Friday, July 19, 2019

Clinical Content Validation Guide Updated

Validation is about how clinical experts review, correct and approve clinical system design (CSD) and build of clinical content (documentation, decision and inquiry support) to ensure that it serves intended purpose, is free of significant safety risks and is compatible with acceptable workflows.

Our Clinical Content Validation Guide outlines consistent processes that should be applied to all CSD validation activities. Although different types of content may merit different reviews, the same accountability, coordination, facilitation, staging and tracking considerations apply. This guide deals with general approaches, while validation scripts, work packages and templates deal with specific content validation tasks.

The Guide is recently updated to better explain how to track validation outcomes. A new section describes how to report bugs or interface problems while we await deployment of an embedded problem reporting system.

All medical informatics leads, knowledge leads and other informaticians facilitating validation activities should review the updated guide:

Thursday, July 18, 2019

Invitation to Participate in User Acceptance Testing - Connect Care to Netcare

In anticipation of Connect Care launch this fall, the Alberta Netcare Portal (Netcare) will be updated to ensure that:
  • Laboratory and diagnostic imaging tests ordered and resulted in Connect Care will be viewable in Netcare
  • Approved care summaries (e.g., discharge reports, consultation letters, some progress notes) generated in Connect Care are shared and viewable in Netcare
  • Health care events (e.g., emergency visits, admissions) occurring where Connect Care is the record of care are included among events listed in Netcare
These functions will undergo robust technical testing, assuring completeness and accuracy. In addition, clinicians need to know that the right information is displayed in the right way in the right place.

We seek physician volunteers willing to participate in User Acceptance Testing (UAT) sometime between August 19 to 30, 2019. Testing involves following a script at a time and place convenient to the physician, with an expectation of about 30 minutes time investment. UAT participants are given clear instructions about how to access the testing system, suggested scenarios to guide testing, and means to record and report any issues encountered.

Physicians with interest or questions please contact:

Wednesday, July 17, 2019

Using Connect Care Tracker Visualizations

The Connect Care Tracker (“Tracker”, ahs-cis.ca/tracker) is a collaborative workspace within the Alberta Health Services (AHS) SharePoint environment. It offers a single place to record, allocate and track the many decisions, issues and requests that may arise during Clinical System Design (CSD) of the Connect Care clinical information system (CIS). It is especially important now that CSD validation is underway.

As the number of tracked decisions grows (many thousands), stakeholders may value focused views highlighting decisions pertinent to specific clinical areas. Most Area Council and Specialty Workgroup collaborative workspaces (ahs-cis.ca/committees) have links to niche Tracker spaces.

A Connect Care Tracker summaries and visualizations dashboard (ahs-cis.ca/trackerviews) provides additional ways to see, at a glance, how CSD validation is progressing. Diagrammatic summarizations appear in a “Connect Care Tracker” workbook. Note that access requires a valid AHS username and password. The following Tip sheets can help physicians who wish to use and get overviews of the Tracker during validation activities.



Tuesday, July 16, 2019

Feedback Requested: Connect Care Charting Etiquette Norms

Charting Etiquette is an important protective against note-bloat, chart clutter and poor signal-to-noise ratios in clinical documentation.

ACMIOs, Provincial Informatics Leads, Medical Informatics Leads and Clinical Knowledge Leads are asked to consider our newly roughed-in Connect Care Charting Etiquette Norms. Are these directionally correct for clinician-users of the Clinical Information System?

Please give a quick read using the link below. Related materials (Charting Principles, Minimum Use Norms, User Charter) have been updated to harmonize with Charting Etiquette and so are also linked below.

Please send any substantive suggestions or concerns using the comment box below, or via email to Debbie Pinter.

Lacking significant protest, we will work with communications experts to render an attractive Charting Etiquette brochure and provide this to clinicians as part of their training.

Monday, July 15, 2019

Using the Connect Care Tracker

The Connect Care Tracker has benefited from many recent improvements, including expansion to handle Clinical System Design (CSD) issues and requests. It continues to record and track design decisions.

