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.

Launch 5 Support Hot Topics - Week 3

This combined posting is updated throughout the third week of launch support, accumulating needs raised in prescriber huddles, with links to support information. Consider looking back each day. 
(Note: Emails from our subscription service show the original version of the post, 
and so will not show any updates made in the body of the email - click the link in the email to see the up-to-date web version.)

Sending Outpatient Notes to NetCARE
  • Reminder that outpatient communication is not automatically shared with Netcare. If a communication is appropriate for sharing to Netcare, be sure to pick the template that includes "Netcare" in its name. See this blog post and tip sheet for a summary of how Connect Care to Netcare document sharing works.
  • There is also a "quick click" function makes it easy to rapidly route notes to a patient's primary care provider (PCP) and referring provider for outpatient encounters. When selected, a tick box above the note will automatically send your note to Netcare as well as the PCP and referring provider (if known). For more information, see this blog postdemo, and the Shared Documents section of the Connect Care Manual.
    • Note: The quick click function does not work for hospital outpatient department encounters (HODs).
Virtual and In-Person Drop-In Support
  • Hours for the Virtual Drop-in Centre are now 10:00-18:00 for all prescribers, until December 2. For oncology prescribers, it opens early Mon–Fri, 08:00–18:00 (regular hours Sat–Sun).
  • Hours for the In-person Drop-in Centres at FMC and RDRH are 10:00-18:00, up to and including this Thursday, November 24. The In-person Drop-in Centres will then close as of November 25.
  • For issues outside of drop-in hours, call the IT Service Desk & Solution Centre at 1-877-311-4300 (#1 for Connect Care). They are able to provide high-level workflow and training support; urgent issues will be escalated to an on-call CMIO training team member.

Launch 5 Support Hot Topics - Week 2

This combined posting is updated throughout the second week of launch support, accumulating needs raised in prescriber huddles, with links to support information. Consider looking back each day. 
(Note: Emails from our subscription service show the original version of the post, 
and so will not show any updates made in the body of the email - click the link in the email to see the up-to-date web version.)

  • Observation Bed Request
    • Some facilities such as the Foothills Medical Centre have "observation bed" designations. When a patient requires a dedicated observation bed on an inpatient unit in such a facility, an "Observation Bed Requirement" order should be placed, for communication to bed planning and nursing. See the blog post for more information.
  • Calgary Zone - Ambulatory Results Management Update
    • Starting November 16, some results from outside of the Calgary Zone will be suppressed from In Basket to reduce duplicate reports.
    • Prescribers must regularly monitor Connect Care In Basket AND hard copy reports, and follow-up on results as needed.
    • To improve the reliability of result delivery to In Basket and reduce hard copy reports, issue Connect Care requisitions to patients.
    • For more information, see the memo.
  • Computerized Prescriber Order Entry (CPOE) and Allowed Exceptions
    • Information on CPOE can be found in a Countdown Checklist post, a general blog post, and the Clinical Ordering Norms section of the Connect Care Manual.
    • There will be situations when prescribers cannot be expected to place time-sensitive orders directly and require the assistance of a qualified healthcare professional to transcribe important clinical instructions. Allowed exceptions to prescriber order-entry fall into three categories, each explained and exemplified in FAQ and Order Norms documents: protocolized orders, urgent verbal orders, and urgent telephone orders.
    • In ordering – as in all other clinical activities – patient care and safety come first. If there is an urgent or emergent circumstance affecting a patient’s care, verbal or telephone orders may be appropriate and can be allowed. See this memo for further details. For additional information on team collaboration for verbal and telephone orders, see the work package for prescribers and nurses, and, for nurses and allied health professionals, the decision-making guide and paging etiquette guide.
  • Consults and Internal vs. External Referrals
    • "Consult" requests relate to assessments to be done within the current encounter and are entered from inpatient and emergency orders activities. "Referral" requests 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.
    • Outpatient services that use Connect Care as the record of care are "internal" referral resources (e.g., a referral from FMC ED to FMC Minor Surgery would follow the internal referral pathway). Outpatient services that are not on Connect Care are "outgoing", or external, referral resources. This status is selected when entering the referral order.
    • All referrals originating in Connect Care must be placed as a referral order, regardless of whether or not the referred service provider/clinic is using Connect Care. This ensures that a record of the referral exists in the legal record of care. 
    • See the Referral Workflows section of the Connect Care Manual for more information, as well as the following resources:

