JIRA Harmonization Project - Change Freeze February 28-March 8, 2022

We've previously posted about an upgrade and reorganization of the "JIRA" project management tool used by builders and clinical system designers to support their Connect Care work.

Preparations have progressed and launch of the new JIRA implementation occurs March 8, 2022. This becomes the single repository for intake, tracking, assessment, prioritization and project management for enhancements and optimizations of the Connect Care clinical information system.

A change freeze, from Monday February 28 to Tuesday March 8 will allow the final integration steps to proceed. The following projects will be available in a read-only state during that time:

• Connect Care CSI Register (CSIR)
• CSD Clinical Documentation (CSDCD)
• CSD Clinical Knowledge Topics (CSDCKT)
• CSD Foundational Knowledge (CSDFK)
• CSD Inquiry Support (CSDIS)

No new tickets can be entered, and no existing tickets can be modified during the change freeze.

Please direct questions to: ConnectCare.JIRA@ahs.ca.

JIRA Harmonization Project - Impacts for Connect Care Designers and Builders

Participants in Connect Care clinical system design and build work will want to know about a recent initiative that will soon affect how design and build activities are tracked in "JIRA". 

"JIRA" is the name of an enterprise software tool published by Atlassian. The system is designed to facilitate software development, bug tracking, issue resolution and project management. AHS uses this platform to support a wide range of information technology processes, including clinical content design for Connect Care.

To date, continuous improvement requests for Connect Care have been logged and managed in multiple JIRA projects; some of these project focus on clinical system design while others track application build and operational supports. Unfortunately, separating these domains has resulted in some duplication of items and inconsistency of documentation. Moving forward, all Connect Care improvement requests are handled similarly, using consistent processes that are followed consistently by governance, design, technical and operational stakeholders. The "Connect Care JIRA Harmonization Project" consolidates intake, assessment, workload estimation, governance review, stakeholder approvals, prioritization, build, implementation and change management tracking. The first phase integrates the following previously independent JIRA projects:

• CSI Register
• CSD Clinical Documentation
• CSD Clinical Knowledge Topics
• CSD Foundational Knowledge
• CSD Inquiry Support

Once the newly harmonized Continuous Improvement Register project is launched in JIRA, early in 2022, it will over time become the home for all continuous improvement requests across all Connect Care teams (including communication and training). A JIRA Harmonization Working Group defines documentation standards, workflows and required fields. New user training and support resources will be available at  launch.

In preparation:

• Data review and clean-up continues in the five phase 1 JIRA projects to prepare for migration of their contents to the new consolidated project, emphasizing closing completed tickets and removing inter-project duplicates. 
• Identify and reconsider any alternate tools that may be used by specific groups to track Connect Care improvement work, as these should all move to the harmonized JIRA instance.
• Contact ConnectCare.JIRA@ahs.ca with questions about the transition.
• Handbook: JIRA

Clinical System Design Priorities During Connect Care Wave 4 Launch Pause

From the Connect Care triad (Penny Rae, Debbie Pinter, Jeremy Theal)...

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As you know, Connect Care project work has temporarily paused to allow physicians and staff from all areas of AHS to support COVID-19 priorities.

AHS’s approach to Clinical System Design and Build is clinically lead. As Area Council members and our project teams are redeployed to meet COVID-19 priorities, the types of work that we can successfully complete will, by necessity, shift to reflect the availability of clinical and operational subject matter experts. 

Over the next several weeks, our Connect Care design and build teams will prioritize work as follows:

1. COVID-19 – Teams will continue to prioritize SME time to design and build revised order sets, clinical guidance, decision supports and patient education materials in support of AHS’s COVID-19 response. Build teams will also manage the system changes needed for surge capacity.
2. Urgent Request (Break Fix) Tickets – Teams will continue to address tickets across all specialties where the issue indicates a potential patient safety or care risk. In all cases, CSD and Build teams will obtain the best available clinical guidance to inform the solution, and will report back to Area Councils for oversight when regular meetings resume.
3. Future Waves – Teams will continue to prepare for upcoming Waves by addressing design and build items that do not require clinical guidance or where clinical guidance has already been provided. Future Wave work also includes making sure that our analysts complete Epic recertification prior to Wave 4 launch.
4. CSD Integration – Design and Build teams will work together to integrate design, content and build processes and tracking, including integration of research build processes.
5. Continuous Improvement Requests – In limited circumstances and only where SME and project team capacity exists, teams may be able to consider design items for previously prioritized continuous improvement requests. If you believe that your Area Council has the capacity to continue this work, please reach out to your CSD Coordinator or Secretariat to discuss.  

We sincerely thank each of you and your committee/council members for your support of AHS’s COVID-19 response.  We know that this means that some anticipated work will be delayed; please rest assured that we remain committed to addressing CSD priorities and look forward to resuming this work with you once COVID-19 pressures ease.

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Connect Care Clinical System Design Toolkit Now Available

The “Connect Care CSD Kit” (csdkit.connect-care.ca), an online toolkit for Connect Care Clinical System Design (CSD) stakeholders, is now available in a new eBook online format that resembles the workings of the Connect Care Clinician Manual (manual.connect-care.ca) and Connect Care Builder Handbook (builders.connect-care.ca).

The Connect Care CSD Kit gathers resources (such as templates), work packages and guidance to support CSD activities (such as Continuous Improvement) for Area Councils, Specialty Workgroups and their support units. 

The Connect Care CSD Kit replaces the retired “CSD Support Kit” and it will continue to guide CSD activities going forward.

Questions, requests for additions and corrections, and alerts to any broken links, are welcomed. Please contact the Chief Medical Information Office Editorial Board (cmio-manual@ahs.ca).

Health Evidence Exchange - Information for Builders and Analysts

Clinical content (documentation, decision and inquiry supports) within the Connect Care clinical information system (CIS) can include "resource links". These serve users who, for example, are able to jump to a different section of the chart (internal links) or open an external information resource that explains a new task (Internet links). 

When designers insert Internet links (external URLs) into clinical content, it is important to take advantage of link management tools. The Health Evidence Exchange (HEE, ahs-cis.ca/hee) is used for link management in Connect Care. It makes it possible to insert a standardized link into new content. That link points to the HEE, which in turn redirects to the desired external Internet resource. 

• Handbook: Health Evidence Exchange
• Presentation: Health Evidence Exchange

Wave 2 Ordersets Ready!

 Good news! All Wave 2 Order Sets are designed, built and validated on time. Personalization sessions starting September 17, 2020, will have a full panel of ordering tools to work with.

Congratulations, kudos and thanks to the clinical system design and build teams!

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.

• Instructions: Patient Name SmartTool Cleanup
• Submissions: ConnectCare.SOGI@ahs.ca

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.

Ready

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.

Set

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.

Go!

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

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.

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:

• Spreadsheet: Connect Care Order Sets in Production

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

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:

• Timeline: Area Council Activities
• Timeline: Area Council Awareness

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:

• Key Concept: Order-Related Clinical Decision Supports

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.

• Byte: Clinical Content Validation
• Key Concept: Order Objects