2019 Unified Epic Optimization & Upgrade High Level Timelines

1. 2019 Epic Upgrade & Instance AlignmentNewborn / NICU ImpactJennifer Ulrich, 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 • Unified Epic and Upgrade Build will be completed and available for User Acceptance Testing: • Providence: Feb 13-March 1 • Swedish: May 16 – June 1 • Kadlec: TBD

5. Epic Learning Resources: March 18th Education Materials Release • One location for end user facing learning content organized into three categories • Epic Updates • Epic User Guide • New Learners • Can search by user role: • 144 roles across all Epicapplications

6. Epic Updates • Use this for Instance Alignment/Upgrade & Optimization change summaries • Also shows 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

7. Epic User Guide • Reference materials for system build, ranging from basic tasks to advanced topics • This replaces current state tip sheets, quick start guides, job aides, etc. located in the Learning Library • 4 organizational tabs

8. New Learners • Summary of learning activities for new users

9. High Impact Changes for Epic v.2018 Upgrade & Instance Alignment Baby naming, including Preferred Names for mom Care Plan Guides The Brain: A Nursing Activity for Better Shift Planning and Documentation Multi-lingual AVS LDA & Wound Avatar Addendum: Risk for Violence Procedure Pass for Pre-op Code Status

10. Naming Convention for Newborn Babies • The system standard for naming newborns is being updated according to this NB/NICU CDT governance decision: • Last Name, Sex MomFirst Name • Warren, Girl MomJennifer • Numeric would be used only if newborn was a multiple • Warren, 1 Girl MomJennifer

11. Upgrade Impact to Baby Naming (Nova Note 641032) UPGRADE • In accordance with other SOGI changes we will show preferred name after patient’s legal first name, if a preferred name for mom has been provided • Example: Warren, Stephanie “Steven” baby will inherit the mother’s preferred name: Legal Name = Stephanie Warren Preferred Name – Steven • For mothers that have no preferred name entered, the baby will utilize mother’s legal name only Legal Name = Jennifer Warren Preferred Name = blank

12. Workflow Alert for Baby Naming UPGRADE • If a mother’s preferred name is entered after the baby is pended, then the names won’t match between mom and baby • Scenario: Jennifer Warren was admitted and gave no preferred name. Her baby was pended, and admitted after delivery with this name: • A few hours after delivery the mother informed staff that she was struggling to get through admission with her labor pains, but would really prefer to be called Kathleen. Staff update Jennifer’s admitting information with a preferred name. Now her name appears in Epic as: • Warren, Jennifer “Kathleen” • KEYPOINT: Babies should NOT be renamed after admission. This can have downstream impacts on baby Labs, Blood Bank, & more. Therefore, “Kathleen’s” baby remains admitted as Warren, Girl MomJennifer:

13. Sexual Orientation/Gender Identity (SOGI) Epic v.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. • The Sex field in Demographics now displays areas to capture Gender identity, Sex assigned at birth, and Sexual orientation. • For Infants complete the following fields unless otherwise indicated: • Sex (legal) • Sex assigned at birth

14. Updated Columns & Headers • Name columns display both First Name and Preferred Name

15. 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

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

17. Future State will be to individualize at this point Current Prov instance workflow is to ‘select all’

18. 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.

19. Beginning and During Shift: Key Points: • Review the care plan • Review patient education • Update patient goals

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

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

22. The Brain: A Central Nursing Activity for Better Shift Planning & Documentation • The Brain presents a timeline view of the orders, events, and requirements for each patient the nurse is assigned to • Nurses can document flowsheet values to satisfy documentation requirements, add patient-specific reminders, and scan patient and medication barcodes to administer medications, all without leaving the Brain • Keypoints: • The patient card – shows key information • Required documentation visibility • Visual Worklist for documentation • Medication administration • To Dos / Tasks

23. Overview of the Brain

24. The Patient Card: Displaying Key Information • Patient Overview: • Interactive – Hover to Discover • Double click to open that section of the chart (i.e. double click on “Allergies” and the chart will open to the Allergies section)

25. The Patient Card: Displaying Key Information View new orders and PRN tasks

26. The Patient Card: Displaying Key Information Required documentation details: A = Admission

27. The Patient Card: Displaying Key Information A nurse can schedule Required Documentation as a task.

28. Meds: Click to View & Document

29. Tasks/To Dos: Click to View & Document

30. Tasks/To Dos: Click to View & Document

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. LDA & Wound Avatar

34. Addendum • Risk for Violence • Procedure Pass for Pre-Op Prep • Code Status these slides may be utilized for disseminating information to your care teams These topics will be covered by separate presenters on the feb 26th NB/NICU CDT Agenda

35. 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

36. Headers & Banners

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

38. Risk for Violence – The Brain

39. Risk for Violence - Linked baby • KEYPOINTS: • Shows on landing pages and in the patient header • Only works when babies chart is linked to mom’s • Because it is based on a linked mom’s 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

40. Who can activate this FYI Alert? • Access to place the FYI risk for violence alert: • Follow Hoag policy for entering Risk for Violence

41. Procedure Pass for Pre-Op • It’s a powerful chart review filter, constantly updating the tasks needed with the most current information available • Only available when a surgical/procedural Case exists for patient • Procedure Pass is a dynamic worklist used to track required tasks that must be completed PRIOR to surgery to prevent cancellations and delays • A few common tasks are automatically assigned. Most tasks will be manually added per local practice for pre-operative care • Tasks can include documents such as Orders, Consent, H&P, Advanced Directives. • Tasks can include tests needing to be performed such as lab tests, ECG and CXR.

42. Task Options • Nurses manage tasks in Procedure Pass as a way to communicate what tests are needed prior to the patient going to surgery • Labs are reviewed and results noted • Results from Care Everywhere will be noted • Outside records can be obtained and linked as well

43. Procedure Pass Integration Design for Inpatient Nursing More (Activities) > Pre-Procedure Navigator The Pre-Procedure Navigator will replace the Pre-op Checklist in Flowsheets, so all pre-op documentation exists in one location

44. Deeper Look at Tasks: Labs

45. Pre-Proc Checklist Section of the Pre-Procedure Navigator

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

47. Future State for Code Status • Newborns: If No Code status in header assume Full Code • 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

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