How is COVID-19 Testing Ordered? - UPDATED

Question: How can a prescriber order COVID-19 laboratory testing in Connect Care?

Answer: Ordering of rapid COVID-19 PCR occurs using the "Respiratory Infection (incl. COVID-19) NAT" order. Connect Care prescribers can enter "COVID" when searching for an order in ER, outpatient or inpatient contexts. Any physician can order the test. If the "Respiratory Infection (incl. COVID-19) NAT" test does not immediately appear in one's department preference list, be sure to click on the "Facility List" tab to find the order. This order is also used to order rapid influenza/RSV PCR and the respiratory pathogen panel (RPP); rapid COVID-19 testing will be automatically selected by default.

Be sure to indicate the reason for testing (symptomatic, infection control screen or pre-transplant testing) and then patient location/disposition (not required for outpatient orders). As resources for rapid on-site testing are limited, answering accurately whether the patient is admitted or is likely to be admitted is very important to ensure the sustainability of the rapid COVID-19 testing program.

For more information, see the tip sheet and lab bulletin.

Can I get tap-badge access for Connect Care as a consulting prescriber to EDs?

Question: Can consulting prescribers in the Emergency Department get tap-badge access to Connect Care like other ED prescribers?

Context: Tap-badge technology supports faster network access to computing devices by eliminating the need to manually enter a username and password. As the use of Imprivata tap-badge technology (i.e., tap-badge access for Connect Care) requires a user license, only select AHS departments have been approved for deployment of this technology.

Recognizing the need for consulting prescribers in the ED to have more rapid access to Connect Care, any physician, physician assistant, resident, fellow or nurse practitioner who logs into any AHS ED computer at least 15 times per month is eligible to request Imprivata access.

Please note that obtaining Imprivata access for EDs will not enable tap-badge access for workstations on other clinical units where tap-badge readers are not available.

Answer: Yes, any physician, physician assistant, resident, fellow or nurse practitioner who logs into any AHS ED computer at least 15 times per month is eligible to request Imprivata, including consulting prescribers. See the tip sheet for instructions on how to request Imprivata access.

How do I manage orders for Long-Term Care/Supportive Living patients on dialysis?

Question: How do I manage orders in Connect Care for Long-Term Care (LTC) and Supportive Living (SL) residents requiring hemodialysis (HD), peritoneal dialysis (PD), or an Alberta Kidney Care (AKC) clinic appointment?

Context: If an LTC/SL resident requires HD/PD or an AKC clinic appointment, there is a specific workflow that needs to be followed so that information flows appropriately through Connect Care. This will allow medication orders to work correctly and help to mitigate patient safety concerns. The specific workflow is dependent on whether the facility is on Connect Care, and, if it is, whether the facility has an on-site pharmacy (e.g., CareWest or Capital Care facilities) or uses a contracted/community pharmacy.

Answer: For HD, PD, or AKC clinic appointments, the LTC/DSL Prescriber and Nephrologist must follow the workflow specific to the whether the facility is on Connect Care (as this will determine whether the resident is considered an outpatient or an inpatient) and whether the facility has an onsite vs. contracted/community pharmacy, with the following considerations in mind: 

  • Connect Care facilities with on-site pharmacy: Medications are ordered in the inpatient "Orders" activity.
  • Connect Care facilities with a contracted/community pharmacy: Medications are ordered in the "External Orders Community" tab.
  • For HD: Ordered via the Hemodialysis Therapy Plan, with any changes to be made by the Nephrologist. The "Dialysis Treatment Orders", "Hemodialysis-Anemia Management Protocol" and "Hemodialysis-Intradialytic Anticoagulation Protocol" medications are already included in the Hemodialysis Therapy Plan. It is important for the LTC/DSL Prescriber to ensure there are not duplicative orders for medications, as duplicative orders may lead to patient safety concerns. 
  • For PD: Ordered via the Adult Peritoneal Dialysis Order Sets, with any changes to be made by the Nephrologist.  

Please see the memo and tip sheet for further details. 

Can I suppress or filter a medication warning?

Question: Is it possible to suppress or filter a particular Medication Warning?

