Why is COVID-19 vaccination information missing in Connect Care?

Question: Why does an important immunization (e.g., first dose COVID-19 vaccine) not appear in the Connect Care immunization history?

Context: A blog posting clarifies where in Connect Care a patient's immunization history can be found, and a Manual section explains how to add vaccination information to that history. The Connect Care record of care should have a complete listing of the most recent instance of all vaccination types, just like it should have a complete listing of a patient's medications, problems and surgical history.

Many prescribers are not accustomed to checking immunization histories. However, this has become increasingly important to pandemic care. Accordingly, more is being done to automatically pull recent immunizations into things like summative documentation (e.g., discharge summaries), health maintenance reminders and even order sets.

Most patients will have some information in their Connect Care immunization record. This may have come from system interfaces with Netcare or pre-Connect Care legacy clinical information systems (e.g., eCLINICIAN). However, there are many reasons why the immunization record may be incomplete:

  • System interfaces are recent and may not include relevant immunizations (e.g., pneumovax) from many years ago.
  • Some immunizations (e.g., some private travel vaccination clinics) may not share information with provincial systems.
  • Immunizations may have been received outside the reach of provincial immunization management systems.
  • Some immunization information shared with Connect Care from external systems is added at set intervals (e.g., end of month), and so may appear in Connect Care days to weeks after administration.
It is important for prescribers to know how to add important missing information when patients present with a valid immunization record from external sources.

Answer: When a patient reports having had COVID-19 vaccination but there is no corresponding record in the Connect Care immunization history, consider whether this might simply result from a delayed interface information feed. If the patient has the immunization record provided at the time of vaccination, a clinician can enter this information to the Connect Care record.

Does Connect Care In Basket or Secure Chat support attachments?

Question: Is there any way to attach an image or document to a Connect Care secure chat or In Basket message?

Context: Alberta Health Services clinical communications norms promote use of the Connect Care clinical information system whenever communications may contain personal health information. This makes sense, but what if one needs to send a clinical document, image, video or other digital file object to a colleague? The object will contain some form of personal health information.

The Connect Care clinical information system (CIS) can be used, within limits, to share clinical information objects with others in the patient's circle of care. However, the framework for doing this is patient-centric. The object (e.g., investigation results from an external system that does not interface with the CIS) must first be attached to the patient. Then the patient chart (with a pointer to the object of interest) can be sent to another prescriber for review. This ensures that clinical attachments benefit from the same privacy and security protections as the rest of the chart. 

A single exception involves use of Connect Care mobility (Haiku or Canto) with secure messaging also supports capture of an image for sending to a Connect Care colleague without having to first attach that image to a patient chart.

Answer: The following workflows support clinical document sharing, with the second working best for images newly captured with Connect Care mobile apps.

In Basket Message

  • Open a patient chart, then the "Chart Review" activity, then the "Media" tab.
  • Find the chart attachment (object) of interest and select its row in the list of Media objects.
  • Use the "Route" button/command at the top of the Media list, then select one or more Connect Care users to send the object to.


  • Upon sending, the recipient will find a "CC'd Chart" In Basket message with the media object attached and immediately viewable without having to open the patient chart.
  • A slightly more complicated workflow is supported through the Media Manager activity (Tip: Sharing Objects attached to a chart).
  • This same method can be used to direct some objects (documents) to external clinicians via their preferred clinical communication method (e.g., fax, mail, eDelivery).

Secure Chat Message

  • Open secure chat (in Hyperspace, Haiku or Canto).
  • Set up a message to one or more Connect Care users.
  • Select a patient to attach to the message.
  • Note the image icon just to the right of the message text box, select this, then select from the patient chart media objects and send the text message with an attached object.


  • This same method can be used with mobile apps to send a quick image (captured with the mobile app) to a colleague even if a patient chart is not selected first.
More Information:

How can I report an adverse effect following immunization?

Question: How can prescribers satisfy requirements for reporting adverse effects following immunization (AEFI)?