Fix to Identity SmartLinks for Unknown Patients

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Unknown Patient - Fix to Patient Name SmartLinks
Sometimes patients are admitted before their identity can be reliably confirmed, as might happen with altered states of consciousness. They are assigned an anonymous name ("UNK..."), chart and record numbers so that care can proceed. Later, when a true identity is confirmed, processes for merging anonymous and permanent charts can begin. Until that process completes, a clinician's choice of documentation SmartLinks can determine whether the unknown or the known first and last name appear.

We have found situations where some documentation tools were reflecting the correct (true) first name but the wrong (unknown) last name. Fixes are applied to all provincial documentation templates (e.g., discharge summary) to make them maximally resilient to rare instances when patient identities are uncertain.

Connect Care users who have created their own SmartPhrases, or regularly use non-AHS SmarkLinks for patient names, are requested to preferentially use the following SmartLinks:
  • for First name: ".PREFNAMEFIRST"
  • for Last name: ".PREFNAMELAST"
  • for Full name: ".PREFNAMEFULL"

Patient List Fixes and Tweaks

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Patient List Enhancement Fixes and Tweaks
Significant enhancements to the functionality of patient lists were introduced pre-launch 5. A catalogue of AHS-approved and tested patient list columns was announced and optimized columns were applied to system lists for facility units, provider teams and specialty consults. In addition, a new RAPID Rounds patient list and report applied the enhancements to multidisciplinary discharge planning.
 
Subsequently, Connect Care users provided post-implementation feedback, with strong appreciation for the improvements. In addition, excellent suggestions revealed small changes that would further improve ease-of-use. A number of requested improvements are in production. These include: 
  • Hover bubbles removed from Room/Bed, DOB, Goals of Care and Level of Care columns.
  • Double-click simplified for Goals of Care, Room/Bed, Patient Identity columns.
  • Visual highlight (background colour) for patients with Alternate Level of Care statuses.
  • Better formatting of provider information column to make it easier to skim for attending, referring and primary care details.
  • Double-click for co-sign orders column to open main orders activity tab.
  • Double-click length of stay column to open Rapid Rounds discharge planning interactive report.
  • Default column widths adjusted. 
  • Discharge readiness column icons enlarged.
  • Formatting improvements to discharge goals section of Rapid Rounds report.
Although most fixes are immediately active, users who created a custom patient list by copying a standard list template (see Manual instructions) will want to re-copy from the appropriate list template.

For more information:

Launch 5 Support Hot Topics - Day 5

Daily postings on this channel address needs raised in prescriber huddles, with links to support information. Content is published around 17:30; any additional hot topics after this time will be posted the following day. Consider looking back at the previous day's posting. Note the next Hot Topics post will be November 14.

  • Non-Standard Medication
    • If a medication cannot be found on inpatient facility order lists (be sure to try different spellings and the generic drug name), it is likely non-standard. The ordering prescriber should request the medication by placing a "Non Standard Medication" order. A pharmacist will then review and modify the order to something they can provide, or contact you to suggest an alternative. 
    • For more information, see the FAQ blog post and Guide.
  • Computerized Prescriber Order Entry (CPOE) and Allowed Exceptions
    • Information on CPOE can be found in a Countdown Checklist post, a general blog post, and the Clinical Ordering Norms section of the Connect Care Manual.
    • There will be situations when prescribers cannot be expected to place time-sensitive orders directly and require the assistance of a qualified healthcare professional to transcribe important clinical instructions. Allowed exceptions to prescriber order-entry fall into three categories, each explained and exemplified in FAQ and Order Norms documents: protocolized orders, urgent verbal orders, and urgent telephone orders.
    • In ordering – as in all other clinical activities – patient care and safety come first. If there is an urgent or emergent circumstance affecting a patient’s care, verbal or telephone orders may be appropriate and can be allowed. See this memo for further details. For additional information on team collaboration for verbal and telephone orders, see the work package for prescribers and nurses, and, for nurses and allied health professionals, the decision-making guide and paging etiquette guide.

