Attaching Media (Objects) to Charts

The Connect Care one-patient-one-record-one-system goal is achieved when all clinicians use the same record of care. Until then, clinicians need to know how external information "objects" can be attached to a patient's chart.

Object (Document) Types

Attachable objects include documents (e.g., consents, advanced directives, worker's compensation forms), images (e.g., retinal scans sent from an optometrist), videos (e.g., record of gait assessment), audio files (e.g., dysarthria assessment) and other types of content in paper, digital or other forms. External objects arrive in a physical or electronic form. Physical objects can be scanned or photographed. Electronic objects can be used as-is or rendered to a standard format (e.g., PDF or TIFF or JPEG) before importing to the clinical information system (CIS).

It is important to consider what type of object, with what purpose, is to be attached to the chart. External documents should be scanned and attached by prescribers only if there is unequivocal clinical value to the information... and expectation that the information will impact clinical choices. It may be more effective to summarize the content of a document using integrated Connect Care charting tools than to park the information as a "media" attachment to the chart.

A simple classification system is used to tag incoming objects. Adherence to object naming and categorizing can make it much easier for other Connect Care users to find attached objects they seek.

Context Dependent Document (Object) Options - Note that the available document types that one can choose from during a scan or import workflow are context-dependent. It is important to access tools like Media Manager from within a patient chart opened to the pertinent encounter and activity. If, for example, importing is done within the consent navigator, the available document types relate to consents, capacity and other legal matters. If importing is part of a "Prep for Procedure" surgical encounter, then Media Manager object import options include consents but also objects like "History & Physical" and "Operative Note".

If the list of document types within Media Manager seems too narrow, consider whether Media Manager was launched from within an encounter, and the correct encounter. It is also possible to open the patient's chart outside of an encounter (patient lookup), then create a "Documentation" encounter type. Opening Media Manager from within a Documentation Encounter makes a wide range of import types available to choose from.

If the available types still seem insufficient, use "external document" type and then provide a more specific document title.

Object Attachment Methods

Prescribers should know where to look when a reminder is needed about how to capture, attach and use media in Connect Care charting.

There are three ways to attach objects to a patient's record.

  • Media Manager
    This Hyperspace tool allows objects to be scanned or imported for attachment at the level of the patient, episode, encounter or action. Once in the patient's media collection, the objects can be further imported or linked to communications, notes or orders.

  • Mobility
    Both Haiku and Canto allow the direct capture of images, sounds or videos that can be attached to the patient and/or encounter (also available via Media Manager).

  • Notes
    Some documentation tools (notes, letters, etc.) allow insertion of images via Media Manager or directly from the local or networked computer or file store (network drive).

Media Manager

The Media Manager activity can be found via the Hyperspace Epic Menu (or top Toolbar) or Chart Search (Hyperspace top right). When opened, it will force patient selection to get to the right chart, then list all of the objects attached to that patient's chart. Select the "Scan" button at the top of the Media Manager to add an object. Depending upon the current computer and its attachments, one may be able to directly scan a document into Connect Care, or be required to generate a file for importing to Connect Care.

Note advice above (Object Types) about how to select the right object (document) type when scanning or importing. It may be necessary to create a documentation type encounter in order to gain access to all desired import document type options.

Scanning

If one is capturing an object with a scanner attached to the current computer, one can proceed as instructed within the Connect Care.

Importing

The following tips illustrate how to capture and share an object stored as a file (usually as a PDF file) on a local computer:

Be sure to delete the file(s) from the local computer once successfully attached to the patient's chart.

Mobility

Both Haiku (smartphones) and Canto (iPads) support capture of images for attachment to a patient's chart and/or insertion into clinical documentation. Indeed, these should be the only tools used to gather and attach photographic images. Connect Care mobility ensures that the images are captured and temporarily stored in parts of the device memory that are not available to other applications and are not at risk for inadvertent sharing through other communications. Moreover, the images are securely uploaded to the Connect Care chart in an encrypted form and are then deleted from the local device.

Clinical image capture is initiated when Haiku or Canto are opened to a specific patient chart.

  • Haiku
    Tap the patient portrait image at the top left of the Haiku chart display and use the "Capture Clinical Media" button that appears. Once an image is captured and approved, it becomes available via Media Manager in Hyperspace and also via "insert image" buttons in clinical documentation tools.
    It is also possible to capture an image directly into a note started with Haiku by using the "Notes Entry" tool within an opened chart and then selecting the camera icon to take a photo that is immediately incorporated into the note. In this way, a draft progress note can be initiated using Haiku (with clinical image(s) included) that is later edited and finalized in Hyperspace.
    A "Media" tool within a patient chart opened in Haiku allows captured images to be further managed, including those no longer wanted.

  • Canto
    Access to the "Capture Clinical Media" tool parallels actions in Haiku. Select the patient portrait image at the top left of an opened chart. Image capture directly into notes is also supported within the "Notes Entry" tools and basic image recovery and management is possible using the Canto "Media" activity within an opened chart.

Note Insert

As described above, Haiku and Canto support direct capture of images from a mobile device camera into a draft documentation note. Similar capabilities exist in Hyperspace when a note is being edited, except that the inserted image is pulled from a file on the local computer.

  1. With a note opened in editing mode, select the "Insert Image" button or menu command.

  2. By default, the user is presented with encounter-specific images already attached to the chart. These may have been captured using Haiku or Canto. Any image can be incorporated into clinical documentation.

  3. In addition, a "Browse" button at the top of the Image Selector pop-up allows browsing of the local computer file stores so that an external image can be inserted into the note. Supported image formats include: Windows bitmap (.bmp), fax and scanner images (.tiff), JPEG (.jpg), Graphic Interchange Format (.gif) and Portable Graphics Format (.png).

Sharing (Communicating) Attached Objects (Media)

Once an object (document, image, report scan, etc.) is attached to a patient's chart, it can be shared with other clinicians in the patient's circle of care. Simplest is to message the receiving clinician to indicate that there is a new "media" object attached to a particular patient in Connect Care, suggesting that they log on, open the patient's chart, go to Chart Review, then find the item in the "Media" tab. This "go check" message can be sent from within Connect Care (In Basket or secure chat) or via a clinical secure email service (e.g., AHS email).

More efficient workflows make use of In Basket or secure chat in-system messaging to "attach" the object of interest to the message.

In Basket Message

  • Open a patient chart, then the "Chart Review" activity, then the "Media" tab.

  • Find the chart attachment (object) of interest and select its row in the list of Media objects.

  • Use the "Route" button/command at the top of the Media list, then select one or more Connect Care users to send the object to.

  • Upon sending, the recipient will find a "CC'd Chart" In Basket message with the media object attached and immediately viewable without having to open the patient chart.

  • This same method can be used to direct some objects (documents) to external clinicians via their preferred clinical communication method (e.g., fax, mail, eDelivery).

Secure Chat Message

  • Open secure chat (in Hyperspace, Haiku or Canto).

  • Set up a message to one or more Connect Care users.

  • Select a patient to attach to the message.

  • Note the image icon just to the right of the message text box, select this, then select from the patient chart media objects and send the text message with an attached object.

  • This same method can be used with mobile apps to send a quick image (captured with the mobile app) to a colleague even if a patient chart is not selected first.

Resources

Training

  • MyLearningLink: Search for eLearning courses using keywords "Media Manager", "Document Types" or "Consent Navigator"