Context: In a separate posts, we describe how to report a patient safety event and how to report serious adverse drug reactions. There is yet another process for reporting adverse effects following immunization (AEFI), defined as an unfavourable health occurrence experienced by a patient that:

  • follows immunization
  • cannot be attributed to a pre-existing condition
  • is determined by a health practitioner to be one or more of:
    • a life-threatening health occurrence requiring hospitalization or urgent medical attention,
    • an unusual or unexpected health occurrence not previously identified or previously identified but of increasing frequency,
    • a health occurrence that cannot be explained  by the patient's medical history, recent disease, illness or use of a medication.
All AEFIs must be reported to the AHS Provincial AEFI team. 

Answer:  AEFI reports can be initiated from within within Connect Care. From within an opened patient chart, seek the "Serious Adverse Drug Reaction Form" activity or use Chart Search with "Serious" as a keyword before jumping to the SADR activity.

Note the "Adverse Effects Following Immunization (AEFI) are reported HERE" link at the top of the SADR activity. Select (click on) this. A popup web page will appear with instructions and a link to the online reporting form.


Once completed and signed, the report is automatically directed for review and reporting.

Related postings:

How can I report a Serious Adverse Drug Reaction?

Question: How can prescribers satisfy requirements for reporting serious adverse drug reactions (SADR)?

Context: In a separate post, we describe how to report a patient safety event. Safety threats that specifically relate to serious adverse drug reactions are subject to federal (Health Canada) reporting requirements and so have unique supports within Connect Care.

To be "serious", an adverse drug reaction should cause or potentially cause a:

  • hospitalization or prolongation of an existing hospitalization
  • congenital malformation
  • persistent or significant disability of incapacity
  • life threatening situation or death
Answer:  SADR events can be reported from within Connect Care. From within an opened patient chart, seek the "Serious Adverse Drug Reaction Form" activity or use Chart Search with "Serious" as a keyword before jumping to the SADR activity.


Note the "Adverse Drug Reaction Note" in the SADR navigator and create a note. A NoteWriter "SmartForm" will open to highlight the required reporting elements. Any clinician can initiate the SADR report. However, the patient's attending prescriber must complete the indicated section, with details about:
  1. The impact of the adverse drug reaction on the patient's health.
  2. Any comorbidities which may have affected the impact of the adverse drug reaction.
  3. The date on which health was restored (if applicable).

Once completed and signed, the report is automatically directed for review and reporting to Health Canada.

How can short-term (on-call) coverage assignments be reflected in Connect Care?

Question: Are there tools in Connect Care that prescribers can use to quickly reflect changes in on-call, attending or other patient-prescriber attachments?

Context: Prescriber-patient attachments (e.g., attending, consulting) can change when prescribers come on or off rotation, or take on-call responsibilities. Connect Care provides in-system tools for managing these changes. These are especially useful for short-term patient coverage changes, such as on-call or weekend assignments. The tools do not replace other systems (e.g., ROCA) used to manage call schedules.

There is no one way to express coverage responsibilities. It is essential that local groups forge a clear understanding about how prescribers will manage and reflect sign-overs within Connect Care.

Answer: A new Manual section and Tip describe and illustrate tools that facilitate quick changes to prescriber-patient attachments, either one-at-a-time or many-at-a-time. Examples of how these tools can be used include:
  • Switch Attending Prescriber responsibility for an inpatient
    • Need: Prescribers may shift a few patients after night-call in order to better balance patient loads or for a better fit of patient need to prescriber expertise.
    • Action: Use Care Teams via StoryBoard or Chart Search to take-over or reassign the attending prescriber.
  • Switch Attending Prescriber responsibility for a group of inpatients
    • Need: Prescribers often have assigned "rotations" with responsibility for an inpatient service or location for a defined period, after which all patients are signed over to the next attending.
    • Action: Use Patient Lists (System Lists for patients grouped by a physical location or department, Provider Team Lists for patients assigned to a specific service, Personal Lists for patients manually grouped by a prescriber) to select multiple patients and reassign attending responsibility for all grouped patients at once.
  • Designate a prescriber with inpatient on-call responsibilities for a defined period
    • Need: A prescriber may take responsibility for a group of patients for an on-call or weekend period, without changing who is designated as the attending prescriber.
    • Action: Using either Care Teams (one patient at a time) or Patient Lists (many patients at a time), add the covering prescriber as an "On Call Covering Physician", specifying a start and a stop time and any specifics about contacting that prescriber.
  • Hand over responsibility for outpatient communications for a defined period
    • Need: A prescriber may be away for a period, with arrangements for another prescriber to handle any outpatient-related communications during that period.
    • Action: Temporarily assign the "out of office" prescriber's In Basket to the covering user(s) and/or message pool(s).
Tools and techniques for taking any of the above actions are illustrated in the Manual and Tip.

