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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 here. The 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. Sending Your Note: See this link.
    4. 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. 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. 
    6. 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. 
    7. 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]. 
    8. 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.
    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/SMG patient to start pump...revised Nov 2022. Use smartphrase .dcccpumpprepbasic 
    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. Lab Requisitions 
      • Ordering Labs
        • Click "+ Add Order" at the bottom of the open chart
        • Search for A1c or meter check (add twice if requesting both).
        • Indicate "Future", "Today", "Routine", "Lab Collect" 
        • Ensure that the expected date is prior to the date the patient will show up at the lab. If the date is after the date they show up, the lab will not collect it.
        • Sign orders as usual - Authorizing Provider is usually the Referring Physician.
        • The lab requisition will print to your configured printer, to provide to the patient. The lab recommends providing the paper requisition to the patient. Many patients report having the blood drawn even if they don't have the paper, but there is no guarantee.
      • Reprinting a lab requisition
        • Go to Chart Review > Labs
        • Single-click the lab you need printed
        • On the right hand side where the preview opens, click "Order Details" 
        • Click "Reprint Order Requisition" to your printer to provide patient
      • Canceling Lab Order:
        • If the encounter is not currently open, re-open it (Use Create Addendum).
        • Click on the Orders icon at the bottom right.
        • Click the X at the right of the order you want to cancel.
        • Enter a reason for canceling.
    13. 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.
    14. Prescriptions
    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. Failed faxes
      Undelivered faxes are remediated by HIM. You do not need to check “My Printouts” in CC to verify if a fax has been delivered. If they are unable to successfully re-send a fax, they will send an InBasket message to the provider.
      To re-send the fax:
      1. Open chart > chart review > notes
      2. Find the note you need to refax; click once
      3. Click "Route" above (if "route" is missing, try clicking the forward envelope top right)
      4. If clinician is outside the system, choose Free Text
      5. Fill in details manually (Do NOT put 1 or 9 in front of fax number!)  and fax
    18. 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.
    19. 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
    20. 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. 
    21. 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.]
    22. Check In patient when arrives ...do NOT use "Admit" button. (If you do by mistake, you need to submit a chart correction.) 
    23. Preferred name enter as Last name, First name in the preferred Name field. 
    24. 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. 
      3. Other pools include e.g. p cgy shc endocrinology dip scheduling 
    25. 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)
    26. For endocrinologists to reply to a message about a referral, they send the reply to this pool specifically: CGY PLC ENDOCRINOLOGY DIP REFERRAL TRIAGE.
    27. 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.
    28. Pools:  To find a POOL when messaging in inBasket, first type e.g. p cgy plc endo (e.g. p space…)
    29. If a patient is scheduled to the wrong department, see this link.
    30. Reminders: 
      • 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).
      • Enter a send date [You will receive a reminder message on that date].
    31. Postpone messages: 
      • Open the message.
      • 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].
    32.  Inform II meter, enter the CSN (Contact Serial Number) as the identifier in the Inform 2 meter, 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.
    33. 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.
        • If you are asked for a password or code, enter your AHS password. 
    34. Interpreter ID
      • To document the interpreter ID, use free text in your encounter note.
    35. 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.
    36. Medication dose adjustments other than insulin, e.g. Metformin. Use "Medication Review" to document new dose. See this link for step-by-step.
    37. 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>)"
    38. Make Smart Text Editable
      • Smart Text, highlighted in blue in a Smart Phrase, is editable - see this link.
    39. Patient Questionnaires
      • Including Carb Counting Quiz, BEDS7 (Binge Eating), PHQ, and others 
    40. Medications (including insulin), vitamins and supplements
      • Documented in "Medication Review".
      • 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.
    41. 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)
    42. 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)
    43. Activity & Workload Statistics 
      • Activity stats are automatically collected by CC when you use the Telephone button or open an encounter from your schedule.
      • You only need to take steps to record activity if:
        • You see a tab called "Attendance/Visit" [This could happen if you are charting in the same encounter as a different provider, e.g. in DIP you might open a patient chart from the MDs schedule]. In these cases go to the Attendance/Visit tab and specify "Visit with Allied Health/Specialty visit..." and click the button "Accept Charges".
        • You respond to a MyAHS Connect message, it took more than 5 minutes of your time, and your response contains clinically relevant information. In these cases, use the Telephone Call button at the top to document your interaction, so that the activity is included.
      • Activity and workload Tip Sheets can be found here.
      • No stats are kept by CC for these encounters: Documentation, Abstract, Letter (out) because there was no direct contact. 
      • To view reports on your statistics (scheduled encounters):
        • Go to Dashboard (top left icon on Epic Toolbar, beside schedule and inbasket)
        • At top right, add a view
        • Give it a name.
        • Use the wrench to edit the view.
        • Select “Add Component” at the bottom left.
        • Search for and add “Number of Visits by Visit Type and Appointment Status”
        • Click the triangle “Run” icon to set parameters:
          • For population, select primary provider (you)
          • Select date range
          • If desired, slice by encounter type
          • If desired “Save Component” for running as desired. I think you will need to update the dates each time.
      • To view your unscheduled activity
        • Go to Analytics Catalog
        • Search for “Unscheduled”
        • Use ‘Save As’ if you would like to save the report for your own use.
