The Connect Care clinical information system (CIS) includes powerful tools for accessing, personalizing, building and sharing patient lists. Some contexts, such as those for emergency and surgical prescribers, have highly specialized lists. All prescribers can access a Patient Lists activity, where groups of patients can be defined, tracked and shared. As always, clinicians should be privacy-mindful when using lists to access patient information.
Personal Lists ("My Lists")
The "My Lists" section of Patient Lists groups lists that matter to the signed-on provider. A default "My Patients" list identifies all inpatients associated with the current provider by virtue of an attending, team or other active responsibility. This may suffice for clinicians with infrequent inpatient responsibilities.
Those working on inpatient ward, consult or service teams can benefit from the creation of one or more personalized lists. The user can copy any existing list (such as My Patients) to make a personalized derivative. It is also possible to create custom personal lists from scratch.
The easiest way to get started with (or update) a personal "My List" is to create a new list in the patient lists activity, then edit its properties (right-click on list, or edit properties from patient lists menu) and copy settings from an AHS template (named such that they appear near the top of copy-template pick-lists) fitting one of the following use cases:
Manage a panel of inpatients: "++AHS IP MD PATIENT MANAGEMENT TEMPLATE++"
Inpatient ward rounds: "++AHS IP MD WARD ROUNDS TEMPLATE++"
Inpatient RAPID (multidisciplinary discharge planning) rounds: "++AHS IP RAPID ROUNDS CORE TEMPLATE++"
Inpatient consultation panel: "++AHS IP MD WARD CONSULTS TEMPLATE++"
Emergency consultation panel: "++AHS IP MD ED CONSULTS TEMPLATE++"
Patient archive (billing): "++AHS IP MD PATIENT ARCHIVE++"
Personal lists can be shared between colleagues. This allows inpatient groups to create and share lists that serve a specific purpose, such as quality rounds cases. Patients can be moved between lists, assigned, de-assigned, or removed.
A "My Patients" list appears in the "My Lists" (top-left) section of the Patient Lists activity. Although this list is present by default and seen at first logon for new users, note that it is a personal list that can be edited. It is possible for users to change its name or properties... and so possibly change its default behaviours. "My Patients" normally shows patients with the following attachments:
Inpatients for whom the current user is an Attending Prescriber, Consulting Prescriber, Principal Prescriber.
Some other, but not all, patient attachment relationships that add the current user to the inpatient treatment team.
The "My Patients" list can also contain patients that are manually added or removed from the folder by the user. This can be confusing if the same folder has patients that come and go according to changing attachments and others that come and go according to manual actions. We recommend that "My Patients" be left in its default state where it contains just one item: the "All My Patients" system list (dragged and dropped from the systems list below). This ensures that "My Patients" reflects inpatient attachments known to the system. Other (custom) personal lists can be used for grouping patients under manual control.
A "My Consults" list may appear in the "My Lists" (top-left) section of the Patient Lists activity when users first login to Connect Care. This functions like the "My Patients" list, except that the default System List association is "All My Patients >> Consults". Patients will come and go from this list according to the placement of consult orders specifying the current user as consultant, or explicit additions of the current user to the inpatient care team as a consulting physician.
System Lists ("Available Lists")
Inpatient lists found in the "Available Lists" area are particularly powerful, as they leverage system information to pre-populate lists with patients associated with particular locations, groups, services, consultations and activities. Prescribers can use these to help populate personal, team and shared lists.
System lists categorize patients by characteristics that span multiple facilities.
Facility lists group patients by current facility nursing unit, support service area (e.g., diagnostic imaging), clinical service, or functions like incoming consult requests.
Connect Care expresses the organization of health services within facilities using inpatient "Provider Teams". These roughly correspond to the hospital service caring for a patient, while allowing for more than one group(s) to provide care as part of a larger specialty service. Within a general surgery service, for example, there may be teams that take turns admitting patients, other teams focused on consulting, and yet others providing specific types of care (e.g., trauma service). "Treatment Teams" and "Provider Teams" are synonymous, and both terms can be used in different places within Epic user interfaces.
A "Primary Provider Team" is the team most responsible for a patient's care while in hospital. A patient can have more than one Provider Team participating in care (e.g., admitting team and consulting teams), but only one can be marked as the Primary Provider Team (usually synchronous with the inpatient Hospital Service) at any one time. Best practice ensures that all inpatients are assigned a Primary Provider Team.
Admitting and transfer workflows may allow selection of an accountable Provider Team, and this is one of the ways by which Provider Team lists are populated with patient names. Discharge and transfer events automatically remove patients from team lists.
The "Care Teams" chart tool (within a chart and found via chart search) and the "Patient Lists" workspace make it easy to move patients between teams. A folder listing all available Provider Teams appears within each facility system lists folder. A right-click menu is available within all Patient Lists, giving options for assigning and removing patients from the Provider Teams available in a facility. Patient lists can contain an "IP Provider Info" column block (by default in lists based on the "++AHS IP MD PATIENT MANAGEMENT TEMPLATE++" My Lists template), which gives double-click access to provider teams quick-editing from within patient lists.
Similar terms are used in Epic to refer to different types of patient-provider attachments. It is important to appreciate the difference between, for example, a "Provider Team" and a "Patient Care Team". This is easiest to appreciate through the "Care Teams" activity, which can be accessed with global search (within a chart) or via the patient's Storyboard or SnapShot.
The "Patient Storyboard" appears as the leftmost column when patient charts are opened in any Connect Care module. Just below the chart search box, the current patient's most responsible provider is identified. Hovering or clicking on this brings up a "Care Teams" activity displaying all providers and teams in a formal care relationship with the patient. The attachments can be added, edited or removed. There are up to four sections:
Attending Provider - Appears for inpatients and reflects the most responsible provider while admitted.
Treatment Team - Appears for inpatients, listing all providers and provider teams associated with the patient while admitted.
Patient Care Team - Appears for all patients, listing providers and teams that have an enduring relationship spanning multiple encounters, including the patient's Primary Care Provider (PCP).
Referring Provider - Appears for inpatients, Emergency Room encounters and some outpatient encounters where a referral for service pertains (this relationship can also be set in the Service Code Navigator activity).