Tippy #23 - External Orders for Inpatients

Tippies can be quickly adopted with immediate workflow benefits...
  • External Orders for Inpatients
Inpatient and outpatient order catalogues are not the same. Some order items are available in one context but not the other. This works most of the time. However, there may be situations when an order unique to the outpatient catalogue must be initiated during an inpatient encounter.

This is made possible with "External Orders", which can be used if the needed order is not part of a discharge plan (see Tippy 22). Use the global search tool from within a patient's chart opened to an inpatient encounter. Seek "External Orders":


This will open an “external orders” activity and make available an Order search tool that gives access to ambulatory orders. This might be used, for example, to set up an outpatient referral while the patient is still in hospital.

Tippy #22 - Discharge vs Inpatient Orders

Tippies can be quickly adopted with immediate workflow benefits...
  • Discharge Orders vs Inpatient Orders
Inpatient and outpatient order catalogues are not the same. Some order items are available in one context but not the other. This works most of the time. However, there may be situations when the purpose of ordering is to organize interventions from within hospital for actions intended outside the hospital.

If outpatient actions are part of a plan of care for when the patient leaves hospital, these can be lined up as "Discharge Orders" within the "Discharge Navigator":


Discharge Orders have access to the full outpatient order catalogue. They do not take effect immediately, rather activating at the time of discharge. Of course they can also be modified (or removed) later. In this way, one can plan for things like specialty follow-up, but confirm details of the request at the time of discharge. Remember to "Save Work - Complete Later" (Save-Ready) for discharge orders entered earlier in a hospital stay.

Tippy #21 - Email alerts to In-Basket status

Tippies can be quickly adopted with immediate workflow benefits...
  • Email alerts to In-Basket Status
Some Connect Care prescribers work a few weeks on (e.g., inpatient service) and then some weeks off clinical work. The clinical information system (CIS) In-Basket is important to check daily when on-service, but results and other messages will be less frequent when off-service.

In circumstances like this it can be useful to configure the CIS to provide an email alert to new, or accumulating, In-Basket tasks. The alert can go to an address of one's choice because no patient information is revealed.

To set this up, go to the "Personalize" menu within the In-Basket activity in Hyperspace.


Select the "Reminder Emails" tab in the popup that appears.


You can set the email to use for alerts, the frequency of alerts and whether specific In-Basket folders should be used to trigger alerts.

Tippy #20 - Patient List MD Notifications

Tippies can be quickly adopted with immediate workflow benefits...
  • Physician Notifications in Patient Lists
One of the more useful columns that can be incorporated in patient lists is "MD Notifications". The resulting list cell has a cloverleaf of alerts. Clockwise from top left, these are 1) New Labs, 2) New Notes, 3) Orders needing Cosign, 4) Notes needing Cosign.


These visual cues can help one focus on new information or unfinished work. However, the new labs and new notes indicators depend upon use of "Time Mark" in Results Review (Chart Tab) and "Mark All as Not New" in Notes Review (Notes Tab):



Making a habit of clicking these review timestamps when rounding can improve the usefulness of patient lists for task management.

Tippy #19 - Avoid Duplicate Orders

Tippies can be quickly adopted with immediate workflow benefits...
  • Duplicate Order Avoidance
It is better to prevent overlapping or duplicate Orders than to try to clean clutter after a long inpatient encounter.

One way to recognize possible duplicates, and discontinue predecessor Orders immediately, is to note the visual cue appearing when Orders are being lined up for signing:


The small purple square to the left of the new Order contains a digit reflecting the number of possible duplicates. Clicking on the number brings up a popup summary of possible duplicate(s), with buttons that can be used to discontinue right away.

Tippy #18 - Custom Schedules

Tippies can be quickly adopted with immediate workflow benefits...
  • Custom Schedules
The Schedule activity is often the best top-level view, and starting point, for ambulatory workflows. Rapid access to one's own schedule is the default. Sometimes one fast, or even default, access to the schedule of a colleague or a group of colleagues. It is easy to create custom schedules to meet this need.

In Hyperspace, go to the Schedule activity, then select the down arrow to expose a pick-list that includes a "Create" button that can be used to initiate creation of a new custom schedule:


Creating a new schedule to show the appointments of another physician or group is done with the create schedule tool (see Guide and/or Demo). Once created, that schedule can be set as the default by right-click on the schedule name, then selecting the "Default Schedule" checkbox:


Resources:

Tippy #17 - Changing Jobs

Tippies can be quickly adopted with immediate workflow benefits...
  • Changing Jobs
Different users can log on to the Connect Care clinical information system (CIS) and experience quite different user interfaces. Those physicians assigned more than one "job" template have the ability to change both "job" and "context". This may confuse.

