Beckman Workflow Updates Effective: August 5 th , 2014

1. Beckman Workflow UpdatesEffective: August 5th, 2014

2. What is our current Beckman workflow?

3. Current Beckman Workflow • Provider writes out order on paper order set. (#105-0320 v5/11) • Order faxed to 13th Fl. Satellite, followed by a call. • Provider also enters order into APEX. • Under “Office Visit” encounter, if available. • If not, under “Orders Only” encounter.

4. Current Beckman Workflow • Pharmacist looks for order under “Office Visit” encounterand prints a label. • If no encounter exists, pharmacist prints label using custom labels function:

5. Why do challenges with Beckman exist?

6. Challenge #1: Not an HOD • Beckman is not considered a HOD*, unlike other procedural areas like Endoscopy and Ortho Institute. * HOD: Hospital Outpatient Department

7. Challenge #1: Not an HOD • For pharmacy, this means orders entered for facility administered medications will not show in the pharmacy verification queue. • This may be okay in other clinics with the exception of Beckman (all Ophthalmology) clinics, since they need short stability products made by pharmacy.

8. Challenge #2: After-Hours • Confusion created by providers generating “Orders Only” encounters for emergent after-hour cases. • Pharmacy cannot see “Orders Only” encounters after they are closed. • In the patient’s profile, order appears as “another visit” and labels cannot be generated.

9. Challenge #2: After-Hours • Ideally, orders should be entered under “Office Visit” encounters. • Pharmacy can see these encounters. • Labels can be generated once alerted by Beckman. • However, providers do not have access to “Office Visit” encounters since it requires provider to complete other fields they do not have expertise to handle (i.e. patient insurance, demographics).

10. What’s changingon August 5th?

11. Changes • With EPIC 2012, non-HOD orders can be programmed to show up in the pharmacy verification queue by specifically identifying: • Clinic contexts where orders will be submitted (slide 13) • ERXs that will be ordered from these contexts (slide 14)

12. Changes • Will show in all adult queues in “EYEB52” location. • Only works for “Office Visit” encounters. • Will not work for “Orders Only” encounters.

13. Targeted Clinic Contexts • OPHTH CORNEA PARN • OPHTH GLAUCOMA PARN • OPHTH NEURO PEDS PARN • OPHTH ONC PARN • OPHTH REFRAC SURG PARN • OPHTH ADULT PEDS PARN • OPHTH NEURO PEDS PARN 400 • OPHTH PED PARN • OPHTH PLASTIC PARN • OPHTH RETINA • PROCTOR GROUP • PROCTOR PROSE CLINIC • OPHTH GENERAL PARN

14. Targeted Orders (ERXs) • AmikacinIntravitreal • Amikacin 50mg/mL drop • Amphotericin Intravitreal • Cefazolin 50mg/mL drop • Ceftazidimeintravitreal • Ceftazidime50mg/mL drop • Cefuroxime Intravitreal • Clindamycin Intravitreal • Dexamethasone Intravitreal • FoscarnetIntravitreal • GanciclovirIntravitreal • Tobramycin 13.3mg/mL drop • VancomycinIntravitreal • Vancomycin 10mg/mL drop • VoriconazoleIntravitreal • Nonformulary (NF) request (for compounded items where ERX does not exist)

15. Changes Location “EYEB52” indicates orders were entered under one of the Ophthalmology contexts. Please change order priority to STAT when verifying unless order indicates otherwise. (see next slide)

16. Changes After clicking on “Edit Clinical Information,” under “Priority,” change default from “Routine” to “STAT”

17. Miscellaneous • Beckman staff will pick-up from 13th fl. Satellite, please call when preparation is ready. • NF medication order is used for rarely used preparations when there is no prebuilt ERX. • Pharmacist will need to reenter order as Custom IVPB. • Beckman must provide recipe for these products. • Stability data should be included in recipe.

18. Miscellaneous • This new workflow applies to most encounters with the exception of “Orders Only.” • On occasion, providers will need to generate an “Orders Only” encounter in emergent situations where there is no administrative staff to correctly generate an “Office Visit” encounter. • In these situations, the orders will be faxed to 13th Fl. Satellite, old workflow will be resumed (Slides 3-4).

19. Miscellaneous • Providers have been given a job aide to detail these changes. • Another branch of EPIC called “Kaleidoscope” will be going live early November 2014. • Improves provider documentation. • Ensures correct billing for procedures. • Will not impact pharmacy operations.

20. Contact For issues that arise after this goes into production, please contact Christine Ha.