Context: Alert/pop-up fatigue is a concern for prescribers. While some alerts such as Best Practice Advisories (BPAs) are important to fire each time and cannot be turned off, Medication Warnings can be suppressed or filtered, if a prescriber does not think it is necessary to see the warning again for their patient(s).

Answer: To suppress a particular warning, when it fires, click "Don’t Show This Warning Again" (click on first camera icon below for screenshot), and then choose to suppress it for just that patient or for all your patients (click on second camera icon for screenshot).

  

FAQ Blog - Maintenance Complete

Many thanks for your patience while maintenance of this blog channel was performed. All posts have now been restored. 

You will notice that Connect Care screenshots are now behind an icon. Whenever you see the below camera icon in other blog posts on this channel (or any of our other blog channels), this indicates that there is an accompanying screenshot. When you click on the icon, it will take you to an Insite page with the relevant screenshot.

Which Encounter Type should be used for Specialty Outreach Services?

Question: Which ad hoc (unscheduled) outpatient encounter type best fits the needs of patient visits (virtual or in-person) that are part of a specialty outreach service?

Context: Specialty health services may be based in an organization using Connect Care as the record of care, yet provide consultative services to community or facility locations elsewhere. Services might include telephone consultative support to clinicians at other (usually rural) facilities, telehealth virtual visits, or drop-in in-person visits to assist with the care of selected patients; all as part of outreach from the central service requiring service documentation in Connect Care.

Outreach appointments may be scheduled or otherwise organized by the remote location (e.g., primary care network) and so not involve Connect Care support staff for appointment management. In such cases, ad hoc (unscheduled) outpatient visits are needed and clinicians may wonder which visit type to select when creating a new encounter in their specialty department.

Answer: If Connect Care is the record of care for part, but not all, of an integrated health service program, it may be appropriate to use Connect Care integrative charting tools (e.g., therapy plans, care paths, disease management documentation, SmartSets) to manage and document related care. A "Documentation" visit can be created if the outreach support need is limited to generating and sharing a consultation letter. More commonly, the "Telemedicine" visit type works best for outreach services because it benefits from specialty-specific visit, order and documentation tools in Connect Care.

How do I manage orders for admitted patients on dialysis?

Question: How do I manage orders in Connect Care for admitted patients on hemodialysis (HD) or peritoneal dialysis (PD)?

Context: If an admitted patient requires HD/PD, there is a specific workflow that needs to be followed so that information flows appropriately through Connect Care. This will allow medication orders to work correctly and help to mitigate patient safety concerns. (Note: There is a separate blog post for managing orders for Long-Term Care/Supportive Living patients on dialysis.)

Patients receiving dialysis have their dialysis treatment and associated intradialytic medications ordered via the Hemodialysis Therapy Plan or Peritoneal Dialysis Therapy Plan. When a patient with a Hemodialysis/Peritoneal Dialysis Therapy Plan is admitted to the hospital, the Therapy Plan is automatically placed on hold so that the Nephrology team can adjust the prescription and intradialytic medication orders. Once the prescription and orders have been adjusted, the Therapy Plan is available for the duration of the admission.

Answer: For HD and PD, to ensure information flows correctly and medication and blood product orders function properly in Connect Care, a non-nephrologist admitting prescriber should first place a consult order to Nephrology. Then there are specific workflows for medication and blood product ordering, including (but not limited to) the below: 

  • For HD: The dialysis treatment prescription, anemia and intradialytic medications are already included in the Hemodialysis Therapy Plan, and changes are to be made by the Nephrologist. It is important to ensure there are not duplicative orders for medications, as duplicative orders may lead to patient safety concerns. 
  • For PD: All PD treatments and medication orders are ordered via the Peritoneal Dialysis Adult Order set and inpatient orders by the Nephrologist. 
Please see the memo and tip sheet for further details. 

How can I refer a patient to the FAST program?

Question: How do I refer a patient to the Facilitated Access to Specialized Treatment (FAST) program?

Context: As part of the Alberta Surgical Initiative (ASI), a central access and intake program called Facilitated Access to Specialized Treatment (FAST) has been implemented across Alberta. The FAST program is responsible for reviewing referrals for completeness and assigning them to a next available provider with the shortest waitlist, a specific provider, clinic or site, or an out-of-zone provider. 

