2019 Epic Upgrade & Alignment

1. 2019 Epic Upgrade & Alignment Diagnostic Imaging Presentation to inform the Diagnostic Imaging CDT and Council members on the upcoming Epic changes that will impact their caregivers. Lisa Hudson MSN, RN Sr. Clinical Informatics Architect

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. Epic Migration 2019 Timeline • Providence April 7 • Swedish June 15 • Kadlec August 17 • St Joseph 2020-2022

4. Epic Beta Testing Environment • Available • Providence Feb13 • Swedish May16 • Kadlec July • Available for informatics and end users to test new features before their released to live environment • Access Instructions https://community.providence.org/sites/LearnLib/LLNurSupMstr/BETA_How_to_Access.pdf

5. Epic Learning Resources One location for end user facing learning content organized into three categories Epic Updates -- Epic User Guide -- New Learners • Instance Alignment/Upgrade & optimization change summaries, new content highlights or other recent updates • Reference material documenting system build, ranging from basic tasks to advanced topics (replaces current state tip sheets, quick start guides, job aides, etc. located in the Learning Library) March 18th Release https://epiclearning.providence.org/Content/Home.htm?tocpath=Home|_____0

6. Epic Learning Home Dashboard Available March 18th • Learning Material Inside of Epic

7. Mapping MRI Scheduling Questions to the Electronic MRI Screening Form • Providence, Kadlec & Swedish MRI Screening questions were evaluated to identify the standardized scheduling questions • Standardized Scheduling questions were mapped to the Electronic MRI Screening Form

8. Real-Time Schedule Updates Now Appear for Appointments on the Snapboard • An appointment that didn't start on time shows a red bar that represents the delay, and the appointment appears at its projected start time instead of the original, planned start time. • A real time projection conflict warning from the Snapboard or Change Appointment activity

9. Interventional Managers – IR Radar Dashboards & MetricsDashboards – melded into one great board (2 slides) • On time and late start metrics • Room turnover metrics • Procedure length accuracy metrics Top Half of Report

10. Lower half of report

11. Quickly Follow Up on Studies From the Breast Coordinator Dashboard • Breast imaging coordinators can easily see what follow-up is needed for each study • Click a link to quickly access the appropriate activity to perform the follow-up • In the Follow-up Details report there is a new section called Required Follow Up that lists all of the items requiring follow up for the selected patient. Clicking the hyperlink will take you to the correction location in Epic to complete the follow up.

12. Get to the Link Orders Activity from the Appointments Without Orders Report • In the Link Requests or Link Orders activity, select the Show all available requests or Show all available orders check box to manually link requests or orders to multiple visits in a panel or other sequentially linked appointments. • Epic has replaced the Verify Orders button in the Appointments Without Orders report with the Link Appt to Orders button so that HOV appointments can be linked to orders. Now, users can link appointments to orders for HOV, inpatient and outpatient visits.

13. Improved Imaging Audit Trail • The audit trail now matches the aesthetics of Hyperspace with print groups that show order, appointment, exam, results, pathology, and billing information. • Schedulers, clinical users, and managers see information about existing charges, printout history, and patient events. *Locate from Epic Button

14. External Imaging Results Report Redesign • A more visually pleasing, external result report to send to external referring providers • External report can now include important information about the patient, exam, providers, result, and recommendations for follow-up. * Pictures will not be included

15. Ambulatory Stored Image Workflow • A Store Image workflow allows the ordering provider to perform imaging that can be stored in PACS. The exam is given an accession number in order to facilitate storage. The exams auto finalize without any involvement from Radiology staff. The images are available in Epic Chart Review under the Imaging tab. • Three Providence sites are piloting this workflow starting in April, 2019 • PMG Bridgeport Sports Medicine 4000068000 • PMG Bridgeport Family Medicine  405507000 • PMG Stewart Meadows Sports Medicine  4000058000

16. Other High Impact Changes for Epic v.2018 Upgrade & Instance Alignment • Patients at Risk for Violence Flag • Sexual Orientation and Gender Identity (SOGI) Updates • Secure Chat • Updates to the look of Ambulatory Navigators & Workspaces

17. Patient at Risk For Violence Flag • New FYI flag titled Risk for Violence • Documenting the flag generates an alert to caregivers that a patient has a risk for violence • Alert displays in Patient header, schedules, lists and reports • FYI placed by House Supervisor, Security, Department Manager

18. Sexual Orientation/Gender Identity (SOGI) Overview • 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. • There are new updates throughout the system to use and show patient’s gender or sex assigned at birth instead of legal sex when appropriate. The Sex field in Demographics now displays areas to capture Gender identity, Sex assigned at birth, and Sexual orientation. • There are also updates throughout the system that make it easier for users to see a patient's preferred name, such as in Patient Lists, Headers, Chart Review , Reports or InBasket. This is especially important for transgender or non-binary patients, but also helps improve the patient experience for any patient with a preferred name that differs from their legal name. • SmartLinks have been updated to retrieve a patient's titles and pronouns based on the patient's gender identity. • MyChart Patients can now view and edit more on the new Personal Information page, including: preferred name legal sex, sexual orientation, gender identity, and sex assigned at birth. • Baby Names now display the mothers preferred name as part of the baby naming convention.

19. RADIANT • Preferred Name add to Control Sheet • Radiant RN – History section in procedure navigator • Preferred name is highlighted in banner • Sex is highlighted in banner when there is incongruence between legal sex, sex at birth and gender identity fields • Report and Smartform can be accessed by clicking on Sex field in banner • Preferred name added to wristband for adults/peds

20. Secure Chat • Secure Chat allows clinicians to communicate with each other in a secure manner through Epic. • Caregivers are encouraged to use patient centric messages when applicable. • Messages are not made part of patients medical record, but are discoverable. • Inpatient Hospitals and Ambulatory clinics are in scope • Nurse and Provider go-live April 2019 • Interdisciplinary Caregivers go-live TBD (May/June 15 2019) • Operations will lead these implementations.

21. Secure Chat • Secure Chat should not be used to communicate urgent or critical results. • Messages cannot be deleted and will not be purged • Sending orders through Secure Chat is banned by Joint Commission • When text information is used for treatment purposes, the relevant information should be documented in the medical record • Feature does not allow for patient communication.  • Message and images can be sent from Haiku, Cantos or Rover mobile apps • Beta test environment login phsiprn/Epic1234 The orange bubble indicates a new message for the caregiver

22. Transcribed Orders Encounter – Ambulatory Facelift • Orders are now placed at the bottom of the workspace for ambulatory encounters

23. LDA Avatar • Clinicians can now review, assess, add, and remove LDAs from an avatar • The visual representation of the body helps clinicians quickly see where a patient's LDAs are located, making it easier for them to select the LDA they want to review or document on