More Mobility Management Alerts

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


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

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

Downtime Procedures for Physicians

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

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

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

Decimal Precision for Oral Medication Measurements

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

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

Solution: Pharmacy, Critical Care and Child Health stakeholders carefully considered the issues and Wave 1 clinical system design review pathways were activated. A decision is made to:
  1. Continue with two digit rounding for volumes of liquid oral medications <1ml; and one digit rounding for volumes >1ml
  2. Monitor a list of 22 liquid oral medications flagged for possible administration problems
  3. Make available a work-around that simulates two-digit rounding with linked orders, while limiting its use because of clinical decision support impacts.
  4. Review and reconsider after 6-8 weeks experience with the current build.

Connect Care Fixes Review - Week 2

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

Results Review - Alphabetic vs Categorical Sorting

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

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

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

Trouble Finding Orders

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

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

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

Connect Care Day 005 Fixes

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

Cutover Provider Mis-Assignments

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

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

Connect Care Day 004 Fixes

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

Connect Care Day 003 Fixes

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

Training for Complex Workflows

Recognizing that some workflows involve more change and challenge than others, some focused training opportunities give 30 minute refreshers for affected staff over the next few days. Two of the topics may be of interest to some physicians:
  • Phases of Care
    • WMC 0C2.59
    • 0900, 1100, 1300, 1500, 1700, 1900
  • Blood Administration
    • WMC 0.C2.60
    • 0900, 1100, 1300, 1500, 1700, 1900

Help us Help you

It is great that users are making good use of the Connect Care Concierge (help.connect-care.ca) to record non-urgent issues and suggestions. A lot of material is coming in, getting categorized and prioritized and then routed for solutioning.

It is already apparent that many help requests are not as helpful as we would like. Analysts consume valuable resources (time) trying to figure out what the problem is in many cases.

When reporting an issue or suggestion, please be as specific as possible, making sure that all fields are filled (e.g. drop-down list indicating clinical area). When describing a problem, please use succinct text that is clear about:

  • Devices - are any medical or non-medical devices involved? If so, what is the actual device number (all devices have a unique number on a prominent label)?
  • Keywords - include in the title specific keywords as much as possible (e.g., flowsheets, navigators, orders, referrals, etc.)
  • Medications - be specific about the drug name, strength and form.
  • Order Sets - try to capture and accurately report the actual orderset name (as it appears in lists)
  • Patient - if a problem is specific to a particular patient, make reference to the Connect Care medical record number (MRN)

Connect Care Day 002 Fixes

Continuing our daily tally of illustrative (selected) fixes...
  • ECG Hard Stop - the hard stop that was slowing ordering workflows involing ECGs has been resolved and implemented in production.
  • ECG Tracings - images are now available prior to being interpreted and reported.
  • Echo Workflows - many problems with device and systems interfaces have been addressed, with attention turning to remaining measurement transfer problems and related workflows. Reports are coming through.
  • Pharmacy - problems with label printers and other technical challenges mean that pharmacy flows are taking longer than hoped to pick up, but a lot of progress in the last 24h.
  • Devices - issues identified with competing Citrix sessions are being mitigated with fixes applied throughout the day.

Connect Care Day 001 Fixes

A project as large and as complex as Connect Care is lucky to enjoy but few hours honeymoon. We got about 10!

As the number of patients and users ramped up through the first day, expected early challenges started to accumulate. I am ecstatic to observe how quickly and effectively our physician informaticians mobilized, spread to trouble areas and collaborated with operations and IT to get things sorted.

Our turn-around time for clinically important problems is remarkably fast.

Selection of Day 1 Issues Resolved (or with a solid mitigation in place):
  • Access: lots of production access issues, including a number of physicians with complex roles who needed adjustments to their security templates. Delighted that Epic allocated some exceptionally able resources to help with rapid access resolution in the physician drop-in centre (WMC 4B1.39)
  • Mobility: surprisingly few calls for Haiku or Canto support (10) with all but 1 resolved so far.
  • Orders: a large number of minor annoyances were found in the procedure and medication order catalogues, usually fixed within 1-2 hours of discovery. Some challenges were escalated to clinical system design SWAT teams, with effective decision-making. Some missed hard stops were stopped.

Find Physician Super Users On-call via Locating

While the physician drop-in centre remains a valuable just-in-time help, sometimes its best to have Super Users drop in on you!

If problems mount and no Super User is in sight, you can call hospital locating via the usual numbers. The physician Super User on call schedule is shared with them. Locating (hospital switchboard) can help locate and call a buddy!