Not all specialties have implemented FAST. Previously, a customized FAST referral order was available for each relevant specialty. Now, to both accommodate a growing number of specialties using FAST and reduce confusion, FAST referrals are placed via the standard specialty-specific referral order. If that specialty uses FAST, a question will be available in the order where the prescriber can indicate that the referral should be directed to FAST and include any FAST specialty-specific questions that may need to be answered. 

Answer: To submit a FAST referral, search for the standard specialty-specific referral order (e.g., "Referral to Orthopedics"), and then add a specialty reason of FAST. Searching for "FAST" referral orders will bring up specialties that are FAST-eligible. 

How can clinicians control whether patients can contact them via secure messaging?

Question: How can a clinician determine whether, and for how long, a patient can send them messages via MyAHS Connect (Connect Care patient portal)?

Context: Patients who have activated MyAHS Connect are able to securely communicate with healthcare providers via Connect Care. This does not mean that they can initiate communication with any provider. Four tests determine whether a patient is able to send a message to a Connect Care clinician:
  1. Recipient - If a provider initiates a secure patient message to an individual active on MyAHS Connect, that patient will be able to respond to the sending provider.
  2. PCP - If the patient's primary care provider (PCP) uses Connect Care as their record of primary care services, then that provider can be messaged directly (if so configured by the provider) or via a clinic-managed message pool.
  3. Consultant - If the patient has been seen by a consulting (specialist) clinician within the prior 90 days in a facility where Connect Care is the record of care, then the patient can send a message to the clinician (if configured to accept personal-direct messages) and/or the clinic patient message pool.
  4. Clinic - If the patient's clinic (primary care or specialty) has a patient message pool configured, and the patient was seen in that clinic within the last 90 days, then appointment request and some other message types can be initiated with the clinic via its managed message pool.
Patients are offered three options when generating a new message:


If the "Ask a medical question" option is selected, additional options appear. These will be seen by receiving clinician(s) as patient messages categorized by the request reason.


If there is no active patient-clinician messaging relationship for the option selected, the patient is immediately informed that there are no providers assigned for that type of question, and they are directed to contact their clinic for assistance.


Most Connect Care outpatient clinics are configured by default to route incoming patient messages to a clinic message pool for monitoring, screening and forwarding. This can help shield physicians from excess In Basket messages, or delays in answering messages when physicians are busy. However, sometimes physicians will want to send and receive a patient message without anyone else being part of the communication loop.
Answer: Patients with active MyAHS Connect accounts can receive and respond to patient messages sent directly from any clinician. Patients can also use the patient portal to communicate with their primary care provider, or with a provider seen in a Connect Care clinic within the last 90 days, but in most cases the messages will go to a clinic message pool for screening and review before possible redirection to the individual provider.

If a provider does not want to receive messages from one or more patients, the following options should be explored:
  • Outpatient clinic messaging protocol - Work with clinic colleagues to confirm an agreement respecting whether the clinic maintains an incoming patient message screening process and ensure that the responsible support staff know that the particular provider does not accept patient messages.
  • Patient-provider relationship - If a provider will not participate in any ongoing care of the patient, or will not offer any further post-visit communications, then the "Care Team" activity can be opened in Connect Care and the provider can "end" any existing primary or specialty care relationship, thus removing the provider from communication availability.
  • Direct communication - Clinicians can always respond (or have their messaging pool respond) to a patient message with a request to not use MyAHS Connect for communications with a particular provider.
For more information:

How can I resend a prescription via direct electronic fax to a community pharmacy?

Question: How can I “reprint” or refax a prescription that was originally sent via direct electronic fax?

Context: Prescriptions sent directly from Connect Care via electronic fax to a community pharmacy are handled by the RightFax application. In the “My Printouts” activity, the “Printer Used” column will show “RIGHTFAX”.

If the initial fax fails, the RightFax application will attempt to send the fax a total of five times, every 5 minutes. After that, the message goes into a failure queue in the RightFax application. Similar to community EMRs that fax prescriptions, the pharmacy or patient would need to request a reprint from the prescriber if the fax does not come through.

