Build Semantics
The Epic software environment uses a number of terms that overlap clinical and organizational terminology. For example, "Department" has a particular significance as a unit of organization for workflow within the Epic ecosystem but a very different meaning, with different organizational implications, in Alberta Health Services and affiliate organizations.
This section highlights areas where healthcare words and concepts may have related but different meanings when used to refer to the design and build of Connect Care.
Service
The word "Service" usually refers to a coordinated grouping of healthcare assets (people and resources) sharing a common clinical purpose. The same word is used in a number of places in Epic and in AHS's Connect Care. Users are confronted with, for example, pick lists and patient lists bearing the name "service" that do not share a common set of available items to choose from. Indeed, these different service listings reflect different underlying concepts.
Hospital (Admitting) Service
The "ADT Service List" (EPT 18886) serves inpatient facilities admitting patients to groups of providers organized to provide a specific clinical service. The options are limited to clinical services that have admitting privileges and beds assigned for use by attending (MRHP) clinicians associated with that service. The admitting hospital service is selected when an admission order is placed (hard stop) but can be revised by bed management staff. It can also be revised if a patient is subsequently moved to a different service through a transfer order. A "patient status" order can be used at any time to make corrections or adjustments to a patient's hospital service.
Contents
Clinical services available within a facility that have capacity to take primary responsibility for a patient in one of the facility beds or other inpatient accommodation resources.
Provided by AHS facilities during preparation for launch.
Terms standardized, as much as possible, so that all services of a particular type share the same name in different facilities.
Context
Inpatient encounter
Use
Bed allocation, reporting, dashboards, reporting workbench, slicer dicer, work balancing.
Not supported in patient lists.
Display
Can be accessed with "AHSIPSERVICE" SmartLink and appears in provincially standardized documentation templates.
Exposed via hover bubble in StoryBoard and in inpatient sidebar displays (transition planning).
Control
Unit managers, ADT staff and prescribers have access to orders or other tools for updating a patient service allocation.
Present in admission order, transfer order and "update patient status" order.
Not available for editing via SmartForms and not currently supported for editing in navigators or activities, including pop-up activities.
Oversight
Clinical Service, Clinical Documentation Service, Author Service
A "Clinical Service List" (ECT 34886) is used to categorize documentation (e.g., progress notes, discharge summaries) entered to a patient's chart by providers. This same list is used to align Handoff Reports and the Subjective-Objective and Assessment-Plan note components in problem-oriented charting (POC), where each service is able to maintain its own layer of shared documentation objects. This list includes clinical services that may not have facility beds (or admitting privileges) assigned and so is expected to be larger than the Admitting Service list.
Contents
Clinical services available within a facility that can contribute to patient care, either as a primary or contributing (e.g., consulting) care team member.
Provided by AHS facilities and clinical departments during preparation for launch.
Terms standardized, as much as possible, so that all services of a particular type share the same name in different facilities.
Context
Provider
Note (HNO 59)
Use
Documentation, chart filtering, reporting, provider-allocation.
Display
Can be accessed with "AHSIPNOTESERVICE" and "AHSOPNOTESERVICE" SmartLinks and appears in provincially standardized documentation templates.
Exposed in note editors and problem-oriented charting navigators.
Control
The inpatient documentation service is entered by the clinician adding content to a patient chart, where a service pick-list appears at the top of the documentation editor (e.g., for a progress note).
Outpatient documentation service is derived from appointment booking attributes and normally cannot be changed by clinicians documenting on that outpatient encounter.
Oversight
Provider Teams Service Name
Inpatient providers are often organized into teams that work together to provide a particular health service. In the case of prescribers, there may be one or more teams within the same hospital service, with each team taking responsibility for a subgroup of all the inpatients admitted under the hospital service. Provider team accountabilities can be spread across multiple hospital wards and so may overlap with but are not the same as logon departments (usually physical locations; see below).
