First Workflow Walkthrough Successful

We previously posted about the nature and importance of Workflow Walkthroughs before each wave of Connect Care implementation.

Waves 1 and 3 shared a Workflow Walkthrough for the Edmonton Zone for most of the day on June 26. A comprehensive patient journey was illustrated using the emergent Connect Care clinical information system. This gave a tangible view of how all phases and settings of care relate. There followed deeper dives into information flows associated with complex multidisciplinary collaborative care. Participants were able to ask questions and point out areas requiring more attention.

Similar Workflow Walkthroughs will be repeated for other implementation waves, allowing local workflow adaptations to be explored.

Key demonstrations are available for viewing online (note that an AHS username and password are required):

• Video: End-to-End Patient Journey
• Video: Emergency Department Workflow

Connie and Carey - Our Virtual Connect Care Team

Connect Care will change the way we work. A series of short workflow-oriented videos highlight strategies for navigating the change, and leveraging features that can ease the way. Connie and Carey, are our virtual guides, are introduced together with some early insights about transformation challenges.

This short (4 min) video is of broad relevance:

Honest Conversations: 1. Setting the Stage

Unfortunate timing. The academic and popular press brims with testimonials about physician Electronic Health Record (EHR) dissatisfaction, just as we rally physicians for Connect Care launch.

Fortunate timing. The products of our collaborative design are emerging, bringing our stakeholders fully into review and validation. We have our eyes on Connect Care well before its first use; and we are totally committed to making the toolkit as helpful as possible for clinicians.

So, this is exactly the right time for us to confront EHR angst. We won't get things precisely right, but we can ensure that we are on the best pathway to continuing improvement. And take time for honest conversations about where things have gone wrong with large EHR initiatives elsewhere.

An excellent starter read gives insight into the American experience. Please take a look and give the Fortune magazine article some thought. We will work our way through its harms inventory and re-affirm our own commitment to harms-avoidance and harms-reduction.

• Analysis: Death by a Thousand Cicks: Where Electronic Health Records Went Wrong

What is CII?

Alberta's physicians are inundated with health informatics acronyms. A relative newcomer is "CII", which stands for Community Information Integration. This references both new technology and information services.

The technology joins the Alberta Netcare Portal suite. It enables exchange of certain types of summative health information between electronic medical records (EMR) and the Netcare electronic health record (EHR). Standards-aware, it could also exchange health information with the Connect Care clinical information system (CIS).

The associated information service initially focuses on private, group and networked physician offices that use compatible EMRs. An early priority is to capture care synopses, including lists of visit diagnoses, allergies and other key information, for patients served by those clinics. The synopsis is added to the patient's Netcare record. In addition, specialty consults documented with compatible EMRs are captured and added to Netcare.

• Quick Reference: CII

Connect Care Implementation Timeline Tweaks

As Connect Care continues to unfold, implementation details are smoothed out. Recent adjustments to Waves 1 through 6 affect when some sites and programs launch.

We've already posted about the need to move Wave 1 launch from November 2 to November 3 in order to accommodate the switch from daylight to standard mountain time.

Other changes accommodate clinical services that need to co-deploy:

• Provincial Tuberculosis (TB) services will be included in Waves 1 and 2. 
• Some community Addiction & Mental Health clinics need to launch with parent sites in Waves 2 through 6. 
• Wildfire impacts delay some North Zone plans. 
• Grande Prairie Hospital launch depends upon an unconfirmed opening date. 
• Calgary Zone tweaks reflect careful sequence process analysis.
• Alberta Kidney Care, Alberta Screen Test and Cancer Control Alberta provincial programs launch in Waves 4 and 5. 
• Details continue to firm up for some programs outside core AHS sites in Waves 7-9.  

To prepare for these changes, some technology infrastructure (internet and hardware) assessments also shift. Updates continue to be posted on Connect Care intranet spaces:

• Timeline: Connect Care Implementation
• Portal: Connect Care Sequencing

Made it - Specialty Clinical System Design Build

Re-doubled Congratulations to the Connect Care team!

We are now 100% complete for build of clinical content (decision, documentation and inquiry supports) in the specialty clinical system design stream. This meets our June 24 milestone.

A big thanks to our build team, partnering with operations, CMIO, human factors, safety, training and clinician builders.

Just-in-time Communications

We’ve all been feeling the summer heat… more Connect Care intensity than nice weather!

As validation, training, readiness and implementation activities accelerate, clear communication can minimize chaos and confusion. There are way too many newsletters, SharePoint sites and Insite pages, agendas and minutes to follow. 

We are redoubling efforts to maintain a steady, but concise, feed of clinical content updates through blogging channels. All channels are listed in ahs-cis.ca/mdresources.

All physicians interested in Connect Care should subscribe to the general-interest physician blog (bytes.connect-care.ca). Any clinician involved in Connect Care design, validation, training or readiness activities should follow the blog for informaticians (informatics.connect-care.ca). Those directly involved in clinical content validation should also follow the internal Clinical System Design blog (csd.connect-care.ca).

