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What’s theEPIC dealwith ConnectCare?The Palliative PerspectiveEdmonton Research DaysOctober 21, 2019
Alberta Health Services, Community Seniorsand Addiction & Mental HealthThis work is licensed under a Creative Commons Attribution-Non-commercial-NoDerivatives 4.0 Internationallicense unless otherwise noted. To view a copy of this license, visit https://creativecommons.org/licenses/by-ncnd/4.0/ .The license does not apply to content for which the Alberta Health Services is not the copyright owner. Logos,trademarks, third party and website images have been licensed separately or reproduced with permission andare not included in this Creative Commons license.This material is intended for general information only and is provided on an “as is,” “where is” basis. Althoughreasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not makeany representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness,applicability or fitness for a particular purpose of such information.
Presenters:Co-Chairs of the Palliative and End-of-Life Care Connect Care Specialty DesignWorking GroupDr. Ayn SinnarajahMedical Informatics Lead Physician, Calgary ZonePalliative Physician Consultant, Calgary ZoneMichelle Peterson FraserDirector of Provincial Palliative and End-ofLife Care, Community Seniors and Addiction& Mental Health
30th Annual PalliativeEducation and Research DayFaculty/Presenter DisclosureFaculty: Michelle Peterson FraserRelationships with financial interests:Other: Employee of Alberta Health Services
30th Annual PalliativeEducation and Research DayFaculty/Presenter DisclosureFaculty: Aynharan SinnarajahRelationships with financial interests:Grants/Research Support: CIHR, Alberta Health, CanadianFrailty NetworkSpeakers Bureau/Honoraria: NoneConsulting Fees: NonePatents: NoneOther: Academic Physician, Division of Palliative Medicine,Department of Oncology, University of Calgary; ContractedPhysician, Alberta Health Services (Medical Informatics, PalliativeConsultant Physician)
30th Annual PalliativeEducation and Research DayDisclosure of Financial SupportThis program has not received financial support from commercialentities.This program has received in-kind support from the ProvincialPalliative and End-of-Life Care portfolio and the Chief MedicalInformation office.Potential for conflict(s) of interest: Presenting on behalf of Alberta Health Services No potential conflict(s) of interest
30th Annual PalliativeEducation and Research DayMitigating Potential Bias Not applicable
Learning Objectives Describe the benefits of Connect Carefor Alberta Summarise key palliative specialtycontent decisions for Epic Demonstrate the patient and healthcare provider journey within thePalliative Care program in ConnectCare
Table of Contents Connect Care Overview PEOLC Specialty DesignWorking Group Decisions Benefits and Challenges
Benefits andDecisionsCopyright – Pexels.comBackgroundAlberta has over 1300 disparateelectronic medical record systems,leading to information silos and anincomplete picture of a patient’shistory.The Alberta Health Services ConnectCare project will amalgamate most ofthese systems into 1 common clinicalinformation system from the EpicSystems Corporation.
What is Connect Care? Connect Care is a bridge to betterinformation. In healthcare, informationshapes every decision we make. ConnectCare is transforming how we use thatinformation. Through a common provincial clinicalinformation system, Connect Care willcreate a seamless health informationnetwork you can use with speed, easeand confidence. You will be able to recordand share patient information to supporthigh- quality care.
PrinciplesDesign and decisions for Connect Care are built on ten guiding principles.Which are the following:1.2.3.4.5.Put Patients & families firstMove fastIntegrate across the continuumAvoid unhelpful variationAdopt and adapt6. Use tools for transformation7. Lead with purpose8. Partner to advantage9. Transform with intent10. Heed best experience
Connect Care UpdateTimeline13
Connect Care Update14
Overarching Structure for Continuing Care and Seniors Specialty ClinicalSystem Design (CSD)This is the overarching AreaCouncil, where we will takedecisions that do not cometo consensus in a workinggroup or do not fitspecifically within a workinggroup or specialty area.Specialty Area/Working GroupContinuing Care &Seniors (CC&S) AreaCouncilCommunityCarePalliative/End of LifeCarePhysician Group(To support allCC&S AreaCouncilWorkgroups)Geriatrics
Process: Six province wide adoption, validationand direction setting sessions (with over1000 participants) were held in 2018 tomake initial decisions on ‘Core’ content. ‘Specialty’ content was handled by over40 Specialty Clinical System Designworking groups including Palliative andEnd-of-Life Care (PEOLC).Copyright – Pexels.com
Working Group:The specialty design PEOLC group included over 60 members from the following areaswhich met regularly to make decisions by March 2019, allowing time for the build ofthe content: Interdisciplinary representationAdults and pediatricsRepresentation from all zonesCovenant Health Palliative InstituteEPICAcute Palliative Care UnitPalliative Frontline CliniciansClinical Knowledge ManagementGrief Support Program Hospice Integrated Home Care/PalliativeHome Care Consult Team (various caresettings) Acute Care Cancer Control Alberta Connect Care Analysts Advance Care Planning WorkingGroup
Working Group Members (Edmonton): Cari RichardsCarleen BrenneisChristina RumseyDonna HildebrandtJalene SuwalaJane ChristensenJanice ChobanukJessica WakefordKatie MahonKelly FournierKonrad FassbenderKristen MoreauLawrence Lee Leila SidiMary SchlosserMeghan RichardsonMichelle PodmoreNoush MirhosseiniPaul BergenRobin Fainsinger / Ingrid DeKockSandra LeungSharon WatanabeStacey BilouTara WrenTracy Bablitz
Decisions Approximately 50 decisions were made for both inpatient,outpatient, adults and pediatrics in order for the build to bedeveloped. Once the build was complete the working group was shownscreenshots of the decisions and validated that the build was inline with the decisions made. Key decisions included the prioritised palliative tools (e.g. ESASr, MMSE, PPS, etc.). ESAS-r questionnaires will be available forpatient use through the patient portal.