Dragon Medical One is Freezing

Problem: Dragon Medical One (DMO) is the software, integrated with the Connect Care clinical information system (CIS) that enables speech recognition and in-system dictation. We are receiving sporadic reports of the DMO software freezing within Hyperspace sessions. The DMO session is rendered temporarily unusable. This is an emerging issue. Alberta Health Services Provincial Speech Recognition (PSR) team is working with the vendor (Nuance) to resolve this issue.

Cause: Although a conflict between the DMO software and the Citrix container which it works within is suspected, all potential root causes are being explored. This includes possible network issues. Specialists are onsite to observe and gather diagnostic data.
Solution: There is no fix at this time. Progress will be communicated. The best mitigation appears to be to force closure of both Epic Hyperspace and DMO, completely close the browser and Citrix, then re-initiate a logon.

Lost Access to Connect Care Icon in MyApps

Problem: Some physicians have reported that one or more Connect Care environment icons (e.g., Connect Care PLY, Connect Care PRD) have recently disappeared when they log on to the Unified Access Portal (UAP) at myapps.ahs.ca.

Cause: The Connect Care initiative has triggered a major clean-up of Medical Affairs, Active Directory and Provider Registry content. Common standards are being applied across Alberta Health Services for things like password expiration dates. As part of this work, some physician application permissions were inadvertently reset (when applying the account standards). About 600 physician accounts are affected. The physicians retain access to the UAP but may have lost access to Connect Care production (something they gained in personalization workshops).

Solution: First, make sure that you really have "lost" an icon. Check the full list of "Apps", as it is possible that the Connect Care application is available but somehow no longer marked as one of your favourites. If the PRD icon still cannot be found, then know that all disrupted accounts will have been batch-fixed by Monday October 21. If PRD access is needed before that time, please request a correction via ConnectCare.SupportTeam.Security@ahs.ca. They know the physician permissions and can do a quick manual fix. More information available in Connect Care Physician Manual.

Function keys not working on Mac Computers

Problem: The Connect Care clinical information system (CIS) relies on a lot of desktop (non-mobile) computer tasks. The Keyboard is key to these interactions. Shortcuts can speed workflows and many are anchored to Function or "F" keys normally arranged as the top row of a keyboard. When some users are logged on to the CIS Hyperspace on a desktop computer, the function keys don't seem to work.

Cause: Keyboard function keys may be "mapped" to functions specific to a particular software product, like a word processor. These mappings may not be understood by the Citrix workspace that sits between Connect Care and the user. And some computers (e.g. Macintosh) have flexible function keys that come up on a "TouchBar" that can be configured.

Solution: A tip sheet explains (see last section) how to force a TouchBar or function keys to always send the intended shortcut to Connect Care.

Should I be Worried: Mobility Management seems to want to Control my Device?

Problem: Knowing that Connect Care mobility (Haiku, Canto, PowerMic Mobile) is important for personalization workshops, participants are encouraged to pre-install. But setting up the secure "bubble" that the clinical apps are installed into can be scary. Some Apple warnings seem to imply that one forfeits all control of one's device!


Cause: In an abundance of caution, Apple posts worst-case warnings. But Connect Care's use of mobility management is very limited, affecting only AHS clinical applications stored a sandboxed virtual space created on the mobile device. This allows those apps, including Haiku, Canto and PowerMic Mobile, to be automatically configured, updated, maintained and protected. They can be deleted in the event of device loss or theft. It is okay to tap "Install". One's personal apps, settings and device are untouched; and not monitored.

Solution: The rationale for, and benefits of, clinical mobile app management are explained in a Connect Care Mobility FAQ provided with installation tip sheets. Have a quick skim to understand what the install process does.... and definitely does not do.

Why does Connect Care access fail after upgrading to MacOS Catalina?

Problem: Some of our early-adopter colleagues have installed the Catalina MacOS upgrade on Apple's Macintosh computers. Understandable, as there are a number of great new features. However, connections to the Unified Access Portal for Connect Care (myapps.ahs.ca) fail. Citrix Workspace, the software that facilitates the connection, throws a security certificate error.

Cause: The method by which MacOS checks the certificates that enable encrypted connections from client to & from the server changed. All versions of Citrix Workspace for Mac prior to today's release (October 8, 2019 version 19.10.0.18.1910) fail. The fix from Citrix is new.

