Connect Care FAQ: 2022

How are triplicate (duplicate) prescriptions handled in Connect Care?

Question: How should prescribers handle tracked (triplicate or duplicate) prescriptions required for outpatient use of controlled substances?

Context: The Alberta Tracked Prescription Program (TPP, tppalberta.ca) monitors use of prescription drugs prone to abuse. It does this by ensuring that such prescriptions are handwritten to prescription pads with security features and copies. Unfortunately, the program has yet to take advantage of the additional security and surveillance made possible by digital health records. It is hoped that the emergence of e-prescribing (PrescribeIT) will avoid paper workflows in the future. Please note that the new Connect Care workflow for sending prescriptions directly to community pharmacies via electronic fax ("eFax") cannot be used for prescriptions for drugs classified as Type 1 under the TPP; these prescriptions still require the use of a paper TPP secure prescription form.

Prescribers must follow TPP requirements for managing tracked prescription copies and records:

TPP: Program Guide

How, exactly, are Connect Care prescribers to keep a copy of a triplicate (duplicate) prescription?

Answer: Connect Care made application to the Alberta TPP program for workflow adaptations appropriate to Connect Care, as a fully integrated clinical information system, like Connect Care. A TPP decision was made (July 2019) to the effect that Connect Care prescribers do not need to scan a copy of the TPP paper form for attaching to the digital chart. The acceptable workflow is as follows:

Order all prescriptions in Connect Care, including TPP specified Type 1 controlled substances.
Write out a manual (handwritten) TPP prescription (3-part or newer 2-part TPP pad) for specified Type 1 controlled substances.
Record the TPP prescription identification number (unique to each prescription) in Connect Care (ideally in the comments field of the actual order).
Do ONE of the following with the original (paper) pharmacy/TPP prescription (see guide):

Option 1: Provide to patient and do not fax to pharmacy.
Option 2: Fax to the patient's one chosen pharmacy, marking "FAXED" on the prescription and do not provide to the patient.

Continue to protect the TPP (duplicate or triplicate) pad with its copy of the hand-written original.
Destroy any leftover copies or artefacts.

The Connect Care tracked prescription order constitutes the official record. It is NOT necessary to scan or otherwise copy the paper TPP prescription to attach to the Connect Care digital record.

How did I get that test order wrong?

Question: Having ordered what seems like the right test, a result is not returned or the test is declined with a request to order differently. How does this happen and how can it be avoided?

Context: Those new to Connect Care may fumble with the occasional test or procedure order. The is more likely with tests based on samples (e.g., aspirates) that can be collected in different ways in different contexts. Possible reasons for delays or declines include:

Wrong Test

A vast number of tests are available to request via Connect Care, including all possible orderables for an entire province.
Different tests can have similar names. It is important to consider possible alternative test names, check the "Facility List" if nothing familiar appears on the "Preference List", and chose the most specific test description to fit your intent.

Wrong Sample

Test orderables can have similar names but relate to different clinical needs.
If ordering a pH, for example, be sure to select the test appropriate to the fluid being sampled (e.g., venous, arterial, pleural).

Wrong Details

Orders for similar investigations may have specific required details for samples collected during specific workflows (e.g., surgical operation).

Wrong Location

An increasing number of assays can be performed using Point of Care Testing (POCT), with rapid result availability. However, the instrumentation needs to be available in-facility, as well as the test kits for the desired assay, with staff certified to use the equipment.
Local variation in POCT availability is inevitable. Be sure to check with colleagues, or laboratory services, that the POCT orderable found in Connect Care is available on site.

Wrong Permission

In some cases, special assays require special permission in order to be performed. This will usually be communicated to the ordering prescriber.

Answer: Just as has always been the case, prescribers need to build an awareness of the laboratory services available at a particular facility. If in doubt, ask. Local laboratory services will know what can be ordered, and how. In addition, Connect Care "Resource Links" (top menu in Hyperspace) are provided for:

How can I add patient information or instructions to the After Visit Summary (AVS)?

Question: How can prescribers add instructions, information or education materials to the After Visit Summary (AVS) provided to patients at the end of encounters?

