Epic_UGM2014_FinalTripReport

―Laxmi Kumar AMBULATORYExcellent Presentation. Nationwide Children's Hospital did a thorough analysis of their existing schedulingmetrics and came up with the plan to improve patient Access. They were able to increase New Patient accessby 100% and reduce No-show rates by introducing simple changes to Provider templates and SchedulingmethodologyKey Points:1) UCLA may be able to improve New Patient access by making simple changes2) It is important to analyze data in a consistent mannerSession SAC03CORRALLING THE HORSES- OPTIMIZING SCHEDULING AND PATIENT EASE OF ACCESS―Laxmi KumarBoston Children's started a project called GPS - Guided Pathway to Services aimed at improving PatientAccess. The approach included the use of Questionnaires, Wait list and One Clicks.Session SAC04USING CADENCE TO IMPROVE ACCESS TO CARE―Laxmi KumarPresented by SVP at Henry Ford Health System. Much like the SAC02 presentation, they talked about how toimprove Patient Access by introducing questionnaires and other efficiencies at their call Center. They too didextensive data analysis to locate existing issues and target those areas for improvement.Key Points:1) UCLA can improve efficiency by using Questionnaires at the Call CenterSession SAC05USING DATA FOR ACCESS IMPROVEMENT―Laxmi KumarVanderbilt University uses Dashboards efficiently to post Appointment volumes, worklist summaries likePatient WQs, Ref WQs, Recall WQs.Key Points:1) We can improve our Manager dashboards so users can have the information at their finger tipsSession SAC06OPEN-ADVANCED ACCESS INITIATIVE USING RADAR―Laxmi KumarGHC, Wisconsin used radar to post most to their reports to the dashboard.Key Points:1) We can use Radar to generate third next available for more accurate results. Need to wait till 2014Session SAF02IMPROVING SAFETY WITH ACCURATE PATIENT MEDICATION LISTS―Laxmi KumarPhysician and Pharmacy engagement in medication reconciliation and leveraging the EHR to encourageAmbulatory medication adherence 51 | P a g e

Key Points: AMBULATORY1) Importance of clinical staff flagging medications for removal that patients are no longer taking2) Highlight comments entered in for a medication to make it more visible for providers completingmedication reconciliation―Meg Furukawa, RN, MNKaiser and Stormont-Vail shared techniques for promoting consistent and effective management of patient'sactive medication lists in the Ambulatory and Inpatient settings. The value of physician and pharmacistinvolvement was discussed along with ways to use the EHR to help with ambulatory medication reconciliationadherence. Improvement is based on measurement develop metrics to monitor baseline performance andtrack improvements. Share data with everyone.Key Points:1) The medication list should be both what the patient should be taking as well as what they are actuallytaking2) Discontinue medications that should not be continued instead of making them \"Don’t Order\" in med rec toprevent downstream consequences of confusion at discharge3) Leverage the EHR to guide providers into proper medication reconciliation. Support the physician'sworkflow and make it easy to manage the medication list and do the right thingSession SNAP27SUCCESSFUL APPOINTMENT CONVERSION―Laxmi KumarHear lessons learned during a successful conversion of future appointments for Cadence go-liveKey Points:1) Do an electronic conversion for accuracy & completeness; downside- data mapping can be onerous2) Do a manual conversion which provides hands-on training; downside - OT costs, space & timeline―Ricardo ZeferinoLaxmi Kumar and Josi Miller discussed their strategy to transfer thousands of appointments from the Legacy(old system) to Epic (new system). The three options included electronic conversion, manual conversion orhybrid. UCLA Health decided to proceed with the manual conversion to ensure a successful conversion, whileinfluencing more hands-on training for staff to schedule and register appointments. Also, we did not need todo extensive data mappingKey Points:1) Converting all appointments from old system was necessary to avoid double booking2) Manually transferring data/appointments allowed for an increase in accuracy and data integritySession SNAP57EMBEDDING DYNAMIC WEBSITES―Andrew BuchipudiLinking dynamic web page in to hyperspace. Learnt how to display patient information in epic on browserdynamicallyKey Points:1) How to use vbscripting in dynamically updating the content in the browser embedded in hyperspace2) How to link BPA to activitiesSession SNAP66 52 | P a g e

AN AVS THAT BUILDS ON THE BEST- AMBULATORY AMBULATORY― Ricardo ZeferinoThe Nebraska Medical center redesigned their AVS form to improve patient satisfaction. The organization wasreceiving a high volume of patient complaints, so they engaged the patients during the AVS redesign toensure customer satisfaction. A standard AVS was implemented for all departments with enhancements tofuture appointments, prescription order during visit, and a to do list. For example, the Medication list nowincludes the reason for taking medications.Key Points:1) Engage customers and implement focus groups to determine their needs and wants2) A standard AVS will allow for the enterprise to ensure consistent information is being distributed to patientwithin the multiple specialtiesSession UnsessionAMBULATORY OPTIMIZATION― Czarina OfallaOrganizations experience and lessons learned with optimization efforts for AmbulatoryKey Points:1) Utilized Epic to do an IAR of the system to see how far away Lancaster was from the Foundation system2) Established leadership governance to help with decision making for the specialties, not clinic3) Establish some metrics on how to measure successes against - look at more analytics before and afteroptimization so you know what worked and what didn’t 53 | P a g e

Session 10 CLINICAL INFORMATICS (MD & RN)TO CLARIFY, ADD DETAIL―Nina EmersonDr. Reilly from Reading Health System did an excellent presentation on some of the reports they have builtthat are data-rich, but easy to review and interpret the information. He emphasizes that you can display a lotof information in a small space if it's well-organized and you utilities font size, bolding, colors, etc., in smartways.Key Points:1) We need more and better Sidebar reports!! We are really under-utilizing this feature2) Spark line graphs often show the same amount of information as you get from an accordion graph line, butin a much, much more condensed space. The other benefit of spark lines is you can include so much moreinformation on one screen for comparison3) They re-did their progress note template and it is a great use of space. There are some nice tables thatmake it easy to put the plan next the problem it's addressing. I would highly recommend anyone that buildsSmartTexts to review his screenshotsSession 12CLOSING THE BARN DOOR: BIG DATA & REDUCED READMISSIONS―Scott BaileyTexas Health Resources and Parkland in Dallas presented regarding their big data predictive modelingprogram which significantly reduced readmissions. They then implemented this across 6 organizations.Key Points:1) Pulled data out of Epic in real time (HL7 feed), created risk scores using predictive modeling, then broughtthe risk score into Epic (HL7/Java) to integrate with the standard workflow2) Achieved 26% relative reduction in readmissions. Found that often there was little coordinators could dofor high risk patients (often getting transferred to SNF).3) This work was created by a non-profit via grand funding - and they are very willing to share. They are indiscussions with Epic to share via the new AppExchange programSession 13EMERGING SUSTAINABLE PRACTICES FOR POPULATION HEALTH―Audrey McClenaghanUsing Dash-Boards to communicate and identify candidates for \"life-style\" overviews. You can set up goalsand care plans and have direct follow-up and on-going coordination for transition to: 1) Complex CaseManagement 2) Behavioral Health 3) Medical Home 4) outreach to members. Then using this data to createautomatic workbench reports called \"radar dashboards\" for surveys, hospital re-admissions scores, and carecoordination efforts.Key Points:1) Are we currently UCLA Using this version of the Care Model?2) Can the reports be filtered?Session 16GROWING YOUR EHR INTO A FIELD OF DREAMS―Meg Furukawa, RN, MN 54 | P a g e

Two hospitals presented an overview of real-time reports created that nurses can use to assess quality CLINICAL INFORMATICS (MD & RN)indicators for patients on their units. Build strategies were presented along with lessons learned and futureplans for the reports. Outcomes of use, adoption and clinical improvements were discussed.Key Points:1) Engage the end users in deciding what information is included in the reports2) Keep the reports simple3) Share outcomes with the nurses so they can see the results of their effortsSession 45GRADE AA COMPLIANCE – TWO MIDNIGHTS AND THE ADMIT ORDER―David MuiBon Secours and Texas Health Resources shared their build approach to satisfy the CMS rule for TwoMidnights. There are a number of ways an organization can choose to build this, and these two approacheswere quite different than what we have at UCLA currently.Key Points:1) Bon Secours used one admit order that had the typical order questions, in addition to the Estimated LOS.Cosign for this order is required if done by a resident2) Recertification BPA fired 2 days prior for MDs, and 5 days prior for Case managers3) Texas Health did some build to their navigators to make it more apparent to clinicians when there areoutstanding Admit orders that need to be cosigned in order to satisfy the CMS guidelinesSession 61IMPLEMENTING NURSE TRIAGE OFFICE HOURS PROTOCOL―Mark Grossman, MD, MBA, FAAP, FACPAfter hour’s nurses log into the department they are taking the call for. Eliminate negative answers to streamline documentation sent to the MDSession 70HARVEST INFORMATION ON CLINICAL DASHBOARDS―Meg Furukawa, RN, MNDashboards were created for nurses and physicians to improve patient care using Reporting Workbenchcomponents. Hyperlinks are included for easy access to information.Key Points:1) Dashboards are an excellent way to display real-time data so nurses can easily tell when requireddocumentation was not complete.2) Physicians use dashboards for analytics to provide insight into their performance in using the EHR3) Physicians hate to see red on their indicators.Session 91WEEDING OUT SEPSIS: EARLY ID AND INTERVENTION―Shehzad SheikhThe presenters from UCLA and University of Iowa emphasis on fatalness of Sepsis and importance of howcatching the symptoms early on by the minutes can decrease the mortality caused due to sepsis. Also talkabout the solutions currently implemented to prompt clinical staff for early identification by doing somecustom builds in Epic.Key Points: 55 | P a g e

1) Informatics could be play a vital role in fighting the diseases such as sepsis CLINICAL INFORMATICS (MD & RN)2) Partner up closely with the clinical informatics teams at UCLA to assess the cases for value adding(Specificity, Sensitivity and Prevalence) with the real-time analytics ability with in OHIA3) Accuracy is a key element in generating alters for the cases such as Sepsis to minimize false alarms―Scott BaileyUCLA (Dr. Frank Day and Dr. Lynne McCullough) co-presented with University of Iowa on Sepsis/SIRSidentification efforts.Key Points:1) Discussed specifics on metrics for screening2) UCLA targeting antibiotic treatment within 60 minutes (ED)3) The biggest challenge at both organizations was the large number of false positives (1st day at UCLA: 1/3 ofpatients flagged)Session 105INCREASING EFFICIENCY WITH KEYBOARD SHORTCUTS―Lynne McCullough, MDEPIC keyboard shortcuts, tips and tricksKey Points:1) Showed keyboard shortcuts and ways to remember themSession 111LIFESTYLE CHANGE TOOLS PROMOTE A HEALTHY HARVEST―Eric Cheng, MD, MS, FAANA really nice talk about an RCT that used as the intervention lifestyle recommendations and reminders to loseweight using MyChart. Summary of messages were compiled in a report and sent to providers just prior totheir scheduled visit.Key Points:1) Enrolling patients in a research study is successful using BPA2) Complex questionnaire build is feasibleSession 116NLP- HARVESTING A NEW CROP OF DATA―Frank Day, MDLearn how Natural Language Processing (NLP), analytics, and operational processes can improve clinicaldocumentation and assist physicians with inpatient ICD-10 documentation. Presenters discuss use casesinvolving identification and follow-up of targeted patient conditions to realize quality and efficiency benefits.Key Points:1) NLP algorithms run on clarity playground (some tables e.g. HNO refresh every couple hours), searches forkey concepts and related contextual terms.2) 37% of patients with AAA on radiologist transcription did not have AAA on problem list; improved PCPnotification & high risk referrals to Vascular3) An icd10 note writer smartform gives additional tool to guide approp i10 documentation; can triggerdictation analysis via hand controlSession 119 56 | P a g e

OLD MACDONALD HAD AND EPISODE- BENEFITS OF USING EPIC EPISODES CLINICAL INFORMATICS (MD & RN)―Tina Nguyen, MD, FACOGThis session focused on linking episodes of care. This is especially relevant to the IVF providers in OB/GYN.The presenter was quite poor and vague but I will contact her furtherKey Points:1) Linked Episodes can be used to streamline IVF cycles and monitoringSession 120SUCCESS AT 7- MEDICATION SAFETY CULTURE―Meg Furukawa, RN, MNThe journey to barcoded medication administration was presented along with strategies to achieve highcompliance with scanning. Strategies to improve compliance were discussed as well as the process forimplementing barcoded breast milk and blood administration.Key Points:1) Standardize the scanners wherever possible2) Scan all medications ahead of time to ensure they would work in the system and give nurses’ confidencethat it would work3) Barcode compliance numbers are a blessing and a curse. Review for medications that don't scan so theycan be fixed. Leadership needs to set the thresholdSession 144ED TO L&D WORKFLOW―Tina Nguyen, MD, FACOGOne center's ED triage to L&D transfer.Key Points:1) Not relevant to UCLA as we do triage and labor admissions in one placeSession 150CLINICAL TRANSFORMATION- URINARY CATHETER PROTOCOL―Meg Furukawa, RN, MNThis hospital did a quality improvement initiative to improve removal of urinary catheters to meet SCIPrequirements. Some of the strategies used included development of a nursing protocol to remove catheters,an order set that nurses enter daily, a BPA to remind nurses to assess the catheter status and a report to lookat urinary catheter usage and removal.Key Points:1) Make it easy to do the right thing2) Protocol format eliminates the need to bug providers for orders3) Integrate the protocol into daily practice with EMR interactionsSession 159DIGGING THE WELL-NESS AND OTHER POPULATION REGISTRIES―Eric Cheng, MD, MS, FAANThis session explained the need to create registries. It summarized the registries available in Epic and theones they had to create. Some tips: RWB used to define My patients. Weekly run will add and deletepatients. Outreach of care gaps done centrally 57 | P a g e

