Viewer Training Student Guide Update Site Name &Training Date

Viewer Training Student Guide Update Site Name &Training Date
June 2017 Site Name Training Date Updates for Release 9.1 Slide 2: Table of Contents updated Slide 3: Updated for Medications evision of language Update with UAO -, replaced screenshot – ONE ID log in and multiple UAO Language replacement – data with information Log out Slide 9- new screenshots Slide10 – Changed title, updated data summary description to be more general and reflective of new content; new screenshots Slide 11 Patient Search - updated language for Health Number search, new screensht Slide 12, 13– new screenshot and desciprtions Slide 16-updated with Medications portlet information Slide 18 –updated for R9.1 changes New slides for Meds Portlet- DHDR required information

Use of this slide deck Note to Trainers
<Supplemental – Remove this slide prior to providing this guide to trainees> Use of this slide deck Note to Trainers eHealth Ontario encourages the use of the materials as they are designed for the education and training of users of the ConnectingOntario ClinicalViewer. You are permitted to customize these materials according to your organization’s learning needs with the following exception: You must not change any messaging or wording regarding Digital Health Drug Repository (DHDR) as it pertains to the Medications portlet. Any changes require approval from the Ministry of Health and Long-Term Care (MOHLTC). Contact for more information This Student Guide presentation contains key messages which are required for Medications portlet-Dispensed Medications (DHDR) end-user education (i.e., information available in DHDR, limitations and clinical use of information, consent management for DHDR). Supplemental information is provided to enhance implementation and adoption. Slides marked as supplemental may be removed. All other Medications portlet (DHDR) slides are required and should not be removed unless the information is provided in an alternate education method It is recommended to provide tip sheets to end-users as a reference during the end-user presentation

You will need to update the slide number for each topic due to slides your site may require for the “Accessing ConnectingOntario ClinicalViewer” and how Medications required content is delivered. Table of Contents <View Notes page on this slide for details of updates made to this student guide> Page Number Introduction 3 Accessing ConnectingOntario ClinicalViewer (Logging In/Out) 5 My Workspace 11 Patient Search 12 Patient Care Overview 13 Timeline 14 Portlets Overview 16 Navigation Bar 19 Medications 20 Lab and Pathology Results 30 Consent Management 33 Updates for Release 9.1 Slide 2: Note to Trainer slide added Slide 3: Table of Contents updated Slide 4: Updated Medications information, data summary reference removed Slide 6: Statement added re: viewing records for patients under selected UAO Slide 8: Updated wording for UAO and screenshot Slide 10: Updated screenshots Slide 11: Title change from Landing Page to ConnectingOntario ClinicalViewer Interface, and corresponding change in subtitle, updated data summary description to be more general and reflective of new content, updated screenshots Slide 12: My Workspace slide moved from end of guide, screenshots updated Slide 13: Updated language for Health Number search, new screenshot Slide 14: Updated screenshot and description for Patient Care Views navigation bar Slide 15: Updated screenshot Slide 18: Medications portlet information added Slide 20: Updated screenshots, information revised for changing views and setting default view Slide 21-30: New slides added for Medications portlet-Dispensed Medications (DHDR) Slide 34-37: New slides added and slides updated for consent management Slide 39: Placeholders added for sites to add site-specific support information

Introduction What is the ConnectingOntario ClinicalViewer?
The ConnectingOntario ClinicalViewer displays Ontarians’ personal health information (PHI) from participating healthcare organizations such as hospitals and Community Care Access Centres (CCACs) Available information includes: Discharge Summaries Hospital Visit/Encounter Details Consultation Reports Diagnostic Imaging Reports Emergency Department Reports CCAC service details and assessments Provincial laboratory information Medication information (provincial publicly funded drugs and pharmacy services including all monitored drugs and hospital medication information) With the ConnectingOntario ClinicalViewer, you are able to readily access accurate and up to date electronic patient information that is external to your organization.

