CPSA Electronic Patient Record RoadMap

​In September 2016, the College of Physicians and Surgeons of Alberta approved a roadmap to move the profession decisively toward use of integrated electronic patient records. This important document clearly positions information sharing and collaborative record keeping as matters of professionalism. Indeed, the roadmap includes commitment to standardized charting protocols that support information sharing; and new norms to share for patient advantage.

CPSA Roadmap News: ahs-cmio.ca/cpsanews

CPSA Roadmap Document: ahs-cmio.ca/cpsaroadmap

Digital Professionalism

​Wide-area digital health record initiatives, like the Alberta Netcare Electronic Health Record and the Alberta Health Services Provincial Clinical Information System, give hope for better coordination of care across generations, geographies and services. However, experience shows that clinical improvement is more a matter of people and processes than products or technologies. Our true paradigm change, and great opportunity, occurs when we move from sequestered to shared health records. Doing this brings all health professions into new and unfamiliar information ecosystems. Indeed, a new professionalism is required to facilitate collaborative documentation, care planning, communication and shared decision-making. The Alberta Health Information Executive Committee has commissioned and endorsed a White Paper about health information exchange and the need for innovative norms, standards and expectations of all health professions. This is an important read.

HIEC White Paper: evidence.ahs-cis.ca?=12290

Feedback to: doreen.rabi@ahs.ca

Physician Concerns about Accessing Digital Records for Quality Assurance

​In mid-August 2016, the Office of the Information & Privacy Commissioner of Alberta (OPIC) publicly reported its investigation into alleged misuse of electronic health records by two physicians responding to a patient complaint. AHS and the physicians appealed the OIPC’s decision to the Court of Queen’s Bench of Alberta, suspending the OIPC order until the Court renders a final decision in 2018. College of Physicians and Surgeons of Alberta (CPSA) newsletters have drawn attention to the Order, offering advice about how to access records when responding to complaints. AHS-affiliated physicians have many questions. The CMO, CMIO, Legal and Privacy have prepared a short memo and FAQ.

OIPC Order: ahs-cmio.ca/oipc201606

CPSA News: CPSA Newsletter

AHS Advice: ahs-cmio/oipc201606advice

AHS Provincial CIS RFP Progress

​Recently, an important milestone for the AHS Provincial Clinical Information System (CIS) program was achieved. The first stage of the Request for Proposal (RFP) process is complete. The RFP solicited proposals from the entire marketplace, with the aim of selecting proponents best suited to address AHS needs. Following a well-coordinated and intensive process, AHS has confirmed a shortlist of proponents. An exceptional evaluation panel achieved clear consensus. The second stage engages a much larger group of clinicians and other staff to carefully examine 24 specific domains of functionality.

 What’s happening at CIS: ahs-cis.ca/news

AHS Provincial CIS info (public): ahs-cis.ca/info

AHS Provincial CIS info (Insite): ahs-cis.ca/insiteinfo

What is Digital Health?

​Canada Health Infoway now promotes use of the term “digital health,” with a view to reinvigorating conversations with Canadians about positive uses of digital health records.  The concept encompasses efficient clinician access to information supporting better decisions, patient and family access to their own information online, and collaborative maintenance of care plans shared by all members of a patient’s health care team. The intent is a more connected health care system always open to patient participation.

It may be wise to promote more inclusive language, avoiding terms that compartmentalize by institution, health sector, discipline or patient/provider access. Calling for a fresh start to digital health record planning may also be shrewd; given significant negative press (and literature) about adverse effects of large scale electronic medical record initiatives; especially impacts on patient and physician experiences.  Check out the links to explore making the case for Digital Health.

Digital Health description: li.ahs-cmio.ca/dh

Canada Health Infoway: infoway-inforoute.ca

Digital Health Week

​Digital Health Week, sponsored by Canada Health Infoway and affiliate healthcare organizations, takes place November 14-20, 2016. Canadians are invited to join discussion about how digital health technology is being used by patients and their health care providers. Conversations, stories and experiences emphasize transitions from engagement as patients to partners in managing health care. Check out the links to learn more about patient-centred eHealth, eHealth literacy learning resources, public expectations of health informatics, and how digital health is expected to positively change the experience of health care. Implications for clinical information systems abound.

