Mixed Provider Contexts
Prescribers who work where the Connect Care clinical information system (CIS) is the record of care and also work in at least one setting where the CIS is not the record of care (inside or outside of AHS facilities supported by paper or electronic medical records) are said to be working in a "mixed context". These mixed-context prescribers need to manage some unique information flows that may relate to clinical documentation, communication and results delivery.
Communication
As soon as a prescriber gains access to the Connect Care CIS, that prescriber has an active "In Basket" and secure messaging presence. Any other Connect Care user can look up a prescriber for purposes of communication. The Connect Care provider directory reflects all Alberta providers. Attempts to send an In Basket or secure chat communication are blocked for providers who do not have Connect Care accounts. Consequently, any Connect Care prescriber, even those who do a minority of their work where Connect Care is the record of care, must make provisions for monitoring Connect Care clinical communications.
The safest approach for mixed-context prescribers is to regularly log in to Connect Care for the purpose of checking communications (In Basket and secure chat). It is also possible to enable Connect Care communication options for short or longer periods when it may not be possible or practical to regularly check Connect Care.
In Basket
Personalize In Basket to send email alerts whenever new content arrives.
Change In Basket status to "Out of Contact" and set delegate providers to forward tasks to for a defined period.
Arrange for one's In Basket activity to "Attach" to another provider, so that by "granting access", the other provider receives copies of tasks sent to the first provider's In Basket.
Arrange for one's In Basket activity to "Copy" to an In Basket messaging pool, as might be monitored by clinical support staff.
Secure Chat
Change one's "Status" to "Busy" or "Unavailable" for a defined time period.
Set all secure chat messages to "Auto Forward" to a different user's secure chat functions for a defined time period.
Note that, while a physician working in a mixed context may be added to a patient’s care team in Connect Care as a Primary Care Provider (PCP) for a patient receiving services with AHS, their role as PCP is related to the community clinic. Patient messages sent via MyAHS Connect in this case would not be related to their care with AHS nor to the work the physician does in AHS. As there are no pools or structure to support these messages, the messages are routed to an IT team error pool instead of to the intended physician. After confirming that the intended recipient does not have a department that schedules appointments in Connect Care and therefore does not have a clinical support advice request pool to support message management. IT will then respond to the patient, letting them know their physician cannot be reached via MyAHS Connect, and to instead contact the community clinic directly.
Documentation
In general, health care must be documented in the record of care for the entity providing that care. However, there are situations where the association between service provision and care documentation is more complex.
Connect Care is the record of care for all AHS facilities. It is also the record of care for all health care organizations that have entered into an agreement where AHS provides health record information services. This includes contracted and affiliated health care organizations as well as health businesses subject to health information management agreements with AHS. "Mixed context" providers work in clinical settings that use Connect Care as well as other settings that use a different health record.
When mixed context prescribers have access to both Connect Care and one or more community electronic medical records (or even paper records), the same group of patients may be seen in more than one facility or context under the oversight of the same health care service. Questions may arise about which health record(s) to use. Examples include:
Specialty service programs
The same population of patients (e.g., persons with HIV) may be served through a regional program that has clinics at more than one facility where different health records may be in play, especially during interim states while Connect Care continues deployment in Alberta. Service providers may rotate through facilities with different records. Patients may be scheduled in one or another facility depending upon first available appointment slot availability, not where their record was last updated. Accordingly, a patient's specialty (program) record may get split across Connect Care and one or more other digital or paper records.Episodes of care
An "episode" of care refers to multiple health encounters that relate to the same health problem. For example, a patient requiring surgery may have a pre-procedure assessment performed and documented in one setting, the surgery performed in a facility and follow-up checks performed in yet another setting. The preparation, intervention and follow-up are all one episode of care but, in mixed contexts, the record of care can become fragmented across more than one information system.Plans of care
Therapy plans, care paths, oncology treatment plans and some other interventions may spread across multiple encounters and facilities, with the same risks for unhelpful, even unsafe, fragmentation of documentation.Virtual Health Services
When health services are provided without co-location of provider and patient at a specific facility, mixed context providers may have a legitimate choice of which health record to use. Pertinent considerations include provider privileging and which system was used to schedule the virtual or ad hoc visit.Outreach Services
Specialty health services may be based in an organization using Connect Care as the record of care and have need to provide consultative services to community or facility locations elsewhere. Services might include telephone consultative support to clinicians at other (usually rural) facilities, telehealth virtual visits, or drop-in in-person visits to assist with the care of selected patients; all as part of outreach from the central service requiring service documentation in Connect Care.
If Connect Care is the record of care for part, but not all, of an integrated health service program, episode or plan, it may be appropriate to use Connect Care integrative charting tools (e.g., therapy plans, care paths, disease management documentation, SmartSets, etc.) to manage and document related care. This can be done with non-scheduled (ad hoc) encounter types. A "Documentation" visit can be created if the outreach support need is limited to generating and sharing a consultation letter. More commonly, the "Telemedicine" visit type is preferred where virtual or outreach service benefits from specialty-specific visit, order and documentation tools in Connect Care.
Whichever outpatient encounter type is used, it is essential to create and attach copies of pertinent documentation to all relevant or implicated health records. The Connect Care ad hoc encounter could, for example, be used to ensure that episodes of care data is kept intact while the resulting consultation letter is attached to Netcare and to the community EMR in play where part of a service is provided.
Care should be taken to ensure that integrated care records are available to all contributing to that care. For example, it is not appropriate to create a note saying “see Connect Care note” since that note may not be available to implicated community providers. Instead, ensure that all notes essential to understanding an episode of care are shared and co-documented in mixed context health records.
Results and Reports Routing
Regardless of where a patient is seen (Connect Care or non-Connect Care context), some test results or reports must route to the In Basket. This applies to all Connect Care users, including those who work in mixed contexts. This lowers the risk of a privacy breach and allows reports to be correctly routed to the correct provider, particularly when the report does not contain specific information about where the result or report should route to.
Most often, the In Basket result is a copy of information routed to a prescriber's preferred external electronic medical record (EMR). In some cases, the In Basket result will not additionally route via mail, fax or eDelivery (independent EMRs appropriately configured). In almost all cases, the information is copied to the Alberta Netcare Portal.
Specific result routing pathways can change over time, as Connect Care continues its deployment throughout Alberta - another reason for Connect Care prescribers to make provisions for In Basket monitoring.
Note: A Connect Care Results Routing Optimization project is currently underway (2024-25), and so details on results routing as found in this Manual may not be up-to-date.