Please skim our blog tips for instructions about how to subscribe. This way you can get digests to your email and not worry about visiting the sites.

Thanks for attending to this advice. We’ll keep the blogs going and rely upon the communications team to use them as source material for more formal Connect Care communications.

What will become of MyChart?

With Connect Care launch soon upon us, users of current clinical information systems, including the eCLINICIAN ambulatory care record in the Edmonton Zone, prepare for transitions. Naturally, there are many concerns and many questions.

We've recently received a number of requests about support for patients using, and depending upon, the eCLINICIAN MyChart patient portal. This is deployed through a number of specialty and primary care clinics, providing users with access to test results, secure communications, scheduling and other health information services.

Connect Care will launch with its own patient portal, "MyAHS Connect". This is configured as a clinical service for those receiving care where Connect Care is the record of care. We've previously described the nature of the offering and will soon offer a lot more detail about how patients will be enrolled and supported.

With release earlier this year of the Alberta Health public service patient portal, MyHealth Records (see past posting), it is important to coordinate portal offerings in the province of Alberta. Accordingly, the answer to questions about exactly what Connect Care will offer and how eCLINICIAN patients will be transitioned is... "its complicated".

Which test results and reports can be released, how records can be shared and how different portals will be linked are all matters of ongoing deliberation. We will communicate more fully as reliable details emerge.

For now, MyChart users can be assured that our intent is to continue equivalent or better services. Exactly how and when this happens continues to be worked out. Stay connected! The following resources are subject to change:

• Byte: Bridges for Patients and Providers
• Byte: Connect Care Patient Bridge
• Overview: Connect Care Patient Bridge

Getting There - Specialty Clinical System Design Build

Congratulations to the Connect Care team!

We are tracking 97% complete for build of clinical content (decision, documentation and inquiry supports) in the specialty clinical system design stream. This is a massive accomplishment, given the thousands of decisions to be tracked, translated, built and configured. This also ensures that we can move forward with testing, clinical validation and training.

A big thanks to our build team, partnering with operations, CMIO, human factors, safety, training and clinician builders.

Connect Care June 21, 2019 Newsletter Posted

The June 21, 2019, Connect Care Newsletter is available via the link below; covering 1) Uses of Barcoding Technology, and 2) Upcoming Readiness Events.

• Connect Care Newsletter - June 21, 2019

Getting to know Enterprise Content Services

The Connect Care clinical information system (CIS) will improve continuity of care by promoting "One Person, One Record, One System". This does not mean that the CIS databases contain anything and everything that could be important to a patient or population.

The CIS interoperates with an Enterprise Content Management (ECM) system, which can capture, manage, store, preserve, link and deliver a wide range of information objects that might relate to a patient's chart, but not constitute core content. ECM tools and processes allow for unstructured information to be managed wherever that information exists, while still preserving meaningful links to the health record.

Enterprise Content Services (ECS) enable users to digitize, store, manage and retrieve documents and images in association with Connect Care workflows. Connect Care ECM systems deploy as Connect Care deploys. Accordingly we'll be hearing more about ECM as workflow testing, validation, training and readiness activities ramp up.

• Glossary: Enterprise Content
• Insite: Enterprise Content Services
• Questions: ecs@ahs.ca

Barcoding in Connect Care - Getting to HIMSS 6

Barcodes are graphic compositions of lines, symbols or shapes organized in ways that convey information to optical devices. Barcodes can be incorporated into identity cards, patient wristbands, medication labels, laboratory test collection tubes or scannable documents.

We know from the experience of others that good barcoding aligns with best practice. The connection is so strong that the Health Information and Management System Society (HIMSS) looks for this as a marker of organizations that have achieved advanced use of digital health records. Indeed, good barcoding for patient identification, medication management, blood product administration, medical imaging and supply management merits Stage 6 (out of 7) HIMSS certification.

We aspire to this level of digitally enabled transformation at AHS and will seek HIMSS stage 6 within 6 months of each Connect Care implementation wave.

• Byte: Barcoding in Connect Care

Thinking ahead - Barcoding Technology

A core Connect Care strategy is avoidance of hybrid (mixed paper and digital) workflows. This is particularly important where data re-entry is error-prone and puts patients at risk. An important example relates to medication administration. Mistakes involving just a character or two can make the difference between intended or unintended person, medication, dose, route or frequency.

Accordingly, Alberta Health Services (AHS) takes the opportunity of Connect Care to implement barcoding technology in medication workflows. A unique identifier will appear on all medications dispensed by AHS pharmacies. When medications are administered, providers scan the patient wristband as well as the medication. This simplifies data entry, safety checks and documentation.

Another core Connect Care strategy is to "close the loop" on as many workflows as possible. In the case of medication administration, this means workflow-attuned tracking so that there is an unbroken informational chain from plan, reconciliation, adverse reaction check, order, pharmacy receipt, decision support, dispensing, administration, documentation and effect monitoring. Barcoding locks down one more step in closed-loop medication management.

Physicians will be less affected by medication barcode scanning than other members of the multidisciplinary team. Still, it is important to understand an important change to team workflows that affect us. Questions can be directed to connectcare@ahs.ca.