Digital Health Week overview: li.ahs-cmio.ca/dhw

Digital health experience poll: li.ahs-cmio.ca/dhwpoll

Alberta stories: li.ahs-cmio.ca/dhab

Clinical Improvement Collaboratory

Alberta Health Service’s efforts in quality improvement, patient safety and operational best practices are complemented by partner commitments to systematic clinical improvement. The Edmonton Zone clinical department of medicine (AHS and University) has established, as one of its top three governance committees, a “Strategic Clinical Improvement Committee”. Already the SCIC helps to define key performance indicators, quality report formats and many other initiatives. The healthcare enterprise and academe work in close partnership.

One shared initiative involves support for a “Clinical Improvement Collaboratory”; an online integrated environment where clinician innovators can access and share information about improvement projects, learning programs, initiatives, and directories of helpful internet resources. Although the CI Collaboratory is largely fueled by volunteerism, we hope that it will offer a practical gateway to resources and opportunities for some time to come. Interested clinicians and improvement advocates can register for access.

Registration and log-on: clinicalimprovement.ca

AH–AMA Agreement Good for Clinical Improvement

​Alberta Health, Alberta Health Services and the Alberta Medical Association (AMA) announced mid-October 2016 that the province’s physicians have ratified amendments to a medical services contract running through 2018. The new deal includes commitments to better distribution of physician services, new models for patient attachment and medical services compensation reform. Of importance to the work of the CMIO, the agreement includes provision for a new “Appropriateness and Evidence-based Initiatives Committee” which will advise about opportunities for healthcare improvement. Establishment of a province-wide best guidance viewer, a Clinical Information System Content Repository (for clinical decision supports) and building eHealth literacy are timely and compatible AHS efforts.

Agreement backgrounder: li.ahs-cmio.ca/ama2016

Recognizing Clinical Improvement

Alberta Health Services (AHS), Alberta Health and partner University strategic plans call for capacity-building in quality improvement, quality assurance, patient safety, clinical informatics, health information analytics and other domains collectively referred to as “clinical improvement science.” Key recommendations include organizational commitment, supportive governance, enabling information services, and faculty development and recognition.

Unfortunately, the contributions of clinician innovators may not be as well understood as work typically presented by “clinician educators” or “clinician researchers.” The Chief Medical Information Office (CMIO) hosts a number of programs where clinicians excel at innovation. We promote career advancement by facilitating preparation of contribution reports that align with the principles, frameworks and language of clinical improvement. See the linked guide for more information.

Clinical Improvement Career: ahs-cmio.ca/career

Operational Best Practices align with Strategic Transformation

​Operational Best Practice (OBP) is an organization-wide AHS effort to promote clinical and administrative efficiencies at all levels of AHS. The goal is to maintain or improve quality and safety of care, at lower cost. Savings have already been realized by heeding front-line insights about what works best. Harmonized development of decision supports for use in AHS Clinical Information Systems can help sustain innovation and progress.

OBP FAQ: ahs-cis.ca/obpfaq

OBP overview: ahs-cis.ca/obp

Senior Provincial Director – AHS Provincial CIS

David van Heerden will be joining the AHS executive team as Senior Provincial Director for the AHS Provincial CIS starting November 1, 2016.

David has over 25 years of extensive senior leadership experience in technology business optimization; with specific focus on information technology application, systems development and implementation. His expertise covers the health care sector as well as complex wide-area information system implementations.

David will be accountable to a CIS leadership triad, including the AHS CIO, CMIO and CIS Clinical Operations Leader.

Alberta Health Services Privacy Officer Appointed

​Linda French, with decades of legal experience in the private and public sector, has accepted the position of Chief Privacy Officer (CPO) with Alberta Health Services. Linda's diverse background in law, change management, leadership development and process optimization will be an asset to the Legal & Privacy department. The CMIO works closely with Privacy; strong collaboration helping to mitigagte information sharing challenges raised by widening adoption of enterprise-wide shared health records. Dawn Lake is acknowledged for her tremendous contributions as acting CPO since February 2016.

