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Diabetes Educators Calgary Charting Guidelines

How To

How To

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Connect Care Help

  1. For login and password problems or other urgent items, call the IT Service Desk & Solution Centre at 1-877-311-4300 immediately.
  2. For non-urgent Connect Care problems (like 'doctor not in database) SUBMIT A TICKET. Of note, you can view previously submitted tickets hereThe easiest way to submit a CC ticket is: inside Connect Care, click Epic button down arrow > Help > CC Submit Help Ticket
  3. For virtual Super User support, please call the Solution Centre at 1-877-311-4300. - Press 1 for Clinical Applications - Press 1 for Connect Care
  4. To search a list of Connect Care help topics, please see this page or search your Dashboard inside Connect Care.
  5. For Diabetes Centre Calgary specific support, contact one of the Education Consultants.
  6. For dietitian-specific support, contact Lia Zyla by email or Skype/MS Teams

 

Depending on your problem, IT or Connect Care help may be asked to share:

  • Medical Record Number (vs patient name)
  • Department where you work e.g. CGY PLC Diabetes Educators
  • Keywords related to what you were trying to do (e.g. flowsheets, medications, scheduling issue, etc) 
  • Device & barcode if it is a scanner/printer etc
  • If related to medications, the drug name, strength, form, order ID
  • Any error message that occurred

Questions, Provisional Answers & Tips

Thank you to everyone who has provided a tip, asked a question, and helped to generate ideas! The following items reflect today's answers to questions people have asked - they are subject to validation over the coming months. And for those who have let us know about useful features they have found (you know who you are) - THANK YOU!!