Key Points: CLINICAL INFORMATICS (MD & RN)1) We should build registries immediately. There is no need to wait2) Naming convention of groups is critically important; this is the most important lesson given by the speakers3) Need to give physicians ability to remove patientsSession 165IRRIGATING THE AMBULATORY SPECIALTY USERS―Allan Wu, MDReport from Lancaster General Health South in Pennsylvania. Described an effort that went BACK to clinicsthat had gone live and had never really been optimized, frequently specialist groups that had particularworkflows that had never been optimized. Their biggest problem was to get buy-in that they could actuallyhelp and felt that Epic TS as part of the team was essential (!). Approach was systematic by specialty levelusing the Epic Specialty Optimization Toolkit which they expanded from 3 weeks to 12 week timeline.Key Points:1) Will review the Specialty Optimization Toolkit from Epic for guidance when optimizing specialty workflows2) Had a very nice presentation of build hours available in dynamic spreadsheet to give to manager and havethem prioritize which things to build for their optimization. It will help each clinic understand the timerequired for any requests made3) Keep monthly meetings with each specialty going forward with NO commitment to build, but opportunityfor them to be heard. Good ideaSession 172FORUM- GENOMICS―Alyssa Doyle BSN, RN2015 development for Genomics. Build is still relatively in beta. Improved genogram and printgroups. Stillno solution for noting half-sibling relationships. Most of the discussion surrounded Must haves vs wants.Although Epic plans to move to a platform where the MD can see genetic sensitivities to medications in orderentry - this is not even in development at this pointKey Points:1) Genomics development still in very beta stage2) Epic presentation on genomics in Executive Address not in development at this time3) Improved genogram available in 2014―Deidre Keeves, PTEpic is starting the \"Eagle Initiative\" to create a roadmap for implementing an epic toolset for: pedigreevisualization, genomic annotation and result review and family centric tools and analytics. New userwebforum devoted to sharing news and information about this development: \"Genomics and Family History\"userweb.epic.com/Topic143. Family history & genomic testing will be key focus.Key Points:1) Epic is putting development into the Eagle initiative that focuses on capturing more robust family historyand tracking high level genomic integration2) More genomic tools will be available in 2015 version. Epic is asking for customer feedback with expertise ingenomics3) There is rich debate over the issue of linking family charts. From a privacy standpoint, some don't wantfamily info shared. From a health perspective there is perception that it would be value added for givingclinicians access to see that a patient has a significant family history of highly sensitive but proven hereditaryconditions such as schizophrenia 58 | P a g e

Session 197 CLINICAL INFORMATICS (MD & RN)TRANSFERS FOR A SUCCESSFUL DISCHARGE READMIT―Allan Wu, MDPresentation of various solutions for transferring a patient from one facility to another. Applicable to UCLAworkflow transferring between RRMC and 1W Rehab in particular where a Discharge-Readmit workflow isunderway vs Discharge and then separate Admit. Applicable to workflow if transferred to RRMC forprocedure as well. No perfect solution so far. Mentioned a phase-of-care, but not clear how used.Key Points:1) Header changes to color PURPLE to indicate that you are in the wrong encounter within the Discharge-Readmit - relatively easy to consider and implement, but will need training to understand how this works2) Modified med rec and included an Order Releaser section -- lots of technical workflow engine rule build --need a broader strategy first3) Learned of a print group that can just reflect the last \"type\" of med rec done -- whether Discharge-ReadmitMed Rec or Discharge Med Rec. CAN BE HELPFUL for our RRMC->Rehab workflow at UCLASession 210CODE NARRATOR TRIALS AND TRIBULATIONS―Meg Furukawa, RN, MNParkview Hospital described their challenges and successes with Code Narrator implementation. Theypresent lessons learned as well as successes in the ED and ongoing challenges in the Inpatient units.Key Points:1) Training is everything! SME engagement creates win. Silence does not equal harmony2) Unable to titrate drips in One Step Meds. Create flowsheet rows in narrator for staff roles - works betterthan Add Staff3) Learned of a print group that can just reflect the last \"type\" of med rec done -- whether Discharge-ReadmitMed Rec or Discharge Med Rec. CAN BE HELPFUL for our RRMC->Rehab workflow at UCLASession 244IMPROVING PHYSICIAN SIGN-OUT USING THE 2014 HANDOFF TOOL―Andrew BeerA presentation by Stanford Children's Health on their implementation of the Epic 2014 Handoff tool. This is anew feature in 2014 and has allowed them to overhaul their physicians' patient hand off process. Discussionincludes their build and issues they faced.Key Points:1) The new hand off tool can be accessed from the patient list and printed from it as well. It prints inlandscape mode, allowing it to contain multiple patients per page, contrary to the older patient list reportsthey were using2) A new feature is that each specialty can have their own handoff notes (cardiology, etc.). This makes it easyif multiple physicians need to hand off the same patient to their respective colleagues. However, thisseparation makes it difficult for one specialty to hand off to another3) There is a view-only version of this available in the 2014 Canto table application, which can make hand offseven more flexibleSession 245GROWING INTO NOTEWRITER FOR TRAUMA―Ashwin Buchipudi 59 | P a g e

Learnt powerful utilization of notewriter to improve patient care CLINICAL INFORMATICS (MD & RN)Key Points:1) Learnt how to customize the notewriter2) How to use notewriter in order to satisfy quality measuresSession 253SUCCESS AT 7- NURSES VS. HAI-CAUTI―Meg Furukawa, RN, MNLearnt powerful utilization of notewriter to improve patient careKey Points:1) Need support from all levels of the hospital for success2) Be careful with the number of BPAs that fire for nurses to avoid alert fatigue, recognize the power of socialmedia in communication3) Need people, process and technology for a successful organizational transformationSession 255FOCUS GROUP- STORK OBSTETRICS―Tina Nguyen, MD, FACOGNew options in upcoming versions of EPIC/StorkKey Points:1) Overall nice options―Nina EmersonThe focus group went through some features that have come out in 2014, as well as a preview for futurefeatures to get customer inputKey Points:1) 2015 will have a new HIE standard interface available for Birth Certificates, although it doesn't sound likeCA currently accepts interfaced information. It is something to keep an eye on though2) In 2014, the results console can open right to putting additional orders in3) In the delivery summary, in 2014 you can set it up so it doesn't include blank items in the note that'sgeneratedSession 270REHAB DOCUMENTATION ROUNDUP―Allan Wu, MDComprehensive look at strategies used to document rehab workflow from Hattiesburg Clinic. Used uniqueNavigator section for handling initial Rehab screen, then extensive use of flowsheets to document work fromeach service and pulls into notes by SmartLinksKey Points:1) Designed flowsheet rows that cross inpatient encounters to facilitate documentation of rehab elementsbetween encounters2) Uniquely got compliance to allow flowsheet rows to serve as signatures electronically for a team-basednote to allow signing of parts of interdisciplinary note (by pulling in the signature) on an as-needed basis incase not everyone is at the same conference 60 | P a g e

3) Impressive work done with SmartLinks, flowsheet rows, and well-designed template to allow team CCLLIINNIICCAALL IINNFFOORRMMAATTIICCSS ((MMDD && RRNN))conference to create note in real-time during discussion shown on board; cut down time for interdisciplinaryconference weekly from 3 hrs to 40 minutes!Session 287PREDICTING & PREVENTING CLINIC NO-SHOWS―Shehzad SheikhLearn how Providence Health is approaching the Clinical No-Shows by using predictive analytics. Themethods that were discussed include Linear model, Ensemble of model and Pilot plans. The sessionemphasize the fact that successful implementation of No-Show predictive model needs to take in account asmany relevant factors as possible, such as, Patient's visit history, geographical distance from clinic (mapdata), household income (public census data), Diagnosis history, insurance, race/ethnicity, appointmenttype, no. of days in between scheduling and appointment day and many more.Key Points:1) It is critical to think carefully and collect the factors to effectively implement a predictive model2) To be more successful with predictions more than one models can be blended using ensemble to refineand improve accuracy of predictions3) No-Show prediction allows the staff to proactively call the potential no show patients for reminders andre-enforcement of appointments to efficiently use schedule able resourcesSession 303STANDING MULTI-FACILITY TRANSFUSION BUILD―Meg Furukawa, RN, MNThis presentation describes how the health system standardized the order sets for adult and pediatrictransfusions including massive transfusions. The session also presents areas that could not be standardizedand strategies for managing these.Key Points:1) Multidisciplinary workgroup is essential for success2) Colors in order sets help differentiate the sections and make it easier to use the order set3) Default all choices in the Massive Transfusion order set, add volume and units row on Blood AdminFlowsheetSession 326THE NURSING SHIFT REPORT HANDOFF HOEDOWN―Meg Furukawa, RN, MNThis session presents ways to create an electronic version of a paper handoff report. The approach taken toensure complete and accurate information needed for seamless patient care is discussed along with how thiswas accomplished across various patient populations.Key Points:1) Create different reports for different specialties (MedSurg, ICU, Behavioral Health, Antepartum, L&D,Postpartum, Nursery, Peds, PICU and NICU) with common assessments across all (Neuro, CC, Resp, GI/GU)2) Get input for content from end users, modify as needed to make the report useful for them3) Make multiple copies of the Assessment print group and configure the lookback time, display names andnumber of rows for each reportSession 327 61 | P a g e

OPERATING SPECIALTY CLINIC FARMS WITH STRATEGIC SMARTTOOLS CLINICAL INFORMATICS (MD & RN)―Eric Cheng, MD, MS, FAANTeam described how to collect discrete data for ambulatory clinicsKey Points:1) Flowsheets is the preferred build, particularly for trending2) Smartforms look nicer, but they are a little bit more work to doSession 340FOCUS GROUP- EPICCARE INPATIENT―Nina EmersonI was only able to attend part of the session since it overlapped with a session I presented. This sessioncovered current and future updates for both Clin Doc and Orders, and reviewed customer suggestions andgathered feedback from customers. They included some information about Canto for rounding as well.Key Points:1) Patient list in 2015 is vastly different. The summary pane is gone, and instead spark lines and additionalprint groups are added right the patient list row for that patient. Now there is a sidebar that pops out formore information when needed2) Foundation has a nice physician documentation checklist. It alerts physicians if that patient has overduecosigns, missing progress note, missing pro fees, or orders to cosign3) 2015 will have a new, updated interface for Patient Education. Includes the ability to mark items that youtaught, but need to reinforce and highlights them in yellow. Also has improved patient summary report printgroups for reviewing the information laterSession 346NEEDLE IN A HAYSTACK- A SOLUTION FOR DIAGNOSTIC HODS―Allan Wu, MDOur own presentation on HOD workflow. It turns out to be a complex build but addresses many commonissues among tech-reader workflows. Many other groups struggle with same issues and we did not hear ofany better solutions, but we gave out many pamphletsKey Points:1) Need better feedback to close the loop on measures of how well each HOD group is utilizing this workflow2) Needs better reporting tools to pull together various aspects. We have requested Epic on how to best dothis3) Needs more specific training tools posted to our CareConnect training site -- will follow up on thisSession 384MOO-VING AHEAD- DISCHARGE TO READMIT MADE EASY―Nina EmersonTwo Organizations shared their lessons learned around discharge/readmit, and how they have improvedtheir build and process.Key Points:1) Baptist Health has updated some button captions and added help text to their navigators, which we maywant to look at doing2) Baptist also utilizes a patient class of \"discharge readmit\" that's tied to Inpatient in ADT. It's in an order,defaulted in the discharge-readmit navigator and satisfies the 'does the pt have a discharge order?\" Criteria.This patient class also allows them for nurses to bypass the AVS checks to print an AVS for the patient. 62 | P a g e

Added signed and held orders the AVS as \"Orders to be continued at receiving facility\" which the abstractors CLINICAL INFORMATICS (MD & RN)love3) Need to review RN 363835, which may help us print an AVS for discharge-readmits without a new patientclassSession 394DICOM SR INTEGRATION FOR ULTRASOUND IMAGING―Tina Nguyen, MD, FACOGTips on how to get data from DICOM to EPICKey Points:1) Need images to be in one central hubSession 414OLD MACDONALD HAD AN OB EMERGENCY―Tina Nguyen, MD, FACOGUsing a trauma narrator to better document OB postpartum hemorrhageKey Points:1) Interesting way of documentation2) Currently unable to pull into MD notesSession 441REAL-TIME DECISION SUPPORT TO IMPROVE HCC CODING―Eric Cheng, MD, MS, FAANWonderful session about lessons learned in improving RAF score by using HCC codes. Most effective tool isdisplaying results in navigator itself. They tried putting HCC in diagnosis codes, and printed reports. Forselected cases, InBasket messaging can gather greater specificity when needed.Key Points:1) We should learn what worked and what did not work at this organizationSession 450NO BULL- TOOLS TO IMPROVE WOMAN’S HEALTHCARE―Tina Nguyen, MD, FACOGUsing third party apps or building your own to improve contraception care to womenKey Points:1) Linked Episodes can be used to streamline IVF cycles and monitoringSession 453IMAGING SOLUTIONS IN HOD’S DUKE MEDICINE―Alyssa Doyle BSN, RNThis session reviewed options for HOD areas such as pulmonary function lab and neurophysiology to storeimages within the system and having the ability to store them in notes. It went through pro's and cons, andthe eventual solution proposed by DukeKey Points:1) Using Blob server vs VNA/PACS2) Best practices for when to use BLOB 63 | P a g e