Why can't I log in to my job type?

Question: Why can't I log in to my other job type in Hyperspace or Haiku/Canto?

Context: If a prescriber has multiple roles (job types; e.g., emergency, family medicine and anesthesia) in Connect Care, it is important to be mindful of limits to multi-job workflows. One cannot be signed on to Connect Care with more than one job at a time. Normally users are protected from conflicting job sessions by the fact that only one Hyperspace session can be open for a given user at a given time; and one chooses a job/role at each login.

Connect Care does allow a user to have both a mobility session (Haiku or Canto) and a Hyperspace session open at the same time. This can lead to conflicts. Haiku and Canto open into the last job/role that a user signed on with in Hyperspace. If Haiku or Canto remain open when the same user tries to use Hyperspace to log in to a different job, an error message is received. 

Answer: The job type choices available when a multi-job prescriber logs in to Hyperspace or Haiku/Canto depends upon whether the same users is already logged in to Hyperspace with another other job type.

  • Logging in to Hyperspace:
    • If not already logged in to Haiku/Canto, one can log in to Hyperspace selecting the desired job.
    • If already logged in to Haiku or Canto, then one can only log in to Hyperspace with the same job type used by Haiku/Canto.
      • Solution: To switch jobs in Hyperspace, log out of Haiku/Canto (closing the app is not sufficient), then retry logging in to Hyperspace.
  • Logging in to Haiku or Canto:
    • If not already logged in to Hyperspace, one can only log in to Haiku/Canto with the user's default job type.
      • Solution: To change one's default job type for Haiku/Canto, submit a request to the service desk (help.connect-care.ca).
    • If already logged in to Hyperspace, then one can only log in to Haiku/Canto with the same job type used by the active Hyperspace session.
More information:

Are there limits to Connect Care Mobility supports for Orders?

Question: What sorts of orders can be entered using Connect Care mobile device applications (Haiku and Canto)?

Context: Haiku for smartphones (iOS and Android) and Canto for iPads are mobile applications from Epic Systems that bring a lot of chart review and patient management functions to prescribers wherever they happen to be. These apps do a few things better than the full Hyperspace user interface. However, most Hyperspace capabilities are only partially reflected in mobile apps. 

Answer: There are major differences in what is supported through Haiku and Canto versus Hyperspace, and significant differences in what is supported in Haiku for iOS versus Haiku for Android. For example, while the mobile apps generally have limited ordering capabilities, the limits are greater on Android devices:

In general, while Haiku for Android offers excellent communication and chart review support, data entry functions like note-taking, ordering and image capture are better supported with the iOS version.

Note that mobile apps are constantly improving, reflecting an Epic Systems top development priority. Prescribers will be able to do more, with greater ease, over time. Improvements affecting prescribers are periodically posted in blogs linked to the Manual mobility page.

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 the occasional test or procedure order. Possible reasons for delays or declines include:
  • Wrong Test
    • A vast number of tests are available to request via Connect Care, using a catalogue that includes 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 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:
  • Reference: Alberta Precision Laboratories Test Directory
  • Reference: DynaLIFE Medical Labs Test Directory

Why are some lab results missing from Connect Care mobile apps?