Launch 5 Support Hot Topics - Day 4

Daily postings on this channel address needs raised in prescriber huddles, with links to support information. Content is published around 17:30; any additional hot topics after this time will be posted the following day. Consider looking back at the previous day's posting.

  • Wet Signature Prescriptions and E-Prescribing
    • The Connect Care team is actively working with the Alberta College of Pharmacy and the College of Physicians and Surgeons of Alberta to specify acceptable standards for direct electronic transmission and authentication of outpatient prescriptions at community pharmacies.
    • We recognize that the current state of having to provide wet signatures on outbound prescriptions from Connect Care is not optimal, and appreciate your patience as we obtain the necessary provincial approvals for direct prescribing from Connect Care.
  • Ambulatory Outpatient Referrals
    • "Consult" requests relate to assessments to be done within the current encounter and are entered from inpatient and emergency orders activities. "Referral" requests 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.
    • 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", or external, referral resources. This status is selected when entering the referral order.
    • All referrals originating in Connect Care must be placed as a referral order, regardless of whether or not the referred service provider/clinic is using Connect Care. This ensures that a record of the referral exists in the legal record of care. 
    • See the Referral Workflows section of the Connect Care Manual for more information, as well as the following resources:
  • Secure Chat and Sticky Notes
    • The Secure Chat and Sticky Note functions in Connect Care should only be used for non-urgent communication and reminders, not for urgent messages or clinical documentation.
    • Secure Chat messages and Sticky Notes are purged after 30 days. Secure Chat messages and Sticky Notes do not form part of the chart.
    • See the Secure Chat and Sticky Notes sections of the Connect Care Manual for more information, as well as the Communication Norms.

Launch 5 Support Hot Topics - Day 3

Daily postings on this channel address needs raised in prescriber huddles, with links to support information. Content is published around 17:30; any additional hot topics after this time will be posted the following day. Consider looking back at the previous day's posting.

  • Patient Movement: Interfacility Transfers (IFTs)
    • For transfers to another site (IFTs), remember to use the Interfacility Transfer navigator, located within the Discharge tab. Using the correct navigator will ensure that all steps required for this workflow are completed and orders are available and actionable at the receiving site.  
      • Note: Every transfer to LTC/Continuing Care is an IFT even if the LTC/Continuing Care is located in the same building.
    • The "RAAPID Service Request" order is used to initiate repatriations as well as non-emergent consultation/transfer requests. See the tip sheet.
    • For a summary on IFTs, see this Countdown Checklist blog post and this infographic for admitted patients (updated). Further information (including other IFT workflows) is available in the IFT section of the Connect Care Manual.

Launch 5 Support Hot Topics - Day 2

Daily postings on this channel address needs raised in prescriber huddles, with links to support information. Content is published around 17:30; any additional hot topics after this time will be posted the following day. Consider looking back at the previous day's posting.

  • Patient Movement: Interfacility Transfers (IFTs)
    • For transfers to another site (IFTs), remember to use the Interfacility Transfer navigator, located within the Discharge tab. Using the correct navigator will ensure that all steps required for this workflow are completed and orders are available and actionable at the receiving site.  
    • Calgary Zone is in an interim state for IFTs - see this tip sheet for more information on how to transfer patients within the Calgary Zone, whether to another Connect Care site or a site not yet on Connect Care. 
    • For a summary on IFTs, see this Countdown Checklist blog post and this infographic. Further information is available in the IFT section of the Connect Care Manual.
  • Computerized Prescriber Order Entry (CPOE) and Allowed Exceptions
    • Information on CPOE can be found in a Countdown Checklist post, a general blog post, and the Clinical Ordering Norms section of the Connect Care Manual.
    • There will be situations when prescribers cannot be expected to place time-sensitive orders directly and require the assistance of a qualified healthcare professional to transcribe important clinical instructions. Allowed exceptions to prescriber order-entry fall into three categories, each explained and exemplified in FAQ and Order Norms documents: protocolized orders, urgent verbal orders, and urgent telephone orders.
    • In ordering – as in all other clinical activities – patient care and safety come first. If there is an urgent or emergent circumstance affecting a patient’s care, verbal or telephone orders may be appropriate and can be allowed. See this memo for further details. For additional information on team collaboration for verbal and telephone orders, see the work package for prescribers and nurses, and, for nurses and allied health professionals, the decision-making guide and paging etiquette guide.
  • Secure Chat and Sticky Notes
    • The Secure Chat and Sticky Note functions in Connect Care should only be used for non-urgent communication and reminders, not for urgent messages or clinical documentation.
    • Secure Chat messages and Sticky Notes are purged after 30 days. Sticky Notes do not form part of the chart.
    • See the Secure Chat and Sticky Notes Manual sections for more information, as well as the Communication Norms.