3) 2015 - will be able to paste images into study review CLINICAL INFORMATICS (MD & RN)Session ACF06PLANTING THE SEEDS OF POPULATION HEALTH―Scott BaileyCleveland Clinic described their population health efforts including their care coordination efforts.Key Points:1) They identified 270 existing care coordinators - then realized there were really 470 after clarifying theirdefinition2) Brought external risk score into the patient record (Optum Insight - data and risk score updated monthly,limited by claims data update frequency)3) Created care coordination outreach encounter typeSession DAC01DIRECTORS ADVISORY COUNCIL WELCOME & FASTRACK TO STAGE 7―Deidre Keeves, PTWelcome session and networking for the Directors and Associates Council. MD and NI from Hospital SistersHealth System (St Mary's, St Vincent, St Nicholas) highlighted their governance structure and use of leanmethodology to optimize and fastrack their Stage 7 journey. After go-live they did walk throughs to identifytheir gaps and used LEAN processes such as standard work, visual management using huddle boards (withprinted metrics and \"Kudos\") to achieve their clinical and IT goalsKey Points:1) Implemented standard work by using a set of coordination guidelines for all key activities (the tool isshared in slides)2) They decentralized the entire HIMS department and put them on the units for faster scanning3) They did rolling on unit training and proficiency checks to roll out their code narrator in 6 weeks―Mason PaknejadAnalysis of compliance levels at subgroups, such as physician groups, can identify which providers needassistance and where. Dashboards can be used to communicate timely information with the impactedgroups. Use real-time monitoring (rather than lagging metrics) to improve outcomes. Do a lot of \"Kudos\" and\"congratulations\" to celebrate progress.Key Points:1) Obtain metrics on compliance level at physician group level, by practice or specialty2) Some pre-Epic metrics will simply not be available after go-live with Epic. Should seek to replace withsimilar metrics. Comparable analysis will be made difficult due to this lack of one-to-one matching of pre- andpost- Epic metrics3) Lean processes can be used to develop Leading Metrics (lagging metrics are less helpful)Session DAC05CROSS-POLLINATING TO IMPROVE YIELD: PAIRING ANALYSTS WITH PRACTICING PHYSICIANS―Scott ShermanReview of approach where physicians are paired with a build analyst to help the physician become a builderwithin Epic.Key Points:1) Approach of close pairing of physicians to build analyst a worthwhile approach2) Physician engagement is key 64 | P a g e

3) UCLA has a similar model already in place CLINICAL INFORMATICS (MD & RN)Session ES-PC01SOWING THE SEEDS OF PHYSICIAN ENGAGEMENT―Allan Wu, MDDescribing basic methods of keeping physicians involved from project management point of view going up togo-live. Need to be creative as to how to measure ROI on interventions.Key Points:1) Should implement an amazon-like tracking of change flow for tickets so users are engaged2) Provide knowledge assessment of competency with system so can target training appropriately3) Novant - strict project management of training for highly personalized training with a high degree of safetyemphasis and ability to training and test within the system to place and back-out real orders. You must besafe in the system as a low-bar. Had some teaching of workflowsSession ES-PC02HERDING CATS CONTINUING PHYSICIAN ENGAGEMENT―Allan Wu, MDMethods of implementing a physician-to-physician training with Master Class at UCLA and search tool. Alsohad high-level view of physician engagement from Cort Garrison at Salem Hospital.Key Points:1) Emails to physicians don't work - Salem uses a website which by contract physicians must check at leastonce every 2 weeks. It is not an excuse to say they did not read it2) Must have appropriate communications for the point during the change management model that isappropriate (Kotter model of buy-in change model)Session ES-PC03HARVESTING HEALTH―Allan Wu, MDSession discussing ways to engage populations. Most interesting is the use of a comprehensive pharmacystrategy where pharmacists should be more actively engaged in assisting healthcare in both clinic andhospital. Also emphasized need for comprehensive Care Plans and use of Healthy Planet.Key Points:1) Pharmacist extenders - pharmacists should not spend >30% dispensing meds; should be available forconsultation ad hoc in clinics2) Care Plans for population management - requires pre-huddles for goals and weekly meetings for care team;requires patient population management reports3) HealthPlanet - need to see how to engage in this at UCLA since we have xDR and HealthyPlanet has its ownCogito Data Warehouse. How to integrate?Session GeneralCOOL STUFF AHEAD―Darryl Hiyama, MDMajor design change in Ambulatory workspace. Heightened mobile connectivity and functionality. Push forpatient engagement and ease of navigation. Interoperability with both Epic and non-Epic providers has beenimproved.Key Points: 65 | P a g e

1) Interoperability is improving. Both Care Everywhere and Connect will likely be major improvements CLINICAL INFORMATICS (MD & RN)especially in our market2) Mobile platforms are improving in functionality though more so on the patient side vs. the provider3) The Ambulatory change is a major one. Looks different from the Inpatient workspace so may not be awelcome change for users―Mohammed Mahbouba, MD, MSAn overview of the latest innovations from Epic's R&D team and what's coming down the pipline from EpicKey Points:1) This was very important session that highlighted the comprehensiveness of Epic's vision in general andspecifically with regards to reporting and analytics. Understanding the R&D agenda is critical to our decisionsaround the development or acquisition of solutions.2) Command Center Dashboard, Visit Volume Prediction, Patient Payment Estimate & Payment Score, CarePathways, Machine Learning, Predictive Analytics, External Benchmarking, Incorporating External Data forPopulation Health, Model System and Collaboration, Embedded Analytics, Decision Support, DataVisualization, Natural Language Processing, Care Modeling, Incorporating Social Determinants of Health,Registries, ACO, Genomics, etc. are either new or improved capabilities that are very relevant to OHIA andour roadmap for the next few years3) Epic is emphasizing their system as a platform for innovation instead of a document and data collectionsystem. Epic APIs open the system to third party developers will open the door of to incorporatinginnovations such as Epic Wear APIs (classes, wach), etc―Hawkin Woo, MD, MPH, FACPJune 2015 Release date for 2015. Connectivity with Infusion pumps, Anesthesia, Beds, patient movement.HealthKit. Care Everywhere auto-import pilot testing in N. calfornia.2014 bundle payment feature. 2015Medicare Advantage in Tapestry data exchange with CMS. Appointment demand forecasting to adjustschedules based on seasonal patterns. Predictive payments based on health plan, offer a discount forprepayment, offer lay away option. Kuiper, server manager dashboard. 2 new Physician Builder Courses(Orders, Analytics). Apple Mobile Touch ID for mobile devices. Mobile with e-check in, send patients withnew apt if cancellations, integrate with patients outlook/google calendar to schedule an apt for them.Bedside tablets to help patients with training and medication reminders, currently on Android, will be pushedto Apple with Bring Your Own Tablet feature. MyChart App branding coming soon. Epic Sense API forconsumer wearable sensors. Epic Wear API for Google Glass and iWatch. Push notification to iWatch patientis ready to be seen.Session GeneralEXECUTIVE SUMMARY―Meg Furukawa, RN, MNCEO presented an overview of the current state of the company, new installations, thoughts on the futurestate of healthcare and a peek at some of the new development that will be elaborated on more duringWednesday's.Key Points:1) Epic has additional support programs for short-term projects and can evaluate your system to see if youare using all of the functionalities that make a system easier to use2) Engaged users create best outcomes3) Technology drives business 66 | P a g e

Session FAC18 CLINICAL INFORMATICS (MD & RN)REFERRAL AND AUTHORIZATIONS WORKQUEUE OPTIMIZATION―Allan Wu, MDHow UCSF created an aggressive 4 week program to fix and re-do all ambulatory clinic workqueue build in anindividual clinic way. They started with just 1 workqueue per DEP?!?! Ran 4 week cycles including build, 2week offsets, 4 projects running concurrently. Big project. Week 1: kickoff, intro, expectations, Week 2:validation of WQ spec document, signoff start build, Week 3: testing and signoff (validate in PRD), Week 4:train end users, cut-over. 6 months.Key Points:1) Referral builds must test in PRD2) KEY - obtain a pre-visit QUESTIONNAIRE - that asks what the pain points are for referral WQ for that clinic -what current WQ used, missing DEP, Visit Types, relative volumes, pain points, staff available; start 2 weeksahead of kickoff; review with manager 1-2 days before3) Created many tweaks and strategies -- 2221 rules; 522 unique rules in DEP's with 332 referral WQ, 98 authWQ, build Visit Types, identified different workflow types (which we can and probably should do)Session GeneralCOOL STUFF AHEAD―Darryl Hiyama, MDMajor design change in Ambulatory workspace. Heightened mobile connectivity and functionality. Push forpatient engagement and ease of navigation. Interoperability with both Epic and non-Epic providers has beenimproved.Key Points:1) Interoperability is improving. Both Care Everywhere and Connect will likely be major improvementsespecially in our market2) Mobile platforms are improving in functionality though more so on the patient side vs. the provider3) The Ambulatory change is a major one. Looks different from the Inpatient workspace so may not be awelcome change for users―Tina Nguyen, MD, FACOGNew research areas and population based data collectionKey Points:1) 2015 versionSession NAC01NURSING EFFICIENCY AND USABILITY QUICK WINS―Meg Furukawa, RN, MNEpic presented ideas for improving nursing usability and efficiency through functionality that is available in2012 or 2014 versions. These functionalities can be easily implemented and include addition of new clinicalreports from 25 sites, additions to sidebar reports, interfacing with infusion pumps, readmission risk andchart search. Epic now has Nurse Builder classes, similar to their Physician Builder classes. UCLA's PatientStory is part of the upcoming Foundation System refuel.Key Points:1) Look at Foundation System for new clinical reports before building your own2) Readmission Risk (LACE) will be added to Foundation System in November 20143) Nurse Builder classes are a good way to gain an understanding of what build options are available to helpfacilitate discussions and plans with business owners 67 | P a g e

Session NAC03 CLINICAL INFORMATICS (MD & RN)CLINICAL ADOPTION: PREPARING FOR HARVEST―Meg Furukawa, RN, MNThis session presented an overview on ways to achieve operational readiness by using three steps,identifying and documenting future-state technology workflows, engaging staff in future-state operationalworkflow assessments to systematically identify the process, policy and job role changes that theseworkflows will introduce and create actionable plans that change leaders and owners can use to implement,communicate and sustain those changes.Key Points:1) Implementation refers to the installation and activation of a functional system at a single moment of time2) Implementation refers to the installation and activation of a functional system at a single moment of time3) Technology, change and operational readiness are necessary for success implementations and adoptionSession NAC06TELLING THE TALE: OB DELIVERY FROM PRENATAL THROUGH POSTPARTUM―Meg Furukawa, RN, MNThis session presented an overview of how providers and nurses worked with end users to develop tools tobe able to see the perinatal patient's story (admission, labor, delivery, and postpartum) in a concise fashionat a glance.Key Points:1) Accordion reports are a good way to present an overview of the patient's story2) Need to include end users in all aspects of the rework to ensure the changes meet their needs3) Testing is important to ensure all data appears where it shouldSession NAC11PEARLS: TRAINING―Allan Wu, MDAlthough nursing training was emphasis, should apply to providers as well; should train by workflow, ratherthan functionality. They did a lot of good things -- got signoff from business owners on workflow curriculumdocuments -- a LOT of work, but pays off in buy-in. They still don't really have a good way to search fortipsheets (!). One group showed a CART rounding method of going around with a mobile cart at various shift-times during day in hospital -- showing tips/tricks, but mostly getting feedback from nursing. Not sure if thiscan be applied to UCLA.Key Points:1) Required web-based pre-requisite session before attending a workflow-related curriculum class2) Created a website for endusers that shows every report that is available. 7000 reports and hyperlink to gothru them. Some videos on how to build and modify. Link for a request for a new report. GREAT idea! Goodproject for resident, nursing, or physician Informaticists3) Need to move toward workflow-based training, but hard to get the business owners involved en masse.Likely needs to be done workflow-by-workflow. Need to assess high-yield ones firstSession NAC12PEARLS: WORK LIST―Meg Furukawa, RN, MN 68 | P a g e

