Showing posts with label Enhancements. Show all posts
Showing posts with label Enhancements. Show all posts

New Cirrhosis Best Practice Advisories

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Rifaximin BPAs
As of March 12, 2024, two new cirrhosis-related Best Practice Advisories (BPAs) have been implemented in Connect Care. Readmission to hospital for patients with cirrhosis is common and, with the added comorbidity of hepatic encephalopathy, the patient’s likelihood of requiring readmission increases. To reduce the risk of readmissions for hospitalized patients taking lactulose for hepatic encephalopathy, the new BPAs suggest ordering/continuing rifaximin with the second and subsequent episodes of hepatic encephalopathy or with lactulose intolerance. 
  • Rifaximin BPA - Upon Signing Lactulose Order: This interruptive BPA will fire for admitted patients with an active problem or encounter diagnosis of cirrhosis and/or hepatic encephalopathy, if the prescriber is signing an order for Lactulose and Rifaximin has not been ordered.
  • Rifaximin BPA - Inpatient Discharge BPA Section: This non-interruptive BPA will fire for admitted patients being discharged with an active problem or encounter diagnosis of cirrhosis and/or hepatic encephalopathy, if the patient has an active order for Rifaximin. This BPA will continue to display until acknowledged. 

RAAPID Documentation Functionality Updated

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • RAAPID Documentation - Sidebar or Floating Window
As of March 8, 2024, two new viewing options will be available for the "RAAPID Documentation" activity, allowing prescribers to create a RAAPID tele-consult note while reviewing a patient's chart in the middle of the screen.

While in the RAAPID Documentation activity, clicking on the window icon in the top right will bring up a dropdown menu of two options, "Move to Sidebar" and "Move to Floating Window" (click on the below camera icon to see a screenshot). When one of these are selected, that preference will be retained for future sessions. If neither of these options are selected, the RAAPID tele-consult note will stay in the center of the screen. 

ASAP Users - Handoff Activity Now in Dispo Tab

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • ASAP Users - Handoff Activity Now in "Dispo" Tab
With the upgrade to Hyperdrive, previous personalization by ASAP module users (ED and rural prescribers) of pinning the Handoff activity to the top of the patient chart has been lost. As a workaround, starting on February 29, 2024, when a patient's chart is opened, a "Write Handoff" option can be found in the "Dispo" toolbar menu. 

New Drug-Disease Medication Interaction Warnings

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • New Drug-Disease Medication Interaction Warnings
As of February 13, 2024, "Drug-Disease" medication interaction warnings with a severity level of "Contraindication" will display to prescribers at order entry, when applicable. 
  • Drug-Disease warnings will fire for the disease documented in the encounter diagnosis and any active problem on the Problem List. The system will look back 30 days for encounter diagnoses.
  • Drug-Disease warnings with a Contraindication severity level cannot be filtered by users (i.e., users will not have an option to select “Don’t Show This Warning Again”, either for individual patients or for a time period).
  • Drug-Disease warnings with a Contraindication severity level cannot be suppressed in order sets.
  • Drug-Disease warnings with a Contraindication severity level will also fire when a new problem is added to the Problem List, if applicable.
For the workflow, including screenshots, see the tip sheet.

Updates to Surgery Postprocedure Analgesics

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Updates to Surgery Postprocedure Analgesics
Since December 2023, the evidence-based "Standard Analgesic Adult" panel has been available to order using browse or the facility list. As of February 14, 2024, certain ERAS Postprocedure order sets will change to incorporate the Standard Analgesic Adult panel in place of the current "Analgesics/Antipyretics" section. "Naloxone" and "Adjuvant" sections will also be added, where appropriate. This change will affect personalizations applied to the Analgesics/Antipyretics section in the affected order sets.
Over time, other surgery order sets will change to incorporate the new Standard Analgesic Adult panel. Head and Neck surgeons and SMEs were engaged in a provincial working group collaborating on these revisions over the past year, and changes to the ERAS Major Head and Neck Cancer Surgery with Free Flap Reconstruction Adult order set are also expected in the future. A standard analgesics panel for pediatrics is under development. 

New Task for Repeating Therapeutic Drug Monitoring

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • New Task for Repeating Therapeutic Drug Monitoring
As of February 1, 2024, there is a new task for the ordering prescriber when ordering a repeating frequency in lab orders for therapeutic drug monitoring. The enhancement should reduce mis-timed blood collections associated with scheduling challenges after an order is entered.

When ordering a repeating frequency (e.g., M/W/F), the name of the frequency will now include “Prescriber to schedule”, and there will be a new soft stop for the ordering prescriber to either attest to a standard time of 07:00 or change the timing of the lab draw. To help with choosing the timing of the lab draw, the medication administration schedules for medications requiring therapeutic drug monitoring are displayed in the order composer.