New Interventional Radiology and Bedside Order Sets

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • New Inpatient Interventional Radiology and Bedside Order Sets
As of October 27, 2022, the following new inpatient order sets for interventional radiology (IR) became available. Use of these order sets will help to ensure that appropriate orders are placed for each phase of care:  pre-, intra-, and post-procedure. Order set names beginning with “Image Guided” indicate the patient is being sent to diagnostic imaging (DI); “Bedside” indicates that a Radiologist will come to the bedside or that another clinician (typically, prescriber) will do the procedure. 
  • Bedside Joint Aspiration/Injection
  • Image Guided Joint Aspiration/Injection
  • Bedside Fluid Aspiration
  • Image Guided Fluid Aspiration
  • Image Guided Organ/Mass Biopsy
  • Image Guided Abscess Drainage
While the release of "Signed and Held" orders is usually performed by nursing, prescribers can also release these orders. Also note that these procedural order sets are not meant for ambulatory encounters or for when users are logged in to a virtual department. The patient location is important for things like sample label printing, and so orders for bedside procedures should be entered from the most specific logon department (e.g., ward).

For details on how to find and place any of these order sets, and how to find and release Signed & Held intra- and post-procedure orders, see the tip sheet. 

Problems with Citrix Workspace on Personal Computers

Problem: Some Connect Care users who rely on personal computers (especially Apple devices) for remote connection to Epic Hyperspace are reporting problems completing logons.

Context: Citrix Workspace software is used by the Alberta Health Services (AHS) remote access gateway (myapps.albertahealthservices.ca) when prescribers logon to Connect Care on personal computers outside the AHS firewall (extranet). 

Some users are reporting that logon efforts are prevented by Epic screens that do not show the expected userid or password fields or are otherwise not functioning.

Citrix released updates to its Workspace software in mid-October and again in the first week of November 2022. The current updates appear to have problems with MyApps or Connect Care. The problems are prevalent with the latest Macintosh updates, especially the new version of Workspace optimized for computers with Apple silicon (M1 and later chips).

Solution: Until further notice, please do not accept Workspace offers to download and update the Citrix Workspace App. If experiencing remote logon problems, and the Citrix Workspace "about" option shows version "2210" or later:

  • Uninstall Citrix Workspace
  • Reboot computer
  • Revert to the September 2022 version (2209 found in "install earlier versions" of Citrix downloads site).
  • Reboot computer
  • Try logging on via MyApps again.

Launch 5 Support Hot Topics - Day 1

Daily postings on this channel address needs raised in prescriber huddles, with links to support information. Content is published around 17:30; any additional hot topics after this time will be posted the following day. 

  • Test Result Release to Patient Portal (MyAHS Connect)
    • Most laboratory result and test report information is released immediately to MyAHS Connect, i.e., as soon as it is reported and available to clinicians (including pathology and genetic results), with DI, cardiology and endoscopy reports released 5 working days after they are available in Connect Care.
    • For consideration of what this means for prescribers, see this memo and the MyAHS Connect section of the Connect Care Manual.
  • Calgary Zone: NP Clinics Scheduled to Wrong Provider Record
    • NPs with concurrent RN roles may have their clinics and scheduling template linked to the incorrect record. The NP will not be able to see appointments nor have NP functionality if appointments are entered from the RN record. 
    • Mitigation: NPs with .e2 accounts to verify that they can see their schedule. Schedulers and Template Builders to verify and reassign as needed. See the tip sheet for more info.

Connect Care Mobility Install Issues

Problem: Connect Care users trying to install mobile applications (Haiku, Canto, PowerMic) may  be unable to complete the enrollment process for their device. 