Two hospitals including UCLA presented an overview of the Work List implementation and optimization CLINICAL INFORMATICS (MD & RN)including challenges, lessons learned and the need for input from nursing to be successful.Key Points:1) Spend time up front with end users to decide how the Work List will be used and what tasks will appear onthe Work List for best buy-in at go-live2) Order transmittal analysts should be involved in the build discussions and decision making from thebeginning to make the build succeed3) An integrated approach (operations, users, application teams) is key to the success of the Work ListSession NAC19PEARLS: MODIFIED EARLY WARNING SYSTEM (MEWS)―Meg Furukawa, RN, MNTwo hospitals present their processes and build to document risk scores using the MEWS score. Details of thebuild were presented and challenges were discussed.Key Points:1) Create a complete workflow with score visibility, score action and score reporting tied to patient outcomes2) Use discrete data where ever possible for best results3) It is possible to configure the build to page charge nurses or a response team when a threshold is reachedSession NAC26PEARLS: MODIFIED EARLY WARNING SYSTEM (MEWS)―Meg Furukawa, RN, MNThe speaker demonstrates their Unit Facility Board which is uses the Epic Monitor functionality. It displayssafety information and discharge readiness using icons. The board preserves patient confidentiality.Key Points:1) 2014 allows grouping of icons within a single column instead of in individual columns2) Customize the display item based on information needed for patient safety3) Consider where the boards will be displayed when planning build. Thin clients don't work at presentSession NAC33GROWING OUTCOMES USING A CLINICAL DOCUMENTATION COMMITTEE―Meg Furukawa, RN, MNThe speakers described a Clinical Documentation Committee (CDC) at their hospital who were responsible forprioritizing the requests for changes. The committee members are multidisciplinary staff along with projectteam. The CDC has positively impacted fulfillment of documentation requirements and quality outcomemeasures at their hospital.Key Points:1) Create a charter to identify the functions of the committee2) Discuss general topics with the entire committee and break into smaller application-specific groups asneeded3) Change from a reactive to a proactive approach to optimizing the systemSession NLF05FOXES WATCHING THE HEN HOUSE? NON-PROVIDER ORDER ENTRY AND SCOPE OF PRACTICE―Allan Wu, MD 69 | P a g e

Summary of process by which Johns Hopkins developed a method for non-providers to enter orders in CLINICAL INFORMATICS (MD & RN)attempted compliance with regulations and internal compliance offices. Extension of ability for MA (and LVN,RN) to place orders per protocol for immediate action. codifies how to make sure orders are ensured to bestrictly within a protocol with build options in orders and reports and a workgroup. Has potential for UCLA,but first need to clarify security and scope issues with UCLA before going forwardKey Points:1) Important points to consider -- UCLA may need a more clear method for establishing protocols for per-protocol orders which we allow in scope, but do not regularly audit or have method to audit2) SHOULD DO - add • Print group – Order Mode Info – IMPLEMENT THIS print group. Need to research whichencounters/reports to put this in• States Order Mode and signed on says action, order mode, communicator, comment, responsible provider,signed by, when signed• Complements “Order Provider Info” (default report re orders)3) Cogito Data Warehouse. How to integrate?Monthly workgroup for non-provider ordering – includes with P&T, Medical, lab, radiology, nursing,pharmacy, regulatory, billing, medical staff, Epic; Runs a regular Rogue Orders ReportSession PAC01PHYSICIAN ADVISORY COUNCIL GENERAL SESSION―Mark Grossman, MD, MBA, FAAP, FACPPatient can submit anytime but 1 business turnaround time, under 2 hrs during work hours. WRvu 0.5...similarto 99212.5 Takes about 5 minutes. $30 for patient ...didn't charge HMO.Piloted by urgent care MDs.Involve specialists in template and branch questionnaire builds for buy in and refining onlyStarted with 4 conditions.Notified via my chart in waves. Not advertised externallyRedirected patients who called to e-visitSinusitis and cough top two, not much back pain, some pink eyeSurveyed patient experience afterwards. Negative experience associated with lack of antibioticSmart phrase created for MDs to useMetrics: turnaround time, pt seen within 7 days after, number per monthKey Points:1) Need for push notify of MD. Sent to a general pool, make sure only one MD takes the case2) Derm needs to involve photos.3) Standardize experience, when patient need to be seen, therapy protocols―Allan Wu, MDShould look at Epic Earth more to engage with colleagues in talks and discussions. They are opening newPhysician Builder courses (Analytics and Orders, apparently a SmartForms class has been added) - we shouldstay on the forefront of this wave. For 2015 and onwards, the focus appears to be (1) richer visualizations (2)predictive recommendations with Express Lane, (3) push for more mobile device integration. Need to buildout VERY carefully.Key Points:1) UCLA should start to engage more in Epic Earth2) UCLA should consider Physician Builder courses for PI's that use this for Orders and Reports (analytics) - aidwith reputation and innovation with PI team3) UCLA should keep eye on and innovate with Canto ideas as future of rounding/amb clinics may depend onCanto 70 | P a g e

Session PAC04 CLINICAL INFORMATICS (MD & RN)MULTIDISCIPLINARY MANAGEMENT OF PATIENTS ON HIGH-COST MEDICATIONS―John Luo, MD, DFAPA, DFAAPLearn how to best utilize episodes, registries, and smart data to effectively manage a patient population.Used multiple sclerosis, some patients seen by internal neurologist, but others use external neurologist butfill meds at group health specialty pharmacy. Analysis of workflow key to integrate all features, and mustbuild registry to scale. Use smart data elements in smartform to run reports. Created modified expandeddisability status scale (doc flowsheet).Key Points:1) Use overview SmartForm tracks patient-level data, but encounter SmartForm tracks patient status overtime2) Referral to MS Services data populates overview note, routes to several groups (pharmacy, neurology,coverage)3) Workflow smartform allows documentation of data in the report, used dashboard reports to help identifypatients that needed follow-upSession PAC05PEARLS: E-VISITS―Darryl Hiyama, MDExperience of two physician groups from Chicago and Northern Kentucky who both have implemented e-Visits.Key Points:1) Very little reimbursement in their situations2) Don't announce rollout3) High degree of provider and patient satisfactionSession PAC08USING EPICCARE AMBULATORY TO SUPPORT PRECISION MEDICINE QI AND RESEARCH―Darryl Hiyama, MDNeurosurgery group from U Penn which organized a workflow by which patient centered data is collected avarious points in the registration, evaluation, preop, postop process. This data in turn can be used for bothindividual and aggregate uses. Did not add to existing workload. Benefit of real time reporting for things likecomplications. Also ability to add predictive analysis of risk for individuals. Also assessment of patientsatisfaction and QOLKey Points:1) Data consent with HIPAA consent2) Use validated metrics to evaluate―Tina Nguyen, MD, FACOGUpenn Nuerosurgery designed a very detailed and in-depth navigator that would allow their providers tohave discrete data for research. The build was intense and the navigator is very wordy and clunky but theygot buy in from physicians by telling them the navigator would allow for research at a later time.Key Points:1) Discrete data elements are easier to track in EPIC for research. The problem is that they are tedious to fillout 71 | P a g e

Session PAC15 CLINICAL INFORMATICS (MD & RN)SOWING WHAT YOU REAP: REDESIGNING AND OPTIMIZING L&D―Allan Wu, MDTerrific summary of phase of care changes implemented by Dr. Tina Nguyen and CareConnect teamKey Points:1) There is an ability to make pseudo phases of care actually have orders that drop off2) Other groups have the same issue; some have implemented similar options; one other at least says thatcannot get buy-in to do phases of care3) How do you prevent trainees from ordering all orders and having nurses pick and choose what to release?Session PAC17PEARLS: POPULATION MANAGEMENT―Deidre Keeves, PTGrant Greenberg MD &Cheryl Dehmlow (University of Michigan) - presented how they used outreachencounters with bulk orders and bulk communications called \"Birthday Letters.\" In patient’s birth month theysend a communication via portal or mail that says what preventive services or tests are due based on healthmaintenance, it gives patient instructions on how to schedule and it’s signed from their PCP. Anita Ung from(Atrius Health) presented in clinic standard work with health maintenance strategies to improve populationhealth.Key Points:1) Patients who received messages by mychart portal had a higher response to outreach encounters thanthose who got paper letters2) Presenter made the point that you can implement population health tools but they are only as strong asthe operational infrastructure that uses those tools3) Atrius publishes their report comparing compliance with health maintenance screening results betweentheir various clinics and PCP's and they call out high performing clinics and low performing clinics. Theysurvey the high performers and publish their operational best practices that led them to get the good results.They believe transparency and healthy competition amongst the providers was key to successSession PAC19OPTIMIZING THE FAMILY HISTORY HARVEST―Frank Day, MDLearn how Dartmouth-Hitchcock created a multispecialty cross-discipline group and modified the basic Epictools to create a new lexicon, navigator display, relative lists, and print groups, resulting in improved FHcollection. Presenters discuss the tensions between detailed vs. generic disease descriptors, and how to setup a governance structure for family history activity.Key Points:1) A multidisciplinary workgroup cleaned up duplicates, misspellings, abbrevs, and inconsistencies in modelfamily history. \"Neg hx\" is first column, then diagnoses appear by most to least common.2) Workgroup met with specialty groups for many items, removed if not clinically useful. Peds Amb contentkept separate3) This would be a great starting point for optimization of UCLAs family history activitySession PAC21PEARLS- AVS―Nina Emerson 72 | P a g e

Yale and UCSF describe the changes they've made to their AVSs since their go live, and how they organized CLINICAL INFORMATICS (MD & RN)their optimization project.Key Points:1) Follow up section: Make sure addresses listed for providers are clinics where they see patients, and nottheir offices, which are sometimes a different location.2) Medication list: Separate PRN and scheduled medications for patients3) Had a great way of getting some lab results on the AVS. Built a flowsheet in the navigator wherephysicians could indicate \"release Chem 7 results to AVS\" and then SmartText populated it onto AVS.However, this was a ton of build, and they find this is only utilized for 1% of discharges. So may be a goodmethod for a particular specialty need like transplant, but wasn't successful for internal medSession PAC24LEVERAGING THE HIDDEN POTENTIAL OF SMARTFORMS―Darryl Hiyama, MDUsed smartforms with rules logic to complete the path review after colonoscopic biopsy.Key Points:1) Versatile tool2) A LOT of build so should only use on bigger utility projectsSession PAC26INPATIENT PROBLEM-ORIENTED CHARTING-FROM DECISION TO ADOPTION―Nina EmersonLee Memorial presented why they decided to utilize problem-oriented charting in inpatient and how theyimplemented at their organization. They have several great screenshots on how this makes specialty notesmuch more visible. They also discussed adoption and training, and tools that can be used to assist, likesidebar reports that can link to the more complete note/encounter. They also discussed how this made coremeasure documentation easier.Key Points:1) With problem-oriented charting, the notes follow the problem and are more easily visible in differentencounters. This is very beneficial for chronic problems2) While we currently allow physicians access to problem oriented charting, our navigators are not set up inthe ideal way to encourage it. With changing navigators and some SmartTexts, it actually becomes moreefficient to use problem-oriented charting. The physician puts their specialty in a section at the top, and theright note template then pops into their navigator.3) Specialist notes are easier to find.Session PAC27ICD-10 AT THE OK CORRAL―Daniel Vigil, MDICD-10 implementation deadline has been moved to October 2015. ICD-10 has many benefits to offer ifstructured correctly in Epic.Key Points:1) Begin training now about ICD-102) Orthopaedic Surgery will be among the most heavily affected by the change of ICD-9 to ICD-10Session PAC29 73 | P a g e

A COMMUNITY COLLABORATIVE APPROACH TO OPEN NOTES CLINICAL INFORMATICS (MD & RN)―Allan Wu, MDExcellent and articulate discussion by panelists in favoring OpenNote. Able to state reasons for and againstthis initiative. Most common concerns addressed including ability to hide certain notes at certain times bycertain providers. Most concerns materialize rather rarelyKey Points:1) OHSU was not aware of concerns with resident/fellow notes being potentially send out by auto routingwithout being signed by attending. Has never been an issue apparently (but we should take seriously atUCLA)2) Most concerns do not materialize, but need to be planned for (i.e. situations of spousal or geriatric abuse,pediatric access, rollout); Make sure have policy in place and can be implemented. Need to have policytransparent on how to handle requests for amendment to records to HIMSSession RF04MRI SCREENING FORM 2014―Alyssa Doyle BSN, RNSSM Healthcare Wisconsin reviewed their implementation of an MRI screening form in the 2014 version ofEpic. The upgrade just took place in June. They had originally one live with a smartphrase for outpatientsand paper process for inpatients. The smartphrase was cumbersome and not user friendly. Ultimately theusers were happy to go-live with the new toolKey Points:1) Analyze opportunities to pull existing data from the chart where possible to reduce clicks2) Utilize print groups and display data in a sidebar to complement the questions in order to view all info onone page3) If planning to printout copy to have patients sign - make sure you program it to display commentsassociated with the FSRSession SAC01ONE-CLICK PHYSICIAN SCHEDULING―Laxmi KumarLearn how LSU use the Discharge Navigator to schedule patients for Follow Up appointmentsKey Points:1) Not useful for UCLA2) Allows for scheduling only one follow up appointment3) UCLA has a better system in place. The discharge order for follow up appointment is sent to a WQ, which isworked on the DOM teamSession SAC02ACCURATE PATIENT MEDICATION LISTS―Nina EmersonTwo organization's approaches to improving accuracy of med lists through utilizing pharmacy techs in the ED,and clinical pharmacists in clinics.Key Points:1) Utilizing pharm techs to update the patient's home med list in the ED really assisted getting accurate listsbefore admission, since they are focused just on the med list and not the acute needs of the patient 74 | P a g e