If a prescriber receives such a reprint request, or if the original pharmacy information was incorrect, there are a few different ways to reprint/resend, depending on the context. Note that the usual method for reprinting prescriptions, via the My Printouts activity, will not work, and the only option in some cases will be to print, sign, and manually fax.

Answer: For ambulatory encounters, the following options can be used to resend/reprint a prescription that was originally sent via direct electronic fax:

  • If the patient’s preferred pharmacy is still the same, from the relevant encounter, the prescription can be resent via direct electronic fax using the “Reprint Meds” link.

  • If the original electronic fax was sent to an incorrect pharmacy/fax number, contact the pharmacy that was sent the prescription in error to cancel the original prescription, and then either:
    • Print on paper by going to Chart Review >> Meds, selecting the medication, scrolling down to “Reprint Prescription”, and clicking the link. Then sign and manually fax to the correct number. 
    • Cancel the original order and reorder with the correct pharmacy information. Follow the steps in the tip sheet to send via direct electronic fax.
For inpatient encounters, the following options can be used to resend/reprint a prescription that was originally sent via direct electronic fax:
  • Print via one of the below methods, then sign and manually fax:
    • In the “After Visit Summary” section of the Discharge Navigator, click the add icon ("+") found beside "Discharge Medications". 
    • In the “Discharge Status” section of the Discharge Navigator, click the “Reprint” link next to the relevant medication. 
  • If the original electronic fax was sent to an incorrect pharmacy/fax number, contact the pharmacy that was sent the prescription in error to cancel the original prescription, and then either:
    • Print on paper by going to Chart Review >> Meds, selecting the medication, scrolling down to “Reprint Prescription”, and clicking the link. Then sign and manually fax to the correct number.
    • In Discharge Med Rec, click on the pencil icon next to the medication and modify/reorder with the correct pharmacy information entered for the patient’s preferred pharmacy. If “Fax” is selected for the order class (as detailed in the tip sheet), it should send via direct electronic fax.


Information on reprinting discharge prescriptions that were originally printed out can be found in this 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.

  1. In the "Recurring Treatments" folder of your In Basket, select the relevant patient.
  2. Click on the 3 dots icon above the message and select "Open Plan" from the dropdown menu that appears.
  3. Review and edit, if necessary. 
  4. 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. Please note that the new Connect Care workflow for sending prescriptions directly to community pharmacies via electronic fax ("eFax") cannot be used for prescriptions for drugs classified as Type 1 under the TPP; these prescriptions still require the use of a paper TPP secure prescription form.

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

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

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

  • Order all prescriptions in Connect Care, including TPP specified Type 1 controlled substances.
  • Write out a manual (handwritten) TPP prescription (3-part or newer 2-part TPP pad) for specified Type 1 controlled substances.
  • Record the TPP prescription identification number (unique to each prescription) in Connect Care (ideally in the comments field of the actual order).
  • Do ONE of the following with the original (paper) pharmacy/TPP prescription (see guide):
    • Option 1: Provide to patient and do not fax to pharmacy.
    • Option 2: Fax to the patient's one chosen pharmacy, marking "FAXED" on the prescription and do not provide to the patient.
  • Continue to protect the TPP (duplicate or triplicate) pad with its copy of the hand-written original.
  • Destroy any leftover copies or artefacts. 
The Connect Care tracked prescription order constitutes the official record. It is NOT necessary to scan or otherwise copy the paper TPP prescription to attach to the Connect Care digital record.

How did I get that test order wrong?

