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.

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 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.

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.

  1. 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.

  2. Select a patient by clicking within the appropriate row of the unit list.
  3. 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.

  4. 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.

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: 
  1. Open the patient's chart (be sure to open to the relevant inpatient encounter).
  2. 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.

  3. 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.

  4. 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.

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.