Solution: We advise Mac users to wait at least another few weeks so that the Catalina-compatible Citrix Workspace version can be more fully tested. For those who already upgraded to Catalina, we suggest installing the very latest version of Citrix Workspace. Please report back to cmio@ahs.ca with your experience so we can learn more about this problem.

Why are keystrokes on my Mac Computer generating the wrong Character in Hyperspace?

Problem: A few users have reported that keys typed on their Macintosh (Apple) computer generate the wrong (unintended) character in Epic Hyperspace when logged on to the Connect Care clinical information system (CIS). Special characters are affected (e.g., @#$%^&). Indeed, this can occur at the Hyperspace logon page and cause one's password to be misread (and so cannot log on).

Cause: CIS access on desktop, workstation, notebook,  or laptop computers occurs via the Alberta Health Services Unified Access Portal (UAP) at myapps.ahs.ca. This causes the Epic Hyperspace software to be viewed within a “virtual machine” that is running on an AHS server. The viewer software is called Citrix Workspace (or Viewer or Receiver).

Problems can occur if the client’s (user’s) keyboard maps keys to different characters than the host (Citrix, then Epic) expects. This happens rarely but affects special characters important to SmartPhrases and SmartLinks.

Solution: A work-around involves forcing the Macintosh computer to interpret all keystroke input as coming from a standard American (US) input device. The Citrix server is already set to US keyboard input and cannot be changed. Simple steps for making this fix are outlined in a tip:

Why is the Playground available only 2 days a week?

Problem: We've heard concern from some users that a "Playground" for testing and practicing learnings is only open 2 days a week. But basic training participants are asked to practice with homework exercises; anytime and anywhere.

Cause: There is a misunderstanding based upon multiple uses of the term "Playground". There is a drop-in centre that is "open" in the 4th floor atrium of the Walter Mackenzie Health Sciences Centre Tuesdays and Thursdays. This is a venue where clinicians can use workstations to try things out and ask questions. The emphasis is on dabbling with different computer and device user interfaces.

But this drop-in centre is not the "PLY" (Play) environment that clinicians can access to practice lessons from basic training. Once registered for training, clinicians should expect to find PLY among the clinical information system "environments" that they can launch from their unified access portal (see Manual for easy access instructions) at myapps.ahs.ca.

Solution: Clinicians should work on post-basic practice exercises using the online PLY environment provided. If this does not appear in one's myapps.ahs.ca applications, contact ConnectCare.PhysicianTraining@ahs.ca to report and get a fix.

Why has my Mobile Device Screen Idle Timeout changed?

Problem: Some users have reported shortening of the time that their mobile device screen remains open while inactive (screen time-out), reducing to 1 minute. This is inadequate for dictation and other clinical uses.

Cause: An early version of Connect Care Mobility Management incorrectly altered screen time-out settings. This has been fixed.

Solution: It should be possible to visit the device setting controls and re-configure the device to the screen time-out of preference. It may be necessary to re-install Workspace ONE (see tips in physician manual).

Why do I get a procedure task-list when logging on?

Problem: Early personalization labs, where users start their access to the production version of the Connect Care clinical information system (CIS), revealed some logon problems for some users. Upon entering username/password, then department, a screen would appear listing procedures to be done or reviewed. But this had no relevance to the user. The screen had to be 'cancelled' in order to proceed.

Cause: It turns out there was an error in the setup of some physician user profiles. A 'Diagnostics Intervention Review' role sub-template was inadvertently attached to over 400 physicians.

Solution: The rogue sub-template is being removed from the affected physician templates. There is nothing for users to do. The fix should to be completed by end of September 2019. Please inform ConnectCare.Fixes@ahs.ca if an unexpected task management tool appears between logon and hyperspace load after that date.

Why Don't I have Access to the Play (PLY) Environment?

Problem: Some prescribers do not find the PLY (Play or Playground) environment when they expect it. This can limit one's ability to do self-study exercises after basic training or to practice some of the skills shown in MyLearningLink eLearning modules.

Cause: Prescribers have been assigned PLY access to time with completion of their scheduled basic training session. However, there have been last-minute changes in schedules and there have been some delays in assignments. Not everyone has PLY when they need it.

Solution: The CMIO portfolio is working with Zone Medical Affairs to get every prescriber registered for training activated for PLY. This will soon be active irrespective of the scheduled date of basic training. Access to full "production" (PRD) Connect Care is provided when prescribers appear for their personalization workshops pre-launch.

If you do not have access, but think you should, please contact ConnectCare.PhysicianTraining@ahs.ca. For more information, see the Connect Care Physician Manual.

