1. Viewer Training
Student Guide
June 2018

2. Table of Contents Page Number Introduction 3
Accessing ConnectingOntario ClinicalViewer (Logging In/Out) 5
My Workspace 11
Patient Search 12
Patient Care Overview 13
Timeline 14
Navigation Bar 16
Portlets Overview 17
Medications 20
Diagnostic Imaging 30
Lab and Pathology Results 39
Consent Management 43
June 2018, Release 10 updates:
screen shots updated throughout to reflect user interface changes
minor edits to language and formatting throughout
Reordered Navigation Bar and Portlets Overview sections
updates for new DI portlet on slides 3 and 19
revised instructions on setting a custom timeline, slide 15
new Diagnostic Imaging portlet section added to Portlets Overview section

3. Introduction What is the ConnectingOntario ClinicalViewer?
The ConnectingOntario ClinicalViewer displays Ontarians’ personal health information (PHI) from participating healthcare organizations such as hospitals, LHIN home and community care services and provincial repositories
Available information includes:
Discharge Summaries
Hospital Visit/Encounter Details
Consultation Reports
Diagnostic Imaging Reports and Images
Emergency Department Reports
LHIN home and community care 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.

4. 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

5. Accessing the ConnectingOntario ClinicalViewer
Single Sign-On Login
If your organization has single sign-on to the ConnectingOntario ClinicalViewer, you will be able to access the viewer directly from your own hospital or clinical information system
As well, if patient context sharing is enabled, the patient you select from your information system will be maintained when you access the ConnectingOntario ClinicalViewer
Follow your organization’s policies and recommendations regarding single sign-on and patient selection
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)

6. Accessing the ConnectingOntario ClinicalViewer
Using ONE ID to Access
To access the ConnectingOntario ClinicalViewer with your ONE® ID credentials:
In your internet browser go to:
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

7. 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)

8. End User Agreement
The first time you access the viewer and at the first access of a new calendar year, this prompt appears
To accept the End User Agreement:
Click OK
The End User Agreement appears
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

9. 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 and close the browser
This is required in order to comply with Privacy and Security legislation
Close the internet browser
Note:
You are limited to using a single instance of the ClinicalViewer at any given time

10. ConnectingOntario ClinicalViewer Interface
Update numbers on pic
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

11. 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 (not shown)
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 a different time interval

12. 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 is 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
Include as much information as possible for more accurate search results
At a minimum, you must provide a first name, a last name and either the patient’s date of birth, or the patient’s address (street address and city)
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

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

14. 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

15. 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 leave today’s date in the field)
Click Go
You can manually type the From and To dates into the field (dd mmm yyyy)
or use the calendar widget to select dates

16. 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 views 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 (if it is not already expanded)
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

17. Portlets
Portlet Icon and Title: Identifies the type of information available in the portlet
Print: Allows you to print a list/portlet view
User Preferences: Allows you to customize how information is displayed
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
Refresh: Refreshes information in portlet
Data Source: Indicates the source for information displayed in portlet
Results Count: The total number of items for the selected period. Scroll to view all items
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

18. Portlets Portlet Name Information Available
Visits/Encounters and Summary Reports
Displays a list of all acute care encounters and associated summary reports
Documents/Notes
Displays a list of individual documents for non-diagnostic notes and reports
Examples: Consultation Notes, Discharge Summaries, History and Physicals, and community documents not associated with a specific community referral (e.g., RAI assessments)
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
Diagnostic Imaging
Displays reports and images from Diagnostic Imaging Common Service (DI CS) provincial repository for each accession
Includes all diagnostic modalities submitted to DI CS
Amended reports are indicated with red text
Other Results
Displays reports for diagnostic tests that do not appear in Lab and Pathology or Diagnostic Imaging (e.g., respiratory, neurophysiology reports)
Cardiology results are grouped and can be viewed in a separate tab
Continued…

19. Portlets Portlet Name Information Available Community
Displays information from LHIN home and community care services that is associated with community referrals
Contains documents such as: long term care referrals, service and equipment/supplies information
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)
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)
Flowsheet view is available for a set of common lab test results in a tabular format
Tests available on the flowsheet can be viewed in a trend graph

20. 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

21. 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

22. 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

23. Reference for Dispensed Medications (DHDR)
A listing of information available in DHDR is accessible through the Data Summary or the Dispensed Medications tab
Via 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
Via Dispensed Medications Tab
Click DHDR

24. 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

25. Clinical Use of DHDR Information
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

26. Clinical Use of DHDR Information
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)

27. Clinical Use of DHDR Information
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

28. Clinical Use of DHDR Information
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)

29. Clinical Use of DHDR Information
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

30. Diagnostic Imaging: Overview
Access reports as well as images from DI CS
All portlet views display the same information columns
All columns are locked (i.e., columns cannot be hidden)

31. Diagnostic Imaging: Data Summary
A listing of organizations contributing reports and images to DI CS is accessible through both the Data Summary and the Diagnostic Imaging Portlet
Via Data Summary
Hover over the Applications Menu to display the link to the Data Summary
Click Data Summary
Click Diagnostic Imaging tab
Click the DI Common Service Data Contributors link
Via DI Portlet
Click this link in the DI portlet to view a current list of organizations contributing to the DI CS

32. Diagnostic Imaging: Tips
Tips about the Diagnostic Imaging portlet:
Sort in ascending or descending order by clicking on the column headers (except for Additional Information). By default, the portlet is sorted by the procedure date and time in descending order
One accession number (row) can be associated with one or more studies. Hover over the Procedure Description or Additional Information columns to view the associated list in a tooltip
Additional Information such as the modality, anatomic region, and laterality are displayed when provided by the source system
Print the contents of the DI portlet using the Print icon

