Epic 2018 Upgrade & collaborative Integration: Ambulatory Features March 12, 2019

1. Epic 2018 Upgrade & collaborative Integration: Ambulatory Features March 12, 2019

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

3. Logins for Beta & Playground Environments Beta - Now Login as yourself or Login as FAMMD## (01-05) Password = Epic1234 After March 18 Provider Logins: FAMMD## (00-30) Clinical Support Staff Logins: FAMRN## (00-30) Password = train • Change department to specialty and create encounter (office visit)

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 • Facey widescreen view will not be affected by these changes Some helper style navigators will continue to use classic navigator (e.g., Amb Screening) Minimum recommended monitor resolution: 1680x1050 (works with 1600x900)

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 – OB Visits Previous prenatal notes are found under Prenatal Notes • Flowsheet and Notes is replaced by Prenatal Visits and the Notes tab

12. Widescreen View Navigators – OB Visits – Results and Procedures

13. Widescreen View Navigators – Anticoagulation Anticoagulation activity combines rooming sections with anticoag-specific sections Moved episode information from top to bottom of screen

14. Widescreen View Navigators – Procedure Orders, Procedures, Charge Capture and Ultrasounds sections Procedure is default activity for Procedure appointments. Can also be accessed from Helper Navigators or More menu Ultrasound orders available vary based on specialty (some may have no default orders)

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

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

17. Visit Taskbar Functions • Place, modify and sign new orders • Print or Preview AVS • Sign Encounter • See Express Lane suggestions

18. What about Order Entry???

19. 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)

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

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

22. Nova Note: 574360 Medication Adherence Scoring • See which patients have been picking up their medications as prescribed • Upon check-in, Epic triggers an eligibility query for a patient’s benefits and medication history and then automatically calculates medication adherence and confidence scores • Medication adherence and confidence ratings appear in Meds & Orders • High and moderate thresholds are 80% and 60%, respectively

23. 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

24. MultiProvider Schedule Update

25. New Clinical Features

26. 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

27. Nova Note: 546142 Morphine Equivalent Daily Dose in Order Composer

28. Nova Note: 575435 Multiple Dosage Meds – New Sig Options Combination Dosage Taper/Ramp Long sigs (> 140 characters) may not be able to be sent electronically (NCPDP limit) Click Full (# Days) to calculate quantity to dispense

29. Nova Note: 587260 Social Determinants of Health (History Activity & LPOC) • Domains: • Intimate Partner Violence • Social Connections • Alcohol Use • Tobacco Use • Financial Resource Strain • Depression • Stress • Physical Activity • Food Insecurity • Transportation Needs

30. 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

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

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

33. Social Determinants of Health – Other Assessments • Custom domains are not yet in History activity (future work) • These are still located in SDOH/ Social Risk Factors flowsheet • For domains in History Activity that are no longer in flowsheet, last entry prior to upgrade will be moved from SDOH flowsheet to history at upgrade

34. Nova Notes: 606330, 606920 Insulin Instructions

35. Insulin Instructions on the AVS

36. Nova Note: 571058 Pedigree – Visualize Family History Display details for selected individual Determine level of detail to display Add annotation Select conditions to view in the pedigree Right-click family member to add relatives and conditions

37. 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 • For pediatric patients, Epic compares the new weight or height to the patient’s growth chart rather than last weight or height

38. 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

39. 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

40. New Personalization Options

41. Nova Note: 559724 New Personalization Options: Order Panels Creating an Order Panel Put orders for the panel in the orders shopping cart and then click Options > Create Panel Supply a name for the panel and indicate the Preference List and section for it

42. New Personalization Options: Order Panels Ordering an Order Panel

43. New Personalization Options: Order Panels Editing an Order Panel in Preference List Composer

44. New Personalization Options: Order Panels Editing an Order Panel from the Shopping Cart Click Star to see options Clicking Remove preference list entry removes the panel from your preference list but leave the group of orders in your cart

45. New Personalization Options: Order Panels Editing orders in a panel in the shopping cart To remove the entire panel from the cart, click the x at the top right of the panel Individual orders can be removed from the shopping cart by clicking the x to the right of the order. This changes only the orders in the cart – does not affect the panel on the preference list Click on an individual order to open the order composer

46. New Personalization Options: Order Panels Editing orders in a panel in the shopping cart To remove the entire panel from the cart, click the x at the top right of the panel Individual orders can be removed from the shopping cart by clicking the x to the right of the order. This changes only the orders in the cart – does not affect the panel on the preference list Click on an individual order to open the order composer

47. New Personalization Options: Order Panels • Limitations: • Order panels must have > 1 order • Order panels can be made up of After Visit orders (medications, labs, imaging, procedures) or Clinic-Administered medications, but cannot contain a mix of the two • Cannot combine an order and a panel in the shopping cart to create a new panel • Sharing user order panels: • Can be done via the Preference list composer, just like other preference list items

48. Nova Note: 575650 New Personalization Options: User SmartLists • No more need to use {Blank Single} or {Blank Multiple} or submit an optimization request!!! • User SmartLists: • Can be used in User SmartPhrases only • Can be nested in other User SmartLists • Can be shared with other users

49. New Personalization Options: User SmartLists Users can additionally embed SmartLists, SmartLinks and SmartTexts into the SmartLists

50. New Personalization Options: User SmartLists