AHS Privacy: li.ahs-cmio.ca/ahsprivacy

AHS Privacy queries: privacy@ahs.ca

What does it mean for the AHS Provincial CIS to be “business-led”?

​With AHS now firmly on the path to a provincial clinical information system (CIS), we face major transformative challenges. We cannot succeed unless both executive and clinician (user) engagement is rock-solid. Indeed, we have committed to run a project that is “business-led”. Our user engagement strategy very much depends upon what we mean by “business-led”. The CMIO team, in collaboration with the CIO, CIS Project, Organizational Change Management, Communications and other stakeholders, seeks a better understanding of what AHS leadership, information technologies, and other stakeholders understand by business leadership, clinician engagement, empowerment and accountability. The aim is to expose core principles that can inform the next stage of clinician engagement planning. More to follow!

AHS Provincial CIS Leadership Opportunity

​AHS is looking for a Senior Program Officer (SPO) for the Provincial Clinical Information System (CIS) Program to co-lead the most significant transformation in provincial healthcare to date. Reporting directly to the VP, Quality and Chief Medical Officer, the CIS SPO will work in a triad partnership with the CMIO and Chief Information Officer (CIO). The successful candidate will provide overall leadership to care transformation, planning, development and change management required for the deployment of a single continuum-of-care provincial CIS. The SPO will co-lead CIS design, build, implementation, optimization and operation, with particular focus on clinical design. A business-focused thought leader, with in-depth understanding of clinical operations, the SPO will have strong communication, liaison and coordination skills that will ensure the successful transfer of knowledge to clinical teams and affected employees.

SCO Recruitment Posting: ahs-cis.ca/SPO

AHS Provincial CIS RFP Progresses to Second Phase

​Alberta Health Services (AHS) has just completed the first stage of its Request For Proposal (RFP) process for an AHS Provincial Clinical Information System (CIS). This proved a complicated logistical and technical process requiring significant coordination. Shortlisted Proponents will be invited to a more in-depth review as part of the second stage of the RFP. This will include a requirement to demonstrate detailed functionality to 250 clinicians, staff and patients in early 2017. A final decision on the successful bid will be made in mid-2017 and will be shared with staff and the public.

The aim of the CIS is to improve patient experiences and the quality and safety of patient care by supporting standardized information management across the continuum of health care.

AHS CIS Facts: ahs-cis.ca/facts

AHS CIS Website: ahs-cis.ca/public

AHS CIS InSite: ahs-cis.ca/private

AHS CIS Queries: provincialcisprogram@ahs.ca

What does the Chief Medical Information Office do?

Under the direction of the Chief Medical Information Officer (CMIO), and supported by three Associate CMIOs, the Office provides leadership, coordination and facilitation of clinical informatics initiatives for Alberta Health Services (AHS). Clinical informatics seeks to transform health care by analyzing, designing, implementing, and evaluating information and communication systems for better individual and population health outcomes.

The CMIO oversees provincial clinical informatics efforts, while the Associate CMIOs guide clinical informatics initiatives in their respective zones (Edmonton, Calgary and North+South+Central). This includes advocacy for the needs of clinical users of AHS Clinical Information Systems (CIS). The Office supports staff, systems, and contracted clinicians providing guidance to initiatives where information technology impacts patients, clinicians and communities. Key clinical improvement services include: 1) Clinical Informatics, 2) Clinical Guidance & Content Management, 3) eHealth Process Optimization, 4) eQuality & eSafety, 5) eHealth Capacity & Adoption, and 6) Stakeholder Relations. We’ll have more to say about each in future CI Bytes.

CMIO Org Chart: ahs-cmio.ca/orgchart

CMIO Overview: ahs-cmio.ca/overview

CMIO Public Website: http://www.ahs.ca/cmio

CMIO Queries: mailto:cmio@ahs.ca

AHS Provincial Clinical Information System (CIS) – Are we ready?

​Now well into the first phase of our effort to select a technology platform for an AHS Provincial CIS, the RFP process is working smoothly and on time. Phase II, with its deep dive into multiple domains of clinical and operational functionality, starts soon. We are firmly on our way to a powerfully integrated cross-continuum, cross-generational and cross-geography CIS.

