Prescriber Roles

Most prescribers work within a primary care or specialty service and are well served by their assigned Connect Care department, role and user template. Their Connect Care login will be straightforward: their "department" will default to their usual choice, requiring only user name and password for a successful login.

Some prescribers will need to provide more information at login. They may require different user interfaces (e.g., emergency, operating room) at different times, and some Connect Care users additionally need to clarify both their role and who is ultimately accountable for the work they do in that role. This is particularly the case for prescriber trainees.

Multi-Role

Some prescribers work in two or more specialty areas that use different CIS modules. The emergency module (ASAP), for example, is not like the critical care user interface. If one needs to switch between different modules for different roles, then more than one "sub-template" needs to be added to one's Connect Care physician record.

Connect Care has made configuration changes for multi-role physicians and all trainees (who rotate through many roles throughout a year). Still, some multi-role physicians could be missed. Medical Affairs facilitates changes to physician roles and profiles. Physicians concerned about the role(s) assigned should request clarification or correction through their Zone Medical Affairs, who takes care of physician privileges and specialties.

Multi-Site

Some prescribers see patients at more than one practice location. While one or more locations may use Connect Care as the record of care, one or more locations may be outside Connect Care and use a different health record. This can affect the best way to handle delivery of laboratory test results and clinical documentation. Connect Care is able to accommodate such complexities by associating more than one practice location with a physician record.

Connect Care provider look-up tools may show a provider name, and within it one or more practice locations (sites). In general, this option only appears where the user's choice may matter. The site name(s) and address(es) appear next to the provider name, and the appropriate practice context can be selected when choosing the provider.

Multi-Record

There are many workflows where users may select provider names. Examples include copying test results, clinical correspondence and referral information. For these workflows to be unambiguous, it is important that each provider have but one provider record and, therefore, appear only once in the pick-lists used to select providers for actions. In general, Connect Care follows a strict rule of one-provider-one-record.

There are some rare exceptions. Connect Care users may notice that a few prescribers are listed in the clinical information system (CIS) phone book (and associated look-ups) more than once. Some healthcare providers care for patients in more than one province, most commonly affecting Connect Care when physicians perform clinical duties in both Alberta and the Northwest Territories. The non-Alberta role is indicated by a two-letter provincial abbreviation in parentheses. Users need to take care when choosing a provider record to match the provider to the correct care context.

Trainees

Prescriber trainees, including medical students, residents and fellows, are supervised by fully licensed prescribers. These "supervising" prescribers may co-sign or attest to trainee activities, and are synonymous with "authorizing providers" for such purposes:

  • Medical student orders and documentation are signed by a resident or a supervising prescriber.

  • Residents sign their own orders but some documentation (e.g., consult, discharge summary) is co-signed by a supervising prescriber.

  • Key Concept: Provider - Physician - Prescriber

All trainees select a "job" (e.g., "Resident Cardiology", "Resident Surgery") and a "context" department (e.g., "EDMONTON ZONE CARDIOLOGY", "EDM UAH KEC GENERAL SURGERY") when logging in to Connect Care. These choices affect how Hyperspace is set up, as well as which CIS modules are available to the trainee. Trainees can change both job and context easily from within a Connect Care session:

Multiple Supervisors

In some contexts, multiple providers relate to the work of a single trainee working in a single Connect Care session. To avoid ambiguity, a requirement for "Supervising Provider" selection at login was introduced for Connect Care trainees in second quarter 2020. This requirement was later removed because of practical difficulties with some workflows. Instead, the CIS assigns a default authorizing prescriber based upon the panel of providers linked to an individual patient for a specific healthcare encounter. This works most of the time; however, there are situations when this information may not suit the trainee's clinical task.

In order for critical, ambulatory and late-reporting inpatient results to route to the right In Basket and co-sign prompts to go to the right supervisor, it is important for trainees to understand Connect Care's default authorizing prescriber and when this should be manually overridden.

Default Authorizing Prescriber

A trainee is assumed to be supervised by another provider according to a hierarchy of possibilities. If first choice is not known, then the second option is used. The default authorizing provider differs by context, using provider associations specific to the patient and encounter:

  • Emergency Departments

    1. Attending provider for the patient ED visit

    2. Current provider (trainee themselves, IF they are an authorizing provider)

  • Inpatient Departments

    1. Attending provider for the patient admission

    2. Current provider (trainee themselves, IF they are an authorizing provider)

  • Outpatient Departments

    1. Encounter provider for the patient visit

    2. Current provider (trainee themselves, IF they are an authorizing provider)

If the first option is not available (e.g., currently unassigned) and the second option is not appropriate (e.g., trainee not able to be an authorizing provider), then the trainee is prompted to select an authorizing provider at the time of ordering.

Authorizing Prescriber Override

The default assignment of an authorizing provider will work most of the time. However, it is important to know how to select an alternate authorizing provider if the default does not fit a specific patient interaction.

Additional Prescriber Copies

Sometimes it is important to bring particular test (“procedure”) results to the attention of prescribers other than the ordering or authorizing prescriber. This is easy to do at the time of ordering by using the “CC Results” field found within procedure orders. One can select one or more "copy-to" providers.

Trainee Authorization Scenarios

Trainees who find themselves in multi-supervisor contexts can review how the supervisor hierarchy may apply:

      • Crib-Sheet: Multi-Supervisor Scenarios