How can a referral be directed to a specific colleague?

Question: How can a referral for specialty services be directed to a specific individual?

Answer: If the referral is "internal" to a clinic, service or consultant using Connect Care as the record of care for the requested service, then use the "To Provider" field (usually left blank) to request a specific individual.

If the referral is "outgoing" to a service operating outside the Connect Care record of care, then it is essential to use the "To Provider" field. The look-up for this will filter for the requested specialty and will allow selection specific to a provider at a particular location.

If the provider and location of interest cannot be found in the "To Provider" lookup, then the field can be left blank. The referral order process is still valuable and a standardized referral letter can still be generated. You can address the letter to the missing provider and mail or fax with information you possess. It is important to submit a help desk request to have the missing provider added to the Connect Care provider registry.

How can a prescriber know whether to choose an "internal" or "outgoing" Referral?

Question: How can a prescriber know if an "outgoing" referral "class" should be used?

Context: The top of Referral order requests asks for the classification of a referral order as “Internal” or “Outgoing”. Think of the province being divided into health care settings where Connect Care is or will become the record of care and settings where Connect Care is not and will not be the record of care. Referrals that start and end within the Connect Care “sector” are “Internal”, even if the destination clinic has not yet launched the CIS. Referrals that are fulfilled outside the Connect Care sector are “Outgoing” and rely upon delivery and fulfillment steps that occur in other information systems.

Answer: The most practical answer to this question is that "you will know". Connect Care physicians will have a limited number of ambulatory referrals used for commonly requested specialty services. Once one of these referral pathways is figured out, the associated referral order properties can be saved as a personal preference. This includes whether an internal or outgoing order class works best.

If in doubt, start an unfamiliar referral order with the class set to "internal". Try finding the refer-to department of interest. If nothing can be found (with various keyword attempts), then it is likely that the required specialty services is not yet active in Connect Care. The "outgoing" class can be selected and an order placed that involves the referral letter being mailed or faxed to the clinic of interest.

If you believe that there is an error in the list of available internal referral destinations, please send this observation, with specific clinic name(s) to ClinicalOperations-Patient.Access@ahs.ca.

During the early weeks to months post-launch, some clinics may not be fully referral-ready. It is always possible to generate the "internal" referral order and benefit from the standardized referral letter it generates. This can additionally be faxed (from within Connect Care) to the clinic as a fail-safe until referral notifications confirm that closed-loop referral capacity is fully established.

How can prescribers complete an outgoing (external) referral without support staff assistance?

Question: How can a prescriber complete an outgoing (external) referral order (and letter) without medical office support staff assistance?

Context: Physicians working in contexts that have medical office assistant support can place outgoing referral orders (ie., to non-Connect Care specialists) and trust that the support staff will take care of tweaks to the referral letter when ensuring that it routes (fax or mail) appropriately. There are other contexts (e.g., placing an outpatient referral order from within an inpatient context) where such support is not available. And some physicians simply prefer to do things themselves!

Answer: A short (7 min) demonstration walks through all of the steps that a prescriber can independently complete and control when ordering an outgoing referral.

How can Referrals be tracked within a Patient Chart?

Question: How can the state of a referral order be tracked for a particular patient using that patient's Connect Care chart?

Context: Prescribers participating in referral intake and management will do most of their work through In-Basket workflows. Referring physicians can also use In-Basket for referral tracking, as that is where they receive notices about the status of the referrals they have ordered. In addition, referring physicians may wish to quickly check the the status of one or more referrals that pertain to a particular patient.

Answer: The "Chart Review" section of any opened patient chart has a tab labelled "Referrals". Opening this gives access to a list of all active referrals for the current patient. These can be selected to dig deeper, check referral progress and facilitate communications.

How do Physicians triage incoming Referrals via In-Basket?

Question: How does the Connect Care In-Basket help prescribers who facilitate triage and acceptance/rejection/deferral of incoming outpatient referral requests?

Context: Prescribers working as part of a specialty service may take turns triaging incoming referral requests. This step of closed-loop referral management usually requires a decision about the relative priority of a referral, a target schedule-by date and any needed actions for the patient to be ready for the clinic visit.

Answer: A short (6 min) demonstration walks through all of the functions and actions that a triage prescriber can manage through In-Basket alone.

Do Connect Care Referral Workflows address CPSA expectations?

Question: The College of Physicians and Surgeons of Alberta (CPSA) has recently updated standards that physicians must meet respecting the receipt, acceptance, notification and fulfillment of referral requests in outpatient settings. There are metrics and milestones. Would adoption of Connect Care closed-loop referral workflows comply with these standards?

