Documentation Quality Improvement - Work Package #1: Medication SmartLinks

The Connect Care Documentation Quality Improvement initiative seeks to enhance the utility of summative documentation templates for history & physical, consult, discharge, transfer, deceased and operative notes. Oversight is provided by the Clinical Documentation Quality Improvement Workgroup, reporting to the Clinical Documentation Committee.

An early task is to improve building blocks used by summative document authoring tools, including the SmartLinks that pull in lists of medications. A presentation describes the design of new prototypes, now ready for validation and review. 

While Builders and Analysts are the first review participants, any Connect Care user is welcome to learn about the work and offer feedback. Start by viewing the presentation. 

Builders can follow instructions provided in the presentation for working with medication SmartLink prototypes in the Connect Care POC or TST environments. Users can also use screenshots provided in the  presentation. All can share feedback and suggestions using an online survey.

• Presentation: DQI Medication SmartLinks
• Builder Handbook: SmartLink Style Guide
• Builder Handbook: Prose-Friendly SmartLinks
• Feedback: DQI Feedback Online Survey

Documentation Quality Improvement - Work Packages #1 and 2 in SUP for Clinical Testing

Documentation Quality Improvement work packages #1 (Medication SmartTools) and #2 (Identity SmartTools) are now in the SUP environment and ready for testing by interested Builders, Super Users and other clinical stakeholders. Testing in SUP is available 09:00-23:00 weekdays this week only.

The last slide in the presentation handout (see the linked work packages) contains instructions for testing. In brief:

• Medication SmartTools
• Open patient chart(s), start a documentation note (any type, but progress note is easy for testing) and then try to replicate a post-admission, inpatient, discharge and outpatient context.
• Inpatient
• Open a chart from a patient list for current inpatients.
• To replicate an admission context, consider selecting an ED patient and initiating an admission with the admission navigator. Do admission medication reconciliation, being sure to review home medications. Then test the MedList SmartLinks (use ".DQIMEDLIST") SmartPhrase.
• To replicate an inpatient context, select any current inpatient.
• To replicate a discharge context, select any current inpatient and use the discharge navigator to access discharge orders and perform discharge medication reconciliation. Then test the MedRec SmartLinks (use ".DQIMEDREC" SmartPhrase).
• NOTE: are aware of a problem with medication reconciliation reports where the dose frequency is not specified. This issue is fixed with an update to the Epic software coming in June 2021. The listing of a discharge med list (take home meds) mitigates this problem when combined with the flagging of meds (by name and form) that have changed, stopped, started, continued.
• Outpatient
• Open a chart and select an outpatient encounter, which you may need to reopen through the "addend" workflow.
• Check the current med list, then test the MedList SmartLinks (use ".DQIMEDLIST" SmartPhrase).
• Provide feedback via: Medication SmartTool Survey.
• Identity SmartTools
• Open any chart and then experiment with demographic (patient preferred/affirmed name) and SOGIE SmartForm (accessed by clicking on gender information in StoryBoard) values while using ".DQIIDENTITY" SmartPhrase to test relevant SmartLinks and SmartPhrases. 
• Note that it will be necessary to switch from the SOGIE form to a different activity (then back again) to refresh the SOGIE values before retesting with DQIIDENTITY by deleting the former note content and re-entering the test SmartPhrase.
• Provide feedback via: Identity SmartTool Survey.

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

Documentation Quality Improvement - Work Package #2: Identity SmartTools

The Connect Care Documentation Quality Improvement initiative seeks to enhance the utility of summative documentation templates for history & physical, consult, discharge, transfer, deceased and operative notes. Oversight is provided by the Clinical Documentation Quality Improvement Workgroup, reporting to the Clinical Documentation Committee.

An early task is to improve building blocks used by summative document authoring tools, including the SmartForms, SmartLists, SmartLinks and SmartPhrases that reflect a patient's gender identity, pronoun preferences, date of birth and affirmed name... collectively "Identity SmartTools". 