• FAQ: Barcode Scanning

Getting Ready - Implementation Stream Activities

This is a busy time! While we have done well to design the clinical content to be used at Wave 1 launch, there are growing demands for stakeholder contributions to the testing and validation of that content. In parallel, demand grows for physician participation in a wide range of launch readiness activities.

We've already heard about Launch Readiness Assessments and Workflow Walkthroughs. In addition, implementation stream activities include a number of other practical tasks. Watch for more information about the following:

1. Launch Readiness assessments: Structured comprehensive reviews of each Connect Care project stream, identifying risks and mitigation plans. These occur at 150, 129, 90, 60, and 30 days pre-launch.
2. Shadow Charting: Relevant to a limited number of complex or high-risk workflows and  applications, users document cases in both legacy and Connect Care environments, providing an invaluable opportunity to check devices, interfaces, multi-disciplinary workflows, and information flows.
3. Appointment conversion: The conversion of appointments, referrals, cases, and waitlists from legacy systems into Connect Care.
4. Abstraction: Patient information not converted may be manually entered into outpatient charts ahead of launch.
5. Cutover: Key information and orders for admitted patients is entered into Connect Care in the 24-48 hours prior to launch. Cutover includes both technical and clinical elements.
6. Protocol Conversion: Many complex or timed protocols, primarily in Oncology and Research, will be converted for continuation in Connect Care.
7. Command Centre: Safe and well-coordinated surveillance, leadership and trouble-shooting support rapid, efficient and responsive issues detection and resolution while deploying assets like Super Users to areas of greatest need.

To learn more about readiness activities, visit the Connect Care Readiness page on Insite (AHS login required).

Launch Readiness Assessments

Among many preparations for the first Connect Care launch later this year are Launch Readiness Assessments (LRA). These bring together all participants in the Connect Care initiative to  report on progress and problem-solve impediments. Each LRA spans the better part of a day, with rapid updates from diverse groups. This taking-the-temperature is invaluable for nimble adjustment and collaborative coordination.

LRAs are scheduled for 150, 120, 90, 60 and 30 days pre-launch. Our 120 day LRA occurs next week. Participants from across the province will meet to review each stream of work for their current state of readiness, identify potential risks and share ideas on how to mitigate those risks.

To learn more about readiness activities, visit the Connect Care Readiness page on Insite.

• Insite: Connect Care Readiness Activities

Workflow Walkthrough

With the Connect Care Wave 1 launch (November 3, 2019) getting closer, there are more opportunities to view and validate the emerging clinical information system. We can see and influence how information tools will affect and be affected by our work and workplace.

"Workflow Walkthroughs" allow street-smart clinicians to review exactly how Connect Care can support complex clinical activities. A Walkthrough event includes detailed demonstration of one or more high-risk, high-complexity, multidisciplinary or high-volume workflows. Patient journey videos are interspersed with feedback and discussion opportunities. The goal is to discover what more we need to do to get the system attuned to our biggest challenges.

The first Walkthrough event will be held June 26, 2019, at the Bernard Snell auditorium in the Mackenzie Health Sciences Centre (Edmonton) with options for telehealth remote access. Workflow Walkthrough videos will also be made available on Insite (details to come). The first Walkthrough will be most relevant to Wave 1 and 3 clinicians.

Although all interested physicians are encouraged to contribute, the Walkthrough event spans an entire workday. Only some parts will pertain. Please take a look at the tentative agenda (updates to come in future postings) and consider whether any of the 45 minute blocks offer an important feedback opportunity.

Did you notice?

If you did... way too OCD!

Our Connect Care Wave 1 launch countdown timer (top of left column) just gained a day.

After extensive consideration, the Connect Care Provincial Program Office has decided that the original Wave 1 Launch date of November 2, 2019 will move to November 3, 2019 at 0400.

The original date fell on the same day as the switch from Day Light Savings Time (DST) to Mountain Standard Time (MST). By launching on November 3, after the time change, the activation of Connect Care order entry, documentation and other functions will be more straightforward.

Ottawa Hospitals and Clinics Launch Epic

The Ottawa Hospital launched their implementation of Epic this weekend! Together with the Family Health Clinic, Heart Institute, Hawkesbury Hospital and St. Francis Memorial Hospital, Ottawa hospital joins the Children's Hospital of Eastern Ontario in adopting an Epic-based fully-integrated clinical information system.

This launch anticipates our own. We are grateful to our Ottawa colleagues for granting a small AHS team opportunity to directly observe go-live processes.

• Ottawa Citizen: New Hospital Information System has Potential to Save Lives

Connect Care June 2019 Calendar

A summary of key Connect Care happenings in June 2019 has been posted to the Alberta Health Services (AHS) internal Connect Care website, linked below.

High priority activities are shifting to devices (medical and non-medical) on the technical side and training on the readiness side.

Most Specialty Clinical Content build is complete, while work continues on Order Sets, Protocols, Therapy Plans and Reporting Content. Validation activities are ramping up, bringing more eyes to the products of design and build.

• Connect Care June 2019 Calendar