Tippy #27 - Attaching Files to Charts

Tippies can be quickly adopted with immediate workflow benefits...
  • Attaching Files to Charts
The Media Manager activity (found via the Hyperspace Epic Menu and via global search) can be used to import files saved to a local or networked hard drive. Such "objects" may be images, documents or other media important to include in the medical record. Once attached, they can be linked at a patient, encounter or order level and can be attached to communications or inserted in Notes. Useful to know a few basics about Media Manager:
Be sure to delete file(s) from the local computer once successfully attached to the patient's chart.

COVID Tip: Remote Assessment in Primary Care

The Connect Care Clinical System Design (CSD) team is mobilizing clinical content (decision, documentation and inquiry supports) for emergency, inpatient and critical care management of patients with moderate to severe COVID-19 illness.

However, the most prevalent COVID-19 syndromes constitute mild disease that can be managed in the community. A recent BMJ article nicely describes how this can be facilitated with virtual care processes:

Tippy #26 - Using Calculators for COVID-19 Assessments

Tippies can be quickly adopted with immediate workflow benefits...
  • Finding COVID-19 Calculator Aids
A number of metrics, measures and decision-rules are emerging to help recognize, prognosticate and triage COVID-19 syndromes.

An excellent COVID-19 measures compendium is available within all Connect Care contexts. Interactive calculators can be used to generate scores for care planning and documentation:
  • From within Hyperspace, go to the "Evidence Library" top-level toolbar, click to expose the options, then select "MDCalc".
  • When the MD+Calc website opens, look to the top-right and select the "COVID-19 Resource Center" link. 
  • This will open a page giving access to CURB-65, SCAP, SOFA, SIRS and other scores. All walk you through online assessments.

The Evidence Library gives access to many point-of-care knowledge resources.

COVID Tip: Virtual Care Assessment of Oxygen Saturation

UPDATE ALERT 2020-04-02: EMERGING EXPERIENCE SUGGESTS THAT THIS ROTH SCORE IS _NOT_ VALID FOR COVID-19 PATIENTS.

Although there are no validated tests for assessing breathlessness via telephone or video conference, a potentially promising test, the Roth Score, is creating some buzz.

This is nicely demonstrated by a Welsh physician via Twitter:


Tippy #25 - Easy Dictation within Mobile Apps

Tippies can be quickly adopted with immediate workflow benefits...
  • Mobile Dictation within Apps
Dragon Medical One remains the app to use when dictating into a patient's chart on a desktop or tablet in Hyperspace. But what if you are rounding and want to quickly initiate a progress note that for touch-up up later when using your favourite computer in the comfort of your office?

Haiku (smartphones) and Canto (iPads) support Nuance Dragon dictation directly into progress notes initiated in the mobile app. You have access to all the medical smarts of Dragon, including personalizations. A demo says it all:
Be sure to use your mobile App Store to update to the latest version of Haiku or Canto.

Tippy #24 - Simple Patient List Reports

Tippies can be quickly adopted with immediate workflow benefits...
  • Simple Patient List Reports
Connect Care's "Reporting Workbench" tool is powerful, if intimidating. It helps users use, create, save and share reports listing patients, encounters or other phenomena matching one or more criteria.

A great way to get started is to customize a very simple report that meets a common need: finding all patients at one or more facilities where one or more physicians serves as the attending provider. We've created a mini-tip showing exactly how this is done (within a few minutes).
The same process can be extended to produce more complex reports to answer clinical questions.

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)".