Answer: Prescribers and support staff who use Connect Care referral management tools (both to place and to receive referrals) will use information flows that include all data elements required by the CPSA. Tracking of CPSA events occurs automatically. Required notifications to referring physicians are automatically prompted. For a quick review of CPSA expectations and Connect Care matching functions:

How can an Outpatient Referral be ordered in an Inpatient Context?

Question: Physicians ordering referrals for outpatient specialty assessment cannot find the needed orders when using the Order activity in inpatient encounters. How can follow-up consultations be arranged?

Considerations: Whereas inpatient consultation requests can only be placed from inpatient or emergency contexts, outpatient referrals are available to outpatient, inpatient, emergency, critical care or continuing care contexts. Unfortunately, inpatient and outpatient order catalogues are different. Users may be frustrated when trying to find outpatient referral orders from within an inpatient order navigator.

Answer: Outpatient referrals can be ordered during Inpatient encounters, but there are a few tricks to be aware of. Emergency physicians need to pay attention to where ("After visit procedures") the referral order may appear. Inpatient physicians need to use either the Discharge Navigator or an External Orders tool to make the outpatient referral arrangements; all explained in:

How are Referring Prescribers notified of a Referral's progress?

Question: How are referring physicians notified of the receipt and processing of their request?

Context: Connect Care has a standardized approach to communicating about the progress of outpatient referrals and appointments.  The Referrals workflow has been designed to transform the referral experience for both clinicians (sender and receivers of referrals) and patients. It meets expectations of CPSA Standards for Referral Consultation, Path to Care and the AHS Wait Time Policy.

Answer: Once a referral has been accepted and processed, an “accepted and waitlisted” letter will be automatically sent to the referring provider according to the communication preferences they have indicated in the system.  Typically, these communications will route via InBasket. If the provider does not use Connect Care, the letter will be generated for print and mail or RightFax.

A number of automated notifications are sent to the referring prescriber as Connect Care referrals pass milestones in close-loop referral management.

Where can Optimization Clinic Resources be found?

Question: Each week of post-launch optimization training has a different theme, with a mid-week optimization clinic as the anchor event. Where can prescribers access recordings and other resources (e.g. tip sheets) that relate to the optimization recommendations?

Answer: Preliminary resources are described and linked in the physician updates blog (blogs.connect-care.ca) at the beginning of each week. Other resources arise during the week, especially answers to questions raised by Connect Care users. These are described and linked at the end of each week. The following exemplifies this approach for the Referrals Workflow theme:

How can I bill retrospectively?

Question: Sometimes busy clinicians are not able to bill for professional services at the time of a patient's hospital or clinic encounter. How can one, within the limits allowed by Alberta Health, go back and submit a claim for services performed in the past?

Answer: The Connect Care Service Code Navigator (SCN) works best when a patient's chart is opened in a current encounter (hospital admission, clinic visit, etc.). However, it is also possible to use SCN to submit claims for services associated with encounters that have already closed (patient discharged, clinic visit closed, etc.). The trick is to open the chart, then open the correct encounter, before using SCN.

For services associated with inpatient admissions:
  • Open the patient's chart.
  • Seek the "Select Encounter" activity (tab) by finding it in the "more" list of additional chart tabs or using the global search with the keywords "select encounter" and "jump to" the activity.


  • Double-click on the "admission" encounter of interest. This will open that encounter and change the chart view to resemble an admitted patient.
  • Seek the "Service Code Navigator" activity (tab) by finding it in the "more" drop-list or use the global search with the keyword "service code".

  • You can use the SCN as if the patient is still admitted, taking care to navigate to the correct date for the billable service using the date selector at the top left of the SCN display.

For services associate with outpatient (clinic) encounters:
  • Open the correct patient chart and select the correct outpatient encounter as described above.
  • Note that an attempt to open the outpatient encounter will cause a query to appear if the encounter is already closed (if the encounter was not closed, the encounter provider can proceed immediately to the SCN and enter a professional billing charge).
  • In order to add a service charge to a past closed encounter, it is necessary to open the outpatient encounter for "addendum".

  • Once the encounter is opened for addending, go to the "Wrap Up" chart tab and work with the "Service Code" activity to record the appropriate professional billing charge.
  • Remember to close ("sign") the encounter when finished.

How can I send a Prescription from Connect Care?

