Beacon Epic 2018 Upgrade & Alignment

1. BeaconEpic 2018 Upgrade & Alignment March 5, 2019 Kim Toler, Monica Mehlman, & Julie Zehetbauer

2. Beacon Items to Review • Improved Functionality for Therapy Plans • Therapy Plan – Review and Expiring Plan • Therapy Plan – Hypersensitivity Orders • New Protocols Available in Library • Medication Spotlight View • Self-Driving Oncology History • Put Unsigned Orders in Plain Sight • One-Stop Ordering for Oral Chemotherapy • Springboard Report Updates • Infuse Clinic Managers' Dashboards with Chemotherapy Infusion Visit Data

3. Improved Functionality for Therapy Plans Nova Note: 577418- Prettied Up Therapy Plans Impacted Users: Oncology and Ambulatory providers and nurses who use OP Therapy Plans Summary: Therapy Plans work more like Ordersets. Workflows are streamlined making the functionality easier and more intuitive. End users can now select orders they want to keep and which ones they want to discard by using checkboxes

4. Improved Functionality for Therapy Plans • Select the protocol and apply it to a patient. • The plan is inactive and you can review the orders. • Standard recommended orders are already selected.

5. Improved Functionality for Therapy Plans • Clear the boxes for any orders you want to remove from the therapy plan and select the boxes you want to add. • When you sign the plan, all unselected orders will fall off the therapy plan. • The plan is active once the orders are signed.

6. Therapy Plan - Review and Expiring Plan Theme: Collaborative Integration Impacted Users: Oncology and OP Infusion Therapy Plan Ordering providers and Support Staff Summary: Providence has been using a “Review” scheme for Therapy Plans. With the Upgrade, the scheme will change to an “Expiring Orders” scheme.

7. Therapy Plan - Review and Expiring Plan Important compliance changes: • Previous scheme of reviewing plans ≠ re-signing the orders • With Expiring Orders scheme, Therapy Plan orders will expire after 365 days. • New scheme will ensure Therapy Plans have current orders. • InBasket message will trigger when plans are about to expire. • In preparation for the Upgrade, providers can begin re-signing plans at anytime. • Weekly reports will be available via Regional CI for expiring orders that need to be addressed. • RWB does not recognize plan that have been resigned.

8. Therapy Plan - Review and Expiring Plan Expiring Orders Notifications: • Providers will receive an InBasket message within a month prior to plan expiring, and will continue to get a message until the orders are updated or discontinued. • Expiring orders messages will be batched every 2 weeks on Sundays Managing Messages for external providers that do not have an Epic EMP: • The IB message is sent based on hierarchy rules • Order authorizing provider • Plan Provider • Last Reviewer • Plan Creator • For the external provider, the message would likely go to whoever last reviewed the plan on their behalf, or whoever created the plan on their behalf.  • Training tip: Any nurses or pharmacists who create plans for external providers should be included in training about the new messages

9. Therapy Plan - Review and Expiring Plan • Expiring Therapy Plan messages route to the Treatment/Therapy folder • Provider can Open Plan to resign or discontinue plan

10. Therapy Plan – Hypersensitivity Orders • Theme: Hypersensitivity Orders • Impacted Users: Anyone who uses Therapy plans • Summary: With Alignment, we will now have an order group added to our therapy plans to include the following: • Benadryl 25mg IV every 15 minutes prn x2 • Solu-medrol 125mg IV once prn • Epinephrine 0.3mg IM every 5 minutes prn x3 • Start oxygen for O2 less than 92% • Acetaminophen 650 mg PO every 4 hours  prn • Famotidine 20 mg IV once prn • NS Bolus • Albuterol 2.5 mg INH Once PRN

11. New Protocols Available in Library • Theme: New Protocols Available in Library • Impacted Users: Beacon Oncologists and Nurses • Summary: With the Alignment, the Beacon team has been reviewing and adding new Beacon protocols to the Protocol Library that Kadlec and Swedish users need. • These protocols are reviewed and approved at OCELOT. • Small workgroups meet separately to review the protocols in detail, which include physicians, pharmacists, and analysts.