ConnectingOntario Benefits
3-Feb-16 ConnectingOntario Benefits Patient, providers and organizations can realize the following benefits through electronic access to provincial level patient information Improves the patient experience by: Enabling faster care decisions Decreasing the need for patients to repeat their health information Reducing the need for duplicate testing and procedures Enhancing communication and collaboration Enables faster and more informed clinical decision-making by: Decreasing time spent chasing information Enabling faster, more informed decisions Enhancing communication and collaboration Increases organizational efficiencies by: Enabling faster care decisions Reducing redundancies Improving resource allocation as providers’ and support staff’s time is freed from administrative tasks Decreasing administrative costs Patient Provider Organization

Accessing the ConnectingOntario ClinicalViewer
Single Sign-On Login If your organization is using Single Sign-On, update this slide with a screen shot of your organization’s access link to the ConnectingOntario ClinicalViewer Delete the following 2 slides pertaining to ONE ID Login Insert Screen shot here Note: You must only view records for patients for whom you are providing care for the organization you are logged in under (unless permitted otherwise by the organization).

Accessing the ConnectingOntario ClinicalViewer
If your organization is using ONE ID to access the viewer, keep this slide and delete the previous slide. Accessing the ConnectingOntario ClinicalViewer If your organization is using a short cut to ONE ID, insert a screen shot here. To access the ConnectingOntario ClinicalViewer with your ONE® ID credentials: In your browser go to URL Select “ONE ID” from the drop down list Click Next Enter your login ID and password on the ONE ID log in page. Click Login

If your organization is using ONE ID to access the viewer, keep this slide
ONE ID Login ConnectingOntario ClinicalViewer opens in a new browser window. If you are authorized to access the ClinicalViewer under more than one authority and under the same user account (e.g., ONE ID account), a pop-up window will appear prompting you to select an organization. *This window will not appear otherwise. Click the organization under whose authority you are working Click Select Note: You must only view records for patients for whom you are providing care for the organization you are logged in under (unless permitted otherwise by the organization).

End User Agreement The first time you access the viewer and during the first access of a new calendar year, this prompt displays To accept the End User Agreement: Click OK The End User Agreement displays Scroll through and review the agreement Click Accept, then click Submit A privacy reminder will be displayed on your first log in of the day and no more than once every 24 hours As you previously learned in the Privacy and Security training, you have a legal obligation to protect the privacy of patient information.

Close the internet browser
Log Out Best Practice: Log out after each use of the viewer and before leaving your workstation To log out of the ConnectingOntario ClinicalViewer: Click the Logout button in the header of the screen This is required in order to comply with the Privacy and Security legislation. Close the internet browser

ConnectingOntario ClinicalViewer Interface
Update numbers on pic ConnectingOntario ClinicalViewer Interface Each screen in the ClinicalViewer displays the following components Header This always appears regardless of the tab you are in Drop-down list of available options Data Summary outlines types of information, sources and other details for PHI viewable in the ClinicalViewer Tabs My Workspace – displays patient lists Patient Care – displays PHI Footer Terms of Use Privacy Feedback Form – enables you to submit your ideas for future improvements Copyright statement

My Workspace My Workspace provides 2 different patient lists:
My Patients List - a customizable list to which you can add or remove patients My Recent Patients - created automatically; based on recently viewed patients (within last year) To add a patient to My Patients List from: Patient Care tab: Click on the Person icon in the Patient Banner Click in the Box to enter a checkmark Click Done My Recent Patients: Highlight the Patient you want to add Click the Add to button Click My Patients List To remove a patient from My Patients List: Click the Trash icon located beside the patient you want to remove To view patients added during a different time frame, select one of the other time intervals

Patient Search There are three ways to search for a patient.
Click Search for a patient in the header Choose from the 3 different search methods by HCN (Health Number): Use if health number, gender and last name are known by MRN/CHRIS Client # Use if organization name that the patient visited and unique patient identification number for that organization are known Advanced Search Most flexible search Include as much information as possible to narrow search results Type in patient identifiers Click Search Click correct Patient Name under the “Patient Search Results” To protect privacy of PHI, a maximum of 5 results will display based on the search criteria entered. Click View Selected Patient

Patient Care: Screen Layout
The Patient Care tab is divided into sections that assist with information finding Patient Banner Patient Care Views navigation bar (to change view, launch individual portlets or create custom views) Timeline Portlets (condensed)

Timeline: Clinical Summary
The Timeline provides a visual snapshot of the patient’s encounters with acute care health care services over a period of time Default Setting Time Interval Refresh button and time since information last retrieved Collapse Timeline Multiple encounters of the same type on the same day show in the hover comments Legend for encounter types The timeline displays encounter types from most recent (left) to oldest (right) Multiple visits of the same type that are very close to each other, in time, will be represented by a single icon. Hover over the icon to see the details of each visit The timeline interval setting (i.e., date range) persists through changes in patient selection, but are not preserved across browser sessions

