2019 Unified Epic Optimization & Upgrade High Level Timelines

1. 2019 Epic Upgrade & Instance AlignmentAnesthesia ImpactCourtney Talbot, 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 • Sand Release for Prov, Swedish, and/or Kadlec Instances: • Build Freeze Feb 19 – May 7 (Sand will then release to PSJ instance only)

4. Role Specific Landing Page • Learning Home Dashboard (LHD) in Epic. • There is a link in the LHD to the external Learning Home site • One location for end user facing learning content organized into three categories • Epic Updates • Epic User Guide • New Learners • 144 roles across all Epicapplications

5. High Impact Changes from Surgical/ProceduralWorkgroup, specific to Anesthesia Surgical/Procedure & Anesthesia Workgroup leads: Courtney Talbot Jennifer K Ulrich James Arndt Lam Johnson Ben Hall Dr. Ellen Derrick DR. Brian Chen With support from clinical subject matter experts & regional clinical informatics

6. Overview of Large Anesthesia Instance Alignment Projects

7. PreadmitNavigator: Anesthesia Staff • Preadmit Navigator: Anesthesia staff can assess a version of the Preadmit navigator, directly from the StatusBoard Procedure Pass: Anesthesia staff will be able to access the Procedure Pass activity Note: Surgeons will not have access to Procedure Pass, this is future optimization

8. Preadmit Navigator PreadmitNaviagator is designed/built for Preadmit Providers

9. PreadmitNavigator: Screenings (Cardiac) • Cardiac: Revised Cardiac Risk Index • .RCRI= Smartphrase associated with the Cardiac Risk screening

10. PreadmitNavigator: More Screenings Preadmit Toolbar: “More Screenings” Three tabs in More Screenings: 1. Pre-Anesthesia 2. Psych 3. Geriatrics

11. PreadmitNavigator: Care Coordination • Provider Evaluation: Used to mark patient as needing Provider Evaluation (if applicable at your site) • Notepad/Log: • Communication with Nursing and Preadmit Providers • Displays the name of the author automatically • Used for Preadmit visit coordination

12. Preadmit Navigator: Other Preadmit Providers Mid-level providers supporting PreadmitClinics: • The same Preadmit Navigator and Procedure Pass activity will be available in addition to their visit Navigator NOTE: Hospitalists, nurse practitioners, physician's assistants must be logged into the Preadmit Clinic context to get the correct navigators

13. What is Procedure Pass (PxP)? • Procedure Pass is a Task-based tool • It is a powerful chart review filter, constantly updating the tasks needed with the most current information available. • Procedure Pass is a dynamic worklist and interactive tool used to track required tasks that must be completed PRIOR to surgery to prevent cancellations and delays. • Certain common tasks are automatically assigned. While other tasks can be manually added per required local protocols. • Some tasks complete automatically based on information in the patient chart. For others, the task is manually marked as reviewed or not needed.

14. Procedure Pass Tasks • 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. • Tasks can include required appointments, such as a Pre-admit Clinic visit or Total Joint Class. Link to Procedure Pass Training Materials (right click on link and click “Open Hyperlink”)

15. Example of Task Functionality Link to Procedure Pass Training Materials (right click on link and click “Open Hyperlink”)

16. Procedure Pass & Inpatient Nurses • The Pre-Procedure Navigator will replace the Pre-op Checklist in Flowsheets, so all preop documentation exists in one location • Inpatient Nursing (including Peds, NICU), the New Pre-Procedure Navigator will be available under the MORE menu