The naming of provider teams varies somewhat from facility to facility and bears resemblance to the provider groupings that existed pre-Connect Care. Naming may resemble hospital services, with subgroups identified by numbers (e.g., "Hospitalist Team 1", letters (e.g., "General Internal Medicine Team C", colours (e.g., "Infectious Diseases Team Purple") or other differentiators.
Most providers encounter team names when searching within system patient lists (provider teams are listed within facility groupings), but the team names also appear in pick-lists used when associating patients with teams or providers with teams.
Contents
Groupings of health service providers that enable provision of care within a facility.
Closest to the naming of hospital (admitting) services but also includes consulting services and may have multiple teams within a particular service.
Context
Inpatient encounter
Use
Finding all patients with a common attachment property.
Display
Exposed in facility system patient lists and in patient attachments.
Control
Oversight
Patient List - Consulting Service
Inpatient facilities have "system patient lists" that facilitate finding all patients assigned beds at a particular location (e.g., hospital ward), or sharing a common property (e.g., consultation order entered for a particular specialty). System lists include facility-specific provider team lists that show all patients "attached" to a particular provider team. The consult service system lists use an informal naming convention that often resembles how consultation services were named for a facility pre-Connect Care. There will be overlap, differences, when patient list names are compared to hospital or clinical service names.
Contents
Clinical consultation services corresponding to those that can be ordered within a facility.
Closest to the informal naming of inpatient consultation orders, although more than one order specialty can be mapped to a single consult patient list specialty.
Context
Inpatient encounter
Use
Finding all patients with a common attachment property.
Display
Exposed in facility system patient lists.
Control
Oversight
Specialty
Provider Speciality
Clinicians may be qualified to offer healthcare services specific to a specialty. Specialties are best defined for prescribers where they are defined in a Provincial Provider Registry with specialty types set by the College of Physicians and Surgeons of Alberta (CPSA).
Connect Care provider records (SER) have a "Provider Specialty) field (SER 1050, to be replaced by 1054 "Active Specialty") for attaching one or more (multi-select) specialties associated with an individual provider. Specialties must be selected from a controlled category list that currently has ~300 entries. There are overlaps with terms in the Hospital Service and Clinical Service categories but the same specialty is also often named differently on the different category lists.
Referral and Consultation Order Specialty
Connect Care users encounter specialty names when placing orders for inpatient consultations or outpatient referrals. The terminology used to identify the specialty services that can be consulted or referred to is not controlled by a category list. Rather the title (name) given to the order (EAP record) contains the specialty name.
These EAP record names overlap with the above Hospital, Clinical and Provider specialty names but do not appear to adhere to a common naming or abbreviation convention. There is no associated category list. The specialty information in the order titles is often more specific and may even reflect local historical conventions for identifying available consultation or referral services.
Department Name
Users log on to a "department" when accessing Connect Care. This Epic department is not the same as an AHS organizational department, although there may be overlap. AHS clinical facilities (hospitals, clinics, etc.) will have a set of clinical "departments" that broadly match the health and clinical specialties available within that facility. Tertiary hospitals, for example, will have a "department "of medicine overseeing many specialty "divisions". Where those divisions have a single outpatient clinic, the division name may approximate the Epic logon department name, at least with respect to the specialty reference. Inpatient logon departments, by contrast, almost always correspond to physical ward locations. A limited number of "virtual" logon departments may have names more closely matching some of the provider and clinical services described above.
A scheduled (outpatient) or admitting (inpatient) department represents a physical location where patient care takes place under the guidance of a specific healthcare service or specialty.
A virtual department provides a common logon and configuration for providers sharing like needs. Appointments cannot be scheduled to virtual departments.
AHS has adopted a naming convention for logon departments in an effort to bring more consistency to the varied legacy conventions used by pre-AHS regional health authorities in Alberta. This naming convention is not necessarily aligned with the naming of specialties evident in hospital, clinical, provider or referral service lists.