33. Diagnostic Imaging: Reports
To view reports:
Click the Report icon in the appropriate row
The report is displayed in a separate report viewer window
The status of the report is displayed in the portlet and in the report viewer
Tips about reports:
Each report is visible on its own tab
Amended reports are displayed with a red reporting status label and the Amended label
Print the report using the Print Current Tab button
Close the window using the Close button or the X at the top right of the window

34. Diagnostic Imaging: Images
To view diagnostic images:
Click the Image icon in the appropriate row
The Image Viewer is launched in a new window and automatically logs you in
It displays the image or images for the accession

35. Diagnostic Imaging: Images, cont’d
Tips about the Image Viewer:
If multiple studies are included in the accession, clicking the study information button allows you to select another study to view
Switch between different layout options using the Options button
Compare one image to another using the Compare Studies button that appears at the top right of the viewer (not shown)
Close the panel using the icon
Learn more about the Image Viewer by clicking Help
Display the image toolbar by clicking on the right arrow icon
Best Practice: Close the image viewer window when you are done viewing the images
Selecting another patient within the ClinicalViewer or logging out of the ClinicalViewer closes the image viewer

36. Integration with DI CS – Multiple Locations for DI Reports
DI reports and images from hospital radiology departments and Independent Health Facilities are contributed to the local DI repository and then to DI CS. These reports and images display in the ClinicalViewer, DI Portlet
DI CS
DI Portlet
DI r
Other Results Portlet
DI reports that are not sent to DI CS will continue to be contributed to the acCDR. These reports display in the ClinicalViewer, Other Results Portlet
Important points to note in regards to the integration with DI CS:
Depending on the workflow of the hospital, some DI reports are still contributed to the acCDR and will display in the Other Results portlet, either tab
Scenario 1 BMD’s (bone mineral density) can appear in DI or Other Results, All tab depending on the workflow of the hospital
Scenario 2 Echo (ultrasound echo cardiograph) can appear in DI or Other Results, Cardiology
Scenario 3 Ultrasound performed in the ED of a local hospital is not sent to DI CS and therefore displays in Other Results portlet, All tab
All of these scenarios are examples of procedures that may be performed in departments other than Radiology. Therefore, the results will be contributed to acCDR not DI CS.
Organizations may contribute to DI CS but not to CDR, e.g. IHFs. Refer to the list of contributing sites available through the Data Summary for more details - there may be DI CS information available for viewing even though there is no other information displayed in the rest of the viewer. E.G.: a patient who has a DI procedure performed at an IHF and has never been admitted to a hospital. Only DI CS would have data for this patient, not acCDR. !
Check both the DI and Other Results portlets for DI information
If a procedure is performed at an organization that contributes only to DI CS, information for the patient will display only in the DI Portlet (no other portlets will be populated)

37. Integration with DI CS – Organization and Facility Names
The coding approach at each contributing organization determines what is displayed in the Organization column within the ClinicalViewer: organization only or organization plus facility. This will result in differences between how the same organization is listed in the DI portlet and all of the others:

38. Diagnostic Imaging: Consent
Red warning text indicates that some data in DI CS has been blocked due to a consent directive. Currently, you cannot override consent blocks in the DI portlet nor retrieve blocked DI data stored in DI CS

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

40. 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:

41. Lab and Pathology Results: Filters
You can apply filters to sort and find results quickly in any portlet
To apply a filter:
Click the Down Arrow in any column header
Click Filters
Type in the search box or select from displayed list
Press Enter
To remove a filter:
Click the Down Arrow in the Test column header
Uncheck Filters

42. Lab and Pathology Results: Trend Graphs
You can display a trending graph for results available from the flowsheet
To graph results:
Check the checkboxes beside the results that you would like to graph
Click the Graph button
Hover over data points to review the details of a given result. Blue dots are normal results, red dots are abnormal

43. 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 (except Diagnostic Imaging)
Informed and express consent from the patient or substitute decision maker (SDM) is required for unblocking 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

44. Consent Management
Consent Management in ConnectingOntario ClinicalViewer
An express consent override in the ConnectingOntario ClinicalViewer will result in all portlets with a consent directive being unblocked (except Diagnostic Imaging)
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 unblock information in the Lab and Pathology portlet or Dispensed Medications tab

45. Consent Management
Before performing an express 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 Acute and Community Clinical Data Repository (All portlets except Lab and Pathology, Medications-Dispensed Medications and Diagnostic Imaging)
Up to 11:59pm on the day that the override was initiated to the user that requested the override
Ontario Laboratories Information System (OLIS) (Lab and Pathology Portlet) and DHDR (Medications-Dispensed Medications)
Available for 4 hours to all users at the organization or practice where the override occurred

46. 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.

47. Consent Management
When a patient places a consent directive on all records, the patient can be found in the viewer, but no information displays in the portlets
It is not possible to override consent blocks in the DI portlet or retrieve blocked DI data stored in DI CS
When a consent override is in place, warning messages appear to inform users of the impact and conditions of viewing blocked information

48. ConnectingOntario ClinicalViewer
Training Resources
Additional information such as elearning modules and tip sheets are available in the training section at the ConnectingOntario ClinicalViewer Support page
Click on the Help button in the ClinicalViewer
Contact your organization’s key trainer, clinical champion or super user
Contact