Update: Reporting Validation Problems

A prior posting about reporting user interface issues still pertains.

Participating informaticians and physicians should work with validation support teams to ensure that design validations, issues, enhancements and requests are recorded in the Connect Care Tracker.

A Connect Care Solution Centre will soon allow all help, bug, suggestion, request and feedback communications to flow through standardized email, telephone, peer and drop-in intake channels. Until then, please continue to send bug reports and interface tweaks to:
Connect Care users can also use the fixes email to report problems until the solution centre becomes available. They can also use monitored email addresses to submit feedback about clinical content (documentation, decision and inquiry supports):
A very simple norm can make it easier to triage reports based on the email subject line, as explained in a resource for Connect Care users:


Connect Care Access Portal in Production

Previous postings have alerted Connect Care medical informaticians to changes in Internet links used to gain access to pre-production and production clinical information system (CIS) environments.

The Unified Access Portal (UAP) has stabilized and is now in production. This involved final tweaks to the UAP addresses used when connecting from inside and outside the Alberta Health Services (AHS) intranet firewall.

For those who have used CMIO physician shortcuts, there is nothing to change. For those who have used prior UAP Internet links, as of today (Sept 13, 2019) myapps.ahs.ca goes to production and uat-myapps.ahs.ca goes to pre-production, with the same links active on and off the Intranet. "mystore.ahs.ca" and "uat-mystore.ahs.ca" are no longer supported

We continue to provide simple shortcuts that always direct to the correct access portal. These can be simplified even further:


Connect Care Impacts on eDelivery

The Non-AHS Community Physician Advisory Group (NACPAG) has produced some important messaging about how Connect Care affects results and reports routing for physicians who do not use Connect Care as their record of care. Many physicians either find themselves in "external" contexts some of the time, or find themselves grappling with questions from physicians working entirely in external contexts.

NACPAG maintains an external website for interested stakeholders and promotes a blog with matching communications.

Medical informaticians may want to consider subscribing to the "Bridges" Connect Care blog. The current theme is results routing, but the blog has lasting value covering issues that matter to our non-Connect Care colleagues.


Citrix Virtual Machine Settings Restored

As previously shared, there were changes to AHS Citrix virtual machine configurations on August 30 which impacted important clinical workflows. Changes included disabling of clipboard, file management and printer selection functions.

We understand that the Citrix settings are restored to prior norms and that any related issues will be explored. This means that Connect Care CIS environments (DMO, SBX, PLY, PRD, POC, TST, etc.), as well as eCLINICIAN environments, should function as previously.

Remember that access through unified access portals also changed on August 30 and continues. See the linked tip sheet and remember the links provided for physician informatician convenience:
Physician design leads and ACMIOs are asked to invite medical informatics leads to test these functions when demonstrating, validating, testing, etc. and bring any issues to the attention of the CMIO portfolio (mip@ahs.ca).


All Connect Care Physician Informaticians - Please Test...

It is important that everything needed for physicians to access the Connect Care clinical information system, both inside the AHS networks (Intranet) and outside (extranet) and for mobility and desktop devices, is anticipated and taken care of before personalization workshops begin later this month.

There have been changes to the access portals recently.

For starters, we need all physician design leads, ACMIOs, medical informatics leads, knowledge leads, power users, super users and builders to confirm their intranet and extranet portal access. Please use the following two links to check to see if you can log on to the physician access portal (AHS UAP):

Please inform mip@ahs.ca if you are not able to log on to the access portal in both contexts.


Oops! Accessing pre-production Connect Care environments

We previously reported about changes to the unified access portals (UAP) that physician informaticians use to find and launch the clinical information system instances set up to support training, demonstration, validation and other pre-launch activities.

We have since edited the preferred links and tips for physician informaticians. There have been problems with security certificate registration and this has meant that Intranet access to pre-production environments has not worked for some physicians.

A work-around is available. To keep things easy for busy demonstrators, we support the (temporary) fix for Intranet access through the user-friendly shortcuts maintained by the CMIO portfolio for physicians. There is a link for when computers connect to the Intranet, and another for locations outside the reach of the AHS Intranet. Once everything settles closer to launch, be assured that we will get down to a single link that works everywhere.


