Inclusive SmartTool Design

Alberta Health Services promotes toleration, inclusivity and respect throughout a patient-focused health system that is accessible and sustainable for all Albertans. Early in the Connect Care experience, we committed to protecting sexual and gender identity by addressing patients by their affirmed (preferred) name... and we expressed this with affirmed names in all user interfaces (e.g., Patient Storyboard, Chart Review Snapshot, etc.).

Post-launch, we discovered some Smart Tools (e.g., SmartLinks found in some SmartPhrases) defaulting to legal rather than affirmed name. Work is underway to close this gap.

Smart Tool stakeholders are asked to help identify any small subset of SmartText records where, for regulatory or other compelling reasons, the legal name should be displayed alongside an affirmed name. Such records, appropriately justified, must be identified and submitted by August 14, 2020.


Continuing Improvement for Clinical Content

As other pre-pandemic activities resume across AHS, Connect Care wave implementation activities also resume.  Connect Care Area Councils and their Specialty Working Groups and Support Units re-engage by reviewing accumulated requests for clinical content improvements, including Optimization and Enhancement for decision, documentation and inquiry supports. A "Continuing Improvement Prioritization" work package offers process guides for defining, categorizing, prioritizing and allocating ongoing Clinical System Design (CSD) tasks. 

Medical Informatics Leads and other clinical informaticians are key to this important work and should plan for participation.


Area Councils and Support Units can get ready by:
  • resuming a regular meeting schedule;
  • deciding whether to set priorities at the Area Council or Specialty Working Group level;
  • allocating meeting time for request review and prioritization.


Area Councils and Specialty Working Groups will review and approve requests that proceed to a prioritization phase. They will also ensure adherence CSD process, validate any completed build, and they help guide change management processes. To prepare, these groups may want to:
  • confirm access to the right content experts for prioritization input;
  • communicate about upcoming work and timelines so that stakeholders and training teams can prepare;
  • anticipate any need for sub-working groups to guide related CSD tasks.


Watch calendars for meeting invitations, and watch the CSD Blogs (csd.connect-care.ca) for more information about continuing improvement processes.


First Looks: Virtual Visits in Connect Care

A flurry of innovation has brought teleconference and virtual care supports to physicians struggling to continue care under conditions of social distancing, with a number of postings highlighting progress made. The uptake of AHS's enterprise Zoom license for videoconference-enhanced patient interactions has been impressive!

At the same time, work has progressed to integrate virtual care supports within the Connect Care clinical information system. The first of many new functions goes into production later this week: clinicians scheduled for virtual care visits in Connect Care can manage teleconferencing from within Connect Care while using advanced Zoom account capabilities.

Dr. Chris White has produced a nice demonstration of how this works:


Super User Onboarding - Waves 2-3

With prescriber Super Users mobilizing, it is essential for any Super User not already onboarded to make arrangements through mip@ahs.ca. Super User training continues through March 2020. CMIO training teams can be expected to connect with all Super Users to arrange training curricula and dates.

This is a good time to take advantage of a wealth of eLearning resources on MyLearningLink. In addition, training guides, tips and exercises are available in training, knowledge and CMIO libraries. As always, Super Users can track new developments here (blogs.connect-care.ca) and additions to the physician manual (manual.connect-care.ca).


Resources for Clinical Informaticians

The general Connect Care Updates blog (blogs.connect-care.ca) serves physicians with news about the clinical information system (CIS). This "Informatics" channel (informatics.connect-care.ca) is intended for physician leaders and change-agents who support the general physician user community, including:
  • Medical Informatics Leads
  • Super Users
  • Power Users
  • Physician Builders
  • Area Trainers
  • Design Leads, ACMIOs
The informatics channel has been quiet for a while but gears up now that the next wave (2 & 3) launches are within 3 months. 

Please contact cmio-manual@ahs.ca with any content or posting suggestions. Please also feel free to comment on any postings here.


New Physician Workgroup focuses on Clinical System Design optimization

Post Wave-1-launch and Pre Wave-2-3-Launch, we recognize some areas meriting more physician input and representation. One relates to all the clinical documentation tools (in-place as well as anticipated) that physicians navigate in a typical workday.

Core Clinical System Design (documentation, decision and inquiry supports) issues that apply across all clinical areas are managed by Connect Care committees, with all the CSD-related committees reporting to the Content and Standards Committee. Specialty CSD works primarily through Area Councils.

Clinical documentation tools have a big impact on physician clinical information system (CIS) experiences. This is a time when existing tools can be simplified and streamlined; while emerging tools can learn from Wave 1 lessons.

A new physician working group for core documentation CSD will parallel an existing Nursing and Allied Health working group, meeting for approximately an hour biweekly for the next number of months. Example issues include optimal use of flowsheets, forms, navigators, communication templates and text automations.