2) Whoever is gathering the information from the patient, need to have comprehensive training. They train CCLLIINNIICCAALL IINNFFOORRMMAATTIICCSS ((MMDD && RRNN))their techs on when to ask questions, how to talk to the patient through role play, provide check lists of whatquestions need to be asked3) Can also utilities clinical pharmacists in clinics. For complex or new patients, physicians can write for aClinical Pharmacist Referral who will then see the patient when they come into the clinic to do thereconciliation and make sure it's accurate. They found focusing on cleaning up medication lists for complexpatients during outpatient visits caught a lot of potential medication errorsSession SAF01WHAT YOU DON’T SEE MAY BE WHAT GETS YOU: PERCEPTION, INFORMATION DISPLAY, AND AVOIDING PATIENTERRORS―Nina EmersonFocused on the importance of the visible display of data and how to avoid showing misleading informationKey Points:1) Need to carefully QA every data element displayed. In one example, final results appear first, followed bypreliminary results in a report. The final result doesn't say Final, and is in sentence case while Prelim is in allCAPs. Since people read chronologically and are naturally drawn to the all caps, they could read the prelimresult instead leading to misdiagnosis2) Time saving devices have unintended consequences. For example, Auto-completion: They had a casewhere their lab system was doing auto-completion, and actually ended up suggesting a very rare pathogenrather than a very common oneSession SNAP08CASH CROPS: PHYSICIAN DOCUMENTATION- DRIVEN CHARGE CAPTURE―Nina EmersonThis was a session from Stanford on some of the build they did to help make the \"Charging note-by-note\"feature in Epic as helpful for the physicians as possible. They described how the functionality can be usedfrom In Basket as well as how to setup rules to be very specific about how/when the pop up occurs.Key Points:1) It's possible to set up the pop up based on an CER rule set in LSD, meaning you get very specific about whatspecialties or log in departments will be prompted to enter charges2) Can set it up so that if a charge was already entered on a note, you don't get prompted a second time (ie,editing a note)3) The most difficult piece of setting this up is around mid-level providers. They had many Aps on the sametemplate, but only some of them can charge. This became challenging to separateSession SNAP38PHEW! WE GOT MEWS―Shehzad SheikhThe presenters from Memorial Healthcare talk about vital signs based early warning system to enhancepatient safety and provide insight on how they developed using Epic's building blocks.Key Points:1) Beside RR, HR, Systolic Blood Pressure, Mental Status, and Temperature. Oxygen Saturation is a keymeasure to capture in epic's build in order to implement a meaningful Early warning system2) Calculation of MEW needs to be done on near-real-time basis 75 | P a g e

Session Unsession CLINICAL INFORMATICS (MD & RN)BLOOD ADMINISTRATION WITH EPIC―Meg Furukawa, RN, MNThe session was divided into groups focusing on BPAM/New to Blood Admin, Anesthesia, Outpatient/Beacon,Ordering, ASAP/MTP, and Reporting. I participated in the ASAP/MTP group where the discussion focused onhow blood and MTPs were documented in ASAP, pain points, strategies for use and orders.Key Points:1) Many hospitals are still documenting MTP on paper2) Requests made to Epic to simplify and streamline releasing blood3) Epic recommends ED using the Narrator instead of Doc Flow sheets to document blood administrationSession UnsessionMEETING THE PERINATAL MEASURES―Tina Nguyen, MD, FACOGA small group of ob/gyn providers and nurses talking about issues with Stork build and how to meet the newperinatal measures.Key Points:1) UCLA is doing well. Many places are having issues with provider buy in 76 | P a g e

Session 13 COMMUNICATIONEMERGING SUSTAINABLE PRACTICES FOR POPULATION HEALTH―Audrey McClenaghanUsing Dash-Boards to communicate and identify candidates for \"life-style\" overviews. You can set up goalsand care plans and have direct follow-up and on-going coordination for transition to: 1) Complex CaseManagement 2) Behavioral Health 3) Medical Home 4) outreach to members. Then using this data tocreate automatic workbench reports called \"radar dashboards\" for surveys, hospital re-admissions scores, andcare coordination efforts.Key Points:1) Are we currently UCLA Using this version of the Care Model?2) Can the reports be filtered?Session 34THINKING OUTSIDE THE CORRAL- CREATIVE ENTERPRISE CRM―Bukeka ChandlerThis session entailed Stanford Health Care sharing innovative usage of CRM within their various entities (i.e.,Patient Access Services, Social Work & Case Management, and Senior Patient Representatives) and presentingeach of their initial workflows, their challenges, and how CRM helped to improve tracking and reporting. CRM(Customer Relationship Management) is an Epic communication tool which allows us to store non-clinicaldocumentation regarding patients in a centralized place.Key Points:1) Out of the entities presented, I could mainly relate to the Senior Patient Representatives due to the natureof their work (i.e., provide resolution for any concern or issue patients and family members may have withtheir care experience). Having CRM reduced the use of a third party system and kept PHI in a centralized,secure system2) To improve tracking and reporting, a SmartForm was created with all of the necessary fields to make thiseasier. To edit documentation at any time within the SmartForm, a SmartText box was created3) Developed a Haiku platform for CRM which allowed CRMs to be accessed directly on phones and respondedto immediatelySession 85AVOID FLYING COW PATTIES FROM PROBLEM PROVIDERS―Deborah FergusonThis was a UCLA presentation by Dr. Hawkin Woo and Dr. John Luo. Their focus was on identifying Md's thatexpressed resistance to the changes that the electronic health record brought to UCLA Health. Recognize thatresistances are rooted in psychology where preservation and defense mechanisms are involved. Providinginitial and ongoing support by peers with positive support has been key.Key Points:1) Allow users to express concerns, being out of their comfort zone, acknowledge the need to be able tomaintain excellence of care2) Multiple sources of support may be required for long periods after \"go-live\"Session 101FOCUS GROUP- MY CHART BEDSIDE―Bukeka Chandler 77 | P a g e

The Nursing Advisory Council (NAC) shared Ohio State University's experience with piloting \"MyChart COMMUNICATIONBedside.\" Bedside is where a patient can see their medical record while being an inpatient using tablets. Thispilot was implemented in December 2013 within their Cardiac Critical Care and Oncology department andboth units received 12 tablet computers. Stats were presented to show demographics, testimonials wereshared to show successes, and lessons learned were discussed to support best practices.Key Points:1) More hands on training for all staff is needed to successfully implement MyChart Bedside2) If implemented, remember to consider longer power cords for rooms and customize apps and display3) The android/tablet is the largest platform based on market share. It makes perfect sense to implementMyChart Bedside through the use of tablets, which cost as low as $50Session 105INCREASING EFFICIENCY WITH KEYBOARD SHORTCUTS―Bukeka ChandlerLearnt how to increase the efficiency for users by using keyboard shortcuts.Key Points:1) Found lot shortcut keywords that helps users to increase the efficiencySession 175FOCUS GROUP- EPIC CARE LINK―Audrey McClenaghanThis was also a 2 hour focus group that highlighted the planned enhancements of EPICARE. The discussionincluded the limitations of the current version and what enhancements were of the most importance. Thenew version also included an upgrade of the In basket Results and a detailed POC (plan of care). The mostinteresting enhancement was the ability to have a video chat or conference between the provider in EPICARELINK and EPIC.Key Points:1) Having access to only \"their\" patients is vital for privacy, as well as the ability to delete patients that are nolonger theirs2) Oder communication enhancements would also be of great use3) Admitted patient list needs to addedSession 203YOU KNOW WHAT THEY SAY- VOICE RECOGNITION―Kathleen CrowMercy Health utilized various speech recognition technology (SRT workflows) in their enterprise. Dragon in 1hospital, scribes in some areas, and a Dragon hybrid in others. Decision was made to use Dragon MedicalEnterprise (network edition) and enlist a consulting group to assist with install. Network infrastructureplanning was a necessary step for long term success.Key Points:1) Coders noted improved documentation after Dragon implementation2) Encounters were closed faster3) Targeted training important for physiciansSession 215LEAVIN’ THE FARM- MYCHART & WELCOME FROM TOTS TO TEENS 78 | P a g e

―Audrey McClenaghan COMMUNICATIONThis session involved two presenters: The Children's Hospital of Philadelphia and Sutter Health. The Children'sHospital of Philadelphia shared strategies to collect vital pediatric information through MyChart andWelcome questionnaires. One method is the use of Epic's Welcome patient kiosk that allows patients tocheck-in for appointments, updated demographics, verify insurance information, make copay payments andcomplete visit questionnaires. Sutton Health, which is a leading nonprofit network of community-basedhealthcare providers, presented how they transitioned into teens having MyChart access; they shared proxyfeatures (i.e., what they can do and see), requirements regarding parental permission and enrollment, buildchallenges, and communications.Key Points:1) Sutter Health emphasized the importance of internal communication being initiated by leadership; a memosent out by leadership to announce project2) Sutter Health has a web page that allows access to be extended past 12 with one click, if it existedpreviously. This is definitely a feature to consider3) Consider social media (i.e., Facebook and Twitter) for external communications announcing upcomingMyChart features, special promotions, marketing, etc.Session DAC03PROJECT INTAKE, QUALIFICATION, AND APPROVAL―Deidre Keeves, PTKaiser presented the evolution of their project intake methodology. Their problem statement was thatproject demand exceeded IT resource capacity and multiple people across the organization were working insilos on the same problems. Their solution was establishing an intake format for project requestors to clearlyidentify up front the business case and anticipated ROI. The intake and prioritization process included a gradeon work effort and impact as well as a scale in each domain for how the project aligned with theorganizations key value initiatives: best quality, most affordable, best service, best place of work.1) Make the business owner define up front the problem statements, goals, business case & value propositionfor each project2) Have leadership pre-define what percent of project resources spend their time in each portfolio valuebucket for projects3) For projects waiting in the \"holding queue\" they use a Magic Quadrant view (From Gardner - low effort,high value). They use a project scorecard to communicate to customers how their project request stacksagainst other projectsSession HIM03HERDING DOCUMENTATION- NO FUSS NOTE ROUTING―David GomezEnhance patient care experience with timely communication of clinical information to referring providers.After CareConnect went live the volume of transcribed documents to patients was decreased by 80% andmanual workflows were decreased by 90%. Extremely important to understand workflows and requirementsfor remediating failed faxes, it was found to be difficult to identify failed \"transcription\" or HIM faxes. Twothings needed to be accomplished: ability to route any transcription fix fax, in basket or mail and assure anyprovider would receive a transcription.Key Points:1) CareConnect reduced transcribed documents to patients by 80% and manual workflows were decreased by90%2) It was extremely important to understand workflows and requirements in order to problem solve―Allan Wu, MD 79 | P a g e

Review of go-live problems with routing of notes at UCLA. Solution has put research of provider addresses CCOOMMMMUUNNIICCAATTIIOONNand recommendations for updating SER records on HIMS. No complaints but may not be frequent HIMSfunction. A lot of work behind the scenes had to happen between M-modal and CareConnect get this systemto work, indicating when a provider was not in the system (using a P and asterix to manually indicate whensuch research is needed). Transcription rates have gone down but not as much as other places.Key Points:1) Auto-routing background better understood; consequences on resident/fellow workflow require Epic TSinput2) How can we make Communications more efficient for providers from here? (Question raised in my mind,not yet addressed)3) How can we decrease Transcription rates? (Question raised in my mind, not yet addressed)Session NAC09IN PURSUIT OF A NOVEL PATIENT CENTERED GALAXY FOR CHRONIC CARE―Deidre Keeves, PTStanford Children's health (pediatric multispecialty ambulatory providers) created a patient flag of \"ComplexCare Patient\" that drives a Shared Goals Activity that is seen across all encounters. They used care teamcomments to determine if a provider was part of the core care team or an advisor. This drove messaging logicwith a new messaging type called \"status chat\" to facilitate communications across the teamKey Points:1) Patient level flags can drive specific custom activities that cross multiple encounters (complex care patient)2) Integrated a custom built \"shared goals\" section across multiple encounters and made this viewable inmychart3) The program greatly improved coordination of care across especially pediatric populationsSession PAC18PLOWING THE FERTILE GROUND OF CARE TEAMS―John Luo, MD, DFAPA, DFAAPUse of care teams is essential for coordinating care. To facilitate frequent updates, the Kaiser system put thecare team report and activity in various locations. They pre-populated the system with care team membersbased on encounter data in clarity reports, and then had them edited by providers for accuracy. The new2015 build of Epic will address attribution with a new 'measure group'.Key Points:1) Care teams are important for coordinating care, especially accurate information with regards to non-UCLAproviders2) Having the 'Care Team' navigator be available in multiple locations ensures that providers will update thecare team assignment because there are no clicks away from their current activity3) Automating the care team using background processing from Chronicles will decrease need for user inputSession PAC24LEVERAGING THE HIDDEN POTENTIAL OF SMARTFORMS―John Luo, MD, DFAPA, DFAAPThe session covered how to use a smartform to create a guideline based system of post-polypectomydocumentation. This standardized process improved and automated follow-up recommendations. Inaddition, the logic in the smartform was used to generate the follow-up procedure and period. Quality ofresults communication improved significantly.Key Points: 80 | P a g e