Changes to Access for Pre-Production Connect Care Environments

There is an important change to how Connect Care physician-informaticians (medical informatics leads, design leads, super users, trainers, builders, etc.) access the emerging clinical information system (CIS) in support of demonstrations, training, validation and other activities.

The "Production" (PRD) and "Pre-Production" (POC, SBX, PLY, TRN, TST, etc.) environments, until today, were access through a Citrix portal (with differences for intranet and external access). As of today, Production and Pre-Production environment access diverges. We rapidly approach the time when end-users will be using the "unified access portal" (UAP, or "myapps") to gain access to all Alberta Health Services (AHS) clinical information assets. These include Connect Care as well as Netcare and legacy CISs (e.g., eCLINICIAN, SCM, Meditech). Today's changes are part of that preparation.

To keep things stable and simple, we continue to provide user-friendly shortcuts for physicians:
Also note that the Physician Handbook (handbook.connect-care.ca) will continue to have physician tip sheets addressing topics like access. The Handbook is intended for our physician informaticians (leaders, superusers, area trainers, CSD participants, etc.). A new Physician Manual will be released soon, in time to address physician-specific support needs for users.


IT Stakeholder Cheat-Sheet Updated

Alberta Health Services Information Technology (IT) maintains a helpful listing of key contacts for organizational liaison. This may also be useful to physician informaticians wondering who to contact for questions about Connect Care impacts on different groups.

We keep a copy of the IT Stakeholder Cheat Sheet in the physician handbook:


Where are physicians in the Connect Care readiness playbooks?

Alberta Health Services (AHS) leaders have a major role to play in supporting staff and helping prepare for Connect Care’s launch. They, in turn, are supported with guidance, resources and facilitation by a Connect Care Readiness Team. This is a systematic process, tapping change management best practices and the accumulated experience of many organizations that have implemented large-scale clinical information systems. The steps, actions, tools and expected outcomes at each stage of preparation are detailed in a "Readiness Playbook", with sequential chapters covering what is needed for each Connect Care wave leading up to launch.

The Connect Care Readiness Playbook is rich with wisdom and pragmatism. However, the readiness needs of physician and non-physician staff have important differences. Physicians skimming the Playbook may find it hard to see themselves in the prescribed work, or find it hard to imagine how to translate tasks when they work in settings that are not staffed by AHS employees.

The AHS Chief Medical Information Office is mindful of such differences. Playbook-compatible readiness supports are adjusted to suit the different circumstances of different physician communities.

The Connect Care Readiness Playbook does contain a lot of physician-appropriate information and physician informaticians can better help their leaders when aware of readiness constructs. Physician leader considerations in the Playbook are marked with a physician tag. The CMIO team additionally summarizes Playbook deliverables for physicians, keyed to each chapter.

Physician reporting is also handled differently. The CMIO portfolio facilitates use of surveys that are disseminated directly to affected physician leaders.


Please Promote Patient Movement Day

Patient movement day offers a unique opportunity for clinicians to take a practical look at what in-patient journeys will look like in Connect Care.

All physicians, prescribers, nurses, allied health and other staff are encouraged to attend. They can see and learn about how complex patient movements are coordinated with clinical information system (CIS) tools and workflows. Morning demonstrations illustrate how Connect Care will facilitate the sequence of events that must occur for patients to flow safely and efficiently from emergency to ward, critical care, surgery, diagnostic imaging and other investigation and intervention venues. In the afternoon, drop-in practice centers (including a physician practice center) allow participants to dig deeper, view more specific workflows, ask questions and practice different patient movement scenarios.

Wave 1 Patient Movement Day occurs Wednesday September 18, 2019 from 08:30 to 16:00, with scenario explorations and demonstrations in the morning and practice activities in the afternoon. A more detailed agenda will follow, allowing physicians to focus on the transitions most relevant to their practice.

Physician and Medical Informatics Leads should promote awareness of patient transitions as a high-risk readiness challenge. Some will help as Champions. All should be aware of the guide (see Byte below) and contemplate how to best prepare for smooth post-launch patient movement in their clinical area.


Clinical Content Stability pre-Launch

August 2, 2019 brought us another massive accomplishment... completion of specialty Clinical System Design (CSD) build. A huge thank you to all CSD participants!

We are thrilled that 99% of tasks were fulfilled, with the remaining few waiting on things like medication checks. This allows specialty content validation to progress and keeps us on track the November 2019 Wave 1 launch.