Context: Encounter overviews (emergency, inpatient and outpatient) are routinely shared with patients as "After Visit Summaries" (AVS). These include information about key events, educational materials, medications, follow-up appointments and discharge instructions. The AVS is automatically sent to the MyAHS Connect patient portal. Additionally, patients are provided with a printed AVS at discharge and at the close of most outpatient visits.

Prescribers can use the "Discharge" navigator (inpatient encounters) or "Wrap-Up" navigator (outpatient encounters) to add instructions and/or educational handouts before the AVS is printed.

Answer: Instructions and handouts can be added to the AVS for emergency, inpatient and outpatient encounters, with slight variations in how this is done.

Inpatient

Open the Discharge navigator and note the "Other Instructions" section in the navigator menu. Select this to open an edit box in the navigator where prescriber instructions for inclusion in the AVS can be entered.

Note that additional instructions can be attached to any outpatient appointments set up in the Discharge navigator.
One or more educational handouts, with patient-specific comments added by the prescriber, can be attached to the AVS. To do this, select the "References" menu item within the Discharge navigator. This opens a section for looking up and adding educational attachments. Individual attachments can be edited to make them maximally applicable to the patient, and overall comments can be added by the prescriber.

Outpatient and Emergency

Open the Wrap-Up navigator (or the Dispo tab in emergency contexts) and note the top-left "Patient Instructions" section. This includes a lookup tool for optionally selecting one or more educational handouts for attachment to the AVS. Educational handouts can be edited to customize to particular patient needs. There is also provision for general instructions or comments that will be included in the AVS.
Just above the Patient Instructions section are icons that can be used to preview or (re)print the AVS.

How can I share discharge summaries with my patients?

Question: How can prescribers share discharge summaries (including print) with patients?

Context: Connect Care supports sharing of chart content with the subject patient or their approved proxy.

The best way to do this is via the "MyAHS Connect" patient portal, which automatically shares most investigation results and many other information types. Encounter summaries (emergency, inpatient and outpatient) are routinely shared as "After Visit Summaries" (AVS). These include information about key events, educational materials, medications, appointments and discharge instructions. Patients who have not signed up for MyAHS Connect receive a printed AVS.

Clinicians are free to share other documentation items with their patients, preferably via MyAHS Connect as an approved and secure patient communications platform. Documents can be printed for patients who are not active on the patient portal.

Answer: The decision to share a document via the patient portal should be made when authoring the item to be shared. Printing a document happens after the document is completed and signed.

Document Sharing

Create or open a document for editing within a patient's chart.
Look for and select the "Share w/ Patient" button at the top of the document editor. A warning will appear if the current patient is not activated on the patient portal (sign-up instructions appear in the AVS).

Note that the "Share w/ Patient" button may appear to be activated (by default) if a Note Type (e.g., progress note, discharge summary, etc.) has not been selected. As soon as that (mandatory) type selection has been made, the share button initiates to its default "off" state. The authoring clinician needs to make an explicit decision to share by clicking on the "Share w/ Patient" button.

The document will become available (including any subsequent revisions) in MyAHS Connect.

Document Printing

Create or open a document for editing, then complete and sign it within a patient's chart.
Go to the "Chart Review" activity and find and select the document of interest in the "Notes" tab.
Look for and select the print icon at the top of the document report. The default printer should be the one assigned to the current patient location. An alternate local printer can be selected (see printing tips).

It is also possible to print documents via the Sidebar when charts are opened to an inpatient encounter. Look to the Sidebar Summary Index and select the "Notes, Sidebars" option. A listing of recent summative documents will appear in the Sidebar. If one of these is selected, a print icon is available and usable at the top of the Sidebar display.

Why must all medication prescriptions be entered into Connect Care at discharge?

Question: Why must responsible prescribers enter and review medications within Connect Care at discharge from inpatient encounters?

Context: When newly onboarded prescribers first encounter discharge workflows, it may seem easiest to continue to write out medication prescriptions on paper pads.

Apart from the fact that such manual medication workflows over time impose greater informational and safety burdens on prescribers, what other reasons justify the requirement that all medications be entered (ordered) within Connect Care, irrespective of what is manually written?