These functions are essential for good CSD validation. As the results of design decisions are presented for validation, important feedback and correction advice should be recorded as edits and additions to the original CSD decision, as found in Tracker. Significant new challenges identified during validation discussions -- requiring resources for further characterization, analysis, problem-solving and oversight --  can be recorded as "Issues" to ensure that accountability is assigned and outcomes are tracked. Validation work may also trigger requests for entirely new functions or clinical content, which can be entered and tracked as "Requests".

We have updated Tracker Tips to reflect these enhancements:

Monday, July 1, 2019

Workflow Walkthrough Videos Available

Workflow Walkthroughs occur before each wave of Connect Care implementation giving a tangible view of the CIS build can work with general as well as complex workflows.

Medical informatics leads may wish to skim recorded videos of Connect Care emergent build for a comprehensive patient experience and some focused ER workflows:

Sunday, June 30, 2019

MyLearningLink for the Rest of Us

“MyLearningLink” (mylearninglink.ahs.ca, or “MLL”) is Alberta Health Services’ (AHS) online learning management platform. It is used to deliver courses offered to all AHS stakeholders in all areas. It is also used to facilitate the registration, scheduling, delivery, completion tracking and assessments for Connect Care training. Users can find, access and complete any self-directed e-learning courses or assessments that can be completed online. MyLearningLink is important to Connect Care.

Unfortunately, until recently, the MLL environment focused on continuing education needs of AHS staff working in AHS facilities on AHS-provisioned systems. Courses are approved for Internet Explorer (IE, version 11) running under Windows 7 on AHS desktop computers. But Connect Care users need to train at non-AHS locations on non-AHS computers.

Fortunately, MLL has recently been upgraded to work on networks both inside and outside of the AHS “intranet”. Testing and support for users of Apple operating systems is coming. For now, physician informaticians need to be ready to help clinician-colleagues who are not primarily Windows users.

We  have prepared a tip giving interim advice for clinicians who may have difficulty replicating the standard AHS computer set-up. Please try this out and send any feedback or additional suggestions to mip@ahs.ca. We particularly need physician testers who use Macintosh computers. When in MLL, search for courses with "Epic" in the name and try any example that appears.

Saturday, June 29, 2019

Connect Care Training and Physician Compensation

Physician training emails and scheduling surveys have gone out to almost 2,000 physicians touched by the Wave 1 Connect Care launch. This makes training and competency requirements real and immediate.

Connect Care clinical informaticians may be drawn into more conversations about why physicians do not receive financial compensation for time spent on training activities. It is important that we understand and consistently message the rationale for Connect Care's physician resourcing strategy. Please skim the linked documents (some updated this week) and feel free to share questions, reflections and suggestions.

Friday, June 28, 2019

Honest Conversations - Please Contribute

Many among the Connect Care clinician user community are worried about harms associated with digital health records; this on top of general anxiety about upcoming transitions.

We have started a "Honest Conversations" series in the general-interest blog at bytes.connect-care.ca. It would be great if members of our medical informatics community could help by suggesting topics, helping to craft short messages and, especially, adding comments to published postings. These could encourage others to also share reflections and so promote "conversation".

Thursday, June 27, 2019

InfoCare - Physician Assessment Required

Privacy awareness is essential to good clinicianship. We all need training, with periodic reinforcement. Our digital world presents ever-changing threats to information security, making it hard to know when we may unintentionally weaken the privacy protections our patients expect. Breaches harm patients, and can be devastating for clinicians.

On the eve of Connect Care implementation, Alberta Health Services has overhauled its universal privacy awareness training. A new online elearning module, called "InfoCare - on our Best Behaviors" is now available on MyLearningLink.ahs.ca (MLL). Although this training is required of all physicians prior to gaining access to Connect Care, the immediate "soft launch" gives opportunity for physician leaders to test for problems and report to the CMIO portfolio so it can collate issues.

It is especially important that physician informaticians assess InfoCare before it is announced for all physicians. MLL is most commonly used on AHS computers in AHS facilities. However, physicians are more likely to complete the course on personal devices outside AHS facilities.