Question: How is it that some laboratory results available for viewing in Hyperspace do not appear in Mobile app (Haiku, Canto) displays?

Context: Not all lab results are available to Haiku or Canto. A default lookback period (2 years for outpatient labs; 1 week for inpatient labs) ensures that the apps remain quickly responsive, even on slow networks; while not consuming too much of a users's mobile data allowance. 

Answer: Two years of outpatient results was selected as the best compromise between comprehensiveness and responsiveness of mobile access. Given the large number of results commonly associated with hospital admissions, 1 week was thought a reasonable lookback limit for inpatient tests. It is recognized that these thresholds may not work well for all settings (e.g., Long Term Care). A working group is re-examining lookback periods for different patient contexts.

What needs to be recorded in Connect Care when an outpatient prescription is refilled?

Question: What is the minimum work required in Connect Care (where it is the record of care) when a pharmacy requests a prescription renewal/refill? 

Context: Busy outpatient physicians may receive faxed prescription refill requests from pharmacists serving the physician's patients. The legacy convenience was to simply sign and return the pharmacy fax. 

Now that Connect Care is the legal record of care, physicians new to Connect Care suffer significant information burdens if the pharmacy request is taken as a trigger to enter all meds (for a patient not yet seen in Connect Care), generate a new prescription, print, sign, scan and fax back to the pharmacy.

Unfortunately, ePrescription is not yet available in Alberta.

Answer: An acceptable interim workflow is to sign and fax back the pharmacy-provided refill request. The prescriber can then enter just those meds to the patient chart, to document the prescribing action. An additional printout does not have to be generated from Connect Care. Later, when the patient appears for an appointment, a full list of home medications can be generated and validated.

The key is that Connect Care, as record of care, must be used to document prescription activities. 

Once over a transition period, charts will be more complete and refill workflows from within Connect Care will prove the fastest way to get things done.

Why can't I find a known encounter?

Question: Prescribers may know about a patient encounter but fail to find it when looking up encounters within a patient's chart. What's happening?

Context: Patient charts can be opened in or out of a specific encounter. Either way, clinicians may want to review all encounters (known to Connect Care) to get a sense of a patient's interaction with the health care system, or to find, open or change the chart in context of a specific encounter they know to have happened.

Sometimes, despite looking in the right place (Chart Review >> Encounters tab), nothing seems to appear in the encounter log for the expected day or type of encounter.

Answer: The best place to search for past, present or scheduled future encounters is the "Encounters" tab within the "Chart Review" activity. Chart Review is available (usually leftmost activity) in all contexts. If looking for an unusual encounter type, be sure to uncheck the "Hide Add'l Visits" filter box. 

If the encounters listing is very long, consider selecting the "Filters" tool and then choose encounter types that match what one is looking for.


Consider using "Chart Search" with keywords specific to the desired encounter type (the keyword should be part of the encounter name; e.g., "Telephone"). This often works well for quickly finding specific encounters.

Finally, it is possible that the encounter of interest occurred at a facility that does not use Connect Care as the record of care or does not interoperate with Connect Care to share health encounter information.

What are "communication" orders?

Question: What is the purpose of a "nursing communication" order in Connect Care?

Context: Communication orders allow prescribers to record precise instructions for healthcare interventions performed by other members of the healthcare team. 

Communication orders are not a substitute for clinical communication (sticky notes, secure messaging, In Basket, paging, etc.) or clinical documentation activities (progress notes, discharge planning, etc.). Nor are they a substitute for otherwise available medication, procedure, imaging or consult orders.

Rather, communication orders are used to set limits on the application of other orders (e.g., parameters to be followed when deciding when to alert a responsible prescriber to concerning clinical observations), guide application of another's professional skills (e.g., instructions about bedside care, dressings or other in-person interventions) or over-ride default protocols (e.g., instruct to discontinue vital sign measurements as part of a compassionate care plan). 

Answer: Use Order Search with "communication" as a keyword in order to find and initiate a "Nurse Communication" order. Frequency, duration and other logistical details can be entered, just like other procedural orders. The "comments" field is a hard-stop, ensuring that this order is used to provide specific instructions.