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

Context: Those new to Connect Care may fumble with the occasional test or procedure order. The is more likely with tests based on samples (e.g., aspirates) that can be collected in different ways in different contexts. Possible reasons for delays or declines include:
  • Wrong Test
    • A vast number of tests are available to request via Connect Care, including all possible orderables for an entire province.
    • Different tests can have similar names. It is important to consider possible alternative test names, check the "Facility List" if nothing familiar appears on the "Preference List", and chose the most specific test description to fit your intent.
  • Wrong Sample
    • Test orderables can have similar names but relate to different clinical needs. 
    • If ordering a pH, for example, be sure to select the test appropriate to the fluid being sampled (e.g., venous, arterial, pleural).
  • Wrong Details
    • Orders for similar investigations may have specific required details for samples collected during specific workflows (e.g., surgical operation).
  • Wrong Location
    • An increasing number of assays can be performed using Point of Care Testing (POCT), with rapid result availability. However, the instrumentation needs to be available in-facility, as well as the test kits for the desired assay, with staff certified to use the equipment.
    • Local variation in POCT availability is inevitable. Be sure to check with colleagues, or laboratory services, that the POCT orderable found in Connect Care is available on site.
  • Wrong Permission
    • In some cases, special assays require special permission in order to be performed. This will usually be communicated to the ordering prescriber.
Answer: Just as has always been the case, prescribers need to build an awareness of the laboratory services available at a particular facility. If in doubt, ask. Local laboratory services will know what can be ordered, and how. In addition, Connect Care "Resource Links" (top menu in Hyperspace) are provided for:

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

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

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

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

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

    Inpatient

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

    Outpatient and Emergency

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

How can I share discharge summaries with my patients?

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

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

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

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

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

    Document Sharing

  • Create or open a document for editing within a patient's chart.
  • Look for and select the "Share w/ Patient" button at the top of the document editor. A warning will appear if the current patient is not activated on the patient portal (sign-up instructions appear in the AVS).
    • Note that the "Share w/ Patient" button may appear to be activated (by default) if a Note Type (e.g., progress note, discharge summary, etc.) has not been selected. As soon as that (mandatory) type selection has been made, the share button initiates to its default "off" state. The authoring clinician needs to make an explicit decision to share by clicking on the "Share w/ Patient" button.
  • The document will become available (including any subsequent revisions) in MyAHS Connect.

    Document Printing
  • Create or open a document for editing, then complete and sign it within a patient's chart.
  • Go to the "Chart Review" activity and find and select the document of interest in the "Notes" tab.
  • Look for and select the print icon at the top of the document report. The default printer should be the one assigned to the current patient location. An alternate local printer can be selected (see printing tips).
  • It is also possible to print documents via the Sidebar when charts are opened to an inpatient encounter. Look to the Sidebar Summary Index and select the "Notes, Sidebars" option. A listing of recent summative documents will appear in the Sidebar. If one of these is selected, a print icon is available and usable at the top of the Sidebar display.

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

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

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

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

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

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

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

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

  • Community Pharmacy Report
    • A "MedRec for Community Pharmacist" report is generated at every discharge once discharge orders are completed. The report lists all medications that a patient should be taking at discharge, highlighting home medications that may have been changed or discontinued. 
    • The report should be manually faxed to the patient's registered pharmacy (it cannot be automatically sent at this time). In the absence of a preferred pharmacy, the report can be provided to the patient together with any printed prescriptions they are taking to a community pharmacy.
  • Decision Supports
    • Checks for drug-allergy, drug-dose, drug-drug, drug-disease and drug-lab interactions are flawed if Connect Care does not have a complete and up-to-date medication list.
  • Summative Documentation
    • Standard provincial templates for summative documents (e.g., discharge summary) sent to Netcare and community electronic medical records automatically incorporate Connect Care medication information.
  • Colleague Information Burdens
    • Accurate discharge medication records make information flows faster when patients return for outpatient or emergency reassessments.
  • Risk of Medication Harms
    •  Prescriptions missing from medication profiles in Connect Care (such as those manually written at discharge) can result in these medications being overlooked when patients re-present for care. 
Compliance with minimum use norms is tracked in Connect Care, with performance measures reviewable in personal and group minimum use dashboards. The measures may also be reportable under prescriber individual service agreement contracts with Alberta Health and Alberta Health Services.

How can "non-standard" medications be ordered?

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

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

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

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

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

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

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

What are Care Gaps/Health Maintenance Reminders?

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

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

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

  • Example: A diabetic patient's demographics and history trigger an alert indicating that a diabetic foot exam is due (Alberta guidelines call for yearly foot exams for those on the diabetes register).
A Care Gap alert flags possible mismatches between evidence-informed care and a patient's current experience. Connect Care chart content is compared to patient-specific health maintenance plans. Missing or inaccurate information (e.g., incomplete problem, medication or lab results) can lead to false positive, or false negative, alerts.

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

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