Connect Care minimum use norms unequivocally indicate that all medications must be entered into the legal record of care (Connect Care) and that medication reconciliation must be done at all discharges or interfacility transfers.

Answer: Proper discharge medication management, including entry of all new or changed medications into the Connect Care record of care, is an unequivocal professional and organizational expectation of discharging prescribers. It is not acceptable to manually write out prescriptions without appropriately recording the patient's intended medications in the Connect Care chart.

This requirement is reflected in hospital accreditation standards, medical staff bylaws and College of Physicians and Surgeons of Alberta standards.

Aside from matters of professionalism, regulation and good clinical practice, a failure to properly record medication orders at discharge can have unintended consequences, including impacts on the following areas:

Community Pharmacy Report

A "MedRec for Community Pharmacist" report is generated at every discharge once discharge orders are completed. The report lists all medications that a patient should be taking at discharge, highlighting home medications that may have been changed or discontinued.
The report should be manually faxed to the patient's registered pharmacy (it cannot be automatically sent at this time). In the absence of a preferred pharmacy, the report can be provided to the patient together with any printed prescriptions they are taking to a community pharmacy.

Decision Supports

Checks for drug-allergy, drug-dose, drug-drug, drug-disease and drug-lab interactions are flawed if Connect Care does not have a complete and up-to-date medication list.

Summative Documentation

Standard provincial templates for summative documents (e.g., discharge summary) sent to Netcare and community electronic medical records automatically incorporate Connect Care medication information.

Colleague Information Burdens

Accurate discharge medication records make information flows faster when patients return for outpatient or emergency reassessments.

Risk of Medication Harms

Prescriptions missing from medication profiles in Connect Care (such as those manually written at discharge) can result in these medications being overlooked when patients re-present for care.

Compliance with minimum use norms is tracked in Connect Care, with performance measures reviewable in personal and group minimum use dashboards. The measures may also be reportable under prescriber individual service agreement contracts with Alberta Health and Alberta Health Services.

How can "non-standard" medications be ordered?

Question: When an inpatient medication is not found on the Connect Care facility list, is there a way to order (request) its use during hospital care?

Context: Whereas outpatient medication orders represent what is dispensable from any of many community pharmacies, inpatient medications reflect what is approved, available and configured within a particular facility. Some medications may not be on the Alberta Health Services (AHS) formulary but still possible to procure or make.

For example, melatonin can be used for seniors' sleep-cycle regulation. While the AHS Drugs & Therapeutics Committee has removed this non-formulary medication from inpatient facility lists, there may be reason to continue the medication at admission for some patients. Other non-standard medications can be made available in some facilities.

Answer: If a medication cannot be found on inpatient facility order lists (be sure to try different spellings and the generic drug name), it is likely non-standard. A pharmacist will need to check to see if it can be provided.

The ordering prescriber should request the medication by placing a "Non Standard Medication" order. Enter "non-standard" in the order search box (using the "Facility List" tab if needed). Other synonyms will work including "Other", "Non-formulary", "Custom", "Unable" and "Non".

Upon selecting the "Non Standard Medication" order, one is presented with a pop-up requiring the drug name, form (e.g., "tablet"), request reason (e.g., "patient taking"), together with details of dose, route and frequency.

Once all details are entered, the specific non-standard medication order can be saved as a favourite (be sure to copy in the drug identification details and suitably name the favourite before saving). This will allow the medication to be ordered in the future without having to enter all the data required of a de-novo non-standard order.

What are Care Gaps/Health Maintenance Reminders?

Question: “Care Gap” alerts appear in my patient’s Storyboard, sometimes related to care I do not provide. What are these and how do I respond to them?

Context: Care Gaps and Health Maintenance Reminders are clinical decision supports in Connect Care that monitor patient characteristics and experiences, then match them to evidence-based preventive care or chronic disease management guidelines in order to recommend actions that may improve care. The underlying algorithms have been adapted to and validated for Albertans.

Care Gap alerts can appear in the patient’s Storyboard (leftward column in an opened chart, “Care Gaps” section), in the Plan of Care tab of the "Chart Review" activity, or in the "Health Maintenance" activity (global search for "maint" works well).