A job maps to a provider template giving access to a particular Epic toolkit, user interface, or "module". Examples include Lumens for endoscopists, Beacon for oncologists and OpTime for anesthesiologists. Physicians doing work that might require use of more than one toolkit must choose the job they wish to log into to for a particular practice setting.


In addition, some 'jobs' may provide access to more than one context or 'department'; selected as the next step in the logon sequence. In general, pick the most general virtual department (e.g., zone general internal medicine):


So, what's the Tip? Happily, once job and context have been selected once, they default to the same value at the next logon and one can simply hit the Enter key twice. If one alternates between multiple jobs or contexts, the commonly selected ones are the defaulted to pick from.

And, once logged on, it is easy to change both job and context from the top right logoff drop-down menu:


This Tip applies only to those physicians with multiple job options in Connect Care.

Tippy #16 - Changing Context

Tippies can be quickly adopted with immediate workflow benefits...
  • Changing Context
The same user can log on to different Connect Care "departments" or "contexts," affecting things like available lists, schedules and activities. Some users will need to change contexts when working in significantly different settings (e.g. Acute vs Critical Care).

In Hyperspace, use the drop-down menu at the top right (same as log-off), then select the context (department) wanted:

In Haiku, tap the top right title bar current user image, then select "change department":




In Canto, tap the top left Canto menu, then select "Department":



Note that changing contexts is rarely needed. Connect Care emphasizes zone-wide specialty "departments" that work across many facilities. Thus, selecting one's specialty-zone combination usually suffices for all work, including inpatient and outpatient.

eSafety Alert - Other Labs in Results Review

eSafety alerts highlight CIS phenomena that require particular attention...
  • Lab Results in 'Other' Results Review
Early in the Connect Care launch, it was appreciated that some laboratory results were not filing to clinically expected categories and subcategories of the Results Review tables. Tests with unique identifiers not yet recognized would appear in an 'Other' category.

Physicians need to be careful to not miss potentially important information while test mappings are being optimized (work progresses quickly but could take another week).

It is always possible to review results chronologically and to use search or filters to find a result of interest. If Results Review is used (convenient organization of many results in one place), then a simple technique can clarify where any 'Other' results belong. This is demonstrated in a very short video (1 min):
Even after test mappings have been optimized, there is always risk that a new interface with a new lab provider will result in a test that does not map to the outline at first. So this technique is good to remember.

Tippy #15 - Time Mark for Notes

Tippies can be quickly adopted with immediate workflow benefits...
  • Time Mark in Notes Review
A prior Tippy highlighted the value of "TimeMark" in results review. It is possible to mark all viewed lab results as viewed, so the next time one opens the chart all the new results not previously seen are highlighted (bold font).

A parallel convenience is available when reviewing documentation notes:


Clicking on this will cause all notes to be marked as already viewed. The next time one opens the chart, and there is new documentation content, the unseen notes are highlighted with bold titles.

Tippy #14 - SmartStuff Butler

Tippies can be quickly adopted with immediate workflow benefits...
  • SmartStuff Butler
Connect Care users know that a lot can be achieved with "SmartStuff" when documenting. But there are so many SmartPhrases, SmartLinks, SmartLists, etc. to choose from... let alone remember. One's own SmartStuff can build to a very long list.

Enter the "Butler". This very useful tool is readily available as a button above most text editing areaz (if not, look for "List my phrases" in the Note menu, or enter ".my"):


Let's say one wants to enter a SmartLink for the patient's admitting diagnosis (link will automatically substitute in the correct diagnosis). Click on the Butler to open a useful SmartStuff tool:


Make sure that "System SmartPhrases" and "Smart Links" are selected at the right. Enter enough text in the search box to get a match (you may have to experiment with different ways of finding the item you seek, such as "admi", "diagnosis", "admi dx") and be sure to select the "Full Text" checkbox to the right of the search box so that both the abbreviation and the user-friendly SmartStuff label is searched. You can then search and select the SmartLink of interest and have it inserted in your text.

Flowsheets for Physicians

Flowsheets are an information tool optimized for tracking observations at multiple points in time.
They are part of the everyday work of nursing (e.g., vital signs, Ins and Outs, etc.) and allied health (e.g., respiratory device measures), but can also be used by physicians to track important clinical findings over time (e.g., CiWA tracking of alcohol withdrawal, Geriatric Depression Scale, etc.).