There is no change to the prescriber workflow when a single blood collection is requested. However, the name of this frequency is changed from “per medication dosing” to “once – nurse to schedule”.

Provider Same Name Enhancements

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Provider Same Name Enhancements
As of February 1, 2024, a few user-interface enhancements to Connect Care will help clinicians select the correct provider name from lists when two or more names are similar.   
  • In the Provider Finder activity (used in used in Order Entry, Referral Entry, and Care Teams), a new yellow-highlighted “CAUTION: Look Alike Name” warning message will appear under each row with similar names. The person’s specialty is bolded, to make it easier to use as a distinguishing factor. 
  • In the Flashback Lookup activity (used in the Intra-procedure activity for Anesthesia), a new “Duplicate” column will show the “CAUTION” warning message.

Medication Ordering Supports for Supportive Care Facilities with External Pharmacies

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Medication Orders in Facilities with External Pharmacies
Where a supported living facility (e.g., long-term care, LTC) uses Connect Care as its record of care but an external (community) pharmacy for the provisioning of patient medications, integrated medication management cannot be taken for granted. Accordingly, prescribers must order and discontinue medications as "external orders" that will be fulfilled outside the facility. New medication orders take the form of a prescription, and any medication discontinuations need to be explicitly communicated to the pharmacy. 

An "External Orders - LTC" chart activity supports prescribers when working in facilities with externally contracted pharmacy services. This gathers needed ordering tools for generating and faxing external prescriptions. It also provides reports summarizing all the medications a patient should be taking and communication tools to share information with the relevant pharmacy. Inpatient charts for such facilities now have a "header," appearing when the chart is opened, reminding about and linking to the new medication order navigator.

Outpatient Problem Oriented Charting Supports

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Problem Oriented Charting Supports for Outpatient Visits
Problem Oriented Charting (POC) is an approach to clinical documentation that emphasizes what is new and important in a patient's healthcare experience, keyed to a list of active problems. Clinicians can better track treatments and trends for multiple evolving issues. 

POC was first introduced to Connect Care in support of more effective and efficient documentation by inpatient teams. Many clinicians have used and helped to improve the tools. Those same clinicians have requested access to POC documentation in outpatient encounters (visits, documentation, orders, telehealth, etc.). 

Although POC workflows differ somewhat in outpatient contexts, the basic approach is the same and documentation building blocks are similar. We are pleased to expose those tools, together with standardized summative and progress documentation templates, alongside a new outpatient sidebar index

Training and workflow supports are linked in the Clinician Manual:

Outpatient Sidebar Index for Prescribers

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Sidebar Index for Prescribers now available in Outpatient Encounters
A "Sidebar" is available in opened patient charts. It can be collapsed or expanded, and facilitates quick access to information that can help with charting tasks performed in the main (center) chart area. Previous postings describe an enhanced "index", appearing at the top of inpatient chart sidebars. This supports rapid switching between a set of Sidebar activities of particular help to prescribers.

A similar sidebar index is now available to outpatient encounters (visit, documentation, order, pre-charting and other encounter types). Indexed sidebar activities remain high-value for clinicians, but optimized for common outpatient work and information flows.

The outpatient sidebar index items and functions are explained in the Clinician Manual:

Long-Term Care Medical Assessment Forms Now in Connect Care

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Long-Term Care Medical Assessment Forms Digitized
The Connect Care Clinical Documentation Committee is coordinating the transfer of common paper/PDF forms to digital formats embedded within the clinical information system. Use of these forms can reduce clinician information burdens by avoiding double data entry/re-entry of information already known to Connect Care.

"Medical Assessment Forms" (MAFs) are part of transition planning for many patients. These are now available to inpatient and outpatient encounters as part of a "Letter Forms" (cForms) workflow, where many similar current and future forms can be activated. Sidebar enhancements for inpatient and outpatient charts make it easier to find all such forms. 

Relevant workflows are explained in the Clinician Manual, where a tip sheet and demonstration uses the LTC MAF to illustrate recommended practices:

Referral Workflow Updates

Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
  • Referral Workflow Updates
As of October 27, 2023, prescribers using referral orders for outpatient (ambulatory) consultation will notice a few changes. There are enhancements to the referral order composer for prescribers, and to the tools specialty services use for referral triage via In Basket. 