1) Single standardized letter template makes generation of follow-up letter easier to generate versus free COMMUNICATIONtext2) It incorporates evidence based guidelines into the generation of time and follow-up procedurerecommendations3) Using smart data elements enabled reporting on reports 81 | P a g e

Session 11 EMERGENCY (ASAP)FROM SEED TO HARVEST- TRAUMA NARRATOR―Lynne McCullough, MDTrauma Narrator FunctionalityKey Points:1) Building a user friendly trauma narrator for nursing documentation is possible2) Approach to training & roll out is keySession 23DON’T HAVE A COW, MAN- WEB SERVICE WAIT TIME APPLICATION―Sheikh ShehzadTrauma Narrator FunctionalityKey Points:1) Building a user friendly trauma narrator for nursing documentation is possible2) Approach to training & roll out is keySession 91WEEDING OUT SEPSIS- EARLY ID & INTERVENTION―Lynne McCullough, MDTwo institutions demonstrated their approaches for early ID and treatment of sepsis in the adult and pediatricpopulationKey Points:1) Elegant triage tools can be built to identify sepsis; Difficult to get the sensitivity & specificity just right2) On-going monitoring of VS for patient VS trending improves capture rate3) Detailed collaborative work with other teams (willow, orders, etc.) can create improved antibiotic deliverytimes by eliminating re-work of inaccurate pharmacy orders―David GomezObjective: Define SIRS (Systemic Inflammatory Response Syndrome), Sepsis and Septic Shock (US incidence is1.7 million cases/year). Studies have shown that timely antibiotic treatment saves lives. BPA created \"It 2SIRS Criteria met\" it sends a page and the patient is admitted in to a room where the physician sees thepatient in a timely manner.Key Points:1) Very important to identify and gather all necessary stakeholders in the same room to discuss and plan,including project timeline and responsible persons2) Identify goal of any intervention including quantifiable metrics to measure impact―Shehzad SheikhThe presenters from UCLA and University of Iowa emphasis on fatalness of Sepsis and importance of howcatching the symptoms early on by the minutes can decrease the mortality caused due to sepsis. Also talkabout the solutions currently implemented to prompt clinical staff for early identification by doing somecustom builds in Epic.Key Points:1) Informatics could be play a vital role in fighting the diseases such as sepsis2) Partner up closely with the clinical informatics teams at UCLA to assess the cases for value adding(Specificity, Sensitivity and Prevalence) with the real-time analytics ability with in OHI 82 | P a g e

3) Accuracy is a key element in generating alters for the cases such as Sepsis to minimize false alarms EMERGENCY (ASAP)Session 95IMPLEMENTING ICD-10-CM IN A MULTI-SITE PEDIATRIC EMERGENCY DEPARTMENT―Andrew BeerA presentation by Cincinnati Children's on their implementation of a clinical ICD-10 go-live. Discusses theirdecision making in choosing how to present ICD-10 to the end users, and also their preparations for dualcoding.Key Points:1) The setup they finally settled on matches UCLA's clinical ICD-10 strategy closely. For example, they areallowing more general diagnosis terms to be used on the problem list, and requiring more specific codes inVisit Diagnosis field only2) They found issues with performance when general terms were searched for (searching on \"fracture\" forexample) as the volume of codes in ICD-10 is much larger. They found a solution through an SU which bringsan enROL setting to system definitions which allows the lookup time for search windows to be limited,preventing the system from hanging during searchesSession 144ED TO L&D WORKFLOW―Lorraine Malden, RN, BSNOptimize Epic build to address non-standard workflow for the ED to L&D pt.Key Points:1) Need field to indicate where the delivery occurs for BOA (birth out of asepsis): LDR, ER, Out of Hospital,Ambulance, Other (comment)2) The screening tool built by this Florida hospital in ASAP for L&D pts being triaged has application at use inour facility. The L&D clerk uses the transfer button to arrive ptSession 168DATA GOVERNANCE FOR ASAP WEBI UNIVERSE DEVELOPMENT―Francisco JordanMount Sinai Medical Center – Miami. Developed an ASAP WebI Univers that allows users to queryinformation on their own with little reliance from IT. Metrics were determined and documented to clearlyindicate where in ASAP the action that triggered the metric should take place. Created reports to tracktrends. Converted the data flow into a Universe, once the metrics were considered \"stable.\"Key Points:1) Difficulties in getting everyone on the same page with the true definitions of the various metrics at hand.Required many meetings with attendance from various disciplines2) Many folks had different definitions on even basic things such as when is a patient \"arrived\" in the ED3) Once the stakeholders agreed on metrics building the reports was easier. But there were many iterationsof the reports and updates of the Universe that needed to take place to meet the needs. It was alsoimportant to have a central group to decide on update requests as more and more folks got their hands onthe BI tool and the report outputs―Frank Day, MDLearn about an ASAP WebI Universe that allows users to query information on their own with little reliancefrom IT. Presenters from Mount Sanai discuss how metrics were determined and documented to clearly 83 | P a g e

indicate which actions trigger metrics, and demo reports created to track trends and convert the data flow EMERGENCY (ASAP)into a Universe, once the metrics were considered “stable”.Key Points:1) A governance committee standardized metric definitions and change management2) Created universe from clarity, accessible by end users via webi and business objects info view (can wrapwebi reports in radar 2014)3) End user errors do occur, but they can compare with daily summary reports and call reporting team forsupportSession PAC06EARLY IDENTIFICATION OF SEPSIS IN A PEDIATRIC ED―Francisco JordanReviewed ED Sepsis build done by the University of Chicago. Using Epic to document and clinical decisionsupport to identify pediatric sepsis patients in their early symptoms and easily intervene. This has helpedreduce the mortality of this sensitive and vulnerable population.Key Points:1) NY regulations prescribes that all hospitals have ways of alerting of patients at risk for sepsis. Based onvarious indicators, i.e. labs, organ system dysfunctions, respiratory syndrome, temperature, etc.2) Adopted a way of alerting by looking at 4 vital values, 4 clinical conditions, and 4 other abnormalities.Based on the findings the system would fire a BPA for RN with additional tools to document on. Once thosewere documented and the physician entered an additional BPA would fire for MDs to document on3) Reviewed outcomes since their implementation of the tool. RN BPA fired more often than MD BPA.Average of 2000 visits per month. Required a lot of testing and buy in from CNO for appropriate nursetraining and education―Frank Day, MDReview sepsis screening smart forms and BPA decision support to assist early identification of pediatric sepsispatients. Presenters from University of Chicago discuss their build and multiple BPA strategy (different forRNs and MDs).Key Points:1) Smart form data collection for triage nurses, BPA fires for RN each time new vitals are entered, includeslook back that allows for data correction2) Additional BPA for MDs, a \"chart review\" option allows is to fire again when next MD opens chart; 80 firesper 2000 visits, lots of false +s3) The majority of sepsis patients are being picked up by abnormal vitals, as opposed to clinical parameters(which are usually documented on obviously sick children, but not in real time)Session SNAP10ASAP DISASTER DOCUMENTATION- NO PAPER REQUIRED―Francisco JordanGenesis Healthcare described their approach to documenting on patients while in Disaster Mode. Theyreviewed their build approach and defining the workflow with nurses, registration staff, and others. Theygave everyone access to review orders, results, and track the flow of patients. Conducted a full scale disasterdrill that involved local authorities, fire department, police, etc. No downtime paperwork needed, system wascapable of capturing all information.Key Points: 84 | P a g e

1) Created a disaster navigator in the disaster department. Users have to change the department status to EMERGENCY (ASAP)disaster to see this navigator. This basic disaster navigator has a specific disaster section in it. 1) Disastercharting section, 2) disaster information, 3) Primary survey: Use ABCD format, 4) Physical Diagram, 5) Orderssection2) Regular staff are called to explain the disaster event and expected number of patients. Reg arrives patientsto disaster ED department so they show up on the track boards. Use peds and adult dummy patients so ordersets display correctly based on patient age3) Preprinted bands are given to patients as well as packets with band, triage tag, generic registration forms,etc. Coordinators place patients in bedsSession SNAP14INTEGRATING THE ED INFORMATION EXCHANGE INTO ASAP―Francisco JordanEDIE is a database used by multiple facilities to interface with Epic. It contains ADT and clinical information.When patients are seen in multiple facilities - not related - the data is sent to EDIE. EDIE then sends thatmessage back to other facilities where that patient is seeking treatment. This is useful for patients who arefrequent flyers or who go from on ED to another ED seeking medsKey Points:1) Created an LPR that would pull in the information interfaced from EDIE. Visti Hx, type of visit, Dx, numberof visits, etc. Displays the number of visits the patient has had to various facilities. Can alert if patient has hada certain number of visits in a given timeframe. Providers can also log into EDIE system to get additionalinformation2) Previously the information was received via fax and was often delayed. This integration made theinformation comes up real time. This also helped with patients who have been see in other facilities but arenot alert enough to notify MD. Using this LRP or EDIE the physician can quickly see where the patient wasseen and then use Care Everywhere to pull additional information3) There is build steps in Epic user web. It helps if many facilities are on Epic and on EDIE. Requires a lot ofcustom build to ensure the interface works and the information files correctly to EDIE. Initial build can becompleted in 120 hours. Before implementing should find out how many other local organizations are onEDIE 85 | P a g e

Session 58 EXECUTIVE LEADERSHIPHATCHING VIDEO VISITS―Scott ShermanReview of E-Visits by Stanford; lessons learned, challenges, and items to consider if an organization isconsidering to implementKey Points:1) Use of video functionality currently requires fat client installation on the hardware2) Technology can be hit or miss for patients since they need to have a working video feed of some type3) E-Visits are only allowed for certain insurances do to reimbursement considerationsSession 182REFERRAL MANAGEMENT FOR THE AFFORDABLE FARMER’S MARKET―Deborah FergusonWith the Affordable Care Act implented UPMC (University of Pennsylvania Medical Center) increased theirpopulation to manage to over 2 million lives. They implented a refferral system that is PCP driven. They havedeveloped what they call a \"Provider Concierge Center\" for referral processing. Even if the pt. was approvedto see a specialist and the specialist submits a referral for a service, an In Basket\" message is sent to the PCPand they must enter the referral again, then the specialist referral gets cancelled.Key Points:1) PCP referral driven process can be duplication of effort and time consuming.2) A referral processing center maybe an efficientSession 216GETTING TO GOVERNANCE- FROM SILOS TO SUCCESS―Josi MillerFollowing a history of limited transparency and mis-alignment with IT, John Muir Health developed anintegrated governance structure driven by operations staff across service lines. Key lessons learned were thatadvance planning and solid communication strategies as well as an ability to remain nimble, let them to asuccessful model. Found themselves to be considered a partner and enabler of value across the institutionKey Points:1) Establish clear and concise guiding principles2) Regularly reevaluate the governance strategy both internally and across key stakeholders to identifyopportunitiesSession 239EXECUTIVE OPERATIONS DASHBOARD DESIGN & DEVELOPMENT―Jodi GasparHow to create a dashboard to monitor KPIs and benchmarks to help with staffing and resource cost savingsKey Points:1) Used clarity reports and radar dashboards to accomplish2) Don't do big bank and release groups every 2 weeks3) Summarize data before displaying in exelcius dashboard―Shehzad SheikhThe session focused on building BI by utilization of current reports to build a Data mart, identifying keyperformance metrics to measure and monitor operations, designing the dashboard with drill down capability, 86 | P a g e

deploying interactive graphs and reports. The presenting organization uses tools such as universes over clarity EXECUTIVE LEADERSHIPdata, xcelcius and webi, and demos drill down on dashboard ability.Key Points:1) Taking the agile/iterative approach can improve chances of successful implementation of a BI solution2) Six weeks sized BI efforts are usually the most successful both for project success and customer satisfactionper presenter's experience3) Use of Epic registries can take the BI metrics and drill down capabilities to the next level. We need toencourage leadership to enable teams for using registriesSession 322OVERCOMING THE OPTIMIZATION BLACK HOLE―Samantha CaoScottsdale Lincoln Health Network described how they wrapped their arms around the massive backlog ofoptimization service requests (600+) after go-live. Leadership decision to freeze optimization and convened a\"clean-up\" crew to review and approve/deny tickets (6 week process). Once list was approved, worked withIT group each month to prioritize tickets. Group consisted of people who understood the bigger picture,system build, and operational workflows. Once cleaned up, the organization implemented a structuredrequest and approval process. Patient safety, user-efficiency, strategic-fit, compliance clinical outcomes,financial implications are evaluated with each optimization request.Key Points:1) Optimization requests must be filtered through clinical informatics staffs who then submit the ticket ontheir behalf completes with desired design details. Currently have only 40 open tickets due to their newprocess (2 wk process from submission to build)2) Changes are bundled to production. All minor changes are communicated on a \"huddle board\" that eachdepartment looks at to share changes with staff. Bigger changes are additionally shared through e-learningsand tipsheets3) Organization stuck to standardized system to minimize maintenance requirements (rejected requests thatare user/department specific)Session DAC02GET CURRENT, GET GOOD, BE ELITE & SUSTAINABLE FEATURE DEPLOYMENT―Nina EmersonHow to create a dashboard to monitor KPIs and benchmarks to help with staffing and resource cost savingsKey Points:1) Used clarity reports and radar dashboards to accomplish2) Don't do big bank and release groups every 2 weeks3) Summarize data before displaying in exelcius dashboard―Scott ShermanReview of approach on controlling, influencing and evaluating new project requests from an organization.Projects evaluated using a numerical evaluation methodology to help remove bias and allow for a moreobjective evaluation of projects against the enterprise list of projects. Projects put into 12 week release cycleto help manage against other competing business priorities.Key Points:1) Let data drive decisions and focus for project work2) Control feature scope; include support AC's as a component of evaluation3) Utilize a post mortem/feedback process to identify areas for improvement/strengths for future projectwork 87 | P a g e