Example: A diabetic patient's demographics and history trigger an alert indicating that a diabetic foot exam is due (Alberta guidelines call for yearly foot exams for those on the diabetes register).

A Care Gap alert flags possible mismatches between evidence-informed care and a patient's current experience. Connect Care chart content is compared to patient-specific health maintenance plans. Missing or inaccurate information (e.g., incomplete problem, medication or lab results) can lead to false positive, or false negative, alerts.

Answer: Connect Care clinical oversight elected to make Care Gap information available to all providers, irrespective of specialty or context (e.g., outpatient vs. inpatient). This promotes opportunistic preventive care, where important gaps (e.g., immunization needs) can be addressed wherever patients interact with the health care system. Patients most in need of preventive care may not, for example, have a primary care provider.

When a possible Care Gap is identified, providers have several options to address it. The alerts are "passive" and can be left for other providers to attend to. Alerts can be acknowledged but deferred (e.g., adding completion date, Postpone, Discontinue, or entering a date for Follow-Up). Finally, patient's health maintenance plans can be adjusted or deactivated (e.g., not applicable for reason of compassionate care).

What are Therapy Plan expiration messages?

Question: Connect Care prescribers increasingly receive In Basket messages to the effect that a Therapy Plan is about to expire. What does this mean?

Context: Therapy Plans help organize the delivery of tests and therapies across multiple encounters for a specific health condition. They are used for a wide range of interventions (e.g., dialysis, iron sucrose treatments) and are increasingly encountered by Connect Care users.

By default, all Therapy Plan orders (usually for repeating interventions) expire after 12 months, with the exception of antimicrobial plans (which expire at 7 days). The lead prescriber assigned to a plan will receive an In Basket notice at the 11-month mark. This prompts to either renew or discontinue the plan.

Answer: Such messages are not received if a Therapy Plan is set to discontinue once a treatment program is complete. Open ended plans need to be reconsidered at least once a year because there are limits to the number of such plans that can be managed at any one time, and it is important to confirm that ongoing plans are still needed.

Why can't I connect to AHS Wireless?

Question: Prescribers need wireless network access for personal devices (smartphones, tablets, portable computers) when providing health services in Alberta Health Services (AHS) facilities. A few issues can frustrate attempts to get connected.

Context: AHS provides wireless network services within its facilities, recognized by the network identifier "AHSRESTRICT". Most facilities also support a "HEALTHSPOT" wireless connection, intended for patient use. The AHSRESTRICT network cannot be joined without AHS network credentials, whereas HEALTHSPOT can be joined without need for a username and password.

Answers: A few pointers can prevent common connection frustrations:

Credentials
A first attempt connecting to AHSRESTRICT will trigger a request for the user's AHS network credentials. Be sure to use the "user name" and "password" combination that also works for AHS email and Connect Care access.
Network Domain
Take notice of any pick-list or edit field for the AHS domain to "Log on to", and be sure that this is set for the "HEALTHY" network.
Security Certificate
An alert or warning (depending upon device type) may follow to the effect that the user needs to accept an AHS "security certificate". Say "yes", however that is expressed for the current device.
Repeats
One may periodically receive prompts to re-authenticate or repeat acceptance of a (new) security certificate. Following the on-screen directions works in most cases. If not, the best work-around is to delete the AHSRESTRICT wireless settings on one's device and then start the wireless connection process afresh.
Other Issues
Please contact the IT Service desk (1-877-311-4300) for assistance if these tips prove unhelpful.

What is Workspace ONE Assist and what does it do?

Question: When help is needed with Connect Care mobile applications (Haiku, Canto), what does the Workspace ONE Assist service have to offer?

Context: Connect Care's mobile apps include Haiku for smartphones (iPhones and Android devices) and Canto for tablets (iPads). Users may require help but find it difficult to describe specific problems. Problem resolution can be facilitated when users share their screen to allow technicians to directly visualize what they are experiencing.

Answer: VmWare's Workspace ONE Assist service works over any network connection (cellular, AHS WiFi or external WiFi) so that, subject to end-user permission (users have to accept explicit prompts before a connection is established), users can demonstrate problems to help desk staff. The Assist service may be offered to users when contacting Connect Care help (help.connect-care.ca) for assistance with Connect Care mobile apps.