Changes to the Referral Order Composer
  • The "Comments" field, where information important for triage and consultation is entered, is now a required field (hard stop). SmartLinks can be used to pull chart information into the comments and SmartPhrases can be used to record frequently used referral indications. 
    • Note: Previously saved Comments field personalizations will need to be re-entered and re-saved after October 27, 2023. 
    • Following this update, if you are using a personalized referral order, you may see a pop-up. See this blog post for more details on how to manage.
  • A reason for the referral must be selected (from the list or via speed button) in the "Reason" field.
  • FAST (Facilitated Access to Specialized Treatment) referral orders will now be entered using the specialty-specific order (e.g., urology) and then indicating in the order that it is for FAST, rather than using a customized FAST referral for each specialty.
  • For outgoing referrals, the "To loc/pos" (location/place of service) field is now a recommended field.  
  • Referral orders now contain a link to the Referrals section of the Connect Care Manual, in the "Reference Links" section.
Note: given the changes to the referral order composer, any personalizations of Order Sets or Smart Sets containing referral orders will have to be re-entered after the update. Order preference lists will not be affected.

Changes to the Referral Triage In Basket Message Report
  • The referral triage In Basket message report is now available from the In Basket Message as well as the Referral Sidebar.
  • A "Notes" section has been created to display specialty comments and referral attachments.
  • A "Messages" section has been added.
  • Referral notifications have been moved to a separate tab ("Notifications").
  • The referral reason ("Rfl Reason") has been added to the message preview. 
  • An "Order Information" section, including a hyperlink to the Ordering Encounter Summary and Appointment Request, has been added.
For screenshots and a walkthrough of each change, see the tip sheet and demo video.

    Workflow Updates for Transferring Patients to Continuing Care

    Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
    • Workflow Updates for Transferring Patients to Continuing Care Facility
    As of October 17, 2023, Connect Care discharge navigator updates will clarify prescriber workflows when patients are sent from an acute care facility to a Connect Care Continuing Care facility. Continuing Care facilities include Supportive Living (SL), Designated Supportive Living (DSL) and Long-Term Care (LTC) facilities with external (contracted) pharmacy services.

    Connect Care will automatically select and present appropriate tools in the discharge navigator's Inter-facility Transfer (IFT) tab. The workflow for transferring a patient to a non-Connect Care LTC facility does not change.
    • Discharge vs. IFT Tab: When sending to a SL/DSL facility, the main Discharge navigator tab should be used because the destination facility is considered the patient's home. When sending to a LTC facility, the discharge navigator's IFT tab should be used. 
    • LTC with internal vs. external pharmacy: When sending a patient to a LTC facility, the IFT navigator will present the appropriate tools based on whether the LTC has an internal or external (contracted) pharmacy service:
      • Connect Care LTC with internal pharmacy services: All orders (medication and non-medication) can be signed and held through the IFT navigator to be released at the receiving site.
      • Connect Care LTC with external (contracted) pharmacy services: As the pharmacy supplying medications is not on Connect Care, this external pharmacy requires Discharge Medication Reconciliation for medication orders. Non-medication orders require the usual IFT to Connect Care process, leaving non-medication orders signed and held for the receiving facility to release. The IFT navigator contains the tools for both these types of orders.
    For more information:

      In Basket Update - Co-Sign and Incomplete Notes Folders

      Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
      • Co-Sign and Incomplete Notes In Basket Folders
      Summative notes authored by trainees require a co-signature from the appropriate prescriber. This contrasts with progress notes, which do not require a co-signature. Often trainees will be asked to, or be in the habit of, having their progress notes cosigned. To date, a corresponding In Basket folder with co-sign messages has not been visible, making it difficult for prescribers to complete the co-sign action. Rather, a deficiency notification was triggered, and the co-sign deficiency would be visible in the "Chart Completion" folder. 

      As of October 17, 2023, "Co-Sign Notes" and "Incomplete Notes" In Basket folders will become visible to those prescribers that Supervised Trainees have selected as Co-Signers, when a note needs to be co-signed.
      • The Co-Sign Notes and Incomplete Notes folders will only display in the co-signing prescriber's In Basket if there are messages in them. 
      • Each notification in the Co-Sign Notes and Incomplete Notes folders will include information about the patient and document type, and action buttons are provided to allow users to complete the task of co-signing/completing the note, similar to notifications in the Chart Completion folder. 
      • Prescribers will continue to see deficiencies in the Chart Completion folder; in addition, a notification will be visible in the Co-Sign Notes or Incomplete Notes folder. When the deficiency is managed via chart completion, the corresponding message will be removed from the Co-Sign Notes or Incomplete Notes folder.
      • Since outpatient encounters are closed when the scheduled prescriber signs the visit, outpatient/ambulatory (progress) notes should not be identified as requiring a co-signature. Outstanding co-sign messages for ambulatory notes will be removed prior to this change; incomplete notes will remain in the "Incomplete Notes" Folder.
      For more information on how to manage notifications in the Co-Sign Notes and Incomplete Notes folders:

      DI Order Update - Order Status

      Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
      • Change to DI Order Status Requirements
      As of October 3, 2023, outpatient diagnostic imaging orders will require a status of "Future" to ensure that DI staff can process the order. 
      • In the "Status" field, imaging orders will default to "Future". 
      • If the order has a status of "Normal" or "Standing", a pop-up will appear indicating that the order status must be changed to "Future" to be able to sign the order.
      • If the imaging is required more than once, rather than using the "Standing" status, multiple orders will need to be placed for multiple exams. This can be done through an order set or through personalizing an order panel with multiple imaging orders (see the poster linked below for more information).