Although we will know a preferred technology and partner soon, we still have much work ahead to prepare for this partnership. As a business-led initiative, the AHS Provincial CIS will succeed or fail contingent on our capacity to use electronic information and decision supports on the front lines of health care. We’ll develop ways to learn about how to use a particular CIS system.

Additionally, we need to build capacity for “eHealth literacy.” This is less about technology and more about the human, social and cultural awareness required for safe, effective and collaborative practice in a CIS-enabled workplace.

As we start work on eHealth literacy pathways, we are eager to learn more about current experiences with clinical informatics training in the workplace. Please help by completing a very short online survey:

CIS Readiness Survey: ahs-cis.ca/staffsurvey

AHS Secure Email for Medical Students and Trainees

​Need to send a patient list, handover instruction or other communication with potentially sensitive information among members of a health care team? 

It is tempting for students, residents and fellows (“trainees”) to pass information around via printouts, files, thumb drives and messaging… dangerous practices. Privacy breeches can happen and have serious consequences for patients and providers. Documents, images and communications sent from one AHS email account to another are encrypted and sequestered. Also, use of AHS secure email on personal mobile devices is easy and convenient. For safer eHealth communications, clinical learners can request email activation when (or after) they get their AHS HEALTHY account.

• eCommunications aids: ahs-cis.ca/comms
• Guide: Clinical Email: ahs-cis.ca/email

What’s in a name?

​The acronyms “EHR,” “EMR” and “CIS” are used differently by different vendors, organizations and countries at different times. While, Canada Health Infoway promotes distinctions that are fairly well adopted in Canada and Alberta, now that the province starts its AHS Provincial Clinical Information System (CIS) journey, we need to be clear about how the CIS might differ from the Netcare Electronic Health Record (EHR) or community Electronic Medical Records (EMR). Use the links to the left to see recently ratified definitions at-a-glance, or to access a glossary supporting CIS efforts. Key definitions appear next page.

Digital Health Record defs: ahs-cis.ca/definitions

eHealth Glossary: glossary.ahs-cis.ca

Bring Your Own App – Use Cases

​With the advent of mobile devices that dwarf the power of typical workplace computers, clinicians increasingly take more control of information technology needs with BYOD (Bring Your Own Device). With the advent of user-friendly development environments, clinicians also take more control of information management needs with BYOA (Bring Your Own App). Clinician inventors and innovators may do this themselves. Others take advantage of the many applications appearing online for browsers and devices. Some apps have genuine merit. They may also have important privacy and medical record implications. The CMIO office can help proponents complete “use cases” both to clarify needs and expose issues that need to be addressed.

Use Case Process: ahs-cis.ca/usecase

Use Case Template: ahs-cis.ca/usecasecsm

AHS Provincial Clinical Information System (CIS) RFP

On June 21, 2016, Alberta Health Services (AHS) published an open Request for Proposals (RFP) to provide the technology platform that will support a provincial CIS. The selection process consists of two evaluation stages. Each focuses on specific criteria that will be used to fairly and objectively rank proponents, with the ultimate objective of identifying one preferred proponent.

The AHS Provincial CIS will cross the health continuum, serving all generations and all Albertans.

Stage 1 evaluation will review strategic level requirements, core functionality and the ability to scale to the continuum of care for the entire province. The goal is to shortlist 2-3 proponents.

Stage 2 involves a more detailed “deep dive” into functionality of the shortlisted solutions, examining specific criteria in multiple clinical and service domains. There will be many evaluators and careful capture of input from diverse stakeholders. Please watch for more information… it is critically important that those who know health care help select a CIS that can help make health care better.

CIS Backgrounder: ahs-cis.ca/backgrounder

CIS FAQ: ahs-cis.ca/faq

CIS Update: ahs-cis.ca/update

Mobile Access for AHS Secure Email

​AHS email can be used for both clinical and non-clinical communications between persons with AHS email accounts or from an AHS account to a non-AHS account (see above re !Private on subject line). Images, letters, lists and other sensitive materials can be shared this way. Even more convenient is secure communication via mobile devices (iPhone, iPad, Android). Until now, AHS secure email activation was only permitted on AHS-issued devices. See the tip links to the left for instructions about setting up AHS mail on personal mobile devices. It is important to secure devices as recommended.