There are some limitations and protections:

Connected analysts may see user names entered to the mobile device during a screen share, but not passwords.
Pop-up messages appear during screen sharing may be visible to help desk staff.
Assist access is limited to display-screen sharing and does not include files or other information stored on mobile devices.
End users can terminate an Assist share at any time.
The Assist service is not intended for questions concerning non-Connect Care applications or for general mobile device performance issues.

Is a Goals of Care Designation valid when printed from Connect Care?

Question: Is a Goals of Care Designation (GCD) record that has been generated from a Connect Care order, then printed, valid?

Context: A GCD status record is automatically printed when goals of care orders are entered to Connect Care and signed by authorized providers. The printed "green sleeve" document is provided to patients and may later be important to, for example, paramedics or non-Connect Care transfer destinations.

Historically, GCD paper forms were "wet-signed" by prescribers. Printed digital GCD records do not have a "wet" signature but are instead considered electronically signed. Some may question whether the e-signature is valid without a handwritten signature from the ordering prescriber.

Answer: A GCD order generated from Connect Care, like all medical orders, is considered valid without any addition or change. An e-signature generated within Connect Care verifies this. If authenticity verification is required, the order with the e-signature can be viewed in the Advance Care Planning (ACP)/GCD navigator.

Manual: Goals of Care Management

How is discontinuation of isolation ordered for patients on COVID-19 precautions?

Question: Are there special considerations when discontinuing isolation for patients with COVID-19 risks, exposures or disease?

Context: Inpatient and emergency patients can be placed on contact and/or droplet and/or airborne precautions by means of an "Initiate Isolation" order. A different order is required to remove isolation precautions already in place.

“Discontinue Isolation” orders must be mindful of evolving COVID-19 protocols. The order composer reflects this by providing within-order links to current guidance and policy while also providing pop-up summaries of relevant clinical data from the patient's chart.

Answer: The discontinue isolation order is unchanged for most exposures. There are special requirements for discontinuation of COVID-19 precautions. Ordering prescribers are asked to affirm that the order complies with those requirements. Links to both relevant guidance and data are provided within the order to facilitate efficient workflows.

Tip: Isolation Precautions - Inpatient and Emergency

How can an inpatient's provider service be changed by ward clerks?

Question: How can the clinical service for an inpatient be corrected by a ward clerk?

Context: Inpatients are associated with a location (e.g., emergency department, ward, facility), a clinical service (e.g., family medicine, general internal medicine) and one or more inpatient or consultant provider teams.

The clinical service assignment is important. It affects the integrity of lists and reports. Patients are assigned to an appropriate clinical service (e.g., general surgery) as part of admitting and bed allocation workflows.

The clinical service can change during an admission if a patient is transferred to a new service (e.g., cardiology, critical care) or when patients are moved within a facility to manage things like outbreaks. Bed management and service census reports depend upon accurate service attachments.

Intra-facility transfer workflows are largely facilitated by non-prescribers, who can double-check and correct inpatient service assignments. The current service attachment is easy to see. Look to the StoryBoard (leftmost column) and the "ADMITTED" section. Hover to reveal admission details, with the "Service" identified:

Answer: Service assignments can be updated during intra-facility transitions. The following steps are available to ward clerks (inpatient unit clerk role), with similar workflows available to nursing and inpatient unit managers.

With Hyperspace opened to an appropriate role and department (e.g., specific ward), select the "Unit Manager" workspace, which lists patients in the location for the login department.
Select a patient by clicking within the appropriate row of the unit list.
Select the "Update" button from among the command buttons at the top of the Unit Manager workspace.

If the Update button is not present, be sure to check the personalization tool (wrench icon at far right of button row at the top of the Unit Manager workspace) for rarely used buttons that can be dragged back to the Unit Manager button bar.
The selected patient chart will open with an "Update Admission" activity displayed by default. Look to the "Service" field, where a new inpatient service can be selected (be sure to document the reason in the field provided by selecting "Patient Status/Service Changed"). The "Finish" (bottom-right) button must be used to save the change.

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