      WCB Form Changes

      Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
      • WCB Form Changes
      As of September 19, 2023, a few updates will be made to the WCB form:
      • In the first section of the form, the "Load previous WCB Connect Care form" functionality has changed:
        • If the "Yes" button is selected, only the below elements will be loaded from the previous WCB form:
        • The "No" button has been removed, and there is now a "Clear WCB Form" button. This button can be selected to clear all the information entered in the form (instead of exiting the form to start over).
      • In the "Treatment Plan Details" section, after the user makes a selection in the "Category" field (i.e., Consultation/Referral or Investigation), a selection in the "Type" field will now be mandatory. The type options will appear in a dropdown list, and are dependent on what category was selected.

        Vaccine Nomenclature Update

        Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
        • Vaccine Nomenclature Update
        As of September 19, 2023, a change in the syntax for vaccines will be live in Connect Care. This change is intended to make it easier for prescribers to identify and order the correct vaccine to be administered.

        The updated syntax will appear as follows: <"(Vaccine code)"><Vaccine name/Description><suffix (where applicable)><Strength><"vaccine"><Brand name><form name>. For example:
        • Old syntax: diphtheria-tetanus-acellular pertussis (dTap) combined vaccine (Boostrix) injection
        • New syntax: (dTap) diphtheria-tetanus-acellular pertussis vaccine (Boostrix) Syringe 

        ED Pre-Op Orders - Change in Sign and Held Status

        Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
        • Change in Sign and Held Status for Pre-Op Orders Placed in the ED
        As of September 19, 2023, all orders placed from the ED using pre-op (preprocedure) order sets will change from being signed and held to signed.

        Currently, all pre-procedure orders are signed and held regardless of where they are placed (ambulatory, ED or inpatient); this works well except for the ED, where the orders are not visible to the ED nurse and the admission orders are held for release, thereby delaying the admission of the patient. As a consequence, several problematic workarounds have been used to release the orders leading to safety issues.

        The Changes:
        1. Any orders that are from a pre-op order set will now be automatically released in the ED, negating the need to do the workaround of changing the phase of care or from signed and held to signed. They will remain as preprocedure phase of care attached to the case selected in the case request portion of the order sets.
        2. A section has been added to the Pre-Op Consult navigator, which is the correct navigator to be using for ED consults that will allow for reconciliation of both home and current (ED) medications. This new section will be at the bottom of the list of activities in the Pre-Op Consult navigator; by clicking on this, you will be given the opportunity to enter home meds and to continue or stop meds active in the ED to avoid ordering duplicate medications. These medications will also be active and not signed and held.

        NOTE: These changes will apply only to orders placed when the patient is admitted to the ED, and will not occur with inpatient consults.

        Cardiovascular Disease Risk Calculator - Enhanced Lipid Reporting

        Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
        • Cardiovascular Disease Risk Assessment made easy with Enhanced Lipid Reporting 
        Enhanced Lipid Reporting (ELR) is a new, easy-to-use, lab-based approach to measure cardiovascular disease (CVD) risk and ensure those at risk get guideline-directed treatment. The Framingham Risk Score (FRS) and Canadian Cardiovascular Society (CCS) Dyslipidemia guidelines have been built into Connect Care, allowing lab reports to provide a CVD Risk score along with treatment recommendations, based on information from a patient’s lab requisition and blood sample. 

        The ELR goes to the healthcare provider, Netcare, and patients through their MyHealth Record account with links to patient education resources. This practice improvement opportunity promotes Alberta Screening and Prevention (ASaP) data reporting, continuity of care and patient empowerment. 

        To order a CVD risk assessment in Connect Care, use the "Order Inquiry" activity. The search terms "cvd", "framingham", "fram" and "lipid" will all bring up the "Cardiovascular Disease Risk Assessment" test name. When the test is selected, the below pop-up with screening questions will appear.


        For more details:

        Surgical Booking Request Options Update

        Enhancement updates provide short alerts to new, fixed or improved Connect Care functions...
        • "Case Request Operating Room" Order Update
        As of August 29, 2023, "E01 - within 1 hour" will be a selectable option in the "Case Classification" field for booking emergency surgeries. Surgeons will see this in the "Case Request Operating Room" order (see below screenshot); Clerks/Nursing will also see this option, in the case request form.