17. Anesthesia Reminders/BPAs NOTE: Details of each Reminder will be available in the training guides

18. Anesthesia Tracking Events: Overview

19. Anesthesia Tracking Events: General Tab

20. Anesthesia Tracking Events: Cardiothoracic Tab

21. Anesthesia Tracking Events: Vascular Tab

22. Anesthesia Tracking Events: L&D Tab

23. Anesthesia Tracking Events: Pain Tab

24. Anesthesia Tracking Events: Ind/Emerg Tab

25. Anesthesia Tracking Events: Data Tab (new)

26. Anesthesia NotewriterImprovements The redesigned Pre-Evaluation has several new features: • ROS/Med Hxsection: • Increased compliance with case mix index and severity of illness regulations for comorbidities documented in the ROS/Med Hx • New ROS/Med Hx section for Family Anesthesia History • Autopopulate medical history with 1-click scripting • Additional functionality (see next slide) • Ability to document consultation details for billing • Note Sidebar & Report: • Does NOT opened by default • Click on the Edit Note hyperlink to open the sidebar • Select the Show Report to open the Report (on left or right side)

27. Anesthesia Notewriter: ROS/Med Hx • #2- "This note is preliminary and needs final review by the anesthesiologist caring for the patient on the day of the surgery" is visible at the top. • #3-"Reviewed" for Medical, anesthesia drug, allergy histories, NPO status verified is now highlighted RED until a checkmark is provided in the box. • #4- Pre procedure Beta-Blocker is given or taken on the day of the procedure can now be answered with a Yes or No from this tab. • #5- A new Autopopulate button in a yellow bar is available for the Anesthesia provider to allow information previously documented on Problem List and patient history can be added automatically into the NoteWriter.

28. Anesthesia Notewriter: Consultation Details

29. Anesthesia Notewriter: Edit Note

30. Anesthesia Notewriter: Show Report

31. ECT Workflow: Overview • The ECT Workflow has been redesigned to include the use of a flowsheetfor the Psychiatric provider in the ambulatory and procedural settings • The flowsheet will capture recommendations for pre-procedure, intra-procedure and post- procedure medications and the procedure settings • An Anesthesia sidebar report has been created for the anesthesiologist to review the recommendations. • A Historical ECT Procedure Synopsis report was created so the provider can see the longitudinal view of the ECT’s.

32. ECT Workflow: Ambulatory Psychiatric Provider • The Ambulatory Psychiatric provider will access the ECT flowsheet by clicking on the Behavioral Health activity and clicking the ECT tab • There are two topics: Historical ECT Procedures report and ECT • Previous ECT Procedure information will display on the Historical report • Provider documents recommendations for the procedure on the ECT flowsheet and files

33. ECT Workflow – Anesthesia Side Bar • Anesthesiologist will be able to review the recommendations from the Psychiatric provider by using the side bar report. • The last filed data will display

34. Other High Impact Changes for Epic v.2018 Upgrade & Instance Alignment Sexual Orientation & Gender Identity (SOGI) / Preferred Names Risk for Violence Multi-lingual AVS Code Status Secure Chat in Hyperspace (will not be utilized at Hoag) Nova Notes: List of Epic Released Upgrade items for Optime

35. Disclaimer • See Epic Learning Resources for full details on these changes • The following slides are intended to give you a high level overview of ten high-impact changes that will come with the 2019 Epic Upgrade and Instance Alignment • Other changes will also be seen with this upgrade • The following projects were not directly managed, nor clinically governed, by Surgical / Procedure Focus Groups. • Most high-impact projects have multiple clinical governance and upgrade committees that have been engaged

36. Sexual Orientation & Gender Identity (SOGI) / Preferred Names

37. Updated Headers and Reports First Name and Preferred Name both appear in header Updated Report headers display complete information

38. Risk for Violence

39. 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

40. Patient Header & Banners Example in the Patient Header: • Banner will display in Anesthesia Navigators > Communication section, including: • Pre • Post Example of Banner in Navigator:

41. Risk for Violence – StatusBoards

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

43. Multilingual AVS

44. 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

45. Project Overview • Translation finalized and approved into: • Russian • Vietnamese • Simplified Chinese • Spanish • Arabic

46. Code Status

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

48. Future State for Code Status • 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

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