Timeline: Clinical Summary
To customize the Time Interval: Click Custom Click the Calendar Icon in the From field Click the Down Arrow on the top of the calendar Select the desired month Select the desired year Click OK Select the desired day Click the Calendar Icon in the To field Select the desired month, year and day or click Today Click Go

Portlets Portlet Icon and Title: Identify the type of information available in the portlet Print: Allows you to print a list/portlet view View and Document icons: Allow you to view the details of a document. Viewed documents can be printed. Follow your organization’s policy for printing PHI, if permitted. [Insert link or reference to your organization’s printing policy here] User Preferences: Allows you to customize how information is displayed Paging Control: Helps you navigate through the pages of the portlet Refresh: Refreshes information in portlet Data Source: Indicates the source for information displayed in portlet To view a document: Select a document by Clicking the Document icon to open the document OR Highlighting the row and clicking the View button Click Close to close the report Note: Certain document types may have to be downloaded to your computer to view. Follow the instructions within the Document Viewer to download and view. Care must be taken to securely delete the file after use

Portlets Portlet Name Information Available Medications
Displays publicly funded drugs and pharmacy services (including monitored drugs) from the Digital Health Drug Repository (DHDR) Displays a list of all medications, by dispensed date, for patients who have a valid Ontario Health Number (HN) Details view shows the full details for a selected medication or service The Drug Utilization Review (DUR) icon is displayed next to the name of any drug that has DUR information. Details are shown in the details view Visits/Encounters and Summary Reports Displays a list of all acute care encounters and associated summary reports Diagnostic Imaging Reports Displays report information for diagnostic modalities: general radiography, CT, MRI, ultrasound and nuclear medicine DI text reports are currently available (images will be available in future) Documents/Notes Displays a list of individual documents for non-diagnostic notes and reports Examples: Consultation notes, Discharge Summaries, History and Physicals Other Results Includes all reports that are not in other portlets – e.g., ECG text reports Tabs are organized by program or discipline Community Displays information from Community Care Access Centre (CCAC) Contains: Referrals, Community Assessments, RAI/MDS Assessments Continued…

Portlets Portlet Name Information Available Lab and Pathology Results
Information is from the Ontario Laboratories Information System (OLIS) Results are grouped by: Chemistry, Hematology, Blood Bank, Pathology, Microbiology, Other (immunology, serology, allergens) and Flowsheets Abnormal results are displayed in red text and flagged: L Below low normal H Above high normal LL Below lower panic limits HH Above upper panic limits A Abnormal (applies to non-numeric results) AA Very abnormal (applies to non-numeric units, analogous to panic limits for numeric units) Amended and Invalid Results are clearly identified

Patient Care Views Navigation Bar
The navigation bar allows you to quickly switch between different ways of viewing information Information can be viewed in several ways: My Views – Customized view(s) that you create Clinical Views Summary View: grid or 3 column view of all portlets in a condensed format (default) Summary List View: single column list or “stack” of all portlets in full format (more columns of information) Individual Portlet View: full screen view of the selected portlet in full format (more columns of information) To select an individual portlet view Click the double arrow on the top of the navigation bar to expand it (optional) Click on the desired portlet (icon) To return to a summary view: Click the Summary View or Summary List View icon on the navigation bar Click the double arrow on the top of the navigation bar to collapse it (optional) To set any view as the default Click the desired view (icon) in the navigation bar Click the default icon Expanded Collapsed

Medications Portlet Overview of Digital Health Drug Repository
The Dispensed Medications tab displays information from the Digital Health Drug Repository (DHDR) for Ontarians with an Ontario Health Number. This includes: Publicly funded drugs and pharmacy services (including monitored drugs) Reflects information the dispensing pharmacy submits to the Ministry of Health and Long-Term Care for reimbursement As of May 2017, includes approximately 7 years of information about: Drugs paid for by the Ontario Drug Benefits (ODB) program. The ODB program includes the Trillium Drug Program (TDP) Most publicly funded drugs paid for by other public drug programs (e.g. Special Drugs Program - SDP) Publicly funded pharmacy services (e.g. MedsCheck), some of which are available to all Ontarians, some to ODB program recipients only Narcotics Monitoring System (NMS) information As of May 2017, includes approximately 5 years of information about monitored drugs (narcotics and controlled substances), dispensed in Ontario, regardless of payor, when the approved identification used was a valid Ontario Health Number For more information about DHDR visit