Why is Haiku failing for lack of a 'profile'?

Problem: "I followed the instructions for installing Connect Care mobility management on my personal devices, then for installing Haiku and Canto, but when I click on Haiku on my iPhone or Canto on my iPad I get: 'No environments configured' and nothing further happens."

Cause: It sounds like you were able to install the mobile clinical information system (CIS) apps from the Workspace One Catalogue (see image), but the apps subsequently did not receive their configuration settings from the mobility management system. This can happen if you did not wait long enough, changed networks before configuration completed, or turned off your device before configuration completed. Note that the app will appear on your device well before the configuration finishes.

Solution: Even though the apps are downloaded, you can "re-install" from the Catalogue (even though the Catalogue shows the app already installed). Tap the "installed" green button to the right of Haiku or Canto in the Catalogue (see image). Carefully observe an allow prompts asking you to install the app and to allow management of the app. You must allow management in order for the configuration settings to be downloaded and installed.

Resources:

Am I in the right (Connect Care) Training Track?

Problem: Some physicians follow instructions received in their Connect Care training track invitation, log on to MyLearningLink, view their "Required Courses", but find eLearning modules that do not fit their specialty or practice. For example, an emergency physician finds inpatient  medicine modules, not ER (ASAP-oriented) modules.

Cause: Physicians are allocated to training tracks based upon information received from Alberta Health Services (AHS) Zone Medical Affairs. Sometimes the physician specialty is not current or correct. Sometimes a physician has more than one specialty or practice type (inpatient, outpatient, etc.) and the wrong one is identified as primary. Sometimes the physician does not answer registration questions carefully.

Solution:
  • First, send a clarification request to ConnectCare.PhysicianTraining@ahs.ca to indicate what you find in MLL and what you would expect to find. 
  • Second, do a search for courses using "Epic". Scan the search results to seek eLearning modules that seem relevant to your specialty. Note the code starting the title of those courses (e.g., "Epic - ER..."). Search again using that code and register for those courses. Your MLL settings will get corrected but this way you can get started on pertinent courses while waiting.



Why is Dragon Medical One taking so long to initiate?

Problem: After opening a Connect Care clinical information system (CIS) Hyperspace session, then clicking on the top left button bar item to launch Dragon Medical One (DMO), the DMO loading screen (see image) gets stuck for 2 minutes or more with a spinning circle.


Cause: A system configuration change was made on Sept 19 that appears to have caused problems where DMO cannot find specific dictation hardware attached to the computer where it loads. Computers that have that hardware work well but all other computers have a painfully slow DMO logon.

Solution: This is a system configuration error. It is being worked on, with expectation of normal DMO load times later this week.

How can I get MyLearningLink to Record Course Completion on a Mac?

Problem: Some users, especially physicians doing coursework on personal computing devices outside of Alberta Health Services networks, report completing courses but not getting credited with completion. The course remains in a list of "required courses", without moving over to the "completed courses" section of MyLearningLink (MLL). Completing courses is important for getting continuing professional development credits.

Cause: Most eLearning modules posted to the MLL system are in "SCORM" format. This depends upon the course web page noting when all content has been viewed and then sending a signal back to MLL to the effect that the current user has finished the current course. This communication can fail.

Solution: We recommend using the Chrome Internet Browser on personal computers, especially Apple computers. There is a trick for forcing the Chrome window holding an eLearning module to "send" information "home":
  • Ensure that your MLL session has not timed out (you can test this by doing a browser page refresh of the browser window that MLL is running in). Log on again if needed.
  • Work your way to the very end of the course screens. Make sure that the course outline shows all sections checked off. You may need to click on the last section and scroll to the end again.
  • Position the cursor (mouse pointer) over the top right area of the browser title bar that the course link appears in (see image). There will be nothing in that space initially. Click if needed. A small computer icon will appear, possibly with the text "send" next to it. Click on this. Click twice for good measure! This should force sending course completion data to MLL.

Tips for physicians have been updated:
If, despite following the tip, a training track EUPA does not get credited or appropriately assessed as “pass”, contact the MyLearningLink Support Centre (HelpMyLearningLink@ahs.ca) immediately with the Subject Line: “EUPA Move to Pass”. In the body of the message, provide your name, email address, course name (EUPA), session number and final grade.

For physicians who need additional Connect Care Training support while using personal computers, contact:

Getting Help - Takes Patience

While planning for "Command Centre", "Solution Centre", "Drop-in Centres" and just plain "Help Desk" to get us through launch, we are reminded of a bit of help desk history.