We seek physicians willing to join and contribute through the new working group that will ideally include clinicians experienced with:
  • Different practice contexts (e.g., ambulatory, inpatient, etc.)
  • Some cross-experience with Area Councils
  • Some cross-experience with Zone medical informatics lead activities
  • Liaison with professional bodies (e.g., CPSA)
Please contact Echo Enns with volunteers or nominations.


Health Professions Education Summer Studentships - Consider Applying

The HPE Summer Studentship grant is a competitive program sponsored by the University of Alberta Faculty of Medicine & Dentistry that can help support students and faculty proposing a summer education research or curriculum evaluation project.

With Connect Care launched and spreading in Alberta, questions about about the best way to provide trainees with initial and ongoing skills training and, more importantly, eHealth literacy and professionalism training.

Medical informaticians with faculty appointments may want to consider this opportunity. We have already reached out to see if there are students likewise interested.


Waves 2 & 3 Training Dates - Latest Update

We are pleased to be on track for recruitment of the Connect Care Physician Area Trainers and Super Users who will focus on the needs of Waves 2 & 3, both launching May 30, 2020.

Key training-related dates (subject to change) are as follows (all 2020):

Jan 06-17Area Trainer online learning
Jan 20 - Feb 21Area Trainer formal training
Feb 24 - Mar 13Super User training
Mar 16 - Apr 24User Basic Training
Apr 20 - May 15User Personalization Training
May 18 - Jun 12Launch prep and support (e.g. conversion)
Jun 15 - Oct 15User Optimization training


Connect Care and AHS Travel Restrictions

Recently, travel restrictions have been implemented across Alberta Health Services and this has generated concern about how Connect Care needs are to be addressed. While Connect Care is aligned with AHS’s overall fiscal constraint, the project is at a critical stage when launch preparations, post-launch troubleshooting, training and other needs require direct face-to-face interactions, especially when these activities directly impact clinical practice.

Connect Care will approve travel expenses, as before, when these are necessary to the successful completion of the project. Examples include:
  • To train for an approved Connect Care role when training must be in-person;
  • To support end-user communities where in-person interaction is needed (e.g., equipment, space or shadowing or where hands-on technology access is essential);
  • To trouble-shoot and intervene with high-risk, high-stress, or escalating challenges where in-person discussions and expertise could more effectively remediate;
  • To support end-user groups through new challenges (e.g., first scheduled downtime);
  • Where new technology is being introduced and the support expertise comes from another location.
Patient care and safety, along with the needs of staff and physicians, is at the forefront of all planning decisions for Connect Care. The successful implementation of Connect Care remains an organizational priority.

Thanks for your understanding of the need to be vigilant about both the effectiveness and efficiency of interactions requiring travel.


Webinar about Clinician Burnout - January 23, 2020

A number of recent articles associate digital health records with clinician burnout. We've previously noted that the obvious observations are important but possibly more important is the "backstory" about contextual drivers. An "Arch Collaborative", involving many organizations like ours, has studied the concerns with a view to finding solutions.

An upcoming webinar will explore the insights and data gathered through the Arch Collaborative initiative that bring greater clarity to why electronic record usability continues to frustrate and what can be done to reduce burnout.


Connect Care Builder Club Master Class - Meeting #1

On behalf of the Connect Care Builder Program, we would like to invite clinical informaticians who are part of the builder community to participate in a first Builder Club Master Class. Through these builder-lead sessions, we will cover tools available to certified Connect Care Physician Builders and Clinical Content Builders. A portion of the meeting is allocated to open discussion of the builder program and related questions.

Many builders are focusing on best practices with Smart Tools. For our first Master Session, please join Dr. Devin Nielsen as he begins our journey covering "SmartLinks and SmartTools for Smart AHS Clinician and Physician Builders".

Register in advance for this meeting: ahs-cis.ca/builderclub
  • After registering, you will receive a confirmation email containing information about joining the meeting.
  • If you’ve never used Zoom, we highly recommend you do a test call prior to the class here: zoom.us/test
  • Short demo videos on how to join a call can be found here: zoom.us/resources
Part 1: SmartLinks Overview and Search – December 19 – 1600 to 1645
  • Overview
  • SmartLink parameters: none, user, system
  • System-level SmartLink build review
  • SmartLink Search engine
  • SmartLink search and build examples 
Part 2: SmartLinks for FlowSheets & Print Groups – January 2020
  • Basic review of Flowsheets and Print Groups
  • Flowsheet & Print Group search engine
  • Report Assistance (Report and Print Group IDs)
  • Data Handbook (UserWeb)
  • Build examples of how-to have a SmartLink pull a Flowsheet or a Print Group into a note


Where's my SUP?