Medications Portlet Link to Information Available to Health Care Providers through the Digital Health Drug Repository The Drug Utilization Review (DUR) is indicated by a red icon. To view the details for a result: Click on a result to select it Scroll down to the Details screen A name that is truncated may have a DUR indicator that is not visible. To view: Widen the column header, OR Select the row to view it in the Details screen below The Print function only prints the Dispensed Medications list. Printing of the Details screen is not currently available

Drug Utilization Review (DUR)
<Supplemental> Drug Utilization Review (DUR) Drug Utilization Review (DUR) indicator is displayed next to the Generic Name Drug Utilization Review information is historical information from DHDR on DUR alerts that were communicated to the pharmacy when the drug claim was submitted for payment DUR information is displayed in the Details Screen: Reason for DUR (Alert Type): e.g., drug/drug interaction potential Action taken: action by pharmacist in response to the DUR alert Additional information: includes severity level of the drug to drug interaction Note: At this time, historical DUR alert information is limited to drug to drug interactions between publicly funded drugs contained in the DHDR

Reference for Dispensed Medications (DHDR)
A listing of information available in DHDR is accessible through the Data Summary or the Dispensed Medications tab Data Summary Hover over the Applications Menu to display the link to the Data Summary Click Data Summary Click Dispensed Medications Click the Information Available to Health Care Providers through the Digital Health Drug Repository link to the MOHLTC’S website which outlines the information available within the Digital Health Drug Repository Click for hyperlink Dispensed Medications Tab Click DHDR

Clinical Use of DHDR Information
<Supplemental: Slide 25-30reflect content from tip sheet: Medications Portlet: Dispensed Medications Guide for Clinical Use and are required content. These can be removed if trainee is provided with tip sheet> Clinical Use of DHDR Information Limitations of Data - Considerations DHDR information is advisory only and is not intended to replace sound clinical judgment It may not represent a patient’s complete medication history as it may not include all the current medications a patient is taking at any time, or all the pharmacy services that a patient has received

Limitations of Data - Considerations Key considerations include: the information should be discussed and confirmed with the patient or other source(s) the patient may not have picked up their medications or may not be taking them as prescribed the patient may be taking other medications such as over-the-counter or privately-paid medications (excluding narcotics and controlled substances) it does not include hospital-dispensed medications it does not reflect details such as: whether a prescription is new or a refill changes to drug therapy (e.g., discontinued, dosage) current use of medication instructions for use (e.g., frequency) Contact the dispensing pharmacy or prescriber for additional information or clarification

Limitations of Data – Important Term Descriptions Dispensed Date: transaction date when the prescription drug was dispensed or the pharmacy service was rendered; it does not indicate if the medication was picked up Strength: strength of the prescription drug dispensed, amount of active ingredient in the drug; for topical and liquid medication it may be shown as a percentage or ratio Quantity: quantity of medication dispensed; may be the number of items dispensed, or, for topical and liquid medication (e.g., Methadone) it may refer to dose, total volume or volume of drug concentrate Estimated Days Supply: estimated days of treatment based on the directions for use on the prescription, and/or the pharmacist’s judgment on usage; estimating usage accurately may not be possible for some prescriptions (e.g., PRN)

Limitations of Data- Clinical Example DUR information if available is displayed in the Details screen of the Medications portlet Prescriber and Pharmacy contact information is available in the Details screen of the Medications portlet Example of Printed Medication List Use caution extrapolating the frequency from the Quantity and Estimated Days Supply Based on the example above, 90 tablets of Metoprolol 50 mg was filled for an estimated 30 days supply. (Quantity / Estimated Days Supply) = 3 tablets per day. The instructions may have been 75 mg (1.5 tablets) twice a day, 50 mg (1 tablet) three times a day or another variation. Estimated Days Supply may not be accurately estimated, further compounding the problem

Limitations of Data- Clinical Example DUR information if available is displayed in the Details screen of the Medications portlet Prescriber and Pharmacy contact information is available in the Details screen of the Medications portlet Example of Printed Medication List The DHDR does not indicate if a prescriber intended current use of a medication The patient may have been instructed to take Metoprolol and Verapamil together, stop one and continue the other, or stop both Changes to medication therapy are not known The patient may have been given alternate dosing instructions (e.g., to decrease the Metoprolol dose to 25 mg (0.5 tablet) three times a day)