12. Medication Spotlight View Theme: Medication Spotlight View Impacted Users: Oncologists, Beacon Nurses, and Pharmacists Summary: New feature of Medication Spotlight View added to the Treatment Plan Manager. This feature is already available in Kadlec and Swedish, so bringing forward to unified version of Epic. This view allows the provider to view and make adjustments to treatment plan medications.

13. Medication Spotlight View The new view can be turned on from within the toolbar Example of Medication Spotlight View

14. Medication Spotlight View Interactive view -

15. Medication Spotlight View Interactive view -

16. Self-Driving Oncology History Nova Note: 590942 Impacted Users: Beacon Providers and Nurses Summary: The Oncology History activity will automatically update when a cancer is staged.

17. Self-Driving Oncology History • The oncology history provides clinicians with an overview of important events, such as cancer staging, radiation therapy, or remission, through the course of a patient's treatment. • When Cancer Staging is signed, the Oncology History will now automatically reflect that in the Oncology History under the Cancer Staged Event.

18. Self-Driving Oncology History In addition, we are aligning the Oncology History Events with Kadlec and Swedish to include the following available events: • Bone Marrow Biopsy • Adverse Event • Endocrine Therapy • Metastatic Disease • Physician Change • Concurrent Chemo Radiation • NeoadjuvantChemo Radiation

19. Put Unsigned Orders in Plain Sight Nova Note: 590926 Impacted Users: Treatment Plan Ordering Providers Summary: New functionality allows clinicians to make sure all of a scheduled treatment day's orders are signed prior to the patient’s arrival

20. Put Unsigned Orders in Plain Sight • New InBasketReminder message: • Sends the provider a message for any unsigned Treatment orders within 7 days of treatment appt • Message appears in the Treatment/Therapy Plans folder • Once the orders are signed, the IB message will automatically disappear without add’l action • Some order categories are excluded from this functionality, including: • Nursing Orders, Physician Communication Orders, Lab Orders, Clinical Trials Information, & Take Home Medications

21. Put Unsigned Orders in Plain Sight Improved Columns for Multi-Provider Schedule • The Signed Tx Plan and Signed Supp Plan columns have been improved with the upgrade. • Will now show the number of orders and the date • Orders awaiting cosign or dual sign will be visible

22. One-Stop Ordering for Oral Chemotherapy Nova Note:587597 Impacted Users: Beacon and Ambulatory Providers who order Oral Chemotherapy Medications Summary: With this setup, clinicians can place a single order with the overall dose they need, and the system automatically creates a group of prescriptions that meet the correct overall dose.

23. One-Stop Ordering for Oral Chemotherapy • When the dose is entered, the IMS (Intelligent Medication Selection) automatically suggests product combinations • This functionality will work both in Treatment Plans and regular ordering sections, such as Manage Orders

24. One-Stop Ordering for Oral Chemotherapy • Training Hot Topic: • If a provider would like to order a brand name medication, they need to include dispense as written (DAW) note to pharmacy to document specific instructions. Conversely, the Rx can be printed and the DAW information hand written on the prescription. The order default will be generic. • Please note: temozolomideand capecitabineare frequently ordered oral chemo meds that may need DAW. • The following orders will not have this functionality: isotretinoin, sirolimus, hydrocortisone, prednisone, and dexamethasone as they are ordered in other non-oncology locations Known Issue: DAW does not work with IMS

25. Springboard Report Updates Nova Notes: 599795, 605696, & 626713 Impacted Users: Beacon Users Summary: With the Upgrade, the Springboard report will now have the following updates: • To reduce clutter and show you the information you need most, the Springboard report now shows only the days in the current cycle rather than days in all future cycles. To view future cycles, go to the Treatment Plan Manager.

26. Springboard Report Updates • Cumulative Dose information appears. • Routing Plan History appears.

27. Infuse Clinic Managers' Dashboards with Chemotherapy Infusion Visit Data • Nova Note: 633900 • Impacted Users: Beacon Nurse Managers • Summary: With the Upgrade, Beacon will be implementing a new registry that will: • Give clinic managers access to chemotherapy infusion visit information on a dashboard • A new Chemotherapy Infusion Visit Wait Times Report will be available in Reporting Work Bench Due to conversion, this info will not be ready at go-live

28. Infuse Clinic Managers' Dashboards with Chemotherapy Infusion Visit Data Due to conversion, this info will not be ready at go-live