Epic 2018 Upgrade & collaborative Integration: Ambulatory Features March 5, 2019

1. Epic 2018 Upgrade & collaborative Integration: Ambulatory Features March 5, 2019

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. Note: Presentation is best viewed in Slide Show mode so as to see animations

4. High Impact Changes

5. Instance Alignment Nova Notes: 600566, 609600 Widescreen View Navigators • Both an Instance Alignment and an Epic 2018 upgrade theme • Kadlec already uses Widescreen View • Epic considers Widescreen View to be the standard for ambulatory • Part of Epic’s overall user experience shift toward showing high-level info at a glance with the ability to dive in deeper without having to do a lot of scrolling • Prepares us for the new Storyboard feature that will replace the Patient Header in the next upgrade • Honor Roll requirement • Default behavior now disables toggling between the classic and widescreen workspace

6. Widescreen View Navigators – Scope • Ambulatory encounter types: • All scheduled encounters • All “on-the-fly” encounters • Users affected: • All ambulatory clinical users (Nurse, Medical Assistant, Provider) • Non-clinical users who work in any ambulatory encounters • E.g., Front desk staff who work in telephone encounters • Specialties in scope: • All Ambulatory specialties (~ 70 specialties) • HODs where the preponderance of patients are scheduled and come from outside of the hospital • Radiant, OpTime and ClinDoc supported departments are outside of this scope • Beacon is releasing a widescreen view option for oncology departments Some helper style navigators will continue to use classic navigator (e.g., Amb Screening)

7. Anatomy of a Widescreen View Navigator • Most visit navigators have at least the following four tabs: • Rooming • Amb Screening • Plan • Wrap-Up • Sidebar has tabs for: • This Visit (default report varies by specialty) • Progress Notes • Visit Checklist • Scorecard • H&P Notes (for surgical specialties) If you aren’t seeing the sidebar, try clicking on this button on the right hand side of the screen Some specialties have additional default activities for other documentation tools Additional functionality can be found in More Activities Visit Taskbar

8. Anatomy of a Widescreen View Navigator - Rooming • Rooming activity has a single-pane format (navigator sections default closed) • Many specialty-specific variations • Generally the default activity for nurses & MAs • The following sections will also appear in the Rooming activity, as needed: • Infection Alert • Epidemic Risk • Pt Reviewed • MyChart Sign-Up • Care Everywhere • Outside Info • DM Documentation • Cardiac Documentation • Patient Hx

9. Anatomy of a Widescreen View Navigator - Plan • Plan activity has a two-pane format (navigator sections default open) • Plan activity is the same for all specialties • Different arrangement than Widescreen in Epic 2017 • Generally the default for providers

10. Anatomy of a Widescreen View Navigator – Wrap-Up Wrap-Up activity right pane may vary based upon how specialty charges (Time Calc vs LOS) Wrap-Up activity left pane is the same for all specialties

11. Widescreen View Navigators – Telephone/Refill Default activity for non-providers is Call Intake Default activity for providers is Take Action

12. Nova Notes: 572340, 596287, 609568 Visit Taskbar • Appears at the bottom of Pre-Charting and encounter workspaces • Not supported in HODs

13. Visit Taskbar Functions • Place, modify and sign new orders • Print or Preview AVS • Sign Encounter

14. What about Order Entry???

15. Anatomy of the Visit Taskbar Print the AVS (shortcut: Ctrl+T) Order Review (with Reprint options for Meds and Procedures) Preference list browser (shortcut: Ctrl+O, Enter) Click to display unsigned orders (shortcut: Ctrl+S) Changes to Sign Orders once orders are displayed: Add orders (shortcut: Ctrl+O) AVS options: Changes to Sign Visit once all orders are signed (shortcut: Ctrl+S or Alt+S)

16. Orders “Shopping Cart” Display orders shopping cart in either pop-up dialog or sidebar tab Additional functionality Order Mode Click to edit Signing Options

17. Nova Note: 605346 Meds & Orders Section Add Patient-Reported medications Link to active treatment plans Link to Insulin Instructions No ability to place new orders

18. Nova Notes: 597502, 549671 MultiProvider Schedule Update Pin calendar and other schedules to left side of screen Ability to view reports on the side or on the bottom Status Meds Due Sticky Note Pre-Charting • Patient photo with ring around it to indicate visit start and length • Similar names in bold italics • Color-coded status (automatic or manually-set) • Schedule Blocks with multiple pieces of information

19. MultiProvider Schedule Update

20. New Clinical Features

21. Nova Note: 635758 PDMP Review Activity • New activity that provides either interfaced access to state PDMP data (Washington), or the ability to log into a state PDMP website (Alaska, California, Idaho, Montana, Oregon) • Available from the More menu, can be starred to make it a default activity • Indicate that the PDMP has been reviewed by clicking Mark All as Reviewed and Close

22. Nova Note: 587260 Social Determinants of Health (History Activity & LPOC)

23. Social Determinants of Health (History Activity & LPOC) Clinicians can search for community resources by name and address and use filters to narrow the search results The hover bubble can help clinicians understand when a patient has recently become at risk for a domain and act accordingly