Context: Mobile applications are managed by Alberta Health Services to ensure that connections are secure and privacy is maintained. This involves enrolling new devices in order to check for things like required password protections. 

There are new reports of users having difficulty completing new device enrollments. A problem with the associated software (VMWare) has been identified and is being worked on.

Solution: Users experiencing difficulties (“device not allowed” message) should call the Connect Care help desk 1-877-311-4300 or open a ticket via the IT Service Hub (Link: help.connect-care.ca). The device will be manually added. A notice will be posted here when normal device enrollment processes resume.

Update 04-11-2022: This problem has been fixed and no further tickets are coming in. Logs show resumption of successful Haiku initiations.

Repatriation and Consultation/Transfer Update - New RAAPID Service Request Order

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Bundled RAAPID Service Request Order
RAAPID (Referral, Access, Advice, Placement, Information & Destination) is a provincial service used to coordinate consults and the transfer of patients between sites. As of October 31, 2022, the current RAAPID Repatriation order will be changing to encompass both repatriation requests and consultation or transfer requests.

The bundled "RAAPID Service Request" order can be used to request the following:

  • Higher level of care consultation or transfer, if not urgent
  • Equal or lower level of care transfer from ED (e.g., capacity move, urgent repatriation)
  • Equal or lower level of care transfer from inpatient (i.e., "repatriation")
For urgent/emergent transfers, prescribers should continue to call RAAPID

A tip sheet details the new order fields. For more information on RAAPID, see the Manual.

Second Sign Updates - Requisition Printout

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Second Sign Updates - Requisition Printout
We previously posted about the Second Sign workflow for clerical/Medical Office Assistant (MOA) ambulatory orders. As of October 27, 2022, enhancements to the automatic printout process of Second Signed orders will be available. 

In the Second Sign workflow, once the order has received the second signature by the responsible prescriber, the requisition is often automatically printed off. Non-AHS MOAs are able to submit a ticket to suppress automatic printing of Second Sign orders, and AHS MOAs can submit a ticket to have print settings adjusted if requisitions for Second Signed orders are going to the incorrect printer (see tip sheet).

If the MOA or prescriber is unsure of the requisition print location, or whether the requisition was printed, two new features are available:
  • Additional information available in Chart Review: In the "Chart Review" activity, if the requisition was printed, the "Order Parameters >> Sign transmittal event" section now displays the destination printer ("Destination Workstation"), and whether it was a mapped printer or an alternate Virtual Local Printer (VLP) destination (workstation ID would begin with "VLP"). If the requisition was not printed, it will say "This order was not sent to a printer."
  • New Reporting Workbench report: In the Reporting Workbench workspace, a new report, "Second Sign Status", can be run that shows existing Second Sign orders. This report will indicate whether a Second Sign has been completed; if completed, an MOA can then find out if a requisition has been printed or not via the Chart Review activity as detailed above. If additional copies of requisitions are needed, MOAs can use "Reprint" from the Chart Review activity.

For more information:

Facility-to-Facility Medication Reconciliation Streamlined

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Medication Reconciliation Enhancements
A Best Possible Medication History (BPMH) is needed when patients present to a Connect Care encounter from a setting (e.g., home or facility) not using the Connect Care clinical information system. The BPMH outcome will be a new or updated list of "home" medications for comparison to medication choices made within the current encounter.

When patients present from facilities also using Connect Care (e.g., patient sent from a long-term care facility to an emergency department for assessment), their facility medication list takes the place of a home medication list. In these cases, there is no need to re-build the medication list through a BPMH process. A home medication list should not be populated. Medication reconciliation involves deciding which pre-encounter facility medications should be continued, held or stopped when the patient is admitted to the new facility.

To make this straightforward, the usual "Home Medications" navigator sections are hidden for Connect Care long-term care patients presenting to Connect Care emergency departments. Instead, the pre-encounter facility medications are displayed and a link is provided to a navigator facilitating the selective re-ordering of pre-encounter facility medications.

Suicide Risk Alert Enhancements

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Suicide Risk Alert Enhancements
As of October 21, 2022, enhancements to the Suicide Risk Alert will be available, which will impact inpatient (including AMH), emergency department, residential treatment, detox, and long-term care departments that are live on Connect Care. 
 