  1. Erroneous Encounter: There may be times when you started an encounter before the patient arrived for the appointment, or you added an encounter without meaning to. To fix this mistake, specify the visit diagnosis as “erroneous encounter” to correct it. Make a quick note and sign, e.g. "erroneous encounter" otherwise the system will not permit you to complete the encounter. 
  2. If ‘Signed the Visit’ before sending note.
    • Use Patient lookup to open the chart, then ‘Select encounter’ (rather than creating a new encounter). Go to Communications to send note.
  3. Nutrition Notes tab is not available for Telephone encounters (by design).
    To add a nutrition diagnosis, use the ‘Flowsheets’ tab.
  4. When you add insulin as an active medication, it doesn't always automatically add "Insulin Instructions" under the Diabetes Management tab.
    • Try pressing F5 to refresh or find the "refresh" button on the Chart Review tab. 
    • Try clicking the Diabetes Management wrench, click accept with no changes.
    • Try closing and opening chart (e.g. x by the patient name on tab)
    • Related:   If you notice that another provider has charted insulin doses inside the Medication Review table (instead of in "Insulin Instructions" please consider using this smartphrase in the Medication Review after selecting "taking differently" .DCCCNoteToProviders  (it will pull in instructions directing them to use Insulin Instructions and how to find.)
  5. IDNN Referral from CAT: Clarified, if referral to RRDTC from PLC is declined by CAT then forwarded to IDNN, IDNN should chart the outcome of their contact in CC (since referral generated from PLC). The process is still being clarified.
  6. Current medical problems are documented to the best of your knowledge. There's no need to document Medical Hx (previous problems). In DIP, some OB Hx may be documented. 
  7. If your document prints to the wrong location:
    1. Temporary fix only: https://insite.albertahealthservices.ca/Main/assets/cmio/AHS_CC_TIP_Virtual-Printing.pdf  )
    2. Submit IT ticket to correct. 
  8. Educators can set or delete "exceptions" in their schedules. 
    1. Go to the Epic button > Scheduling > View Schedules.
    2. Search for yourself.
    3. Click on the desired date.
    4. Click on the time you would like to block
    5. Right-click and go to Exceptions > Hold Time > Set [or Delete, as appropriate]. 
  9. Episode of Care; Diabetes in Pregnancy
    1. Start a pregnancy episode for a pregnant patient, if it has not already been done.
    2. If someone else has started a pregnancy episode, do not modify what they have entered.
    3. In most cases, we do not end a pregnancy episode – OB will do that.
    4. If we are seeing a post partum patient and the pregnancy episode has not been ended, we should end it.
  10. Postpartum visits: End pregnancy episode (if it hasn't been ended already). Create new episode for existing DM post partum [e.g. name: DIP, type 2 post partum (free text); type of episode : Diabetes Chronic mgt (or similar)
    1. GDM post partum letter... Create new phone encounter; reason for visit: post partum instructions (for note use) .dipc...(for post partum). 
  11. PLC/SMG patient to start pump...revised Nov 2022. Use smartphrase .dcccpumpprepbasic 
  12. Glucose targets, or other specific data for which there is not a dedicated field, e.g. Patient authorized LibreView Clinic access
    • Chart on the Problem List > Click on Problem > Overview. Add to the Comment box.
    • Data is viewable by hovering over the problem list on the Storyboard, then clicking on the problem.
  13. For future "Intake" encounter, possibly use Problem list  type 1 diabetes > sf diabetes e.g. smartform diabetes (as can check off quickly existing complications as they populate as buttons)
  14. Labs (ordering labs) 
    1. Use + Order at bottom of chart
    2. Search e.g. A1c or meter check
    3. Indicate "3rd party" and "future" Routine. 
    4. Sign orders as usual
  15. To view when you're scheduled, and see which department you're in, go to the Epic Toolbar > Reports > Scheduling Reports > Provider Calendar. Search for yourself. Click on specific days to see details about your schedule that day.
  16. Documenting a phone call for a medication prescription request: Use the "+Refill" button in the Epic toolbar [Dietitians can find this button under the Epic button > Patient Care > Refill Medication]. Reason for Call = Med Refill; Under Routing, specify the provider to authorize the prescription. (The authorizing prescriber gets an InBasket task, and everything becomes part of patient chart.)
  17. Certain sections in the patient chart have a "Close" button at the end of the section. The button will save data you've entered, then close the section. When you see that button, you need to click it to save the data.  
  18. Dietitians change encounter department for unscheduled phone calls.
    Dietitians log in to a virtual department (Calgary Zone Nutrition Services). To make it easier to find unscheduled encounters under chart review, when you phone a patient use the "Telephone Call" button at the top, click on "Change Enc Provider/Dept" under the Call Intake tab. Change the department to the one where the patient is being seen:
    • CGY SMG Endocrinology DIP
      OR
    • CGY SMG Diabetes Educators
  19. To Re-fax if didn't go through
    1. Your inbasket will have a failed fax message
    2. Open chart > chart review > notes
    3. Find the note you need to refax; click once
    4. Click "Route" above (if "route" is missing, try clicking the forward envelope top right)
    5. If clinician is outside the system, choose Free Text
    6. Fill in details manually (Do NOT put 1 or 9 in front of fax number!)  and fax
  20. Add Pregnancy Wheel to Epic Toolbar to determine current gestational age during triage. Wrench (epic tool bar) > “tools”  > “Obstetric tools” > click and drag “pregnancy wheel” to your toolbar.
