General Quick Start Guide

This resource has been created to provide guidance for Medical Learners (including Physician Assistant Students, NP Students, and Clinical Clerks) who are new to using Connect Care. 

Log In Department

Leaners login to the virtual department for the zone. Each department is configured to ensure that the user the appropriate functionality is available, surgery users have additional functions that a pediatrics user would not need.

The department you select will be named Zone + Specialty, e.g.,

• EDMONTON ZONE NEUROLOGY or

• CALGARY ZONE PEDIATRICS.

Exceptions to the Zone + Specialty department name include:

Emergency Medicine when you are working in an emergency department, since patients are coming to that ED room you need to login to that specific ED you are working at, for example:

• CGY ACH Emergency

• CGY PLC Emergency

• EDM UAH WMC Emergency

• EDM RAH ATC Emergency

Labour & Delivery is another example of logging in to the hospital department rather than zone department, for example:

• CGY PLC L&D

• EDM RAH LH L&D

outpatient configuration 🗓️

The Schedule activity is where you find the Schedule for Outpatient (Ambulatory) clinics

• Schedule shows the patients that are scheduled to be seen today by you. But as a medical student patients are, typically, not scheduled to be seen by you they are scheduled to a physician.

The steps below can be used to see the schedule for the physician(s) you are working with.

• from the schedule activity click on your name, where it appears in the top left corner

• click the pushpin to pin this view

• click the ➕ create button

• name the new schedule view

• click configuration tab

• click Provider radio button

• enter the name of the physician you are working with

• click Accept

The schedule for that physican will now appear and be available for you to select each time you login.

Customizing Columns in the schedule 

The standard set of columns that you see is fine, but you have the ability to add or remove columns.  

For instance, if you are working with a surgeon you will benefit from adding the Procedure column. 

• To do this right click on the schedule you created and select properties 

• Notice that the available columns are shown 

• Use the search thing to find “procedures” 

• Add that then Accept 

Access the OR Schedule

When working on a surgical clinical rotation you will want to be able to easily see the schedule for the operating rooms at your facility. 

Snapboard provides this view, but it is not visible by default so you will have to add it to your Hyperspace toolbar 

Add Snapboard

To access Snapboard you must first login to a surgery department, such as Edmonton Zone Surgery or Calgary Zone Surgery, then: 

• Click Epic (top left corner) 

• Hover over Patient Care 

• Find Snapboard 

• BEFORE clicking on it, hover over to see the pin icon  

• Click the pin 

• Select “Add to hyperspace toolbar”

You can rearrange the hyperspace toolbar to make activities easier to access or when they are hidden under the More option. 

Launch Snapboard

After logging in to a surgery department launch snapboard, then

• from the list of facilities select where you are working i.e., FMC, PLC, RAH, etc.

Patient Lists

As a Medical Learner you will be, primarily, interacting with patients that are admitted to the hospital or scheduled for an outpatient office visit.

Add by Supervising Provider

The most helpful way to populate My Patients is to add the patients of your supervising physician(s). To do this:

• Right click on the title My Patients and select Edit Criteria

• The top of the window that appears is titled Add Providers

• Make sure there is a checkbox next to Admitting, Attending, and Treatment Team

• In the provider search field enter the name of your supervising provider. Be careful that you are selecting the correct person if there is more than one matching name.

• Click Accept

• The list will update to show the seven patients associated with that physicianFind a patient

Add the unit patients are admitted to

• • In the lower left corner of the screen there is a list of the hospitals in the zone that you have logged in to.  

  • Scroll through the list to find the facility you are working at

  • After clicking on the name of that facility, notice the first folder that is titled "Units"

  • Click units, scroll down to find the unit that your patients are admitted to. 

  • right click, then choose “send to” --> “My Patients”

Add the Provider Team you are working with

On day one you will need to find out the name of your provider team

• • after finding your facility in the lower left corner, scroll down to find the folder labelled Provider Teams

  • Notice as you look through this list that there are provider teams for all specialties 

  • Find the list that matches with the name of your provider team

My Consults 

• Go back the facility list, scroll down to New Consults - Physician

• in that folder scroll down to find the service you are working on e.g., Internal Medicine

• right click select, then select Send To, My Consults

Customizing Your Patient Lists

The default patient list columns are okay, but there is information missing, such as name of the Attending physician, what provider team a patient is associated with, etc.