Does Connect Care support generic logins for shared clinical workstations?

Question: Some facilities have grown accustomed to using "generic" workstation login credentials, usually specific to a location (clinic, unit, ward, etc.). The associated user ID and password are known to those who work there. How might this affect Connect Care?

Context: The Connect Care clinical information system interacts with a host Windows operating system (software that runs on most clinical workstations) to gain important information about the current user, location, printer, etc. 

The credentials used to access a workstation matter. Problems can occur if the same user ID and password are used on two different workstations at the same time.

Answer: It is very important to ALWAYS log in to an AHS computer workstation (and then Connect Care) with one's own unique credentials (user name and password). This prevents "session stealing" and other information system challenges. "Generic" logins should not be used.
[ access, generic, account ]

How can ED prescribers admit to a different facility?

Question: How can an ED prescriber at one site (without inpatient beds) admit to a partner site (with inpatient beds)?

Context: Some AHS facilities have an emergency department (ED) service but no inpatient beds. A partnered (usually rural) facility has inpatient beds and the ED prescriber may be admitting a patient from the first ED to the receiving second facility. Indeed, the prescriber may have cross-covering responsibilities at the second site. 

Answer: Such workflows should be handled like an Interfacility Transfer from one Connect Care site to another for direct admit. There are some special considerations:

How can Therapy Plans be scheduled in Emergency Departments?

Question: How can Therapy Plan treatments be scheduled for actions to take place in Emergency Departments (EDs)?

Context: Therapy Plans help organize the delivery of tests and therapies for a specific health condition. They are most commonly used in medical outpatient units and outpatient clinics. Examples include IV Iron Therapy, Transfusions and some Antimicrobial therapies.

Sometimes a Therapy Plan is initiated or continued in an ED setting. There may be considerations unique to the intended ED, its Connect Care status, and how scheduling is supported.

Answer: A tip summarizes two options for scheduling therapy plan activities in participating EDs.

How can I reprint a discharge prescription?

Question: How can I reprint a discharge prescription from the Connect Care clinical information system?

Context: The standard Connect Care discharge process is guided by a Discharge Navigator. The easiest way to make sure that things like discharge prescriptions and medication instructions print is to follow all the steps in the navigator (in order). 

At the point that the discharge order is signed, two documents are printed for the patient to take home. An "After Visit Summary" (AVS) includes information about the hospital stay, together with easy to understand alerts to continuing, changed, discontinued and new medications. An accompanying "MedRec for Community Pharmacist" summarizes changes from prior home meds. 

Any new medication prescriptions are also printed, as a third document, with expectation that the prescriber will sign these (wet signature) for delivery or fax to the chosen pharmacy. 

The AVS and pharmacy instructions can be reprinted at any time from the "After Visit Summary" section (last) in the Discharge Navigator, and the user can select a local printer for this purpose. 


Unfortunately, the same ease of re-printing is not presently available for actual prescriptions (note: the "MedRec for Community Pharmacy" cannot serve as a prescription). The physician may not be at the patient's discharge location at the time of departure and may need to print and sign prescriptions at a different (physician-local) printer.

Answer: The following workflow assumes that the discharge medication reconciliation is complete and that a discharge order is signed. 
  1. Open the patient's chart (be sure to open to the relevant inpatient encounter).
  2. Open the "Orders" activity.
  3. Select the "Order History" tab within Orders.
  4. The recent discharge medication orders should appear at the top of the list (reverse chronological sorting... toggle the "Event Time" column header if not sorted by default)
  5. Select a medication by clicking on its name-row, then look to the report that appears (below or to the side) and scroll down within the report to find a "Reprint Prescription" section. 
  6. Select the medication link within the Reprint Prescription section. A preview of the prescription will appear.
  7. Right-click, then select the "print" command from the pop-up menu that appears. Select the desired printer and proceed.