The MLL user guides do not offer much help for non-Windows browsers or for users of Apple computers. Accordingly, the CMIO portfolio will consider feedback and prepare tips specifically for the physician community.
  • Go to MyLearningLink.ahs.ca (we recommend the Chrome Internet browser for those who do not have access to Internet Explorer 11 on Windows 7 or 10).
  • Sign on with your usual AHS credentials
  • Search the Course Catalogue for courses containing the word "InfoCare"
  • Register for and complete the course online
  • Verify that your confidentiality and user agreement is accepted and the course is marked as complete.
  • Send any error reports or other feedback to mip@ahs.ca (medical informatics program)

Wednesday, June 26, 2019

Clinical System Design - The Road Ahead

​It seems the only reward for successful clinical system design (CSD) is more and more work! It is true that we have a lot left to get done before Connect Care clinical content ready for front line use. Impending tasks can be less overwhelming if we have clear line-of-sight to appreciate what's coming when.

We hear that Connect Care Area Councils seek a better understanding of how diverse CSD activities play out over time. They also need a better sense of other launch readiness activities may compete for attention and resources. Accordingly, we've prepared two timelines summarizing how key activities sequence from now until post Wave 1 launch. The first infographic focuses on matters of accountability and the second on matters of awareness:

Tuesday, June 25, 2019

Connect Care Implementation Timeline Updates

General information about Connect Care implementation timeline tweaks has been posted to our general interest blog. Physician informatics leads may appreciate additional details, especially those affecting zone launch plans:

Monday, June 24, 2019

Launch Readiness Assessment 120 - Tomorrow

We've previously described Launch Readiness Assessments (LRA) and the importance of this readiness checkpoint.

LRA-120 occurs tomorrow. Medical leads and informaticians are encouraged to consider tapping into relevant parts of this overview.

Sunday, June 23, 2019

SBX now the Preferred Validation Environment

Medical Informatics Leads, Knowledge Leads and other clinical informaticians play important roles facilitating clinical content validation sessions. These ramp up right now.

Many have access to Proof of Concept (POC), Playground (PLY) and Demonstration (DMO) hyperspace environments. These differ by when they are updated and what information persists from refresh to refresh.

A new environment is available to all clinical informaticians. "Sandbox" (SBX) is the preferred hyperspace instance to use when preparing content validation activities. All MILs, KLs, Builders and clinical informaticians should use their usual access credentials (username, password).

Please follow these instructions to confirm that access and shift validation preparation work from POC and PLY.
  1. Logon through Connect Care unified access to your list of available applications:
  2. Add SBX to your favourites:
    • Find the "Apps" banner link and click on it.
    • Seek the "SBX" application and click on "Details".
    • Select the button for making SBX a favourite.
  3. Go to the Favourites banner items, select it, then launch the SBX environment and logon with your usual user name and password.



Saturday, June 22, 2019

eLearning: Super User Overview

Connect Care clinical informaticians, including physician leads, medical informatics leads, knowledge leads, power users and builders need to understand how Super Users will contribute to training, implementation and optimization. Indeed, many informaticians will take on Super User roles themselves. Even those without an explicit Super User assignment can benefit from exposure to the coaching and mentoring skills learned by Super Users as we prepare for the stresses of first launch.

An eLearning course entitled "Super User Preparation" is now available on MyLearningLink. This should take no more than 30 minutes for a Connect-Care-aware clinical to review. A perusal is strongly recommended.

The self-directed learning is available to all. It includes useful Epic modules with practical tips for dealing with new users during and after training. Different phenotypes (enthusiastic, apathetic, grumpy, difficult, etc.) are explored.

The course is complementary, not compulsory. You can send feedback to ConnectCareSuperUser@ahs.ca.

Friday, June 21, 2019

Clinical System Design Solstice Success!

​Happy midsummer solstice!

Although we all wish to enjoy long summer days outside, our teams clearly have been working long hours on Clinical System Design. We are thrilled to have achieved design of all the Order Sets targeted for Wave 1 Launch in November 2019. Design efforts continue, turning to Order Sets slated for later waves.

Designed Order Sets still need to be built, then carefully validated, before they are ready for Connect Care user training, personalization workshops and adoption for launch. Here too the progress is encouraging. Weekly build rates have picked up, very close to targets. Clinical validation has begun, anticipating increased validation rates as Area Councils and Specialty Workgroups tackle this work.