Specialty CSD focus shifts to validation, training and change management. Our clinicians and experts are re-mobilized to ensure that what is built matches what was intended. And the build team must juggle other build tasks with fixes flagged through validation.

Stability is our new target. Training and readiness work (e.g., workflow walkthroughs, patient journey reviews, etc.) needs solid clinical content. Accordingly, the Connect Care team cannot act upon new specialty requests until when post-launch CSD optimization initiates about 4 months from now.

Of course, some clinically essential content may have been missed. And all good content design ideas need to be recorded. Every effort will be made to address critically important missed content pre-launch. However, all CSD requests must be presented, considered and approved through Area Councils and Specialty Workgroups. Their support units continue to ensure that requests are well characterized, then entered to the Connect Care Tracker. Pre-launch, wave-1-essential requests must also be reviewed and cleared by the CCC coordinating support unit (CSU).

Validation of content continues through August and September. Launch-ready content is then locked down until CSD optimization starts post-launch. Again, this is critically important to training and readiness deliverables. All medical informatics leads and other prescriber leaders are asked to support this need.

Please relay any questions to ccc-suppport@ahs.ca


Another Training Milestone - First MD group through basic training.

We are delighted to see the first group of Wave-1 physicians complete their basic training!

12 paediatricians worked with a physician trainer and 2 physician super users to progress through a curriculum customized to their typical workday, work setting and clinical tasks. The training environment worked well and everyone was able to progress through the planned tasks. All participants were appropriately allocated the right Connect Care applications. And it was clear that physicians training physicians is appreciated.

Of course, we noted ways in which the experience could be improved. The trainers' learnings are summarized, shared and used to tweak the next set of training sessions.

In particular, we are very aware of some challenges with the MyLearningLink learning management system. The recommended self-directed modules are not filtering correctly, with the result that physicians see all possible modules when checking "Required Courses", not the ones that pertain to their track. We are putting together supplementary QuickStart guides to help the next wave of trainees to pick out what matters most.

Huge thanks to our first participants, and to the Connect Care training team. We're finding our stride!


Learning about Clinical Inquiry Opportunities within Connect Care

We've previously posted about how Connect Care in-system inquiry tools can help AHS grow as a learning healthcare organization.

The Connect Care Clinical Inquiry Newsletter offers an excellent way for those interested to keep updated about developing capabilities, supports and processes related to clinical inquiry. There are many applications, including personal practice reviews, quality assurance, quality improvement, clinical research and process optimization.

The Newsletter releases monthly. For those interested in the same content via shorter but more frequent communications, subscribe the Clinical Inquiry Blog

With our current emphasis on training, change management and readiness, the Newsletter is full of great information about courses, webinars and emerging key contacts.


ClinOps 2 Minute Updates

Clinicians work as a team. Connect Care both increases and leverages our interdependence. There will be many opportunities for the professions to help one another by reducing duplicative documentation, improving handover, coordinating communications and keeping all aligned with patient goals.

While Bytes blog has a prescriber (physicians, medical trainees, pharmacists, clinician assistants, nurse practitioners, etc.) focus, our interests often overlap those of non-prescribers. A basic awareness of colleague's Connect Care efforts is important.

The clinical operations team maintains an excellent "2 Minute Update" approximately weekly. This summarizes key happenings and priorities for non-prescriber colleagues; lots relevant to prescribers.


Reporting Interface Problems

Validation activities involve demonstration of Connect Care functions, with significant clinical content problems are reported as “Issues” in the Connect Care Tracker.

Validation activities also uncover a wide range of lesser problems. Bugs (overt failure or unintended action when a function is activated or workflow tried) and design flaws (misspelling, screen layout, inconsistent labels, poorly organized pick-lists, etc.) should not be reported through the Tracker. CIS build teams use a different product (“Sherlock”) for recording and tracking resolution of user-interface problems.

Clinicians participating in validation, training and other CIS exposures need a quick way to report concerns that builders can manage with the right systems. For now, the following email address should be used to report bugs and minor interface problems:
Problem reports will achieve better results if a simple standard is used to format the email subject line, as explained in a tip:


Unified Access Portal moves to Production

The "Unified Access Portal" (UAP) provides physicians with the access they need to Connect Care environments (e.g., HyperSpace, Link) and other Alberta Health Services (AHS) information resources. As a single gateway, it will become a common-denominator experience for clinicians working with desktop or laptop/notebook computing devices.