While Builders and Analysts are the first work package review participants, any Connect Care user is welcome to learn about the work and offer feedback. Start by viewing the presentation. 

Builders can follow instructions provided in the presentation for working with SmartTool prototypes in the Connect Care POC or TST environments. Users can also use screenshots provided in the  presentation. All can share feedback and suggestions using an online survey.

• Presentation: DQI Identity SmartTools
• Builder Handbook: SmartLink Style Guide
• Builder Handbook: Prose-Friendly SmartLinks
• Feedback: DQI Feedback Online Survey

Documentation Quality Improvement - Work Package #3 - Problem Management SmartTools

The Connect Care Documentation Quality Improvement initiative seeks to enhance the utility of summative documentation templates for history & physical, consult, discharge, transfer, deceased and operative notes. Oversight is provided by the Clinical Documentation Quality Improvement Workgroup, reporting to the Clinical Documentation Committee.

An early task is to improve building blocks used by summative document authoring tools, including the Navigators, SmartForms, SmartLists, SmartLinks and SmartPhrases that facilitate problem list management, problem reconciliation and problem-oriented charting... collectively "Problem Management SmartTools". 

While Builders and Analysts are the first work package review participants, any Connect Care user is welcome to learn about the work and offer feedback. Start by viewing the presentation. 

Builders can follow instructions provided in the presentation for working with SmartTool prototypes in the Connect Care POC environments. Users can also use screenshots provided in the  presentation. All can share feedback and suggestions using an online survey.

• Presentation: Problem Management SmartTools
• Manual: Problem List Management
• Manual: Problem Oriented Charting
• Builder Handbook: Problem Management SmartTools
• Feedback: DQI Feedback Online Survey

Documentation Quality Improvement - Progress Report #1

We've posted previously about the Documentation Quality Improvement Initiative. 

Work is progressing well:

• Two work packages have been developed, posted, presented to stakeholder groups, subjected to testing and improved after feedback:
• Medication SmartTools - With clinical and stakeholder review/optimization complete, the new SmartLinks, Print Groups and SmartPhrases will move to the SUP pre-production environment next week for testing with a wider range of patient charts. If all goes well, the goal is to have this package moved to production by the end of the month. The Documentation Quality Improvement Workgroup has forwarded its recommendation to the Clinical Documentation Committee that the new products be approved.
• Identity SmartTools - This work is at a similar stage of development. Subject to final SOGIE workgroup endorsement, a recommendation to ClinDoc will be made for approval to move to production. Testing and optimization has been completed. An end-of-month goal for move to PRD also applies.
• Work progresses on two new work packages:
• Problem-Oriented Charting Tools - With improvements to navigators, editing tools, progress note templates and text automations for streamlining summative documentation when problem-oriented charting processes are followed. Other tools (e.g., hospital course) facilitate preparation for discharge summaries. The work package will be posted next week.
• Laboratory Data SmartTools - Text automation tools that facilitate succinct prose-friendly inclusion of laboratory data in clinical documentation are the focus of this work package, expected to be available next week.
• Remaining Phase 1 work packages:
• History SmartTools - Prose-friendly inclusion of medical, surgical, family and social history information in summative documentation. 
• Objective Data SmartTools - Include those that pull vital signs, physical exam, lines and other observed information into summative documentation.
• Transition Planning SmartTools - Representation of information key to discharge and transition planning.
• H&P Summative Documentation - Building blocks assembled to form new H&P templates for conventional as well as problem-oriented charting.
• Consultation Documentation - Building blocks assembled to form new consult templates for conventional as well as problem-oriented charting.
• Discharge Documentation - Building blocks assembled to form new discharge and deceased templates for conventional as well as problem-oriented charting.
• Transfer Summative Documentation - Building blocks assembled to form new interfacility transfer templates for conventional as well as problem-oriented charting.
• Operation Summative Documentation - Building blocks assembled to form new operative note templates for conventional as well as problem-oriented charting.
• Sequencing of remaining Phase 1 work packages:
• The Documentation Quality Improvement Workgroup will consider how best to sequence remaining work packages needed to deploy new summative documentation templates, seeking to first release components most helpful to the Wave 3 launch.