The previous Storyboard Alert (activated by a Precaution Order) will be replaced by the following:
  • Storyboard Alert for High Suicide Risk: Visible across users and encounters.
  • High Suicide Risk Best Practice Advisory (BPA): Visible only to the user who documented high suicide risk.
  • Moderate Suicide Risk BPA: Visible only to the user who documented moderate suicide risk.
These enhanced alerts are triggered by observations documentation in either the Columbia Suicide Severity Rating Scale (C-SSRS) Screen (questions answered by patients), or Suicide Risk Rating questions (answered by clinicians) in the same Suicide Risk flowsheet.

Professional practice respecting when to screen for suicide risk is not impacted by the alert enhancements. 

Details regarding suicide risk decision supports, and the underlying guidelines, can be found in the resources below.
Questions regarding this alert can be submitted to AMH.ClinicalInformatics@ahs.ca.

Observation Bed Requirement - New Order

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • New Observation Bed Requirement Order 
As of October 13, 2022, a new "Observation Bed Requirement" order is available in Connect Care. 
This order should be used to communicate to bed planning and nursing that a patient requires a dedicated "observation bed" on an inpatient unit. When the observation requirement no longer pertains, the order should be discontinued. This order does not replace specific patient monitoring orders (e.g., telemetry, psychiatric observation, etc.). 
 

The new order should only be used at facilities that support some kind of observation bed designation.

Communications Update - Sensitive Letters

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Confidentiality Feature - Marking Letters as Sensitive 
As of September 16, 2022, letters (like notes) can now be marked as "Sensitive". When a letter is marked sensitive, it will only be routed to the selected recipient(s) of the letter and will be excluded from Netcare and automated eDelivery to the patient's Primary Care Provider (PCP).
  • The patient’s PCP will only receive a letter marked as sensitive if they are specifically selected as one of the recipients. 
  • In Hyperspace, viewing of the letter contents will only be available to users with the same specialty as the letter author, users logged in to the department of the patient’s encounter, or users logged in to the virtual department that matches the specialty of the encounter department. 
A letter can be marked as "Sensitive" by selecting the "Sensitive" button appearing in the communications workflow. The "Sensitive" property can then be removed by selecting the "Addendum" option in the identified letter and unchecking the "Sensitive" designation. Only the author of the letter can adjust the sensitive properties of the letter. 

Sensitive letters should always be used with discretion and professional judgement, and in a manner that supports access to health information required for continuity of care. 

For more information on the use of this feature, see the Confidentiality Practice Guidelines.

Communications Update - Send Notes Buttons

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Renamed and New Send Notes Buttons 
As of June 7, 2022, in the Communications section for ambulatory encounters, the "Send Notes" button has been renamed "Send Last MD/NP Note". An additional "Send All Notes" button has also been added, which captures all progress notes or telephone notes for the current encounter.  

         

Fix for Mobile App Short Time-outs on Android Devices

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Connect Care Mobility for Android Time-out Fix
Mobility application (PowerMic Mobile, Haiku) users on Android devices can increase the amount of inactivity time before the device screen locks.

By default, the screen will lock after one minute of inactivity. This setting has been changed to five minutes of inactivity and can be altered in the Android device settings. For some, the fix may occur automatically. For others, it may be worth checking the mobility settings and increasing the inactivity time-out to five minutes, if desired.

Improvements to Consent Forms Management

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Improvements to Consent Forms Management 
Some recent Connect Care updates address user requests for improvements to patient consent workflows: 
  • Document Status
    When completing an eForm within the Consent Navigator, the document’s completion status can now be updated manually. 
  • Capacity Status
    Updates have been made to the Capacity Status section within the Consent Navigator and Advanced Care Planning / Goals of Care Designation Navigator. 
  • Relationships & Alternate Decision-Makers
    Revisions have been made to the Relationship options and Alternate Decision-Maker options in the Patient Contact card.

  • MHA Questions

Second Sign for Clerical/MOA Ambulatory Orders

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Second Sign for Clerical/MOA Ambulatory Orders 
As of April 28, 2022, orders placed in ambulatory settings by AHS clerical staff and non-AHS Medical Office Assistants (MOAs) for medications, procedures, laboratory testing, diagnostic imaging, and cardiology and surgical procedures (with some exceptions listed below) must be "Second Signed". 