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

Answer: It depends upon what is intended by "Send". Assuming the question relates to outpatient contexts, one could:
  1. Print prescribed medication(s), then sign and provide to the patient to independently 'send' to a pharmacy of choice.
  2. One may want to 'send' a prescription directly to a preferred pharmacy by fax.
  3. One may fantasize about 'sending' a prescription electronically to an external pharmacy information system.
Working backwards, the third option is an aspiration. We await pharmacy information system adoption of standards-based protocols for receiving and reconciling electronic prescriptions. A Canada Health Infoway initiative called "PrescribeIT" addresses the need for standards, currently piloted in Alberta. Connect Care plans to work with this protocol when tested and ready.

The second option is not possible as a matter of policy. Prescriptions must be signed and electronic signatures are not yet accepted in Alberta for the same reasons that option 3 is not tenable now. It may be okay to print, sign, then fax the printed and signed prescription to a pharmacy; or telephone verbal prescription instructions to some pharmacies, where medications are delivered to a home or continuing care facility. 

So, until outpatient pharmacy information systems are able to interoperate with clinical information systems, we are left with printing. One must print medication prescriptions, sign them and provide to the patient or patient's agent.

If the patient requires a reprint or refill at a later date, consider opening an "Orders Only" or "Prescription Refill" encounter. Order or renew one or more meds, taking care to look to the bottom of the order dialog and select the "Class" as "Print":

If printing from the original computer and printer... Note that an orders review icon appears just to the left of the "Sign Encounter" at the bottom right. Clicking on this lists the meds for potential printing and provides icons for printing individual or all prescriptions:
If printing from a different computer or personal device and locally installed printer... From an open chart, go to Chart Review, Select the Meds tab, then either double-click on the medication to be reprinted or right-click to display the medication information in a side bar. Scroll to the bottom of the medication information (report) and note a link for generating a new prescription printout (1). Click on this, then the print icon (2), then select the correct local printer and generate the paper prescription for signing.


How can I print a note or letter?

Question: When I open the "Notes" activity (inpatient) and then view and try to print the note of interest, I find the top-right "Print" menu greyed out. How can I print a specific note?

Answer: Printing is disabled in a number of activities and views. This may be because the information object does not have clear boundaries or is not set for an acceptable print layout. The "Notes" activity is one of these areas. The Print menu (top right of Hyperspace) will be "ghosted" to indicate that it is not available.


It is possible to print notes, letters and other chart objects. The best place for this is the "Chart Review" activity (inpatient and outpatient). This has a tab for Notes and a display area that shows the note content when selected. The button bar of this display area, as well as the top-right print menu, are active for printing.


Look for similar functionality for just about anything else that can be found through the various tabs of Chart Review.

How can I generate a report of recent professional billings?

Professional billing reports are available through the Reporting Workbench workspace. A generic report can be accessed and run. It can also be saved as one or more personal favourite reports. These can be tuned to focus on specific time intervals, contexts (e.g. inpatient, outpatient) or even billing codes.

Do Connect Care Users have an Information Manager Agreement?

Question: How should physicians respond when asked about an information manager agreement for use of a electronic record?

Answer: It's that time of year again. College of Physicians & Surgeons of Alberta (CPSA) practice permit renewals are due in just over a month. Many physicians will be completing their annual surveys. A survey section entitled "medical records" asks if the respondent shares patient information with other physicians and if an Information Sharing Agreement (ISA) is in place. Connect Care users may not know how to respond. We suggest:


Unfortunately, the CPSA standard respecting Information Sharing Agreements dates back to 2009 and has not been updated to reflect the advent of clinical information systems (CIS) capable of supporting the record of care across a continuum of care. The CPSA is aware and will be updating its annual survey for the next cycle.

Know that the CPSA participated in the development of the Clinical Information Sharing Approach (CISA) for Connect Care. This meets CPSA requirements and is an accepted surrogate for an ISA. CISA includes an Information Sharing Compact that all participating physicians must uphold.

Information Sharing Agreement: When asked if an ISA exists, say "Yes".

Custody of Patient Records: When asked if a written agreement exists to maintain custody and control of your patient records, you can answer "Yes" since this is provided for in Connect Care business continuity and most specialty group arrangements.

EMR Use: When asked if you currently use an Electronic Medical Record (EMR), select "Yes" and pick "Clinical Information Systems" as the type of EMR.

Level of EMR Use: When asked "What is the level of your EMR use?", you can select Level 5 as Connect Care is designed for shared care and has a full patient portal.