Session DAC03 EXECUTIVE LEADERSHIPPROJECT INTAKE, QUALIFICATION, AND APPROVAL―Scott ShermanReview of new project request management at the program level by Kaiser Permanente. Approach outlinedlessons learned, challenges, and implemented methodology that identified value as a key driver for projectselectionKey Points:1) A tool/methodology is needed to develop a predictable means to select projects against other competingprojects based on value2) Demand will always exceed capacity; establish a means to place projects into a holding queue3) Business leaders/owners should help identify strategic goals to help align project selection―Deidre Keeves, PTKaiser presented the evolution of their project intake methodology. Their problem statement was thatproject demand exceeded IT resource capacity and multiple people across the organization were working insilos on the same problems. Their solution was establishing an intake format for project requestors to clearlyidentify up front the business case and anticipated ROI. The intake and prioritization process included a gradeon work effort and impact as well as a scale in each domain for how the project aligned with the organizationskey value initiatives: best quality, most affordable, best service, best place of work.Key Points:1) Make the business owner define up front the problem statements, goals, business case & value propositionfor each project2) Have leadership pre-define what percent of project resources spend their time in each portfolio valuebucket for projects3) For projects waiting in the \"holding queue\" they use a Magic Quadrant view (From Gardner - low effort,high value). They use a project scorecard to communicate to customers how their project request stacksagainst other projects―Scott BaileyKaiser Colorado showed their process to intake, qualify, and approve projects using a business casemethodology, objectively measuring the impact of the project using their organizational goals. Project intakeconsists of a two-hour evaluation, producing a project scorecard with the impact and \"T-shirt sizing\"(S/M/L/XL) of the project. Projects are displayed on a Gartner-style Magic Quadrant - or \"Un-MagicQuadrant\" as the case may beKey Points:1) Great way to objectively measure impact of projects using organizational goals2) Great answer to \"Why don't you like my project?\" - \"We like your project, but here's how it stacks upagainst the other 800 requests\"3) The project intake focus is on the business impact - not the sizing (contrary to what is often seen)Session DAC07BUILDING AN ENTERPRISE ANALYTICS ORGANIZATION―Scott BaileyOur own OHIA delivered a presentation describing how UCLA established a new central analytics andreporting organization, then consolidated existing \"silos of excellence\" to form a central powerhouse of morethan 80 multidisciplinary professionals.Key Points:1) This session achieved \"Legendary\" status within the conference and even Judy Faulkner had heard about it! 88 | P a g e

2) The room was at full capacity, the doorways packed with people - and someone was even sitting on the EXECUTIVE LEADERSHIPfloor. We estimated 500 attendees.3) The presentation seemed to resonate very well with the attendees. There were a number of questionsafter the presentation for the entire team - and even a public offer to \"buy\" Dr. Mahbouba lunch while atUGM―Francisco JordanEstablishing a new department in charge of data, reporting, and analytics to support the organization acrossthe organizations missions. The organization consolidated existing analytical silos of excellence and createdan analytics powerhouse of more than 80 professionals. Presented by UCLA. Discussed the structure used atUCLA to ensure an efficient and sustainable department to oversee everything and anything reporting.Key Points:1) Reviewed a successful organizational chart for the department2) Discussed the many issues facing the organization and outlined potential solutions. Discussed pitfalls andexpensive mistakes to avoid3) Described ways to engage in meaningful internal discussions regarding challenges facing the provision ofanalytics and potential solutions and approaches.Session ES-PC01SOWING THE SEEDS OF PHYSICIAN ENGAGEMENT―Allan Wu, MDDescribing basic methods of keeping physicians involved from project management point of view going up togo-live. Need to be creative as to how to measure ROI on interventions.Key Points:1) Should implement an amazon-like tracking of change flow for tickets so users are engaged2) Provide knowledge assessment of competency with system so can target training appropriately.3) Novant - strict project management of training for highly personalized training with a high degree of safetyemphasis and ability to train and test within the system to place and back-out real orders. You must be safein the system as a low-bar. Had some teaching of workflowsSession General SessionCOOL STUFF AHEAD―Diane CarterTakeaway was development of the EPIC product will be more accessible to the patient and the patient moreinvolved in the recording of their careKey Points:1) June 22, 2105 is the release date for EPIC version 20152) Referring physicians can use link to request a placement or consult. Receiving physicians can review theserequests in Haiku and Canto. Physicians can accept a patient using their iPhone3) Future development efforts will allow patients to get an estimate of future services based on phone thatallows them to prepay for services using mychart mobileSession General SessionEXECUTIVE ADDRESS―Diane CarterJudy Faulkner provided a welcome. Showing growth in attendance in 2014 to 10,300 users attendingsupported by 7,800 EPIC staff 89 | P a g e

Key Points: EEXXEECCUUTTIIVVEE LLEEAADDEERRSSHHIIPP1) Represented this year at the conference were 326 healthcare organizations and 10 countries2) 182 million patients are in EPIC3) 2013 initiative - 12 specialty steering boards were created, UCLA is participating―Scott BaileyThe executive team discussed the future of Epic, the industry, and discussed their international expansionKey Points:1) The \"General Epic\" acquisition had everyone going!2) Epic is aggressively pursuing international expansion3) Epic is creating a new AppExchange program for customers to share add-on solutions amongst themselves―Bernard Katz, MDEpic seems to be trying to meet the needs of their customers and is expanding rapidly―Deidre Keeves, PTThere were 18,300 attendees at UGM this year, 10 countries, 326 healthcare organizations. 182 MillionPatients currently use epic. Judy Falkner reviewed epic strategy and included a call for healthcare industryleaders to become involved in the healthcare reform policy discussion to help improve interoperabilityincluding: rules of the road, provider directory, digital certificates for authenticationKey Points:1) Judy's prediction on next generation of Healthcare: More healthcare consumption but not in the hospital.Epic will focus a lot on ambulatory care, and have AM, AC for the sub areas of ambulatory by specialtyexpertise. They've created specialty steering groups to guide design needs2) Carl reviewed population health management strategy and Epic's future plan to create broader integrationof external data using Cogito data warehouse. He discussed future plans to extend the system to allow sharedinstances of Healthy Planet3) They predicted organizations will compete for the patients and that engaged patients will take better careof their health. Epic plans to develop further in the areas of eVisits, virtual care, teleeverything, and mychartbedside―Tina Nguyen, MD, FACOGLots of new Ambulatory and research stuff coming in 2015.Key Points:1) Care Everywhere2) Express Lane workflows―Shehzad SheikhEpic Executive share the achievements, welcomes new customer organizations, statistics and shed light onorganizational vision and strategy for future.Key Points:1) Leverage Epic's OOB framework for Benchmarking and compare UCLA against other organizations on over300 metrics if possible.2) Machine learning would be a key focus in future development. It could really take health care to the nextlevel―Hawkin Woo, MD, MPH, FACPJudy: Technology drives business. Epic customer curve, 326 total, slope curve with MU poin. 5 million recordexchange per month Epic-epic, 500K epic-nonepic monthly. Hope Is not a Plan. Growing Specialty Board 90 | P a g e

group, Boost Program, Upgrades services, Stars Program, Foundation System Pediatrics ready, Free Externs. EXECUTIVE LEADERSHIPFuture trends - fewer vendors, MU is creating steep barriers. Epic not acquiring. Government will be moreinvolved. Government appointees often represent a constituency and may not know much about topic.\"What you see as work, I see as freedom\". MyChart users have lower NS rate 10% down to under 1%. CEOCarl Use Healthy Planet across organizations to form and meet ACO. Epic Earth. Mychart future - add FamilyHistory details and link family member profiles. New Genomic Module - pedigree visualization. MyChartClinical Trial recruitment with consent form and video consent. Link Cogito, Slicer Dicer, Epic Earth andResearch Network into big data. Nova can auto-scan your system if you may want a new feature. Simplebutton to suppress unused activity buttons. Express Lane - tees up notes, simple navigator composer.Session SAF02IMPROVING SAFETY WITH ACCURATE PATIENT MEDICATION LISTS―Nina EmersonTwo organization's approaches to improving accuracy of med lists through utilizing pharmacy techs in the ED,and clinical pharmacists in clinics.Key Points:1) Utilizing pharm techs to update the patient's home med list in the ED really assisted getting accurate listsbefore admission, since they are focused just on the med list and not the acute needs of the patient2) Whoever is gathering the information from the patient, need to have comprehensive training. They traintheir techs on when to ask questions, how to talk to the patient through role play, provide check lists of whatquestions need to be asked3) Can also utilities clinical pharmacists in clinics. For complex or new patients, physicians can write for aClinical Pharmacist Referral who will then see the patient when they come into the clinic to do thereconciliation and make sure it's accurate. They found focusing on cleaning up medication lists for complexpatients during outpatient visits caught a lot of potential medication errors 91 | P a g e

Session 31 FINANCIALREAP WHAT YOU SOW- NURTURING YOUR FINANCIAL LANDSCAPE―Kathie HaleEAP master file build is complex. Learn key infrastructure & tools to quickly learn about charge issues tomaintain the EAP master fileKey Points:1) Need to provide proof of charge trigger integrity as EAP master identifies where/how much $ will becharged in future state2) Engage finance, IT, EPIC, clinics in revenue recognition3) Review revenue daily & drill down to the EAP level as needed―Jody GasparEAP build has many issues with implementationKey Points:1) Need to provide proof of charge trigger integrity2) Build content in EAP table whenever possible3) Review revenue daily WQs and usage reports dailySession 56THE BIG CHEESE- PROVIDER BASED BILLING―John Luo, MD, DFAPA, DFAAPPatients left cardiology clinics due to higher co-pays, so accurate E&M and Technical charge billing isnecessary to reduce frustration. Depending on the insurance payor, a cloned charge from professional billingis sent for technical charge. This methodology ensured accurate co-pays for the patient, and decreased userconfusion on what charges to file. Handout is essential as it details how they accomplished this.1) For device fee, they added cloned charge with dummy modifier to facilitate bundling in claims processing2) CPT cloning only when the dame for both professional fee and technical charge3) Epic is building in a modified LACE tool into their 2014 model systemSession 58HATCHING VIDEO VISITS―Jody GasparFirst to accomplish video visits and turned in on in 6 monthsKey Points:1) Need to understand the infrastructure requirements of all who may use as each as its own problems withadoption2) Marketing to the right people is key3) Need to educate patients about the value and train the clinical teams on how to engage patientsSession 64BIG DATA TO THE RESCUE―Scott BaileyHennepin County is using big data to build standardized metrics to identify excess costs.Key Points:1) Were able to identify specific areas with high excess costs and prioritize by diagnostic category2) Process: Aggregate data, identify benchmarks, identify variance, produce drillable reports, identify andtarget actionable opportunities 92 | P a g e

3) Using drill-down WebI reports FINANCIALSession 160HARNESSING THE HORSEPOWER OF REGISTRIES FOR BUNDLED PAYMENT―Jody GasparOverview of how they set up their system to handle bundled payment strategiesKey Points:1) Create document utilizing patient tools from my chart2) Use outreach encounter and charge navigator3) Used the health maintenance modifier but maybe not the best choiceSession 199CULTIVATING A CHARITY CARE GARDEN―Jody GasparHow to utilize the Tapestry system to handle their financial assistance programKey Points:1) Load a \"bridge\" assistance pending plan and use co-insurance field to put in 20% assistance (discount)2) Use Registration category = managed care (prelude security class) and benefit package to see what theyqualify for3) Create batch jobs to handle the ones with secondary coverageSession 225BARNSTORMING ACROSS HEALTH INSURANCE EXCHANGES―Frank Day, MDLearn how an HMO uses Tapestry to assist their operations in managing changes in the health insurancemarketplace based on Health Insurance Exchanges. Presenters discuss challenges faced in this newmarketplace environmentKey Points:1) With health insurance reform, coverage isn't effected until premium is collected (Healthcare.gov nowenables paying first month up front). 90% enrolled without agents, many didn't understand plans and wantedto switch plans but had to comply with government rules2) 80% on exchange patients will have subsidies, and many enrollees don't report major events tohealthcare.gov (divorce, new child, lost job)3) Government sends 90 day subsidy termination letters if income or citizenship not confirmed, but don't ccthe HMOSession 306FORUM- ICD-10―Audrey McClenaghanThis class was a description of EPIC'S approach to the upcoming ICD10 transition planning. Due to the pushback of the mandate of ICD10, the transition was obviously delayed. Epic has been ready for over a year nowand is encouraging group / users to begin with Dual Coding ASAP. This will allow groups to have a smoothertransition and have the ability to work out any kinks that may occur.Key Points:1) To check out the USER Web site2) Verify if we are set up and testing for ICD10 93 | P a g e