Limitations of Data- Clinical Example DUR information if available is displayed in the Details screen of the Medications portlet Prescriber and Pharmacy contact information is available in the Details screen of the Medications portlet Example of Printed Medication List The DHDR reflects an historic record of drug and pharmacy service information. There is no functionality for medications to be marked as discontinued, placed on hold, or to record adverse events or allergies. It cannot be assumed from the appearance of a record that a patient was successfully treated or can tolerate a specific medication

Lab and Pathology Results: Amended Results
An amended result is a test that was at a “Final” status and was subsequently revised Report displayed in Document Viewer

Lab and Pathology: Invalid Results
An invalid result is a test that was incorrectly entered on the wrong patient and has been subsequently removed Detail View

Lab and Pathology Results: Flowsheets
You can apply filters to sort and find results quickly To apply a filter: Click the Down Arrow in the Test column header Click Filters Type the desired Test Name in the search box Press Enter To remove a filter: Uncheck Filters

Indicates that a Consent Directive has been applied.
Consent Management A patient can withhold consent for the viewing of their personal health information by putting in place a consent directive on all or some of their health record Indicates that a Consent Directive has been applied. Temporary consent override is available in all portlets Informed and express consent from the patient or substitute decision maker (SDM) is required for unmasking of any PHI. A signed hard-copy express consent form is required for Dispensed Medications information. If you override a consent directive, the privacy officer at your organization will be informed of the activity and the patient will be notified All activity in the ConnectingOntario ClinicalViewer is tracked and auditable Refer to the Privacy and Security Information tip sheet for best practice reminders

Consent Management Consent Management for all Portlets in ConnectingOntario ClinicalViewer An express consent override in the ConnectingOntario ClinicalViewer will result in all portlets with a consent directive to be unmasked Although the data in the Dispensed Medications tab may not be required to provide care, an express consent override in another portlet will also release this data and you must complete the express consent form in addition to the Consent Override Dialogue box Risk of Harm overrides will not unmask information in the Lab and Pathology Portlet or Dispensed Medications tab

Consent Management Before you perform an override on any portlet in the ConnectingOntario ClinicalViewer: Confirm if a block is placed on the Dispensed Medications tab. If it is blocked, you must print a hard-copy express consent form. This can be obtained from the Consent Directive Dialogue Box Inform patient or substitute decision maker (SDM): the reason for overriding consent the override will apply to any other information or portlet where a block has been applied they may refuse to permit the override the information will be available: If the patient agrees to the override and the Dispensed Medications tab is blocked, obtain consent and document the receipt of consent by requesting a signature from the patient or substitute decision maker on the express consent form and complete the Consent Directive Dialogue Box Data Source Duration and Users Who May Access ConnectingOntario Clinical Data Repository (All portlets except Lab and Pathology and Medications-Dispensed Medications) Up to 11:59pm on the day that the override was initiated to the user that requested the override. Lab and Pathology Portlet: Ontario Laboratories Information System (OLIS) and Dispensed Medications: DHDR Available for 4 hours to all users at the organization or practice where the override occurred.

Indicates that a Consent Directive has been applied.
Consent Management If a consent block is in place, a yellow banner with Override Consent button and red warning message appears To override a Consent Directive: After obtaining informed consent from the patient or substitute decision maker (SDM) (as applicable): Click the Override Consent button Click on the circumstance that applies For #1 and #2, if a block is placed on Dispensed Medications, click consent form to print the hard-copy consent form and obtain signature from the patient or SDM For #2, complete SDM information #3, Significant Risk of Bodily Harm is not a condition for overriding blocked lab and pathology results (OLIS) or dispensed medications data (DHDR). If this is selected, the Lab and Pathology Results portlet and Dispensed Medications tab in Medications portlets will not be unblocked Click the Override Consent and View Patient Record button The patient’s information displays with a warning that the information was previously blocked Indicates that a Consent Directive has been applied.

Consent Management When a patient places a consent directive on all records, the patient can be found in the viewer, but no information is displayed in the portlets When a consent override is in place, warning messages appear to inform users of the impact and conditions of viewing blocked information

ConnectingOntario ClinicalViewer
Training Resources Additional information such as computer-based training modules and tip sheets are available in the training section at the ConnectingOntario ClinicalViewer Support page Click on the Help button in the ClinicalViewer Resources: <insert list of resources and where they can be found i.e., intranet website, binders etc.> Contact: <insert name(s) and phone # of site resource(s) /super user(s)> Contact

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