The SUP instance of Hyperspace is a copy of PRD and so valuable when working through problem scenarios brought to us by users. It contains actual patient data. It can be used to test complex workflows, without actually altering any production records.

It is important that physician informaticians retain access to SUP.

There was a bit of a hiccup when SUP was removed from regular users. Post launch, it is no longer needed and it was causing some error when users were documenting in SUP instead of PRD.

The recent change caused all favoriting of SUP to disappear. So, if you had marked SUP as a favourite, you might think that your access was removed. You can re-favourite.

The other source of confusion is that SUP has been moved to the Training folder. Look there before reporting that you have lost access.

Let us know (CMIO@ahs.ca) if you have truly lost SUP access and we will ask (again) for it to be restored.


Super User Schedule and Area Mappings

Lots of logistics with launch!

One of many complexities is making sure that prescriber Super Users are well used and not over-used. Many spreadsheets have been collated to an integrated database and, better yet, visualization of who needs to be where for how long.


Super User Lanyards

Stand out!

It is important that Super Users be easy to find and recognize. Physician and resident SUs can be grateful that we're not asking them to wear aprons! Instead, we would be most grateful if all who will be helping on the front lines of Wave 1 Launch pick up a Connect Care lanyard.

These are available at the physician drop-in Centre (5G1.11 for Nov 1; thereafter WMC 4B1.39).

Resident SUs wear orange lanyards. Physician SUs wear yellow lanyards.


Drop-in Centre Volunteers - Please!

The CMIO portfolio runs a physician drop-in centre which is proving all-too-popular. Our colleagues come at a time that suits them and a place close to their work. We have dealt with a wide range of access, mobility, dictation and... anxiety needs.

This is a most rewarding way to help, with direct and immediate benefit to prescribers, and therefore patients.

We continue to look for prescriber Super Users, Area Trainers, Builders and Power Users to help us deal with increasing volumes and demand. Best is a commitment to a shift of at least 4 hours. A few brave souls are needed for the evening hours.

If open to chipping in, please contact david.pincock@ahs.ca.


Slack for CMIO Launch Support

Calling all physicians, trainees and learners supporting Wave 1 launch activities!

The CMIO portfolio is using "Slack" for launch support, internal team communication and rapid knowledge exchange.

What is Slack?
Slack is an Internet-based collaboration tool that can be used on desktops (slack.com) and all mobile platforms as a dedicated app (iPhone, Android, etc.). Slack brings communication, consulting and collaborating together in one place.

What is Slack to CMIO?
The CMIO portfolio has set up a Slack workspace (ahscmio.slack.com) dedicated to support of Connect Care physician informatics activities.

Teamwork in Slack happens in channels — a single place for messaging, tools and files — helping everyone save time and collaborate together. These conversations are divided by channels as well as direct messages to help streamline our work by combining all communication into one app rather than via text, email, docs, and etc. and accessible at computers as well as on phones. We have set up channels to facilitate those supporting Wave 1 launch.

How to Join?
You can join the CMIO Slack workspace through a simple link and easy process:

  • ahs-cis.ca/slackinvite
  • If not already a Slack member, then provide an email address, confirm via email, and create a username and password.

Key Slack Skills

CMIO Orientation 
We’re currently orientating our MILs and SUs to the tool. Folks are organizing conversations based on clinical departments.


Launch Orientation Manual Posted

Many physician informaticians are helping out with Connect Care's Wave 1 launch in Edmonton Zone, and many helpers are from out-of-zone or out-of-facility.

A new launch orientation manual has a wealth of information about the launch location, command structure activities, problem reporting protocols and other practical details. Worth a bookmark!


BBIT in Production

The Basal Bolus Insulin Therapy (BBIT) tools for glycemic monitoring and control are in production. A long gestation but excellent outcome.

Please take a look at the new manual section and consider how best to support colleagues with these workflows.


Which Order Sets are Released?

Lots of understandable urgency to get our validated and built Order Sets into production (PRD) where they can be reviewed and personalized!

The majority of Order Sets have been released to production by now, but significant numbers are still undergoing last minute medication and other fixes. They get moved into PRD as soon as the authors and accountable designers (e.g. Area Council) have signed off that fixes have fixed.

We'll update this spreadsheet tally of released Order Sets:


For our AI and Voice Recognition Enthusiasts

Reposting from Microsoft's AI Blog, there continue to be exciting developments with voice activated virtual-assistance and intelligent processing of clinical speech and dictation.

We are taking a great first step in moving from dictaphones to Dragon Medical One. We know that Epic will release its "Hey Epic" voice assistant for mobility soon. And we have hope of semantic reporting markup of narrative dictations within a few years.

For those interested:
Thanks to Steven Zachary for this posting.