Palliative assessment tools built in EPIC Folstein Mini Mental StateExamination (MMSE) CAGE Questionnaire Richmond AgitationSedation Scale (RASS) ESAS-r PPS Montreal CognitiveAssessment (MoCA) “scoreonly” row ESC-CP Confusion AssessmentMethod (CAM) POS Caregiver Risk Screen (CRS) Carer Support NeedsAssessment Tool (CSNAT) –built as smart text Support Needs Approachfor Patients (SNAP) - built assmart text
Connect Care UpdateConnect Care BenefitsBetterBetterdocumentation communication Templates Dictation Shortcuts Colleagues Timely reportsShare info Patients OwnershipBetterguidance Decreasepracticevariation DecisionSupportBetterworkflowsBetterinsights Personalization Quality andoutcomes ofcare Mobility Inquiry22
Palliative Program Benefits In the end, ALL palliative programs (consult teams (at anysite), palliative care units, home care (including palliative),certain hospices) will be using Epic allowing seamlessintegration across all sites. All palliative referrals and consults will be entered andtracked through Epic. Physician billings can also be captured directly through Epic. There’ll be improved access to data for clinical analysis andresearch.
Connect Care UpdatePalliative Challenges Starting point will not be perfect There will be a interim phase where people will need to workin 2 systems Continued challenges with non AHS facilities and providers Most family physicians and long term care and hospicefacilities will not be on Epic.However, they can use EpicCare MyLink portal to view keyparts of the AHS patient record.24
Connect Care UpdateConnect Care Patient Portal“MyAHS Connect” Patient access to their medical information– After Visit Summary Two-way communication with providers Access through MADI (MyAlberta Digital Identity) process25
Connect Care UpdateConnect Care Patient Portal“MyAHS Connect” Pilot with current eClinican MyChart users Soft roll out January 202026
Connect Care UpdateConnect Care Provider Portal“AHS Provider Portal” Results ReviewChart ReviewConfigurable Event Alerting2 way communicationOrdering27
Curriculum Review Board –Consult NurseTraining Planning Focus of training – Using the system to manage workdayactivities. Not training clinical content Practice changes Core Readiness – trained separately Interim Planning/Strategies – some pieces may be included intraining
Curriculum Review Board –Transition CoordinatorTraining Strategies Pre-Class E-LearningIn-Class training and exercisesAfter class training (TBD)Tip Sheets and Quick Start GuidesAdditional training for managers (Reporting)Additional Training for super users
Curriculum Review Board –Consult NurseConsult Nurse Lesson Plan Learning Home Dashboard Find patients on patient lists (inpatient) and on schedule (ambulatory)Chart Review Update allergies, problem list, history Advance Care Planning Document Assessments and phonecallsDocument recommendation/ordersDocument team/family conferenceCommunicate recommendationsPlanning for follow upFollow up on lab/test results orderedby prescriberFlagging a patient as being on thepalliative consult teamFinalize consult/remove from listsBasic reportsScenario: will have Palliative Adult,Palliative Pediatric, and GeriatricScenarios available.
Lesson Structure
Demonstrationof the PatientJourney(no videos or recordings to be posted online)
Questions, FeedbackQuestions?Contact InformationMichelle Peterson FraserMichelle.PetersonFraser@ahs.caDr. Ayn SinnarajahAyn.Sinnarajah@ahs.ca
certain hospices) will be using Epic allowing seamless integration across all sites. All palliative referrals and consults will be entered and tracked through Epic. Physician billings can also be captured directly through Epic. There'll be improved access to data for clinical analysis and research. Palliative Program Benefits