AHS Preferred SmartLink Catalogue

The Connect Care Documentation Quality Improvement (DQI) initiative has worked to design and promote use of provincially standardized documentation templates (e.g., discharge summary). Along the way, the "Smart" building blocks (e.g., SmartLinks) used to assemble the templates have been carefully reviewed to ensure that Alberta Health Services style, format, safety and other norms are complied with. 

A helpful byproduct for designers, builders, analysts and super users -- as well as Connect Care users who build SmartPhrase personalizations -- is a curated catalogue of AHS approved and preferred SmartTools. This is maintained in the Builder Handbook and is linked from the Clinician Manual and from prescriber learning home dashboards.

• Manual: SmartTools

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

Documentation Quality Improvement - Progress Report #3

We've previously posted about the Documentation Quality Improvement (DQI) initiative. 

After a few months of testing among early-adopters, a number of fixes and improvements are released mid-September in a continued "soft launch" that makes new tools available to interested users without affecting pre-existing tools or workflows:

• SmartTool Building Blocks
• Some documentation building blocks (SmartLinks, SmartPhrases, SmartLists, etc.) used in problem-oriented charting tools have been further improved. In some cases, ways have been found to better format for more skimmable reports. In other cases, options have been added to make it easier for users to bypass documentation components that they do not need for a particular note. The end result is fewer clicks for the user and a faster workflow.
• The new components, all prose-friendly and complying with common style guides and data formatting standards, are being listed in the Connect Care Manual for the benefit of users wanting to include them in personalized templates or text blocks. 
• Data-Documentation Integration
• Enhanced documentation templates and charting views now include more "precision links" to relevant charting tools. If, for example, one selects frailty assessment as part of transition-planning documentation, a link "hot spot" appears in the document draft to facilitate instant access to a pop-up for entering or updating frailty score information. 
• Adaptable Charting Elements
• More work has been done to support a "build-your-own-journey" approach to problem-oriented documentation. Templates include optional SmartLists that allow users to pull in the types of information, and level of detail, appropriate to their charting purpose. 
• Dynamic Charting Elements
• We have added and tested an ability to display customized summative documentation content when specific patient (e.g., age, health problems), provider (e.g., specialty) or context (e.g., outpatient, inpatient, emergency) conditions are met. The first application of this ability brings some disease management content into discharge summaries when patients are on specific care paths.
• Hospital Course
• An improved optional starter text block for the hospital course is implemented with SmartForm support allowing the same data elements to be pulled into appropriate parts of  consult, discharge, operative and transfer summaries.
• Problem Overviews
• Support is added for using standardized problem overview elements, with SmartForm support for reusing the data in other documentation objects.
• Support is added for dynamic problem overviews that bring unique content in for common chronic illnesses.
• COVID-19 Status
• A new COVID-19 status text block is included in many templates, bringing swab, serology, immunization and self-reported immunization information together in one place.
• Sidebar Support
• The problem-oriented charting sidebar for inpatients has been improved to include more hotspots for rapid updating of structured chart data.
• Summative Documentation Templates - Instant Access
• A phase I deliverable for the DQI initiative is a set of summative documentation templates (History & Physical, Consult, Discharge  Summary, Transfer Summary, Deceased Summary, Operative Note).
• Previously, users would need to know the correct SmartPhrase or SmartText name to use these templates to initiate a summative document. Now, the document types, preloaded with the intended templates, can be initiated with a mouse click from the POC sidebar or the general inpatient sidebar.
• Next Steps
• These and other enhancements are implemented in the second week of September, with DQI soft-launch proceeding in the third week.