  21. Scheduling when blocked to help endo in DIP
    1. If your schedule is blocked (e.g. you are helping an endo) and you need to indicate you saw someone in-person unexpectedly, try this. 
    2. Go to Epic>schedules>your name> find the block of time you need, right click, delete the unavailable. You can try, from the patient chart > Encounters > new, but if you don't see an available encounter type that make sense for in-person, see steps below.
    3. Go to patient chart> appt tab > walk in> and choose your visit type, reason etc as normal to book into your schedule for that available time. You can insert times that have already past.  Note, if you are an RD you have to have PLC endocrinology DIP chosen as program or you won’t get options for Visit type. 
    4. Check in patient from your schedule then > double click to open the chart and complete appointment as usual
  22. Emails, document under Telephone > other > email
  23. Outpatients, requesting orders or new referral from GP not in CC. use smartphrase .DCCCREQUESTREFERRAL and edit as necessary. Note, SMG outpatient have MD fax response to RRDTC 403-476-9626. 
  24. Addendum:
    1. From your schedule, double click the patient whose visit you had completed. You'll be asked if you want to create an addendum or just open chart review. 
    2. If the patient is no longer in your schedule, open chart to review > Chart Review > Encounters > Right click on the encounter > Edit or Addend Encounter. 
  25. Error - Referral in Endo or Educator InBasket
    1. This is being worked on.  The communication below was sent to the doctors, but in case you get a question from one of the endos, please direct them to the communication, and suggest the following steps:
    2. If you see a referral in your inbox that you are not expecting – file a ticket.  Please see this blog post for instructions (http://www.bytesblog.ca/2022/05/26b.html
    3. Do NOT action (i.e., approve or decline) the unexpected referral. It will be removed from your inbox once the triage staff actions it.
  26. DIP Patient Lists: Aye Chan and Carmen are building a patient list in CC to replicate what you use in XLS for phone calls. They are trying to find the appropriate columns (fields) to include into the list to try to match the xls sheet (e.g. email, last visit, next visit, general comments). Please connect with them if you've started something and can share useful info (or want to learn tidbits). 
  27. Scheduling FU in DIP when you are not with the patient
    1. If same day as appt but chart complete, you can simply make an addendum (right click encounter, choose addendum) > wrap up > Follow up. Indicate timeframe using buttons and type in your note. Close at bottom. This automatically populates the patient to Karen and Kate in their FU scheduling workqueue.
    2. If you haven't seen patient since Connect Care start (e.g. last contact in Soprano), the patient is a no show, or it's a different day and you don't want to associate this with a certain encounter:
      • Search patient, open, create a New Encounter > Documentation. Dietitians (RDs): ensure that the department for the encounter is "CGY SMG Endocrinology DIP". Note that you can submit a ticket to IT, to have the default department changed to the correct one).
      • At bottom of documentation tab, open DISP & CC.
      • Indicate timeframe using buttons and type in your note. Close at bottom. [This automatically populates to the DIP “Appt Request” WQ.]
  28. Physicians at the Maternity Care Clinic are getting chart notes in their In Basket, and they prefer to receive them by fax to the clinic. When a physician from their clinic (Andrea Behie, Allison Chapman, Nicole Panich, Valerie Lewis, Katy Hicks, Nicole Labrie, Leah Detman, or Jaime McMurren), is the referrer, please specify "Maternity Care Clinic" as the provider, so that notes will go via fax. June 14: The previous note's instructions are not currently working; Carmen submitted a ticket. Even though Maternity Care Clinic is added as a team member, clicking Team under Communications (in Wrap up Tab) does not give the clinic as an option. Two current workarounds: 
    1.  Click + add contact inside communication, add Maternity Care Clinic
    2. Or leave MD as contact but switch the form of contact from inBasket to Fax 
  29. Check In patient when arrives ...do NOT use "Admit" button. (If you do my mistake, you need to submit a chart correction.) 
  30. Preferred name enter as Last name, First name in the preferred Name field. 
  31. View Sent Notes/Faxes - check your inBasket "sent" or "completed"
  32. Forwarding an inBasket Message to a pool e.g.CGY SMG Endocrinology DIP Referral Triage (this is taken from Triaging-Referrals
    1. IF you receive a reply about a referral to your personal inBasket from an endo, (e.g. if they didn't send it to the POOL), then you need to send it to the POOL for CGY SMG Endocrinology DIP Referral Triage.  
      • In your inBasket, look for an envelope with an arrow pointing to the right (on the top right of the message).
      • When that opens, click magnifying glass.
      • Then type CGY SMG Endo, but into the POOL field. Hit enter. You'll see your options and one is for CGY SMG Endocrinology DIP Referral Triage. This is your DIP triage pool. See image here.  
    2.  After you've sent to the CGY SMG Endocrinology DIP Referral Triage pool,  click "done" for this item in your own personal inBasket. Refresh. It should be gone. 
  33. For Endocrinologists: Follow-up requests from MD (verbal, email, in your personal inBasket).e.g. Endos requesting FU appts in DIP
    • Clerical staff do not have the option currently to enter verbal, email or inBasket requests for patient appointments into the FU workqueue.
    • Please instruct MDs to use one of these methods:
      1.  > Wrap up > Follow Up during an encounter
      2. Or if after the fact, make an addendum via Chart Review > Encounter > (right click on the visit and choose Addend) 
      3. Or from inBasket  See detailed instructions here. From above the patient lab results in inBasket choose > More > New Enc > Orders Only > (under orders tab) Disp & CC. Once familiar with this, it takes < 30 seconds. 
      4. Or if no contact use: Create New Encounter > Orders Only > Orders tab …Disp & CC. (similar instructions to option 3. above)
  34. For endocrinologists to reply to a message about a referral, they send the reply to this pool specifically: CGY PLC ENDOCRINOLOGY DIP REFERRAL TRIAGE.
  35. For endocrinologists to request clinical action on a patient already in DIP program:
    1. inBasket message the educator directly or…
    2. inBasket message any DIP educator or your DIP team by sending to a different pool called CGY PLC ENDOCRINOLOGY DIP CLINICAL SUPPORT. If the message is directed to a specific DIP MD team, please title it that way e.g.  “Dr. K-K Team” then the relevant educators would know to address that one in the pool.
  36. Pools:  To find a POOL when messaging in inBasket, first type e.g. p cgy plc endo (e.g. p space…)
  37. If a patient is scheduled to the wrong department, see this link.
  38. Reminders: NFS shared this with us
    • Use the Remind Me activity to send yourself reminders about a patient if you need to follow up at a later date. Create a reminder message (e.g. Call patient back regarding medication dosage increase).
    • In the patient field, press F3 to pull in the current patient you are viewing.
    • Enter a send date 
    • You will receive a reminder message in the All Reminders .
  39. Postpone messages: NFS shares this tidbit -
    • Open a Results message.
    • You might receive certain results for a patient, but are awaiting others
    • Open the Properties menu and select Postpone and pick a date. Accept.
    • The message disappears from your In Basket and re-appears on the desired date.
  40.  Inform II meter, you must input the CSN (Contact Serial Number), in one of 2 ways (full details are available on this document):
    • Ask clerical to print a patient label (IP 1 X 3") from within the encounter. Scan the barcode on the label.
    • With a patient encounter open, hover over the MRN on the Storyboard to see the CSN. The number is 12 digits long, and is entered in the format "AC000012345678"  Note, you must add the AC before the 12 digit number when inputting into the Inform meter. 
    • Note that you may use AC911911911911 as a patient number if necessary, then send a General Corrective Action form.
  41. Confidential or Sensitive Information
    • Confidentiality Features - Quick Start Guide located here.
    • Encounters, notes, or entire patient charts may be made confidential to help manage concerns associated with information sharing. In these case, you will get a "Break the Glass" message:
      • You will need to provide a reason you are accessing the record.
      • You may need to enter your credentials (username and password) depending on the level of security applied.
  42. Interpreter ID
    • To document the interpreter ID, use free text in your encounter note.
  43. Consent
    • Use the 'Consent Navigator' on the Storyboard.
    • To document consent for virtual appointment [phone or Zoom], click on ‘Jump to Document List to update filed documents’ > add ‘Consent – Other Patient Authorization’ and fill in details.
  44. Medication dose adjustments other than insulin, e.g. Metformin. Use "Medication Review" to document new dose. See this link for step-by-step.
  45. Hold orders for insulin.
    • The insulin order is entered as usual
    • Use "Insulin Instructions"
      • In the "Time of Day" column, indicate for example "Bedtime (Hold until <xyz>)"
  46. Make Smart Text Editable
    • Smart Text, highlighted in blue in a Smart Phrase, is editable - see this link.
  47. Patient Questionnaires
    • Including Carb Counting Quiz, BEDS7 (Binge Eating), PHQ, and others 
  48. Medications, vitamins and supplements
    • Documented in "Medication Review". Insulin is entered as an order. Other medications are entered as 'Reported'
    • If you can't find the medication you're looking for, try using the 'Facility' or the 'Database' tab when doing the medication lookup. If the desired med, or other supplement isn't there, select 'Other' under the Database tab.
  49. FINDING Doctors Orders see video for a few methods
    • In your InBasket
    • In the Chart > Chart Review
      • > Encounters...click the encounter you had sent the note from, scroll to bottom of the note, see Communications > View Encounters Conversation Summary, click to see doc's answer
      • > Media ...if faxed back the PDF is there
      • > Referral ...may accidently be a PDF in this tab
    • In the Chart > Diabetes Mgt Tab > Insulin Instructions
      • Occasionally the doc may have put the units into the insulin instructions and perhaps may have written "pending" or "applies when ...(e.g. starts pump or FBS > X mmol/L in DIP)
  50. Finding DCC Referrals, Opening Referrals, Seeing if patient referred to endo
    • Chart Review > Referrals
    • Click the referral once
    • Scroll down to "Referral Notes (excluding letters)" .You may have to click a "letter" to see this heading appear, if it is not there. 
    • First, under that heading, view any typed comments from CAT 
    • To view the PDF referral, click the link to it
    • You will see a blank cover page. You cannot scroll to see more pages. Move your curser just beyond the top of that pdf referral page, and to the left. You will see controls for viewing that page (e.g % to enlarge it to etc). You will see an arrow to click to progress to the next page. E.g. if 2 pages you will see 1/2 with arrow to right. If 8 pages, you'll see 1/8 etc. 