The following steps allow you to quickly update all the columns

• Select My Patients in the Patient Lists tab with a single Click

• Select Edits Lists –> Properties from the area above

• Notice the top half of this screen shows Available columns and the bottom half shows Selected Columns.

• On the right side of the window, half way down is a button labelled Copy, Click that button

•  The window that appears is a list of templates that you can apply

•  The one you want is MD Ward Rounds

•  Click the down arrow 10 times or slowly scroll down to find it

•  Select IP MD Ward Consults

• Click Accept

Patient Lookup

You may have noticed that there is a Patient Lookup button in the toolbar at the top of the screen. This would seem like an obvious way to search for a patient.

• When using Patient Lookup the search opens to chart history

• To do any actions on the chart you must first select the correct encounter.

• Do this by clicking on the Select Encounter activity tab.

• Do NOT click on the chart tab titled Place Amb Orders!

Chart Navigation 📁

The Connect Care chart allows access to a patient’s historic and current medical chart. Getting

familiar with all the chart activities can be a daunting task

Search

At the top of hyperspace, you will find the Search Assistant bar. This search bar has two main functions:

1. searching Connect Care to find functionality, tools, resources and

2. When you have a patient chart, open searching for information in the chart.

Storyboard

The vertical column on the left side of the chart is called the Storyboard. It is visible in all charts, regardless of context or specialty. The storyboard enables you to access a lot of specific information without navigating into the chart, from top to bottom you can see

• Demographics: name, age, mrn, uli

• Location: bed and unit

• Goals of Care

• Consent

• Attending

• Allergies

• Admission information including diagnosis (principal problem)

• Vitals

• Lab results

• Meds

Notice that hovering over any detail opens a floating window that shows more information i.e., hover over attending and the entire treatment team details are shown.

Chart Review

This activity tab gives you access to a patient’s entire chart history. It shows all the information that is available in Connect Care for as far back as is possible. 

You will find many patients have years of information available. Explore the different “sub tabs” that are available including Notes, Labs, Cardiology, etc. Each of these will show all the information available, e.g., Notes will show every note that has been written on a patient’s chart across all AHS encounters whether an admission, outpatient appointment, etc.

Encounters

In the Chart Review activity please notice the Encounters subtab.

• Encounters are a fundamental Connect Care concept that is important for you to become familiar with.

• Activity in Connect Care is associated with Encounters. Every note, medication order, lab result is part of an encounter.

• Encounters is a concept that you will hear referenced as you begin to use Connect Care.

The Summary Activity

The Summary activity tab provides information for the current encounter i.e., this admission.

• Overview is the default section that will appear when you access Summary.

• Take a minute to explore what information is available in Overview, Event Log, etcetera.

Problem List

Problem List entries are signs, symptoms, presentations, disorders, or diseases that have an impact on, or could be impacted by, a patient’s current care. This section focuses on problem management skills.

When to Add a Problem

An affirmative answer to any of the following questions merits adding a health condition to the Problem List:

• Is the issue/condition a reason for presentation?

• The reason for admission is usually marked as the patient's principle or primary problem. A reason for consultation, or emergency visit, or outpatient follow-up also belongs on the active problem list.

• Could the condition affect the reason for presentation?

• Co-morbidities that contribute to admission belong on the Problem List. Heart failure, for example, could complicate the management of an exacerbation of chronic obstructive pulmonary disease.

• Could the reason for presentation affect the condition?

• Many chronic conditions can destabilize when a different problem presents or is managed. A common example is chronic kidney disease, which may slip into acute kidney injury in association with an acute infection.

• Is the patient being treated for the condition?

If a patient receives medication or other ongoing treatment for a health condition, that condition should be considered active and be placed on the Problem List. Changes to medications mandated by other problems  (e.g., kidney failure) could affect the condition.

If a medication is used solely to prevent a possible future problem, no Problem List entry is needed (e.g., statins as part of preventive care would not merit a Problem List entry but statins used to treat familial hypercholesterolemia would).