With Second Sign, orders are not visible and cannot be carried out until the second signature is obtained electronically from a responsible prescriber. Once the second signature is applied, the affected orders can be acted upon.

Why is this change being made?
  • This change was reviewed by eSafety, AHS Legal, CCEC and Zone Medical Leadership, and was determined to be required for patient safety when delegating order entry to unit clerks/MOAs.
  • Compared to verbal orders needing co-sign, second sign ensures that orders entered by the ambulatory unit clerk or MOA are reviewed, approved and signed by the authorized prescriber prior to being visible in the patient chart and actionable by other healthcare providers.
  • It assists with prescriber and patient care workflow efficiency by allowing clerical staff and non-AHS MOAs, within their scope of practice, to enter certain order types on behalf of the prescriber.
  • Use of the second sign order entry workflow allows the order entry process to be transparent and auditable via reporting tools in the reporting workbench.
What else you need to know 
  • When booking urgent cases, prescribers should enter orders themselves.
  • Approved exceptions to second sign are as follows:
    • Paper orders with a wet signature can be transcribed by unit clerks and MOA’s into Connect Care, provided all order components align from paper to Connect Care format. 
    • PLEASE NOTE:  Providers with Connect Care (CC) access are expected to place orders within CC and orders submitted on paper by these providers will be returned.
    • Orders to schedule a procedure may be entered by an ambulatory unit clerk or MOA as an active order, so that scheduling/booking can proceed without need for second sign.
  • Second Sign orders can be found in the authorizing prescriber’s "Second Sign Needed" In Basket folder, which can be "favourited" to ensure visibility.
  • Order printing:
    • Orders with requisitions will not print until the second sign has been completed by the prescriber.  Upon second sign, requisitions will print to the location that the current workstation is mapped to; alternatively, prescribers can use Virtual Local Printing (VLP) to choose another destination for the order to print. Information around virtual local printing can be found in the Connect Care Manual.  
    • MOAs can use Reprint from Chart Review if additional copies of requisitions are needed.
For more information:

Navigator Update - Discharge as Deceased

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Navigator Update: Discharge as Deceased
As of April 21, 2022, there are changes to the "Discharge as Deceased" navigator within the "Discharge" activity available to patient charts opened to an inpatient encounter.

The navigator has been streamlined. Some low-value materials have been removed, including the prior "death" and "organ procurement" notes, which were not used consistently. New point-and-click sections allow things like Medical Examiner's review criteria to be quickly documented.

The navigator update is paired with improvements to discharge summary templates for inpatient encounters where patients die in-facility.

Documentation Update - Deceased Note Type Retired

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Deceased Note Type Retired
As of April 21, 2022, the "Deceased" note type will no longer be available when generating new notes in Connect Care charts opened to an inpatient encounter. These note types were being used inconsistently (e.g., as a record of bedside death pronouncement), often with inappropriate information going to Netcare.

Inpatient encounters end when patients die in-facility and the appropriate summative documentation is a "Discharge Summary" note type. This note type supports templates for conventional discharges, as well as "Deceased" and "Inter-facility Transfer" templates. A "Deceased" template within a Discharge Summary note type should always be used to to document encounters that include patient death.

Quick Click Update for Ambulatory Encounters

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • 'Quick Click' Update for Ambulatory Encounters 
As of April 21, 2022, new functionality has been enabled for outpatient encounters to make it easier to rapidly route notes to the patient's primary care provider (PCP) and referring provider. The Quick Click communication function does not work for hospital outpatient department encounters (HODs; e.g., Rehabilitation Medicine).
  • Clinical observations (consultation or updates) can be documented in the progress note associated with an outpatient encounter. When prescribers use this note to record all pertinent clinical observations, assessments and plans, the progress note can then be incorporated into a standardized "letter" that goes out (e.g., to PCP, referring provider, copied provider) via the "communications" part of an outpatient navigator. A new shortcut allows this workflow to be automated.