Versions of the UAP have been deployed to physician volunteers for over a year in support of user acceptance testing (UAT). As of today, UAP has moved to the "production" server infrastructure to be used for Connect Care launch.

Connect Care physician leaders, including medical informatics leads, should confirm that they shift use to the production UAP. Please change from "uat-myapps.ahs.ca" to simply "myapps.ahs.ca".

We continue to provide physicians with simple and stable internet address shortcuts. These are re-mapped and continue to work by directing to the correct UAP site:


Emergency Workflow Walkthrough Demo Available

Medical Informatics Leads (MILs) increasingly are called upon for just-in-time demonstrations of the emerging Connect Care clinical information system (CIS).

Development of demo skills is helped by seeing systematic explorations of CIS modules, showing how different disciplines use different views to work with the same system and record. We've previously posted about the first large Walkthrough Event where our own Connect Care ecosystem got its first comprehensive viewing.

An Emergency Room workflow walkthrough is now available for viewing. Also linked are tips for informatics leads using Connect Care demonstration environments to help their colleagues see parts of the user experience most relevant to them.


Oncology Workflow Walkthrough Demo available

Medical Informatics Leads (MILs) increasingly are called upon for just-in-time demonstrations of the emerging Connect Care clinical information system (CIS). With first launch soon upon us, this is more than understandable.

Most MILs, ACMIOs, Physician Design Leads, Knowledge Leads, Trainers and Super Users have access to either "Sandbox" (SBX), "Demonstration" (DMO) or "Play" (PLY) hyperspace environments. See the tips below for updates about how to access these environments both from within and without the AHS intranet. Any work well for demonstrations.

Development of impromptu demo skills is helped by watching systematic "walkthroughs" of different CIS modules. A nicely done end-to-end Oncology workflow is available via the link below.


Demonstrating Connect Care - Start with the Big Picture

Medical Informatics Leads (MILs) increasingly are called upon for just-in-time demonstrations of the emerging Connect Care clinical information system (CIS). With first launch soon upon us, this is more than understandable.

Development of demo skills is helped by getting the big picture; a walkthrough of a representative patient journey, end-to-end. We've previously posted about the first large Walkthrough Event where our own Connect Care ecosystem got its first comprehensive viewing. Check out the "End-to-End Patient Journey" demo to gain perspective on how different CIS modules integrate for a coherent patient experience.

Most MILs, ACMIOs, Physician Design Leads, Knowledge Leads, Trainers and Super Users have access to either "Sandbox" (SBX), "Demonstration" (DMO) or "Play" (PLY) hyperspace environments. See the tips below for updates about how to access these environments both from within and without the AHS intranet. Any work well for demonstrations.


Readiness Thinking: Command Centre Participation

A "Command Centre" will be established to activate at a Wave launch and then remain responsive for 4-6 weeks post-launch.  This virtual centre ensures that the right leaders and supports are in easy and continuous contact during the time of greatest transitional strain.

All affected by launch are represented in the Command Centre, with 24/7 responsiveness. Physicians leaders will be accountable to the physician population, as well as coordination needs related to other clinicians and stakeholders.

The CMIO portfolio has specific responsibility to ensure that daily physician huddles are organized and that empowered physician leaders are available for trouble-shooting.  Preparation tasks include:

  • Prepare for all relevant meeting schedule, agendas, and communication processes at launch for physicians.
  • Prepare physician/ACMIO rounding processes during launch
  • Schedule Physician resources for Command Center time period 24/7
  • Assign rounding physician SuperUsers, MILs and ACMIOs
  • Prepare for running and supporting daily physician huddle
  • Prepare for peri-launch communication strategy
  • Prepare for end-user forums, help and sharing strategy (and social media tools)
  • Anticipate and work with physicians who may resist system adoption
  • Anticipate and enforce no-training-to-access policy
  • Continually promote personalization

Good to be thinking of these needs now. Anyone who would like to contribute to the leadership needs, please get in touch with cmio@ahs.ca 


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:


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:


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.


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.


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:


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:


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.


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.


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".


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)