging Wave 3 workflow involves a prescriber assessing a patient at an ED at one facility (without inpatient beds) and admitting to another facility where the prescriber may continue or handover care. The best way to handle this is being worked out and may involve an addition to the Patient Movement section of the Manual. 
  • ED Prescribers Entering Inpatient Orders
    • Another workflow emerging as Connect Care encompasses more rural sites involves a prescriber working in an ED context admitting a patient to the same facility (possibly as an emergency inpatient) where the ED prescriber is also the inpatient attending. Connect Care orders, navigators and documentation tools tend to be anchored to specific contexts (i.e., inpatient, ED, critical care, outpatient) and so generate alerts if a prescriber logged in to one context tries to take actions for the same patient in a different context. Best practice supports are being enhanced.
  • Controlled Printing of Prescriptions at Discharge
    • Upon signing a patient discharge order, important documents are automatically printed at the relevant patient's hospital location (ward). These include an after visit summary (AVS), medication reconciliation report for community pharmacy and any new physician prescriptions. The printing location is tied to the patient location, under system control.
    • Pandemic and rural workflows may involve responsible physicians off-site at the moment of discharge. Yet the printed prescriptions need to be signed and faxed or otherwise delivered to the preferred pharmacy.
    • Enhancement requests are submitted to improve options for reprinting (under manual control) physician prescriptions, just as it is possible to re-print AVS and pharmacy forms.
    • A workaround for physicians is communicated, hoping that this will decrease temptation to (inappropriately) use signed pharmacy MedRec reports (which can be printed to local devices).
  • Provider Teams
    • Continued progress is made capturing few remaining provider team needs and setting up the associated lists.
    • A summary listing of all Wave 3 provider teams will be linked to the Manual towards the end of the week.
  • Ordering Norms
    • As happens with each Wave launch, prescribers and their supports struggle with situations where it may be difficult for physicians to enter orders directly to Connect Care. 100% CPOE (computerized provider order entry) is the goal, for many reasons, but there are some clearly defined exceptions described.
    • There are many ways (including use of mobile apps) for prescribers to order from a distance without distancing themselves from decision supports.
    • All clinicians are reminded to follow Connect Care Ordering Norms and the heads-up provided in the Wave 3 countdown checklist.
  • Communication Norms
    • Also shared with prior launch Waves is the need for prescribers and healthcare teams to consider appropriate uses of the new secure clinical communication options made possible by Connect Care. Professionalism must guide sensible tool use.
    • All clinicians are reminded to follow Connect Care Communication Norms, especially to devise and adhere to communication pacts among teams. The Norms recognize that different teams may need to use particular tools in different ways. But all must have a clear understanding of which tools to use for different levels of urgency and response timeliness. 

Wave 3 Launch Support Hot Topics - Day 2

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).
  • Blood Product Information System
  • Dose Ranges in Medication Orders
    • Pharmacy has noted difficulty fulfilling some PRN orders containing instructions for dosing within pre-defined ranges. Dose ranges that are too wide create dispensing challenges when the range exceeds what can be covered within a particular medication concentration (strength).
    • Prescriber best practices, highlighted in the Manual, are re-emphasized.
  • Printer Mapping
    • A common early post-launch challenge relates to ensuring that all clinical workstations are mapped to appropriate local printers. This work continues as problems are discovered.
    • Prescribers are reminded about the difference between printing tasks that are subject to system-set printer mappings versus other tasks where the user can control the print location.
  • Provider Teams
    • Post-launch, a need for some additional inpatient provider teams (important to Patient Lists) has been identified and the needed teams are being created.
  • Therapy Plans and Departments
    • Some NZ departments are not available in relevant pick-lists within therapy plans.
    • A rapid configuration tweak is underway.
  • Cardioversion Information Flows
    • An opportunity for additional training and change-management support has been identified, without need for Connect Care build changes or optimizations.
  • Medical Scribes
    • As in prior waves, questions are raised about ordering norms and how they apply to situations where there may be a duty to accommodate.
    • Related questions about the possible use of "medical scribes" provide opportunity to remind prescribers that any exceptions to Connect Care ordering norms must be formally requested and approved, and that substitute ordering can only be done in a pre-approved way where the involved extended-role non-prescribers are appropriately trained and AHS-certified.
  • Problem List Management
    • Team members have commented about the number of Wave 3 charts that lack problem lists reflecting patients' health conditions.
    • Problem list management is very important to do, but a bit daunting early in one's Connect Care experience.
    • A new series of Problem Power Tips is started in the Connect Care Tips channel. 

Wave 3 Launch Support Hot Topics - Day 1

Daily postings on this channel address needs raised in physician huddles, with links to support information. Content is locked in at 16:00, and any additional hot topics after this time will be posted separately. Consider looking back at the previous day's posting(s).
  • WellSky Blood Product System Downtime
    • A planned downtime for the WellSky blood product management information system had to be extended when interfaces to core Connect Care information systems did not restore as expected.
    • Prescribers have continued downtime procedures as reminded in an all-user bulletin and login alerts.
  • Drop-in Centre Move
    • As of Sunday morning, April 11, the in-person Drop-In Centre at the Grande Prairie Queen Elizabeth II Hospital is being moved to a more convenient location: room 2509-2510 (previously called 2-2 North), located just outside the physicians' lounge.
  • Goals of Care Management

Wound Treatment Orders Can Be Linked to a Specific Wound

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Change to Wound Orders
As requested by surgical specialties, wound care orders can now be linked to a specific wound site by selecting from a list of documented wounds at the time of order entry.


IVIg Therapy Plan Changes

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Change to Therapy Plan for IVIg
As requested by a number of specialties, intravenous immunoglobulin G (IVIg) can now be ordered through its own Therapy Plan. Previously it was necessary to work through a transfusion (Blood Administration) Therapy Plan to order recurring treatments with IVIg.

The IVIg Transfusion (ADULT) Therapy Plan includes two series of appointment requests and two sets of Prepare, Dispense and Immune Globulin orders for divided doses.

New SmartText Available for Declined Inpatient Co-signs

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • New Declined Co-sign SmartText
Sometimes prescribers receive In Basket messages reminding/requesting a co-sign for an inpatient order where the receiving physician did not supervise the ordering trainee, or otherwise was not accountable for the action.

A new SmartText can facilitate a quick response, clearing the message (and request) from one's In Basket. The returned text reminds to suggest the appropriate co-signing provider. To retrieve the SmartText, type "cosign" in the SmartText lookup box above the response message edit area:

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:

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:

How to Manage Misdirected In Basket Results

Problem: Laboratory results can occasionally get misdirected. 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.

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:

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.



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
  • 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.
  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.