2019 Unified Epic Optimization & Upgrade High Level Timelines

1. 2019 Epic Upgrade & Instance Alignment Nutrition ImpactDeb Van Soest, Sr. Clinical Informatics Architect - System

2. Disclaimer: Please note that based on feedback from Validation and User Acceptance testing changes to the build were possible after the development of this presentation.Therefore screen shots available in the presentation may not represent the final build delivered.

3. 2019 Unified Epic Optimization & Upgrade High Level Timelines • PSJ Unified Epic & Upgrade Release: April 6-7 • Care Plan Upgrade: April 6 • Swedish Go-Live on PSJ Unified Epic: June 15 • Kadlec Go-Live on PSJ Unified Epic: August 17 • Last Sand Release for Prov, Swedish, and/or Kadlec Instances: Feb 19th • Build Freeze Feb 19 – May 7 (Sand will then release to PSJ instance only)

4. BETA Testing • Available • Providence Feb13 • Swedish May16 • Kadlec July • Available for informatics and end users to test new features before their released to live environment • Access Instructions https://community.providence.org/sites/LearnLib/LLNurSupMstr/BETA_How_to_Access.pdf

5. Epic Learning Resources: March 18thEducation Materials Release

6. Epic Learning Resources Website • Learning material categories • Epic Updates • User Guides • New Learners • Materials for Dietitians • Website Link • https://epiclearning.providence.org/Content/Home.htm?tocpath=Home|_____0 Available March 18th

7. Epic Updates • Instance Alignment/Upgrade & optimization change summaries, new content highlights or other recent updates • Instance Alignment/Upgrade changes summaries • Role-based most impactful changes • Summary of change with links to more details where appropriate • Organization specific • PHS, Swedish and Kadlec

8. Epic Epic Learning Home Dashboard Learning materials inside of Epic

9. Other High Impact Changes for Epic v.2018 Upgrade & Instance Alignment Care Plan Guides Sexual Orientation & Gender Identity (SOGI) / Preferred Names Risk for Violence Multi-lingual AVS Code Status Secure Chat in Hyperspace

10. Disclaimer • See Epic Learning Resources for full details on these changes • The following slides are intended to give you a high level overview of nine high-impact changes that will come with the 2019 Epic Upgrade and Instance Alignment • Other changes will also be seen with this upgrade • The following projects were not directly managed, nor clinically governed, by Women & Children’s. • Most high-impact projects have multiple clinical governance and upgrade committees that have been engaged

11. Clinical Practice Guidelines are now Care Plan Guides • Updated evidence and authoring methodology • New look and feel • One consistent format • New way to access • 100% Inpatient reviewed & revised • New topics! Key Point: A Care Plan Guide is a tool that reflects a synthesis of best evidence and practice that guides care without a “prescriptive” focus of a clinical practice guideline

12. Preview: 2018 Care Plan Format Key Point: The New Overview Care Plan includes Universal Goals like Prevent Skin Injury.

13. Care Plan Templates - Applying Only Active Problems • From the template the dietitian will add only the problems that are active/pertinent to the patient’s care plan. • No more “Select All”. Dietitians will no longer select all active and potential problems and add them to care plan. • This change improves individualization of the patients care plan.

14. The Comorbidity Template provides further opportunities to individualize Key Point: Changes have been made with the intention that the plan can be individualized without adding an entire CPG.

15. Care Plan Problem Related Goals • There is no longer a need to add free text Problem Related Goals and Strategies under the Edit Goal – Care Team Goals and Evaluation • The Problem-Related Smart Text will longer displays at the top of the therapists Plan of Care note. • There are now discrete data fields to document against problem related goals and expected goal dates