  • To send an outpatient progress note to the patient's PCP and referring provider, click the "Send to PCP & referring" checkbox appearing at the top-right of the note editor.
    • The PCP and referring provider fields must be populated in the patient's chart for this checkbox to appear. If one of these fields are not filled in, the checkbox will be named "Send to PCP" or "Send to referring". If neither field is populated, "Send notes" will appear.


    • The outpatient communication letter will be routed using the receiving providers' default communication method.

  • Note that this workflow also sends the communication to Netcare (and, later this year, to community EMRs that have updated to receive such letters via eDelivery) and should be used only when this is appropriate.

  • To edit the communication before it is sent, including adding additional recipients (e.g., copying yourself), click the "Communications" link to the right of the checkbox or use the communications section of the "wrap up" navigator.
    • If there is no PCP or referring provider indicated in the chart, they can be added in the communications tool.
In addition to the new functionality, the content of the relevant letter templates (AHS TO REFPROV + NETCARE CONSULT, PRESCRIBER PROGRESS NOTES [Consult/Netcare Notes] and AHS TO REFPROV + NETCARE PROCEDURE, PRESCRIBER PROCEDURE NOTES [Proc/Netcare Notes]) has been simplified:
  • Modified content: "Please find below select notes from the Connect Care medical record for @FNAME@ @LNAME@."
  • Previous content: "Thank you for referring @FNAME@ @LNAME@ to me for evaluation. Below are my notes for this consultations. If you have questions, please do not hesitate to call me."
For more information:

Mental Health Act Flag Order - Update

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Improvement to Mental Health Act Order 
The Mental Health Act (MHA) order, Flag Patient as Certified (Mental Health Act), is used as a communication tool, to display an alert in the patient's Storyboard based on the information in the order. As of April 21, 2022, new required questions will be seen when the prescriber places this order: 
  • In the "Certificate" section of the order window, which MHA Form the patient is being certified on must be chosen.
  • Based on the Form selected, required cascading questions will appear where date and time of issuance or triage date and time must be specified (backdating is possible). This time will then be visible in the Storyboard.

Relevant to this update is the recent Bill 17 (Mental Health Amendment Act), which has expanded the scope of practice for nurse practitioners (NPs), enabling the ability to issue admission certificates, renewal certificates and community treatment orders. NPs should be familiar with their legislated scope of practice and which MHA Forms they are able to complete. For more support, please refer to Bill 17 Summary of Changes or contact advancedpracticenursing@ahs.ca.

MHA eForms will continue to be developed when the Connect Care Teams have capacity to work on continuous improvement items; in the meantime, MHA Forms must be manually completed and scanned into Connect Care.

Urine Culture Orders - Clinical Indication Required

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Clinical Indication Needed for Urine Culture Orders 
(Edit: Change date has been moved from April 11 to April 8.) As of April 8, 2022, entry of a clinical indication when placing a urine culture order is required. Requiring provision of an indication is part of a provincial effort to reduce unnecessary urine culture ordering and treatment of asymptomatic bacteriuria.

To complete a urine culture order, the ordering provider must select the appropriate indication within the "Indications" section. If none of the options are relevant, select "Other" and enter the reason in the "Other Indications details" free-text field.


Removal of Ambulatory Clinical Letters

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Removal of Two Ambulatory Clinical Letters 
As of March 29, 2022, the following two ambulatory clinical letters will be removed from Connect Care, to ensure the correct referral workflow is being used for generating a referral in an ambulatory context to a specialty:
  • AHS AMB PRIMARY CARE RFL SIMPLE
  • AHS AMB PRIMARY CARE RFL DETAILED
Referrals from Connect Care providers should not be managed with letters in the communications activity. Instead, all outgoing referrals should be managed in Connect Care using referral orders. Doing so ensures that the referral becomes part of the patient's chart and is properly managed by the receiving department. A referral order facilitates Closed Loop Referral Management communications for both referring providers and patients. This applies for both internal referrals to services where Connect Care is the record of care, and external referrals to services using a different information system.

 For more information:

RAAPID Intake Encounter Charge Filing

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • RAAPID Intake Encounter Charge Filing
Charges dropped in Intake encounters (used in the RAAPID workflow) will now file automatically upon acceptance by the clinician, with no change to the RAAPID workflow. 

When these charges are accepted, clinicians will immediately see the status change to "Filed". Any charges entered in error can still be removed after filing.