Thanks to all for rising to the challenge in midsummer!

Thursday, June 20, 2019

What's happening with privacy awareness training?

Medical Informatics Leads (MIL), Provincial Physician Trainers, Physician Area Trainers and Super Users will all be aware of opportunities to preview, review and help with the e-learning modules contributing to upcoming Connect Care physician training tracks.

We hope to emulate the full training experience. A key component involves mandated completion of basic privacy awareness training, then attesting to an online "Confidentiality and User Agreement" (CUA), as a condition for gaining access to Connect Care online training environments. The attestation must be satisfied before the user can complete an "End User Proficiency Assessment", required to progress from Basic to Personalization training.

It was expected that all physician leads would be able to complete privacy awareness training through "InfoCare - On our Best Behaviors" by this time. However, the e-learning module has suffered technical challenges in early exposures. This mostly relates to embedded audio and video, which has since been trimmed. In addition, more testing is needed to prepare clear instructions for physicians participating in e-learning outside of AHS networks. The CMIO is helping to render tip-sheets attuned to the circumstances of users of non-Windows devices and internet browsers.

We now expect InfoCare availability sometime next week, before the end of June. You can access and complete the course through MyLearningLink.ahs.ca. List available courses, use "InfoCare" as a search term, and self-register.

We would be most grateful if all physician informaticians could try InfoCare as soon as it becomes available. Please send feedback to mip@ahs.ca and we will collate physician comments, technical problems and work-arounds.

Wednesday, June 19, 2019

Understanding Implementation Activities

This is a busy time! While we have done well to design the clinical content to be used at Wave 1 launch, there are growing demands for stakeholder contributions to the testing and validation of that content. In parallel, demand grows for physician participation in a wide range of launch readiness activities.

We've already heard about Launch Readiness Assessments and Workflow Walkthroughs. In addition, implementation stream activities include a number of other practical tasks. Watch for more information about the following:
  1. Launch Readiness assessments: Structured comprehensive reviews of each Connect Care project stream, identifying risks and mitigation plans. These occur at 150, 129, 90, 60, and 30 days pre-launch.
  2. Shadow Charting: Relevant to a limited number of complex or high-risk workflows and  applications, users document cases in both legacy and Connect Care environments, providing an invaluable opportunity to check devices, interfaces, multi-disciplinary workflows, and information flows.
  3. Appointment conversion: The conversion of appointments, referrals, cases, and waitlists from legacy systems into Connect Care.
  4. Abstraction: Patient information not converted may be manually entered into outpatient charts ahead of launch.
  5. Cutover: Key information and orders for admitted patients is entered into Connect Care in the 24-48 hours prior to launch. Cutover includes both technical and clinical elements.
  6. Protocol Conversion: Many complex or timed protocols, primarily in Oncology and Research, will be converted for continuation in Connect Care.
  7. Command Centre: Safe and well-coordinated surveillance, leadership and trouble-shooting support rapid, efficient and responsive issues detection and resolution while deploying assets like Super Users to areas of greatest need.

Tuesday, June 18, 2019

Just-in-time Communications

We’ve all been feeling the summer heat… more Connect Care intensity than nice weather! 

As validation, training, readiness and implementation activities accelerate, clear communication can minimize chaos and confusion. There are way too many newsletters, SharePoint sites and Insite pages, agendas and minutes to follow.  

We are redoubling efforts to maintain a steady, but concise, feed of clinical content updates through blogging channels. All channels are listed in ahs-cis.ca/mdresources

All physicians interested in Connect Care should subscribe to the general-interest physician blog (bytes.connect-care.ca). Any clinician involved in Connect Care design, validation, training or readiness activities should follow the blog for informaticians (informatics.connect-care.ca). Those directly involved in clinical content validation should also follow the internal Clinical System Design blog (csd.connect-care.ca).

Please skim our blog tips for instructions about how to subscribe. This way you can get digests to your email and not worry about visiting the sites. 

Thanks for attending to this advice. We’ll keep the blogs going and rely upon the communications team to use them as source material for more formal Connect Care communications.