        • Favorite the report.
    44. 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.
    45. 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 equivalent for type 2. 
    46. 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.
      • Set the date range and run the report. 
    47. Total Daily Dose (TDD) of Insulin
      • There is currently no set field (Nov 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 
    48. Options for Sliding Scale Correction Doses
      • Use the smartphrase .DCCCslidingscale  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  
        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. 
    49. 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
    50. 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*** Complete the Attendance/Visit tab fields, if the patient was not in your 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 .pnotes all notes within that encounter are combined 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, copy/paste only the desired notes 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
    51. 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
    52. The Alberta Health Care Number (AHC#) is the ULI. You will find it on the storyboard or by hovering over patient demographics (near MRN) in storyboard.
    53. To document patient activity, use the "Social Determinants of Health" at the bottom left of the Storyboard. To pull the documentation into your note, use the Smart Link .activity
    54. Patient has no family doctor:
      • For PCP, select and choose "PCP, Patient has no".
    55. Stop reminder calls for patients (suppress patient reminder calls). See Auto-Appointment Reminder Calls and Patient Consent - Quick Start Guide (albertahealthservices.ca) 
    56. Work or school excuse (attendance) letter
      • Go to Communication.
      • The work excuse letter might appear as one of the defaults (i.e. one of Send All Notes, Copy Letter, etc).
      • If it is not there, choose “Other Templates” and search for the desired letter. One of these two is likely appropriate:
        • AHS AMB Attendance Letter
        • AHS Gen to Work, Excuse
    57. Share your note with the patient
      • By default, your CC note is not shared with patients who have MyAHS Connect. There’s an icon at the top right of your note, that, if pressed, shares the note with your patient. Be sure to only press that icon if you want to share your note.
    58. To learn if patient sees an Endocrinologist
      • Check referral doc (Chart Review > Referrals)
      • Check attached letters (Chart Review > Media) 
      • Check Appts tab for Future, Past and Finalized Requests (Finalized requests show referrals both to DCC Educators and to endos at Associate Clinic; double click to view)
      • Check Netcare for letters (On the Storyboard click "other clinical systems > Netcare...it opens patient Netcare chart)
    59. Foot Exams - copy forward last filed information [DCC staff access this video link (no audio)]. To carry forward the foot exam results from a previous encounter, follow the steps below. You need only update any value that has changed. 
      • Under Diabetes Management tab, go to Foot Screening Tool
      • Click 'Flowsheets' on the right-hand side. 
      • On the next flowsheet screen, the far right column is labeled "Last Filed". Click the arrow right beside "Last Filed" and choose "Copy column to another column"
      • Select today's date and time
      • Click into any cell you need to change e.g. hover, click the magnifying glass and you'll see your options. Left click to pick (or unpick) and right click to stick. 
    60. Contacting Booking Clerks
      • Email: EndoMetab.Booking@albertahealthservices.ca
      • In Basket: P CGY RRDTC DIABETES EDUCATOR SCHEDULING
      • In Basket: P CGY RRDTC ENDOCRINOLOGY SCHEDULING
    61. Printing Class Lists
      • Go to Schedule (the page you "check in" your patients from)
      • Directly under where it says "Schedule", near top left, click "Open Slots"
      • Choose the day on calendar of the class
      • Click your department, e.g. CGY RRDTC DIABETES EDUCATORS, so it opens
      • Scroll down past some educator names, to click on the class you want, e.g. CGY RRDTC DIABETES INTRO TO PUMP CLASS, 
      • On the right you'll see rows with patient names appear
      • At the very top right, choose "Print" > Schedule ...and choose your printer or print to PDF
    62. Viewing Lab Results in Synopsis Tab
      • The Tab “Synopsis” offers a useful compilation of vitals and labs: Note that the first column shows the most recent value for each parameter. Pay attention to the date for each one – in the “most recent” column the weight could be from one date and the A1c from another.
      • After the first column, data is in chronological order.
      • At the bottom, you can change the time period over which the data is extracted.
    63. Print AISH letter for patient (extra funding for food)
      • Create a documentation encounter. Reason for documentation = AISH letter
      • Use the Smart Phrase "DCCCAISHLetter" to create your note.
      • Choose Patient as the recipient
      • Template to choose is “Blank”
      • Use the Smart Phrase “.pnotes” to populate the letter.
      • Click “Send Now” and the letter will print
    64. Dietetic Intern and Preceptor Workflows 
      If the intern (or other student) is seeing the patient, and doing the charting:
      1. The student logs into CC. 
        1. Opens patient from the provider’s schedule
        2. Charting is done as usual. 
        3. When finished the note, student selects “Pend on Accept” at the bottom.
        4. After the note is reviewed by the dietitian, the student adds “Reviewed by <provider name>, RD/RN, CDE” to the note. Changes to “Sign on Accept” at the bottom. Accepts the note.
        5. Communications sent to appropriate parties (i.e. referring MD, specialists as indicated).
        6. Student signs encounter.
      2. Stats:
        1. By checking in the patient, the activity is automatically credited to the provider the patient was scheduled to.
    65. If you need to make a note in CC for a deceased patient, open the patient and create a ‘Post Mortem Documentation’ encounter.
    66. Preferred Pharmacy see Chart Review tab > Snapshot