Connect Care FAQ

Can I use Z-codes to change the status of a patient to Alternate Level of Care?

Question: Can I enter Z-codes to indicate the barriers to discharge that cause my patient to remain in hospital as an Alternate Level of Care (ALC) patient?

Context: When inpatients no longer need the intensity of care or level of service provided by their admitting acute care facility, it is important for the Most Responsible Provider (MRP, usually the attending prescriber) to change their "patient status" to "Alternate Level of Care" (ALC). The ALC designation effectively stops the clock measuring a patient's actual length of stay (LOS). Recognizing when medical management has finished and switching to ALC status is among meaningful use norms expected of prescribers.

The easiest way to make changes to the inpatient status is to use the "Level of Care" column in patient lists. This is built-in to the Rapid Rounds patient list template. Double-clicking on the LOC row value for a patient opens a pop-up editing tool where the "ALC - TBD" button should be used.

Prescribers can also initiate an ALC status using the "Orders" activity, by using an "Initiate ALC" order or a "Patient Status" order, then using the "ALC - TBD" speed button.

It is important that prescribers ONLY select "ALC - TBD" and not Z-codes. Transition coordinators and/or nursing staff take care of more detailed (Z-code) ALC statuses. Selecting Z-codes too early can trigger direct charges to the patient.

Note: If a patient already has an ALC status and an "Initiate ALC" order is entered with "ALC - TBD" selected, any Z-codes assigned to that patient will be overwritten.

Answer: To change the status of a patient to Alternate Level of Care, the MRP should use the "Level of Care" patient list column or enter an "Initiate ALC" order. Either way, it is important to use the "ALC - TBD" quick-button, and to NOT select ALC statuses with Z-codes. Prescribers can document barriers to discharge using the Expected Date of Discharge (EDD) comment field and the Discharge Planning report built-in to the inpatient sidebar.

For more information:

What happens when a Restricted Medication Therapy Plan has a date change?

Question: Why do I need to re-sign a Restricted Medication Therapy Plan when only the date has been changed?

Context: Therapy Plans can be entered in advance and expected dates may change. While nursing can make changes to Therapy Plans, plans with Restricted Medications cannot be signed by nurses. Therefore, if there is a date change to a Restricted Medication Therapy Plan, the plan will then have to be re-signed by the prescriber. (Note that Connect Care is continuing to look at options to reduce this workload on prescribers.)

Answer: If a date has been changed in a Restricted Medication Therapy Plan, you will receive a notice in your In Basket indicating that review and re-sign is required.

In the "Recurring Treatments" folder of your In Basket, select the relevant patient.
Click on the 3 dots icon above the message and select "Open Plan" from the dropdown menu that appears.
Review and edit, if necessary.
Sign the plan.

For more information:

What happens to patient messages sent via MyAHS Connect to their physician?

Question: My patient indicated that when they tried to send me a message via MyAHS Connect, they received a reply indicating that direct messaging is not available. Why did it not go to my In Basket, and why are patients able to send these messages?

Context: While patients can send messages via MyAHS Connect to their physicians who are on Connect Care, whether those messages are able to reach a physician’s In Basket is determined by whether that physician is in a department that schedules appointments in Connect Care. If they are, the message will route to the clinical support In Basket pool of that physician’s department, and can then be forwarded by the clinical support pool staff to the physician; these messages can be found in the “Pt. Advice Requests” folder.

A physician working in a mixed context (i.e., working in an AHS facility as well as at a private clinic/office in the community) may be added to a patient’s care team in Connect Care as a Primary Care Provider (PCP) for a patient receiving services with AHS; however, their role as PCP is related to the community clinic. Patient messages sent in this case would not be related to their care with AHS nor to the work the physician does in AHS. As there are no pools or structure to support these messages, the messages are routed to an IT team error pool instead of to the intended physician.

Answer: When IT receives a message sent by a patient via MyAHS Connect that is intended for a mixed-context PCP, IT will confirm that it was intended to go to a physician who does not have a department that schedules appointments in Connect Care and therefore does not have a clinical support advice request pool to support message management. IT will then respond to the patient, letting them know their physician cannot be reached via MyAHS Connect, and to instead contact the community clinic directly. IT will no longer forward these messages to the physician. Connect Care is working on a technical solution to prevent patients from being able to send messages to physicians on their care team who do not have an associated pool structure to support them.

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.

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).
Provide the paper TPP to the patient, or fax to the pharmacy (see guide).
Destroy any leftover paper 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 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 is automatically sent (fax for now, digital in future) to the patient's registered pharmacy. In the absence of a preferred pharmacy, the medication list is provided to the patient together with printed prescriptions for them to take 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.

How can patients view and print immunizations in MyAHS Connect?

Question: How can patients view and use Connect Care immunization records, including COVID-19 vaccinations, using the MyAHS Connect patient portal?