Friday, June 14, 2019

Complex Workflow Walkthroughs

With the Connect Care Wave 1 launch (November 3, 2019) getting closer, there are more opportunities to view and validate the emerging clinical information system. We can see and influence how information tools will affect and be affected by our work and workplace.

"Workflow Walkthroughs" allow street-smart clinicians to review exactly how Connect Care can support complex clinical activities. A Walkthrough event includes detailed demonstration of one or more high-risk, high-complexity, multidisciplinary or high-volume workflows. Patient journey videos are interspersed with feedback and discussion opportunities. The goal is to discover what more we need to do to get the system attuned to our biggest challenges.

The first Walkthrough event will be held June 26, 2019, at the Bernard Snell auditorium in the Mackenzie Health Sciences Centre (Edmonton) with options for telehealth remote access. Workflow Walkthrough videos will also be made available on Insite (details to come). The first Walkthrough will be most relevant to Wave 1 and 3 clinicians.

Although all interested physicians are encouraged to contribute, it is particularly important for physician leads and medical informatics leads to consider in-person or telehealth attendance.

The Walkthrough event spans an entire workday, clearly impractical for physician schedules. However, only some parts will pertain, given the clinical area focus of medical informatics leads. Please take a look at the tentative agenda (updates to come in future postings) and consider whether any of the 45 minute blocks offer an important feedback opportunity.

The CMIO portfolio is very keen to hear feedback about the event, with input collated through mip@ahs.ca.


Thursday, June 13, 2019

Did you notice?

If you did... way too OCD!

Our Connect Care Wave 1 launch countdown timer (top of left column) just gained a day.

After extensive consideration, the Connect Care Provincial Program Office has decided that the original Wave 1 Launch date of November 2, 2019 will move to November 3, 2019 at 0400.

The original date fell on the same day as the switch from Day Light Savings Time (DST) to Mountain Standard Time (MST). By launching on November 3, after the time change, the activation of Connect Care order entry, documentation and other functions will be more straightforward.

Wednesday, June 5, 2019

eLearning: Introduction to Epic in Connect Care

Medical informatics leads, clinical knowledge leads and other clinical informaticians may be interested in a new self-directed e-learning opportunity on MyLearningLink (mylearninglink.ahs.ca).

"IT Introduction to Epic on the AHS Platform" provides an overview of the Connect Care initiative through an information technology lens. We know that Epic Systems software serves as the core integration engine for the Connect Care clinical information system (CIS). But some of us may still struggle with constructs for how Epic relates to CIS functions, Connect Care offerings, and other information systems that, together with Epic, comprise the CIS.

The introductory curriculum describes integrative requirements and why Epic was chosen to address them. The different modules of Epic technology are defined and described. How modules support continuum of care functions is explained. Clinicians who have already completed the physician introduction, Power User or Builder courses may have covered much of the content. Still, it is useful to review the purpose and acronyms associated with the Connect Care Epic infostructure.

Anyone can self-register. Completing the curriculum can take as long as an hour. Go to MyLearningLink and search for courses with "Connect Care" in the title.

Wednesday, May 29, 2019

Wave 1 Physician Training Notices Go Out

A big day for the Edmonton Zone! Notices have been emailed to all anticipated Wave 1 physician users. These provide information about the physician training program, gather information about scheduling preferences and explain how registration occurs.

Medical Informatics Leads may expect questions from colleagues. A good time to brush-up about the Connect Care training strategy, content and delivery for physicians.

Physician advocates can refresh understanding by skimming any of the following resources (shortest listed first; all recently updated). Better still, view the short (5 minute) physician training orientation interactive online video (5 minutes).

Tuesday, May 28, 2019

Has the Wave 1 Launch Date Changed?

Physician informaticians may hear rumours of a Wave 1 Launch Date change. It is important to be clear that the intended early November launch in the Edmonton Zone remains firm.

We have been grappling with the fact that our launch weekend also happens to be when all clocks fall backwards one hour in the annual shift to Daylight Savings Time. To activate order-entry, documentation and other functions on the originally intended November 2 would force us to immediately contend with the complexities of a time change protocol in the early hours of Sunday November 3.