24. Social Determinants of Health (History Activity & LPOC) View previous recommendations

25. Social Determinants of Health (History Activity & LPOC) SmartLink .COMMUNITYRESOURCES pulls selected resources into Patient Instructions for displaying on the AVS

26. Nova Notes: 606330, 606920 Insulin Instructions

27. Insulin Instructions on the AVS

28. Nova Note: 553523 Significant Height or Weight Change Window changes • Change is large and easy to see • Graph with reference range to help users distinguish between a change that’s out of the ordinary and one that’s physically impossible

29. Nova Note: 585060 Clinicians are Required to document smokeless tobacco use to Mark History as Reviewed • CMS quality measure 138 – Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention now requires documentation of both tobacco and smokeless tobacco use

30. Instance Alignment Nova Note: 616305 CAM replaces FAM • Up until now the Providence instance has used a Facility-Administered Medications (FAM) preference list for medications that are administered while a patient is at the clinic (documented on the MAR) • With the April Epic 2018 upgrade release, we are switching to a Clinic-Administered Medications (CAM) preference list for these orders • The medications on the preference lists are not changing Syringe icon instead of bed icon

31. New Personalization Options

32. Nova Note: 577544 New Personalization Options: Patient Instructions Speed Buttons • Works just like Progress Note Speed Buttons • Can use your own or system SmartPhrases • SmartTexts must be set up to work in Patient Instructions • Clinical References are SmartTexts in our system

33. Nova Note: 588880 Hide Rarely-used Toolbar Buttons Chart Review

34. Hide Rarely-used Toolbar Buttons Multi-Provider Schedule

35. In Basket & Card View Changes

36. Nova Note: 636756 In Basket Alert Bar moves to top of screen • Status bar at bottom of the window has moved to the top of the screen IB Alert Bar appears in window header User name is next to chart search The current time no longer appears in Hyperspace

37. Collaborative Integration Overdue Results In Basket Folder • For Future lab orders • Epic will send an IB message 14 days after an order’s expected date • Message will be sent to Clinical Support Staff pool • If there is no expected date then the message will be sent 14 days after the expiration date • Will only apply to orders place post upgrade Message generated 14 days after order expiration

38. Provider Efficiency Elimination of Automatic Covered Work and Addendum Notifications • Reducing unnecessary IB messages increases provider efficiency • Epic recommends turning off Covered Work as providers don’t likely need to review everything done by a covering provider • If needed, send message manually, or speak directly to provider • Addendum Notifications are often generated for changes not needing provider review • If needed, clinicians can still add the encounter provider’s name to the routing recipient list from the Sign Addendum activity to send an IB message

39. Nova Note: 592248 Consolidation of Pt Rx Request folder and Rx Request folder • Existing Patient Rx Request messages will stay in the Pt Rx Request folder until addressed • RX Source column indicates where the refill request originates (MyChart or Telephone)

40. Nova Note: 640739 Improvements to Care Everywhere Outside Events Filter messages by event type New Care Teams button Reply to and forward event notifications Additional reports available

41. Nova Note: 643117 Revamped Patient Sidebars in In Basket • Added notification icons: • MyChart Status • Active FYIs • Pregnancy Status & Gestational Age • Preferred Language & need for interpreter • Indication of active Hospice episode • Indication of new outside information available • Others • Hover for more information Added Primary Coverage Added Next Appt

42. Nova Note: 549784 Letter Reason now appears in the body of Letters In Basket Messages

43. Documentation Tool Updates

44. Nova Note:573501 Delete SmartBlocks from Notes • Clinicians can now delete SmartBlocks and related content from their notes • When a SmartBlock is deleted, the quick button is removed from the note editor toolbar and the related SmartForm is cleared and removed from the NoteWriter • SmartBlocks cannot be deleted when: • A procedure SmartBlock has an associated order (the order has to be removed first) • A note is open in an editor where NoteWriter isn’t enabled, such as in In Basket • Anesthesia users can’t delete the procedure SmartBlock ANPROCDOC

45. Nova Note:595899 Copy Previous from More Note Types • Clinicians can now copy content from a previous note of a different type

46. New Usability Features

47. Instance Alignment Nova Note:591027 Lot Manager / Track vaccine quantities • Supports alignment with Swedish • Makes immunization documentation quicker and more accurate • Epic 2018 adds ability to optionally track lot quantities • No requirement for clinics to use the Lot Manager feature • In order to use the feature, clinics need to enter vaccine lots manually • Can be done by a nurse or nurse manager

48. Lot Manager / Track vaccine quantities 4 – Configure lot in storage unit (quantity tracking, VFC) 1 – Set up lots in Lot Editor (lots only need to be set up once) 2 – Set up the storage unit in Lots tab 5 – Associate department(s) with the storage unit in Departments tab 3 – Add lots to the storage unit in Lots tab

49. Lot Manager / Track vaccine quantities • Once lots and storage units are set up, and departments are associated with storage units, when a vaccine is administered, the Lot #, Manufacturer, NDC, Product and Expires fields should all default based upon the information provided by the lot record in the storage unit.

50. Nova Note:598395, 607235 Chart Review – Bookmark Tab • Items bookmarked in Chart Review now appear in the new Bookmark tab Bookmarked items appear in Bookmark tab Filter bookmarks by user who added them Bookmark Chart items