Context: Pandemic public health directives have increased the importance of ready access to immunization information for Albertans.

The Netcare provincial electronic health record contains a good representation of COVID-19 vaccinations administered in Alberta (although some pharmacy and other locations can be missed). Patients can download and print a PDF summary via a dedicated website (www.albertavaccinerecord.ca). Their Netcare information can also be viewed and printed from MyHealth Records.

The Connect Care clinical information system also contains an immunization record, which receives information from Netcare and other clinical information systems. It also contains information added by clinicians to fill gaps where immunizations were performed in other jurisdictions or countries. In short, the Connect Care immunization record is part of the patient's digital chart, supporting where Connect Care is the record of care. Patients may ask if and how they can access and print immunization information using the Connect Care patient portal, MyAHS Connect (https://ahs.ca/mac).

Answer: Once logged in to the web version of MyAHS Connect, patients can enter "imm" in the top search box of the portal "Your Menu" tool, then select the "Health Summary - Immunizations" option that appears.

At the "Health Summary" screen, be sure to select the "Immunizations" tab, then select "View details" for COVID-19 vaccinations (grouped in one box).

With the COVID-19 vaccinations display opened, use the print icon appearing at the top right to generate a PDF file that can be saved or printed.

While immunizations can be viewed through the MyAHS Connect "MyChart" mobile app, the app does not support rendering to a PDF file for printing or saving. The app is useful for reminders about the types and dates of immunizations.

Should an implant be documented as a problem or history item?

Question: Is it best to draw attention to an implanted medical or surgical device by adding it to the problem list or to the surgical history list?

Context: Medical or surgical devices may be attached to or implanted within a patient. These are important to document in a structured way, as this facilitates use of the information in clinical decision support and awareness during relevant interventions. For example, that a patient has an artificial hip matters when selecting the type and duration of antimicrobial therapy for septic arthritis; that a patient has an inferior vena cava filter is essential to know when considering interventional radiology procedures or angiography.

Answer: The answer is neither the problem list or the surgical history list. There is a dedicated place where information about devices and implants should be documented.

The "Devices & Implants" section of the "History", "Problem List" and "Problem Oriented Charting" activities gives easy access to tools for adding, updating and removing relevant information. The same functionality can be accessed via a global (chart) search for "Implant" and then selecting "jump to implants".

With the "Devices & Implants" tool open, first see if the object of interest has already been documented. If not, use the "New Implant" button to start the documentation process.

The data capture interface that appears may be intimidating, with many details that could be entered. Detail matters most for devices requiring regular surveillance until an anticipated explantation date. For other objects, it is sufficient to indicate the type of implant, name, status and insertion date. If no appropriate category appears in the pick-list for implant types, then that field can be left empty and a descriptive name entered for the device or implant of interest.

Device and implant data is incorporated into standard documentation objects (e.g., admission history & physical, discharge summary) and can be added to other documentation with the ".DEVICEHXT" SmartLink.

In general, the existence of a device should not be documented in the problem list or in the surgical history section of the chart. Those sections might appropriately reference an entry in the Devices & Implants list when relevant to another problem or health event.

Manual: Documenting Devices and Implants

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. The same section can be used to reprint the discharge prescriptions.

With the After Visit Summary section open, note how an add icon ("+") can be used to include the "Discharge Medications" (prescription) among the document(s) to be (re-)printed. The remove icon ("x") can be used to de-select other documents for printing.

Unfortunately, there is a catch. The document(s) will print to the designated printer for the patient's current location. This is by design to ensure that support staff on the relevant nursing unit can provide materials to patients being discharged... and to follow their instructions for faxing materials to a pharmacy of choice.

There may be situations when a prescriber needs to direct the prescriptions to a device (printer, PDF or print-fax) in a location distant from the inpatient unit. The prescriber may not be at the patient's discharge location at the time of departure and may need to print, sign and send without returning to the unit.

Answer: The following workflow assumes that the discharge medication reconciliation is complete and that discharge orders are signed. The trigger for printing discharge documents at the nursing station is a signed discharge order.

Use the Discharge Navigator After Visit Summary section, as described above, to select and print the discharge medications. This will print to the nursing station.

The discharge prescription can be reprinted to a local device using the following steps:

Open the patient's chart (be sure to open to the relevant inpatient encounter).
Use Chart Search (in Storyboard or at the top right of Hyperspace) with the term "print" to find and "Jump to" the "My Printouts" activity.
When opened, My Printouts should list all recent print activities initiated by the user's actions, including the most recent. Use the "Print Again" link in the rightmost column of the row for the latest AVS print event.
This time, a printer selection dialog is presented. Locally attached printers, including "Save to PDF", are available for selection. The rest is as usual for local printing.

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.

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