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. Be prepared to share
  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". For information about how to find this feature, see updated tips here
  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. 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). 
  10. PLC patient to start pump...send summary note quickly itemizing prep is done at PLC in CC and patient needing appt with pump educator .need other details eg TDD, insulin type etc ..fax to RRDTC
  11. 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.
  12. 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)
  13. 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
  14. 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.
  15. 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.)
  16. 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.  
  17. 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
  18. 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
  19. 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.
  20. 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
  21. Emails, document under Telephone > other > email
  22. 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. 
  23. 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. 
  24. 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.
  25. 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). 
  26. 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), 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.
      • 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 “Appt Request” WQ.]
  27. 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 
  28. Check In patient when arrives ...do NOT use "Admit" button. (If you do my mistake, you need to submit a chart correction.) 
  29. Preferred name enter as Last name, First name in the preferred Name field. 
  30. View Sent Notes/Faxes - check your inBasket "sent" or "completed"
  31. 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. 
  32. 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)
  33. For endocrinologists to reply to a message about a referral, they send the reply to this pool specifically: CGY PLC ENDOCRINOLOGY DIP REFERRAL TRIAGE.
  34. 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.
  35. Pools:  To find a POOL when messaging in inBasket, first type e.g. p cgy plc endo (e.g. p space…)
  36. If a patient is scheduled to the wrong department, see this link.
  37. 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 .
  38. 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.
  39.  Inform II meter, you must input the CSN (Contact Serial Number), in one of 2 ways
    • 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" 
  40. 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.
  41. Interpreter ID
    • To document the interpreter ID, go to the tab "Flowsheets". Search for the flowsheet "Communication Needs / Interpreter" (note that you can use the wrench to add it as a standard flowsheet for next time). When you select Yes for 'Is an interpreter required?' a cell appears where you can document the interpreter ID.
  42. 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.
  43. Medication dose adjustments other than insulin, e.g. Metformin. Use "Medication Review" to document new dose. See this link for step-by-step.
  44. Hold orders for insulin.
    • The insulin order is entered as usual
    • Use "Insulin Instructions" to indicate "Hold until <xyz>"
  45. Make Smart Text Editable
    • Smart Text, highlighted in blue in a Smart Phrase, is editable - see this link.