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. 

  

• Business 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, with intent that the test be performed AFTER discharge, are routed. 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
• A few more Provider Team list configurations have been received. A definitive Wave 3 teams list is anticipated this week and will be posted when finalized.

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. 
• A 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
• 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 relevant section of the Manual has been updated to include mention of this specific workflow and what to do ("Interfacility Transfer from Connect Care ED to Connect Care Admitting Site"), linking to a new tip, and a FAQ has been posted.
• Tweaks to Discharge Report for Community Pharmacy
• The medication report printed for community pharmacy use at the time of a patient's discharge has been enhanced to emphasize that is not a prescription and must not be used as such.
• A new tip explains how to use the Community Pharmacy discharge report.
• A new Manual entry addressed discharge document printing for prescribers.
• A workaround for physicians needing to re-print prescriptions is communicated, and meetings are arranged with analysts to examine easier workflows.
• Ordering Norms
• A new blog posting emphasizes the importance of computerized provider order entry and the very few allowed exceptions.
• All clinicians are reminded to follow Connect Care Ordering Norms and the heads-up provided in the Wave 3 countdown checklist.
• 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
• WellSky came back online last night, giving opportunity to remind prescribers about blood ordering workflows within Connect Care. 
• 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
• It is important for clinicians to know how to indicate, or update, patients' goals of care when transitioning from paper to digital charts.
• A Connect Care Manual section has been added to reinforce the most important things for prescribers to know, while also providing links to relevant guides.
• FAQ: How can I change a goals of care designation?

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.

• Manual: Therapy Plans
• Guide: IVIg Adult Therapy Plan

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:

• Manual: Referral Norms
• Manual: Referral Workflows

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

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

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

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

• Manual: Delegated Orders

Trouble Subscribing to Connect Care Blogs

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

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

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

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

Solution: The fix is usually easy. 

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

How to Manage 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.

• Manual: Mis-directed Result Messages

Interfacility Emergency Department (ED) to ED Transfers

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

• Clarified ED to ED Interfacility Transfer Process

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

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

Discharge from Leave of Absence Workflow

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

• Discharge from Leave of Absence Process

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

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

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

Change to Post-Procedure Navigator - Short Stay

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

• Change to Post-Procedure Navigator - Short Stay

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

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

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

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

Wave 2 Launch Support Hot Topics - Week 02

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

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

Troubleshooting Patient Discharges for Wave 2 Cutover Patients

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

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

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

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

Improvement to External Orders for Imaging at another Facility

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

• Improved Order Composer for External DI Procedures

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

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

A prescriber tip is updated.

Finding Order Numbers to use when Reporting Printing Problems

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

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

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

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

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

Wave 2 Launch Support Hot Topics - Day 09

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

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

Wave 2 Launch Support Hot Topics - Day 08

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

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

Wave 2 Launch Support Hot Topics - Day 07

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

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

Wave 2 Launch Support Hot Topics - Day 06

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

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

Wave 2 Launch Support Hot Topics - Day 05

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

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

Wave 2 Launch Support Hot Topics - Day 04

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

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

Problems with Physicians' Program List in Netcare

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

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

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

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

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

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

Wave 2 Launch Support Hot Topics - Day 03

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

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