One can also go to the "External Orders" tab (within the Orders activity, since the discharge orders are external to the inpatient admission), look to the bottom "Signed External Orders" section, select a drug name, then scroll down to the "Reprint Prescription" section of the pop-up report that appears. Again, select the medication name in that Reprint Prescription section, then use the right-click print command or the print icon (at top of pop-up report).

A similar workflow can be used when selecting the "Meds" tab under the "Chart Review" activity in an open chart.

The downside of these alternative discharge prescription workflows is that each medication is printed to a separate page.

How are Goals of Care reviewed and changed in Connect Care?

Question: Where can a clinician quickly determine a patient's current goals of care designation (GCD), review past decisions, change a designation and record a rationale for change?

Context: A Goals of Care Designation (GCD) is a medical order used to describe and communicate the general aim or focus of care, including the preferred location of that care and any limits placed on care.

It is important to ensure that all patients have an active GCD, to enter new GCD orders with care, and to periodically review GCD orders in compliance with advanced care planning policies. All changes to GCD orders should be paired with documentation of both the authorization and reason for change

Answer: The Connect Care Manual has a short entry highlighting the most important things for prescribers to know about managing GCD orders and documentation, with links to more detailed guides. The following are explained:

  • Quickly finding current GCD information via the Patient Storyboard
  • Identifying patients/charts with missing GCD information
  • Entering and changing GCD orders
  • Using the GCD Tracking tool to record more detailed patient instructions or considerations
  • Finding and attaching external GCD documents to the patient chart

How can one prescriber order on behalf of another?

Question: How can a prescriber enter an order on behalf of another prescriber without disrupting intended results routing?

Context: There may be situations during cutover or soon after launch when prescribers (e.g., Super Users) need to help others in order for patient care to proceed safely.

Answer: First, prescribers should not enter orders on behalf of one another. This is not consistent with Connect Care Ordering Norms. The substitute prescriber may not handle decision supports, and other order-linked activities, appropriately. Most importantly, the accountable prescriber should place orders so that it is clear who to contact if clarification is needed and so that any associated results or communications get to the right person.

If a provider must enter an order on behalf of another, then the correct Authorizing Provider must be selected via the Options >> Providers drop-down menu (in the Orders sidebar) to avoid incorrect results or communications routing.




Again, entering an order for another provider is NOT recommended. This workflow can have unwanted downstream and backend consequences, particularly if the providers have different login departments. 


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: 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 have some unique properties that reflect new and evolving policies for COVID-19 precautions. An enhanced order becomes available April 9, 2021, illustrating how just-in-time instruction, guidance and documentation can be supported with an integrated workflow. 

Answer: The discontinue isolation order is unchanged for most exposures. There are special requirements for discontinuation of COVID-19 precautions. These are addressed through a linked progress note, automatically created from within the discontinue isolation order:

Where is that Intake (RAAPID) encounter?

Question: Prescribers who have participated in, and later seek follow-up access to, an "Intake" encounter may have difficulty finding this in the usual places. What could be the problem?

Context: RAAPID consultations facilitate care of patients in their home facility, as well as transfer to other facilities when needed. Associated communications, documentation, billing and other clinical activities can be managed through the "Intake" encounter created by RAAPID services when a consultation, referral or transfer event is initiated. The correct encounter is automatically opened when prescribers seek the relevant patient in a "My RAAPID Consults" or similar system patient list.

There may be reason to go back to an Intake encounter after the RAAPID event has closed and the patient has dropped off the associated system patient list. For example, additional documentation may needed or professional billing taken care of.

Answer: Intake encounters can be found within any opened patient chart. Go to the "Chart Review" activity and then select the "Encounters" folder. Look for encounter(s) of the "Intake" type. If not listed, be sure to uncheck the "Hide Add'l Visits" filter checkbox. 


If the encounters listing is very long, consider selecting the "Filter" tool and then choose encounter types that match "Intake".


The Intake encounter can be opened for additional work by selecting the appropriate row then using the "Encounter" button (above the list) to jump to that encounter.