Many mitigations have been considered and a launch hour of 0400 on November 3 (after the time shift) is currently considered our best option.

Wednesday, May 22, 2019

Orders in Epic-Speak

​The Connect Care clinical information system (CIS) anticipates 100% prescriber order-entry, giving opportunity to speed what is typically a cumbersome process while also helping clinicians avoid error, improve utilization and contribute to our understanding of how health care interventions affect outcomes. Indeed, much of the value-case for a CIS pivots on effective clinical decision support (CDS). And the most present and prevalent CDS relates to order-entry.

Epic provides diverse order-related tools, labelled in ways that reflect software modules, branding and history. Those helping to review and validate clinical content built with these tools may not find developer terms intuitive. Also, it is important to recognize when a particular order tool is not the best fit to the clinical problem meriting decision support.

A new Connect Care "Key Concepts" summary focuses on order-related tools:

Thursday, May 16, 2019

Clinical Content Validation - Next Big Push

Validation is about how clinical experts review, correct and approve clinical information system (CIS) content (documentation, decision and inquiry support) to ensure that it serves the intended purpose, is free of significant safety risks, and is compatible with acceptable workflows.

Although content validation applies to documentation (e.g., note templates, handover reports, etc.) and inquiry (e.g., dashboards, reporting workbench templates, etc.), formal validation processes focus on complex clinical decision supports; especially Order Sets, Order Panels, SmartSets, Therapy Plans, Express Lanes and Protocols. All validation is informed by Connect Care principles and is organized for meaningful clinical input.

Clinical content validation begins when content is built and ready for review. Many validation activities started in early 2019. However, the bulk of complex clinical decision supports validation occurs in May, June and July of 2019. Outpatient orders (SmartSets) must be validated by end of June, while some inpatient Order Set validation will continue through the end of August 2019. The content most needed for training curricula is prioritized for earlier validation.

Area Councils, medical informatics leads, clinical knowledge leads and clinical informatics leads, plus a number of other stakeholders, are oriented to validation processes; allowing us to ramp-up and address this next readiness challenge over the next few months.

Friday, May 10, 2019

Non-Medical Device Workflows

The Connect Care communications team has produced a nice video illustrating how clinicians can interact with non-medical devices (computers, mobility, etc.) in inpatient environments.




Thursday, May 9, 2019

Dragon Medical One and Hyperspace

As discussed at the April provincial medical informatics lead (MIL) retreat, we are very happy to have begun testing "Dragon Medical One" (DMO, Nuance's voice recognition and digital transcription solution for the cloud) within the Connect Care implementation of Epic Systems software.

Please get in touch with cmio@ahs.ca if you are a MIL and would like to participate in the testing. We have applied to free up as many preview licenses as possible for this group. A tip sheet is in the works to help you get started and an intake email for problem reports is coming soon.

DMO works in conjunction with Hyperspace to facilitate easy voice recognition for dictation, user interface navigation, activity commands and text automations. All require some user-investment in recording personal preferences and text-hotkey-command sequences.

A different Nuance product brings additional functionality to the Haiku mobile environment. "Epic Voice Assistant" works a lot like Siri (Apple devices) or Alexa (Android devices). The user can ask questions, such as "who is my next patient" and the assistant will line up both an answer and the best mobile activity for taking next steps.

For more information:

Wednesday, May 1, 2019

Physician Area Trainer - A Great Opportunity

We've previously posted about Physician Area Trainer recruitment, a great opportunity for interested clinicians to benefit from exceptional clinical information system orientation and change management coaching. Stipend-supported Area Trainers can supplement their usual clinical activities, play a pivotal role at Connect Care launch and positively impact health care in Alberta.

In addition to a posting and role description, linked below is an early guide for clinicians potentially interested in the Area Trainer role. The guide clarifies how Area Trainers are themselves trained. The support stipend is explained. Overall time expectations are outlined for before, during and after launch.

Tuesday, April 30, 2019

Who relates to Who in AHS IT?

The Alberta Health Services IT department has put together a really useful cheat-sheet highlighting stakeholders working with a wide range of IT services. Useful to check when unsure about meeting invite lists!