Session 341 FINANCIALFOCUS GROUP- RESOLUTE HOSPITAL BILLING―David McCloskeySession that allows Epic customers to discuss new enhancement suggestions among themselves and with EpicKey Points:1) Work queue scoring and timely filling parameters2) Charge capture navigator changes multiple line select for charge review work gurus perform CRWQ actionsin Transaction inquiry3) Government sends 90 day subsidy termination letters if income or citizenship not confirmed, but don't ccthe HMOSession 463AUTOMATIC OBSERVATION HOURS CHARGE CALCULATOR―David McCloskeyPresentation that looked at different options to handle observation charge calculation and entryKey Points:1) Used patient acuity scoring system2) Based on documentation and subtracts standard time for procedure (agreed by compliance)OP to IP does not stop the observation clock3) Get presentation and review release noteSession DAC04INCREASING YOUR YIELD- PROGRAMS TO LEVERAGE THE EPIC COMMUNITY―Scott BaileyDiscussed various Epic programs including Emeritus, Stars, and Benchmarking and how to leverage them.Epic's Benchmarking program publishes to academic and pediatric peer groups monthly and requires at least10 unique submissions before metrics are published (to protect identities). In 2015 they will expand toadditional peer groups.Key Points:1) Benchmarks published monthly2) Free functionality, requires operational engagement (free) to validate data3) As of August, 49 clinical benchmarks and 14 financialSession FAC01FINANCIAL ADVISORY COUNCIL WELCOME AND RECENT DEVELOPMENT―David McCloskeyThis session is a welcome and introduction to FAC. See a preview of upcoming development for ResoluteProfessional Billing, Resolute Hospital Billing, Registration, ADT, and TapestryKey Points:1) New features in future releases: tapestry hospital billing integration2) Dual admissions-same patient can be in 2 beds at the same timeOP to IP does not stop the observation clock3) Financial pulse - comparisons across Epic hospitalsSession FAC03HOSPITAL BILLING ROUNDTABLE 94 | P a g e

―David McCloskey FINANCIALThis roundtable session showcases recent development projects and plans for the future of Resolute HospitalBilling. Attend this session to learn about enhancements and provide feedbackKey Points:1) Monthly design review 3rd Friday of the month, bundled payments - international and estimate templatescan use contracts modules2) Can have date range and cumulative billing on same account3) New charge lag dashboard, denial cube and AR cube – Cleopatra preview and new AR evaluation reportSession FAC08REVENUE GUARDIAN―David McCloskeyPresentation of a tool within Epic Resolute Hospital Billing that identifies certain hospital accounts that don'thave the charges you expected. You can hold billing on these accounts until the missing charges are added.Ensures your claims include charges that would have been otherwise missedKey Points:1) Does not work across multiple accounts2) Be sure to test after installing SU’s3) Start with simple revenue guardianSession FAC19PEARLS- WELCOME PATIENT KIOSK―David GomezKey Objectives of the Welcome Kiosks: Convenient self check in, reduce wait time, print appointment details,make payments, sign consent forms and get directions. Customer feedback: Positive - quick and easy to use,convenient and speedy process, Kiosk assistance and efficient check-in process. Negatives - Copay stepswere confusing, pen attachment too short to sign consent, and don't want Kiosks to replace front desk thatthey knew. The goal is to have Kiosk check ins be at 30%, but the Kiosk check ins have been consistentlyaround 20% nearly one year after Go-Live, this includes a 3-4 week period when the Kiosk was down due toan Epic 2014 upgrade.Key Points:1) It was very important to get physician involvement when implementing Welcome Kiosks. In the facilitieswhere there was strong physician involvement there was more usage of the Welcome Kiosks2) Better preparations of Welcome Kiosks with the upgrade. Welcome Kiosks were down for 3 - 4 weeksduring the upgrade, and customer satisfaction went downSession FAC25COWS AND HORSES IN THE SAME PEN- TAPESTRY-RESOLUTE INTEGRATION―David McCloskeyPresentation from Kaiser outlining challenges and benefits to Tapestry integration with Resolute BillingKey Points:1) We should look at options to send 837 claims to tapestry then receive response back if case is part of DOFRor denial to send claim to health plan?Session General SessionCOOL STUFF AHEAD 95 | P a g e

―David McCloskey FINANCIALSession that highlights new features that are will be in new Epic releases or things they are looking into.There are highlights from each applicationKey Points:1) Testing help from Epic2) Ability to build your own APP and Epic boost program – epic assistance program3) Bundled payments Hospital and professionalSession PAC05PEARLS: E-VISITS―Tina Nguyen, MD, FACOGE-visits being used for specific conditions. Minimal to no reimbursements, can require copay. Algorithm todetermine what can be a e-visit and what needs to be seen. Patients can manipulate the system.Key Points:1) E-visits (email not video) may be viable way to decrease urgent care visits2) Need strict algorithms 96 | P a g e

Session 6 INPATIENTHEARDING THE FLOCK INTO MED REC COMPLIANCE―Jason WilliamsThis session discussed how to set up alerts, warnings and other decisions to lead to higher med reccompliance. Topics covered were how to name sections in med rec to make them more clearly to users. Alertsand warnings to drive physicians to med rec and methods to do so. Also how to create system lists andtechniques to educate users and monitor compliance.Key Points:1) Most of these methods are already used by UCLA2) Using med rec compliance report patient list to monitor steps is appreciated (already implemented atUCLA)3) Create Print groups to determine if there are still medications/procedures to complete in med rec (alreadyimplemented at UCLA)Session 10TO CLARIFY, ADD DETAIL―Nina EmersonDr. Reilly from Reading Health System did an excellent presentation on some of the reports they have builtthat are data-rich, but easy to review and interpret the information. He emphasizes that you can display a lotof information in a small space if it's well-organized and you utilize font size, bolding, colors, etc., in smartways.Key Points:1) We need more and better Sidebar reports!! We are really under-utilizing this feature2) Spark line graphs often show the same amount of information as you get from an accordion graph line, butin a much, much more condensed space. The other benefit of spark lines is you can include so much moreinformation on one screen for comparison3) They re-did their progress note template and it is a great use of space. There are some nice tables thatmake it easy to put the plan next the problem it's addressing. I would highly recommend anyone that buildsSmartTexts to review his screenshotsSession 12CLOSING THE BARN DOOR- BIG DATA & REDUCED READMISSIONS―Scott BaileyTexas Health Resources and Parkland in Dallas presented regarding their big data predictive modelingprogram which significantly reduced readmissions. They then implemented this across 6 organizationsKey Points:1) Pulled data out of Epic in real time (HL7 feed), created risk scores using predictive modeling, then broughtthe risk score into Epic (HL7/Java) to integrate with the standard workflow2) Achieved 26% relative reduction in readmissions. Found that often there was little coordinators could dofor high risk patients (often getting transferred to SNF)3) This work was created by a non-profit via grand funding - and they are very willing to share. They are indiscussions with Epic to share via the new AppExchange program―Lynne McCullough, MDIn Texas, they pulled data from multiple EHR's on demographics, clinical and social info to try to do predictivemodeling to reduce readmissionsKey Points: 97 | P a g e

1) Need a strategic plan to approach population management INPATIENT2) Predictive modeling does not always work as you would thinkSession 16GROWING YOUR EHR INTO A FIELD OF DREAMS―Meg Furukawa, RN, MNTwo hospitals presented an overview of real-time reports created that nurses can use to assess qualityindicators for patients on their units. Build strategies were presented along with lessons learned and futureplans for the reports. Outcomes of use, adoption and clinical improvements were discussedKey Points:1) Engage the end users in deciding what information is included in the reports2) Keep the reports simple3) Share outcomes with the nurses so they can see the results of their effortsSession 17CULTIVATE CONSISTENT CHARGING―Christine Alanes, RNLearned that their strategy for charge capture is similar to what we did here at UCLA. There were a few itemslisted below that I spoke with Dr. Cheng we may want to consider looking into to help improve the physicianexperience when chargingKey Points:1) Could creating a \".\" blank charge be a workflow we could us to help determine what charges are missingfrom the physicians charge preference list?2) Could we use \"Help Me\" to better drill down in charge issues?3) Do we need to consider having a streamlined process of testing new EAPs and the chargesSession 21A PATIENT-FRIENDLY AVS- THE ULTIMATE TRACTOR PULL―Christine Alanes, RNUse patient centered language i.e. \"your medications are listed below. You have just had a cesarean sectionand you should be cautious about….\" In newborn documentation refer to your babies. Define specialties,don’t assume pts understand terms like neurology, urology. Gave MDs a picklist of reasons the pt should call.AVE has a tear off medication sheet.Key Points:1) Good suggestions on altering the language in AVSSession 27MULTISPECIALTY SURGICAL CASE REQUESTS VIA EPIC―Hanna TameruSession was presented by health partners. They went over their physician surgery case ordering andscheduling workflow. Surgeons place the case orders via a pre-op orders set. The case order has a status field.Once the surgeon places the order, it automatically changes to a status of RN Pending. This populates the RNboard. RN changes the status to insurance authorization review. Once the authorizers give the case a status ofcomplete, the case drops in a main depot to be scheduled.Key Points: 98 | P a g e

1) To keep the main depot clean, cases do not fall into that depot until they have a status of complete and are INPATIENTready to be scheduled2) The biggest challenge with this workflow was the surgeons not picking the proper preference card whenputting in the case order3) If physicians want to edit a case order they have already placed, there is no way to do so electronically. Itneeds to be a manual process of communicating this to the schedulersSession 45GRADE AA COMPLIANCE – TWO MIDNIGHTS AND THE ADMIT ORDER―David MuiBon Secours and Texas Health Resources shared their build approach to satisfy the CMS rule for TwoMidnights. There are a number of ways an organization can choose to build this, and these two approacheswere quite different than what we have at UCLA currently.Key Points:1) Bon Secours used one admit order that had the typical order questions, in addition to the Estimated LOS.Cosign for this order is required if done by a resident2) Recertification BPA fired 2 days prior for MDs, and 5 days prior for Case managers3) Texas Health did some build to their navigators to make it more apparent to clinicians when there areoutstanding Admit orders that need to be cosigned in order to satisfy the CMS guidelinesSession 56THE BIG CHEESE- PROVIDER BASED BILLING―Jeff Banting, MBAPractice of charging for physician services separate from building and facility overhead. HOD billing as a clinicfor non-gov payors. Billing both PB and HB for commercial payors out of PBKey Points:1) Lessons learned - will need buy in from lead coders, cross training with business owners is a must, and workwith Epiccare on charging functionality (OPC)2) Set up destination routing to route to PB so that the charge router can split the charges and trigger bothpb/hb chargeSession 64BIG DATA TO THE RESCUE―Scott BaileyHennepin County is using big data to build standardized metrics to identify excess costs.Key Points:1) Were able to identify specific areas with high excess costs and prioritize by diagnostic category2) Process: Aggregate data, identify benchmarks, identify variance, produce drillable reports, identify andtarget actionable opportunities3) Using drill-down WebI reportsSession 67HERDING RECORDS- CONTENT MANAGEMENT FOR MIGRATION―David Mui 99 | P a g e

Community Health Network shared their experiences with the new Content Management tool within Epic. INPATIENTThis tool essentially tracks what records should not be migrated, or which records need to be communicatedto certain teams before migration can occur. This is relevant to UCLA as we are currently using this for the2014 upgrade.Key Points:1) To access Content Management, you will need access to DC security. At CHN, build team had access tothese tools2) Content Management cannot account for Category Lists at this time3) Content Management does not have Item control currentlySession 70HARVEST INFORMATION ON CLINICAL DASHBOARDS―Meg Furukawa, RN, MNDashboards were created for nurses and physicians to improve patient care using Reporting Workbenchcomponents. Hyperlinks are included for easy access to information.Key Points:1) Dashboards are an excellent way to display real-time data so nurses can easily tell when requireddocumentation was not complete2) Physicians use dashboards for analytics to provide insight into their performance in using the EHR3) Physicians hate to see red on their indicators―Nina EmersonMount Sinai presented on how they setup their system to appropriately capture metrics needed to populateclinical dashboards. They needed a 'war room' style approach to get the build completed, and how theincreased visibility of these metric to their clinicians has improved compliance in several areas.Key Points:1) The setup is difficult - Epic is new to the functionality, and they needed to get developers to come onsitefor a war room style setup because they weren't getting the answers they needed trying to work remotely.2) They made dashboards the home page because they felt that otherwise, people wouldn't regularly viewthem. However this is then an extra click to get to schedule or patient lists3) Nurse managers use the dashboards in huddles with their staff, and review why certain patients are or arenot meeting metrics as a groupSession 91WEEDING OUT SEPSIS: EARLY ID AND INTERVENTION―Scott BaileyUCLA (Dr. Frank Day and Dr. Lynne McCullough) co-presented with University of Iowa on Sepsis/SIRSidentification effortsKey Points:1) Discussed specifics on metrics for screening2) UCLA targeting antibiotic treatment within 60 minutes (ED)3) The biggest challenge at both organizations was the large number of false positives (1st day at UCLA: 1/3 ofpatients flagged)―Ricardo ZeferinoUCLA Health is implementing new strategies to screen out patients that might develop sepsis. Physicianbuilders have created a new epic module with the ability to screen out patients with sepsis. The application 100 | P a g e