Update: AHS secure email access changed August 2020 to be available via webmail, Outlook for Desktop devices and Outlook for Mobile devices. See more recent posting.

• Guide: Clinical Email: ahs-cis.ca/email
• Tip: AHS email for iOS: ahs-cis.ca/emailios
• Tip: AHS email for Android: ahs-cis/emailandroid

Sending AHS Secure Email to non-AHS Addresses

Electronic mail is widely used within the health sector. Most health care providers and patients have email addresses. As tempting as it may be to send personal health information via email, there are a number of risks to be aware of. Alberta Health services (AHS) provides health care providers with the opportunity to transmit clinical information via secure email, including encrypted email to external addresses. Relevant policies, procedures and best practice guides are summarized via the links to the left.

AHS securely transfers email messages and attachments between any sender and receiver with AHS email addresses (@albertahealthservices.ca, @ahs.ca). AHS mail can also be used to send secure email from an AHS sender to a receiver without an AHS email address. Simply add “!Private” (note exclamation mark and capitalization) to the email subject line. Test this before using regularly.

• Guide: Clinical Email
• Guide: Clinical Copy-Paste
• Guide: Clinical Secure Messaging

AMA Dr2Dr and Messaging in AHS Facilities

The Alberta Medical Association (AMA) recently launched a Clinical Secure Messaging (CSM) application, called “dr2dr” for use by Alberta physicians. Clinicians may wonder how this relates to AHS Medical Staff, practitioners, medical residents, and medical students working within AHS facilities or with AHS medical records. At this time, AHS will not be supporting direct connections between dr2dr and any AHS Clinical Information System (CIS, such as eCLINICIAN, Sunrise Clinical Manager, MEDITECH). 

Clinical communications between AHS clinicians, especially when involving identifiable patient information, must use any available AHS-provisioned tools. Default to AHS CIS-based messaging when sender and receiver are users of an AHS CIS. Otherwise, AHS secure email or Netcare messaging should be tried. 

If these resources are unavailable or inappropriate (e.g., sender is does not have access to AHS-provisioned tools), then it may be appropriate to use a non-AHS CSM tool (such as AMA dr2dr) as long as the use complies with AHS policies and procedures cited in the guides. If the non-AHS CSM tool is to be used with an AHS CIS, then an evaluation and OIPC-approved addendum to the CIS privacy impact assessment must be arranged with AHS Privacy prior to implementation.

• Communique to physicians: ahs-cis.ca/csmmemo
• Clinical Secure Messaging: ahs-cis.ca/csm
• Clinical Copy-Paste: ahs-cis.ca/ccp
• Clinical Email: ahs-cis.ca/email

Clinical Secure Messaging

Instant messaging relates to person-to-person communication tools optimized for short chat-like exchanges. Clinical Secure Messaging (CSM) adds encryption and user-validation protections for secure transmission of clinical information. 

While CSM can be a big help within organizations, perhaps the greatest appeal is for quick, secure, communications between clinicians in different contexts. Growing frustration with facsimile technology increases demand for Internet-based services. However, messaging-type applications are relatively new to medicine and users may not appreciate the harms that could befall patients and practitioners. AHS is working on guides that expose risks and requirements when CSM is used for healthcare (see links).

• Clinical Secure Messaging: ahs-cis.ca/csm
• Clinical Copy-Paste: ahs-cis.ca/ccp
• Clinical Email: ahs-cis.ca/email

What's in a name: digital health records?

The acronyms “EHR,” “EMR” and “CIS” are used differently by different vendors, organizations and countries at different times. Canada Health Infoway promotes distinctions that are fairly well adopted in Canada and Alberta. These are adapted to Alberta’s present context:

EHR	Electronic Health Record	Longitudinal collection of personal health information supporting multiple health service providers across the continuum of care with appropriate information securely delivered to authorized individuals.
EMR	Electronic Medical Record	Record of health services and related information maintained by health care providers in an electronic system for access and use by the providers.
CIS	Clinical Information System	Integrated information management platform supporting the collection, access, use and sharing of information supporting the delivery of health services to persons and populations in multiple settings across the continuum of care.

• Glossary
• Key Concept: Digital Health Records