Scales, Scores and Calculators
Clinical Scales, Scores and Calculators are important clinical decision supports that can help physicians measure and track patient risks, functions and responses to treatments. Some tools static, supporting a single calculation or assessment. Others are dynamic, supporting serial recording and tracking of measures over time.
Connect Care provides access to a wide range of clinical calculators that can be used to adjust medications, predict diagnoses and simplify complex calculations. Static calculators can be found in many of the resources listed under the top-level "Resource Links" drop-down menu, with "MdCalc" offering the largest collection. A "Clinical Calculator" activity is also available as an activity that can be opened within any patient chart (find by entering "Calculator" in chart search and selecting "jump to Clinical Calculator").
Where the data used by a score or scale score is part of the medical record, and possibly tracked over time, Connect Care Flowsheets serve diverse clinical needs. Flowsheets can be used to track serial data, like vital signs or glucose measurements. They can also be used to track mixtures of objective and subjective data, as well as calculations.
Most Connect Care scales and scores use the Flowsheet toolkit. They can be accessed via the flowsheet activity where there is a search tool allowing available flowsheets to be discovered and possibly added as personal preferences to activity tabs. Many hundreds of clinically validated instruments have been built into Connect Care, all able to save data that can later be pulled into reports and other decision aids using SmartLinks.
An increasing number of Connect Care's scores and scales use "SmartForms" to capture, process and store data. These may serve as an interface to flowsheets, providing a more powerful user interface but still storing the resulting data and calculations in flowsheets. However, SmartForms can also function independently of flowsheets, storing data as "Smart Data Elements". These cross encounters and are useful for data that is updated, not followed, and attached at the patient level.
Many flowsheet-based scores and scales can be viewed in a clinician-friendly "layout that facilitate rapid data entry. Multiple tools can be grouped together in a "Scores and Scales" navigator activity, viewable from with any open chart (find by entering "Score" in chart search, then selecting "jump to Inpatient Scores and Scales"). The navigator has an overview at the top, with information about related Connect Care resources and links to help.
Navigator score forms are organized in body-system groups within the navigator and alphabetically within groups using an outline appearing in a leftward column. Selecting a Score or Scale will open data-entry tools as well as important data entry or interpretation instructions. Most tools have corresponding SmartLinks that allow results to be pulled in to clinical documentation.
Sidebar and Popups
Patient charts opened to an inpatient context have a rightward "sidebar" that opens by default. This has an "index" at the top containing interactive labels that will open other sidebar displays. One of these is a "Scores" sidebar. The top of the sidebar has links for opening the Scores and Scales navigator, as well as the Clinical Calculators activity and MDCalc. The top also has a link-bar for jumping between lists of tools that focus on particular body-systems.
The Scores sidebar displays are interactive. One can select a Score label to activate a popup display of the calculator for easy data entry and review. When the score is saved, the popup closes and the sidebar can be refreshed to show the new result.
All sidebar-linked scores and scales have corresponding SmartLinks that can be used to include results in clinical documentation (see resource listed below). In addition, Connect Care provincial templates for summative documents (e.g., Admitting History & Physical, Consults, Progress Notes, etc.) contain SmartLists that facilitate the easy selection and import of score results into notes. These templates can be activated for standards-compliant documentation via links listed within the "Notes & Sidebars" index item in the inpatient sidebar.
Scores and Scales that are embedded in Connect Care -- with all necessary data capture, calculation and interpretation elements -- are provided for clinical use under permissions explicitly obtained by Epic or Alberta Health Services from the copyright owners. In some cases, AHS does not have permission to embed a full score instrument but is able to capture a result (numeric or prose) and include this in documentation. These scores will have but one data entry space, usually for a summative result obtained from an independent (outside) instrument. Links are provided to the original score or scale. Selecting the link will open the tool for in an openly available format, with simple instructions about copying and pasting result(s) back in the Connect Care tool.
Some scores and scales can use data already in the Connect Care clinical information system, with no requirement for direct user interaction. Such automated scores may be interactive (e.g., LACE Index for readmission risk), allowing users to select the score title to obtain popup information about how its value was derived from system data.