Flowsheets are but one of many ways for deriving clinical scores and metrics. When one-off summary measures are wanted, it may be better to use the Clinical Calculator or the Scales and Scores Tool.

Flowsheets are available in all care contexts and are organized in an Activity Tab.

Tippy #13 - Canto Layout

Tippies can be quickly adopted with immediate workflow benefits...
  • Canto Layout
The Canto mobile app for iPads can be useful when rounding or quickly reviewing a panel of patients. However, different layouts work better for different physicians. Surgeons, for example, may prefer a case list to a patient list. There are 4 "slots" in the Canto display and each can hold a different activity. Personalize these from the iPad settings:



Available activities to populate slots with include patient lists, outpatient schedule, in-basket, dictations, links, status board, secure chat, notifications and blank.

Tippy #12 - Power Search

Tippies can be quickly adopted with immediate workflow benefits...
  • Power Search
The search function (CTRL-Space) in Hyperspace (top right or within StoryBoard) is remarkably useful. It can help find an activity or navigator that may not be among one's favourites.

Search supports clinical discovery when used within an open chart. One can find, for example, all visits where mention was made of a specific symptom or sign. Searches can be made more specific by using multiple terms joined with "AND",  or more sensitive with "OR":


If you want to get fancier still, parentheses can be used for more complex logic (e.g., "Refill AND (Ryan OR Robert)".

Printing from Personal Devices

It is unlikely that a personal computing device (notebook, tablet or iPad) will be able to find or map to printers in clinical practice areas. There is a work-around if a report (e.g. After Visit Summary) needs to be printed or saved for printing:



  • Initiate a print command.
  • Look for the "Microsoft Print to PDF" printer name from the list of available printers. 
  • When prompted with a dialog seeking a location to save the pdf file, click on the drop-down list to the right of "Save in:" and select the storage device for your personal device, then seeking out the desired folder and giving the pdf file an appropriate name.
  • --> it is essential that this workflow only be performed with approved personal devices having encrypted storage; and that pdf files be deleted as soon as the purpose (e.g. billing data transfer) is complete.

Tippy #11 - Provider Name Tweak

Tippies can be quickly adopted with immediate workflow benefits...
  • Provider Name Tweak
In addition to confirming one's provincial provider registry, Connect Care PhoneBook, and MyAHS Connect patient-facing demographics, physicians can often adjust their name format in things like lists. If in doubt, hover over your name on a Connect Care display, right-click, and look for "properties" in the popup menu. For example, within the outpatient schedules activity:


This allows those of us with multiple (or embarrassing) middle names to simplify how we are presented to others!

Tippy #10 - Fast Menu Buttons

Tippies can be quickly adopted with immediate workflow benefits...
  • Keyboard launch of main activities
It is easy to launch button-bar activities without leaving the keyboard: combine the Control (CTRL) key with the number of the button, counting from the left. Hovering over the button will bring up a reminder of its keyboard shortcut.


"Dragon Login" is always the left-most button and so can be easily launched with CTRL-1.

Surgical Order Flows - Infographics

Surgical events challenge information systems and users alike: workflows can be complex and it is important that current and anticipated orders occur at the right time and place. A couple of new infographics summarizing surgical order flows pre-op and post-op:



These are linked in an updated section of the Connect Care Physician Manual:

Tippy #09 - Personalized Toolbar

Tippies can be quickly adopted with immediate workflow benefits...
  • Personalized Toolbar
The main toolbar is the set of horizontally arranged buttons at the top of Hyperspace. These can be changed to reflect what is most commonly needed. The order can be changed. Users should select commonly accessed activities not otherwise easy to launch from tabs.

Click on the right-most wrench 🔧symbol in the top toolbar. This will open a personalization activity. Drag and drop buttons to select and arrange to one's liking.


Clear any but the most useful buttons and consider adding: Patient Lookup, Phone Book, My Reports, Sign My Visits, Evidence Library.

Tippy #08 - Startup Activity

Tippies can be quickly adopted with immediate workflow benefits...
  • Set a Favourite Startup Activity
Physician work may recur in the same context (e.g., inpatient, outpatient, office) for days or even weeks at a time. It can help to have Connect Care open to the most useful activity at every logon. This is done by selecting the star at the right of the title bar for the selected activity tab:


The activities available for default vary by specialty but the personalization method is the same. The favourite can be changed at any time, even more than once in a day.