Prior problems recorded in the Medical History can be moved to the active Problem List, as happens when recurrent (not ongoing) issues resurface. When the recurrence or exacerbation resolves, it can be moved back to the Medical History.

When to Resolve a Problem

An active Problem List entry should be "resolved" when it has been managed to a new baseline and will not be the subject of ongoing care. A treated infection, for example, can be resolved if no future action is anticipated. An acute exacerbation of a chronic condition (entered as an independent problem, e.g., acute kidney injury, in addition to the chronic problem, e.g., chronic kidney disease) can be resolved if a new baseline is attained. 

• Resolved problems do not go to the Medical History. They remain available in a list of "Past Problems", which can be exposed at any time.

Hospital Course

Please notice the section below Problem List that is titled Hospital Course. The hospital course section is used to provide a high-level, concise, summary of key developments during the inpatient or emergency department encounter.

• Hospital course is a collaborative activity, allowing multiple providers to record key developments occurring during a patient’s admission, which is then incorporated into the Discharge Note. 

• This allows for important elements of the Discharge Note to be started at the beginning of, and updated throughout, their admission. 

History

Medical history includes substance use, family history, and surgical history.Updating history in this section ensures this information is available to everyone that accesses the patient’s chart and allows for ease of entering this information into current and future documentation.

• Medical history and Surgical history can be updated by entering the appropriate item, or by selecting one of the items that appears.

• Notice the icon that looks like piece of paper next to each item, clicking that icon allows for additional details to be added.

• Family history can be used to update relevant medical information for each family member.

• Social history, including substance use and sexual activity is found by scrolling past family history

Notes

The inpatient chart has a dedicated Notes activity tab. You will see that this tab shows all the notes that have been written so far for this admission encounter.

• Notice that there are subpages for different types of notes: Prog Notes, Consults, Procedures, H&P.

• Clicking on any of these will filter to only show that type of note.

Co-sign Requirement

As a learner, the notes you author will require a Co-Signor.

Use a Standard Note Template

Standardized note templates have been developed by AHS physicians and are available to all users.

To access these templates type ".ahsipheadings" in the blank area of the note you have started.

• The list that appear shows templates for the main note types, including Progress Note (which appears last in that list.

• Have a look through the format of this note

Personalize the Note List Layout

The note list for an admitted patient defaults to showing All Notes, with notes over 72 hours old filtered out. 

Notice the Sort option buttons that appear at the top of the list. 

• These are Note Time, Note Type, and Service, the default is Note Time. 

• Selecting to sort by Note Type can make it easier to find specific notes. 

To the right of the sorting options is a small wrench that allows you to personalize the layout. 

• For example, it is helpful to remove the default option to display a photo of the note author.

• Click the wrench and select "note list layout settings"

• notice the different options that are available

• Bottom left of this window has the option to deselect "Always Show Author Photo"

Orders

The order activity tab shows orders for this hospital encounter. Oriented horizontally across the top of the orders activity are

• Active Orders -- the default display and shows the currently active orders. Notice the options to sort active orders. Notice the Sort By action that is available in the Active subtab, select each option to see how it changes the display of the active orders.

• Signed & Held -- lists orders awaiting a decision or phase of care to be released. For example an Obstetrician will enter pre-operative orders for a pregnant patient scheduled for a c-section, these orders are held until the patient is admitted for the procedure and can be released by nursing.

• Home Meds -- A review of home medications takes place as part of the admission process.

• Cosign -- Orders visible in the Cosign section are active but awaiting co-signature by a prescriber.

• Order History -- Notice the row of action buttons that is visible in Order history that make it easier to find notes by, for example phase of care.

• External Orders -- The external orders subtab will display signed orders for procedures, investigations, or ambulatory referrals. Take a moment to read through the information about external orders.

• Manage Labs -- The manage labs subtab is used for specimen collection workflows in specific settings.

Only Orders in the Building

When you access the Orders activity for an admitted patient, it is important to recognize that you can only order medications and investigations available at the site the patient is admitted to.

• It is not possible to enter an order for an ambulatory referral for an admitted patient.

• If the site the patient is admitted to does not have an MRI suite, you cannot enter an MR order in the order side panel.

Accessing Personalized Orders of Other Users 

As a learner you will find it helpful to access orders that your supervising physician has personalized, it is especially helpful for accessing personalized Order Sets such as admission order sets.