    • Additionally, to check if a patient has an endo referral you can check the patient's Appt Desk to view future appts or Active Requests. (or call CAT if all else fails 403-955-8030)
  51. Can't Find "Create Encounter" tab?
    If you used Patient lookup> Opened chart to view > But there was no “create encounter” tab (e.g not even in the wrench, and not when use the storyboard search field) then: 
      • In the storyboard search field, type in Encounter; don’t hit enter
      • Choose Encounter  (e.g if there is no "create encounter”)
      • It opens up a popup chart showing the past encounters
      • Ignore the past encounters. Instead, on the left bottom of that pop-up screen should be a “new” button. Choose that.
      • Then create the new encounter (e.g. choose Documentation if you are charting on a No-Show and need to send note to MD)
  52. Stats (statistics)
    • Stats are automatically collected by CC for Telephone, or any encounters opened from your schedule or encounters that you create that indicate you are communicating with patient (e.g. virtual FU...)
    • You only need to enter statistics if you see a tab called "Attendance/Visit". This could happen if you are charting in the same encounter as an MD at the same time e.g. DIP.
    • No stats are kept by CC for these encounters: Documentation, Abstract, Letter (out) because there was no direct contact. 
  53. EDD ( Estimated Date of Delivery) & Pregnancy Status (episode of care) 
    • The EDD established in Astraia will push through to CC and overwrite the EDD that has been manually entered.This date should not be changed. 
    • Please make sure the pregnancy status (episode of care) is done in the encounter area so it is appropriately linked and that the due date is not changed.
  54. Visit Diagnoses regarding pregnancy: 
    • If patient had GDM, now seen post-partum: Use "Gestational Diabetes Mellitus (GDM) Postpartum"
    • If patient with pre-existing diabetes: use “Type 1 diabetes affecting pregnancy, antepartum” or same for type 2. 
  55. Viewing patient names moved from your schedule (e.g. you are sick or away and want to see who was moved out of your schedule for that day)
    • Make sure you are in the correct context e.g. department (Epic > Change Context > e.g. CGY SCHC Diabetes Educators or other) 
    • Then...Epic > Reports > Scheduling Reports > Moved Appts and run the report. 
  56. Total Daily Dose (TDD) of Insulin
    • There is currently no set field (Nvo 2022). The request has been made to have a comments field inside each of the options of "Insulin Instructions". If that exists, please chart it there. 
    • Otherwise, consider a free text row inside one of the Insulin Instruction tables 
  57. Options for Sliding Scale Correction Doses
    • Use the smartphrase .DCCCslidingscale. (this is a hack). It does not show up in insulin instructions and needs to be manually populated each visit as free text (or copy/pasted from a previous visit). It has the bonus of having columns for all meals and you can write whatever individualized glucose ranges you need on the left.  
    • Use Diabetes Medication Tab > Insulin Instructions > Fixed Dose Instructions (this is a hack)
      1. This will stay visible and editable in Insulin Instructions; you can individualize your glucose ranges and doses per range; but you’d need to make 3 of these if require a different one for each meal and name appropriately e.g. correction insulin for breakfast, correction insulin for lunch ...
      2. Name: Be clear e.g. Correction Insulin (add to meal bolus)
      3. Time: This column is not time. Be clear, add mmol/L to each row!
    • There is a built-in way through Connect Care however it has many limitations currently (Nov 2022) so we are not placing the instructions here. 
  58. Faxing Lab Orders
    • If before signing the chart: After creating the order & signing it, on the bottom right when you hover over it ("Orders Signed This Visit") click the printer to the right (beside the X button). Then choose RightFax. 
    • If the chart is already closed: Use patient lookup, Chart Review > Encounters > ...one click on the encounter.
      • On the right by the report, look to find "Orders Placed" for that encounter. Click it. then click Reprint Order Requisition. Then choose the small printer up top and choose RightFax. 
    • Or, Chart Review > Labs, click the one you ordered, choose Reprint Order Requisition and select right fax
  59. Two (2) people in a patient chart at the same time
    • If 2 people have a chart open at the same time:
      • Each can add data to fields within the chart.
      • Each can add visit diagnoses.
      • ***Very important*** The second person to open the chart will need to complete the Attendance/Visit tab fields, if the patient was not in their schedule.
      • The second person to open the chart might think that they're unable to chart their note, BUT
        • Click on “Create Note”, and do your own note
        • When sending the communication, using ‘Send All Notes’ combined notes into one Progress Report, clearly showing who wrote which note. If both notes are people in the DIP clinic, that’s great. Do be watchful; if the OB’s note is combining with yours, you won’t want to choose ‘Send All Notes’. An option would be to use ‘Consult/Netcare A+P’, then copy/paste only your note into the body of the communication.
      • Once both providers are done, one needs to close the chart, and then the last one signs the visit
  60. How to clear open chart message in your InBasket:
    • From InBasket message: need to only do once …right click on Chart, choose double click to open
    • Double click the name of the patient from inside the inbox
    • The chart opens and highlights the encounter (under Chart review)
    • Right click to Edit/Addend
    • Complete as usual
    • The patient name is removed from InBasket