16. Beginning and During Shift: Key Points: • Review the care plan • Review patient education

17. End of Shift 1 2 Key Point: Document the evaluation of each goal through the new document button

18. Create a plan of care note Key Point: Summarize the overall assessment of patient’s progress toward all goals.

19. Sexual Orientation/Gender Identity (SOGI) Overview 2018 Upgrade Changes • SOGI Phase 3 focuses on improving the patient experience and on better supporting patient-centered care. You can already capture nuances in patients' sex and gender, that goes beyond their legal sex, in Epic today. • There are new updates throughout the system to use and show patient’s gender or sex assigned at birth instead of legal sex when appropriate. The Sex field in Demographics now displays areas to capture Gender identity, Sex assigned at birth, and Sexual orientation. • There are also updates throughout the system that make it easier for users to see a patient's preferred name, such as in Patient Lists, Headers, Chart Review , Reports or InBasket. This is especially important for transgender or nonbinary patients, but also helps improve the patient experience for any patient with a preferred name that differs from their legal name. • SmartLinks have been updated to retrieve a patient's titles and pronouns based on the patient's gender identity. • MyChart Patients can now view and edit more on the new Personal Information page, including: preferred name legal sex, sexual orientation, gender identity, and sex assigned at birth. • Baby Names now display the mothers preferred name as part of the baby naming convention.

20. Epic v.2018 Upgrade Notes and SOGI Committee Decisions Better Support for Patient Preferred Names in Epic 561082 • Display both First Name and Preferred Name where possible Better Support for Transgender, Intersex, and Nonbinary Patients in Epic 561390 • In columns and reports, do NOT use Epic updates to replace legal sex with gender id • Have columns and reports display both legal sex and gender id information where possible SmartLinks Now Show Sex and Pronouns Based on Gender Identity 608365 • Updated SmartLinks now respect incongruence and preferred pronouns Copies of Sex SmartLinks Now Show "Boy" or "Girl" instead of "Man" or “Woman” 631112 • .sex should display “adult” or “child”

21. Updates to Columns • Name columns display both First Name and Preferred Name

22. SOGI Updates to columns (con’t) • Columns displaying Sex / Gender ID / Sex Assigned at Birth are labeled as such

23. Updated Headers and Reports First Name and Preferred Name both appear in header Updated Report headers display complete information

24. Updated SmartLinks now respect incongruence and preferred pronouns

25. Risk for Violence • New FYI Flag ALERT titled Risk for Violence • Will trigger- • Separate alert in Headers • Banners on Landing Pages • PAF columns with Icons Note- Use will be defined by the individual ministry and governed by local policy Why? Violence towards healthcare workers is a nationally recognized problem

26. Headers & Banners

27. Risk for Violence - Patient List The patient Name will turn Red A column can be added with Icon

28. Risk for Violence – OB Boards

29. Risk for Violence - Linked baby • KEYPOINTS: • Shows on landing pages and in the patient header • Only works when babies chart is linked to moms • Because it is based on a linked moms chart, it does not offer cross-functionality to alert to violent dads or other family members • If baby is discharged, the link to mom’s chart breaks and the banner no longer displays

30. Who can activate this FYI Alert? • Access to place the FYI risk for violence alert: • Follow Hoag Policy

31. Multilingual AVS • Multilingual AVS provides the ability to print a patient discharge or instructions in languages others than English • Includes rule based verbiage for: immunizations, sleep apnea, smoking cessation, Warfarin, Aprepitant, Sugammadex, methotrexate, designated care providers, antibiotics, and call 911 verbiage • Swedish currently provides multilingual AVS’s. Providence provides multilingual in Ambulatoryonly. • Epic cannot translate certain pieces of information: procedure names, medications, free text notes BENEFITS • Improved patient experience • Standardization of care and documentation • Approximately 10% or more of our patients have documentation that a language other than English is their preferred language

32. Project Overview • Translation finalized and approved into: • Russian • Vietnamese • Simplified Chinese • Spanish • Arabic

33. Code Status Key Differences in build & literature reviews were conducted

34. Future State for Code Status • Binary Code Status • Full Code, Full Code By Default (TBD) • Do Not Attempt Resuscitation (DNR) • Level of medical care desired moves from order workflow to documentation workflow • Retiring: • Partial Code & Limited Life Sustaining Treatments Orders • Code Status Icons (such as below) will be sunset, and using Text only

35. Desired Level of Medical Care • New SmartForm for Providers • “Not Addressed” will Default • Text Generation for Goals of Care Note