To access personalized orders you can use the "Follow Users" option by:

• In the Orders activity click the + New option, located on the right side of the order search field

• Find the "Follow Users" option at the top of the window, and click it.

• Search for the Clinician: Use the search function to find the name of the clinician whose preference list you want to follow.

• select that person's name, be careful to select the correct person if they have a common name.

• click Accept

• Their name will now appear at the top of the window.

• Putting a checkmark next to their name will show their personalized orders.

Navigators

Navigators help prescribers navigate multistep workflows where it is otherwise easy to forget key requirements. As a clerk you will be interacting with navigators related to ADT: Admission, Transfer, Discharge.  

If you are involved in a patient going through one of these transitions, you MUST use the appropriate navigator. By default the Admission navigator and Discharge Transfer Gateway will appear when you are in the chart of an admitted patient. 

Admission Navigator 

Take a moment to look at the structure of the Admission navigator. 

Activities of this navigator are grouped in to  

• Review  

• Updating the patient’s problem list, medical history, etc. 

• Actions 

• Completing order reconciliation and using an admission orderset to add orders  

• Documentation 

• Completing the admission note. 

Discharge Transfer Gateway 

This is new functionality that provides access to the appropriate navigator based on the patient’s destination. 

• The gateway has clear headings identifying these different workflows  

• A link is available for each workflow to launch the appropriate navigator to complete updates to the chart, place orders, and complete documentation.  

Ambulatory

Let’s jump over to an outpatient chart to quickly look at Notes, Orders, and talk about a consult workflow. Please go to your schedule and open the first patient chronologically in your schedule, this is 9am Fred. 

Notice the difference in appearance of the outpatient chart for Fred compared to the inpatient chart.  

What is the same 

• • All charts have the Storyboard and the Chart Review activity tab, and you are already familiar with how to use these to find information about the patient.

What is different 

• • The obvious difference is that there are no activity tabs for Notes and Orders. Recall that each office visit is a separate encounter that will have a diagnosis, a note, and may include updating existing or adding new orders.  

This contrasts with the inpatient chart, which is also a single unique encounter, but inpatient encounters can last for days and will have multiple notes, different types of notes, and many orders. Since there is, typically, one note and not as many orders there is not the same need for a separate Notes and Orders tab. 

This Visit 

Most of your outpatient activity will be done in the ‘This Visit’ activity tab. This is where the Visit Diagnosis is entered, Problem List is updated, Medications are reviewed, and Orders are added. It also includes wrap-up activities such as tools for identifying a follow-up visit, providing after visit instructions to the patient, WCB forms, and Communications. We will talk about the communications function a little later. 

Ambulatory Note 

There isn’t a notes activity tab, but there is a dedicated area on the right side of the chart for writing your note.  

Starting your note:  

You will see that you do not have to identify what type of note is being written.  

Finishing your note: 

Pend your note!  Notice that there is a choice menu at the bottom of the note, the options are:  

• Pending your note  – allows you to come back later to complete the note. Your staff physician can also update and complete the note, in fact the visit cannot be signed off while your note remains Incomplete. 

• Must do some extra work to find it but it is very important that you Pend on Accept 

• Outpatient visits are scheduled with a staff physician and the note needs to be in their name, this is done by you starting a note and having them take it over after you have saved it. 

Note for a Consult Visit 

When a consult note is created by a medical learner (Clinical Clerk, NP Student, PA Student, AIMG candidate) it will not be incorporated into the consult letter that is created from the communication activity.   

To use the note authored by a learner as part of a consult letter, the supervising physician can create a copy of the note using the "Copy and Create" function by:  

• Click "Edit" on the note authored by the learner.  

• At the bottom left of the note, click the icon that looks like two overlapping pieces of paper (click the camera icon below to see a screenshot. This button will copy the note text and create a new note with the supervising physician as the author. Then, complete the note: 

• Add to the note as necessary.   

• Select "Send to PCP & referring" or, if desired, click on the Communications button to use the Communications tool, or use the Communications tool in the "This Visit" activity to have a consult letter sent to Netcare.  

• Click the "Accept" button.   

• Once the visit is signed, the letter will be routed.