Control over EMR Use: When asked "How much control do you have over the EMR?", you can select the second option "Shared Custody and Control" since physicians actively customize Connect Care through Area Councils, Specialty Workgroups and User Groups. In addition, there are extensive personalization controls available to physician users.

Level of Netcare Use: When asked "What is the level of your Netcare use?", you can select Level 3 because Netcare PIN data can be imported and integrated into Connect Care and Connect Care shares summative information back to Netcare.

How can I change what MyAHS Connect says about me?

Question: Physicians appreciate that patients are entitled to their full name and practice address. However, there may be situations where a physician might wish to share a name variant (e.g. without middle name) that differs from the official information stored in the Connect Care provider registry. How can this be done?

Answer: The MyAHS Connect patient portal shares information about a patient's physician and possibly other members of a ongoing health care team. Physicians can adjust how their name and other information (e.g. biosketch, interests, research, etc.) appears to patients.


Do this by seeing the "About Me" submenu item from the "My Settings" menu within the main Epic drop-down menu. This can also be found by entering "About Me" in the general search box at the top right of Hyperspace.

Why is my Provider Contact Information Wrong?

Question: Some providers express concern about how their name, and possibly some address information, appears in After Visit Summaries and other Connect Care communications. How can this be changed?

Answer: Basic identification and contact information for Connect Care prescribers comes from the clinical information system provider registry. Drawn from Medical Affairs and Licensing Organization databases, this information may be out of date. Indeed, some physicians provided a home address for professional communications. This may not be what is wanted for Connect Care.

It is easy to check how Connect Care describes a provider, as this information appears in the "Phone Book", available to all authorized users. See the Identity, Roles and Contact Information section of the Physician Manual. In particular, note the tip sheet and its instruction about how to submit a provider information change request.

Why does my Pulse Dashboard seem off?

Question: As we move into our second week of Connect Care use, the physician 'Pulse' and other clinical dashboards draw attention but seem to have odd values for the available metrics? Are these ready for attention?

Answer: Any Dashboards, and especially any minimum use metrics, will be questionable in the first week or two of Connect Care use. Types and amounts of data in the system are in a state of rapid change. Anything that relates to the performance of the initiative overall (e.g. CPOE rates) are being independently analyzed. Know that work will continue for at least 6 weeks to carefully validate the information being fed back to clinicians. Take anything appearing in physician feedback reports with a grain of salt until given the signal that we have credible numerators, denominators and measures.

How can Patients Indicate Willingness to be Invited to Studies?

Question: How can patients consent or otherwise indicate a willingness to be approached about research studies?

Answer: The Connect Care clinical information system supports clinical inquiry in a number of ways. One important capability relates to identification of patients who are willing to be approached for possible participation in research studies.

There are two ways for patients to indicate a willingness to be approached for potential participation in research studies. The first is simplest but requires patient access to MyAHS Connect. Patient portal users can register research preferences as described in the Connect Care Physician Manual and the tip below. The second method involves explicit consent to inclusion in specific research initiatives, is handled through the Consent Navigator.

Can Haiku, Canto or Rover be used to capture patient signatures?

Question: The Consent Navigator (accessed via StoryBoard) is a powerful tool for streamlining consistent consent processes, but struggles with the patient/provider/witness signature capture. Can eSignature capture happen with mobility (Haiku, Canto, Rover)?

Answer: That would be nice! Epic has heard the need and has this on the list for updates to mobility (~summer 2020). In the meantime, we need to use touchscreens, mouse-sig and signature pads. We have increased the number of pads assigned to ER. We have also published tips to the Connect Care Physician Manual to clarify some workflows and emphasize use of alternatives to pads.

Which Physicians use Connect Care for Professional Billing?

Question: Most physicians who are required to enter billing claims in Connect Care know who they are, especially those in alternative reimbursement plans and service contracts with Alberta Health Services. But there may be uncertainty about grey areas, like fee-for-service physicians on time-limited contracts with group plans.

Answer: See a 1-pager summarizing how professional billing is supported in Connect Care. For the most part, physicians who have billed through eCLINICIAN will shift to billing through Connect Care. All physicians working through clinical and academic ARPs (AMHSP) will have been informed about whether their plan has arranged to shadow bill through Connect Care.

Those arrangements include the locum and fee-for-service physicians seconded or contracted to the ARP to fill clinical service gaps. They are expected to bill through Connect Care.

Physicians who have an independent billing service are able to take advantage of Connect Care for claim capture, then generating a report for provision to their billing service.