Epic2015 Expert Group MeetingTrip Report
Table of ContentsTop Takeaways ........................................................................................................................................3Academic ................................................................................................................................................11Ambulatory..............................................................................................................................................12Analytics .................................................................................................................................................22Beacon Oncology ...................................................................................................................................29Clinical Informatics (MD & RN) ...............................................................................................................32Communication .......................................................................................................................................42Executive Leadership .............................................................................................................................43Financial .................................................................................................................................................47HIM .........................................................................................................................................................55Inpatient ..................................................................................................................................................56Interoperability ........................................................................................................................................67Meaningful Use .......................................................................................................................................69MyChart and Mobile Apps ......................................................................................................................71Pharmacy................................................................................................................................................78Project Management...............................................................................................................................82Reporting ................................................................................................................................................83Research ................................................................................................................................................95Security .................................................................................................................................................100Systems ................................................................................................................................................103Training .................................................................................................................................................118Other .....................................................................................................................................................121Index by Author.....................................................................................................................................122Table of ContentsPage 2 of 122 | XGM 2015 Trip Report
Top TakeawaysAshley Abraham• My first takeaway is that EPIC has added functionality to Data Courier. We have more options that will let us use filters. We can now broaden our search for Masterfiles, Records, and Items to send, and find an item’s Data Courier-enabled status. The Data Courier tool will better enable us to support the build teams.• My second takeaway is that we can add steps to our audit strategy. We can setup auditing for the Lookit tool and the Cache Prompt. We also can setup EPIC CONNECT to run checks against EPIC employees to see when they have left to the organization so we can inactivate them quicker.David Akin• Epic and Cache are working on synchronous Mirroring of the Cache Database. Once this is released it has the potential to replace PowerHA for AIX.• Cache 2015.2 has numerous performance and monitoring enhancements.Hector Anguiano• Hyper-V evaluation and deployment as a Hypervisor standard for Epic Customers• Epic Print Service changes for Epic 2015 and BCA changes for Epic 2015Mike Artino• Collaboration - Talking to and working with both internal and external customers will help ensure positive outcomes.• Planning - Getting the correct information and the right people together will help streamline development.Mohammad Asad• Install System Pulse Analytics• Install CereBroKevin Baldwin• Comparable organizations are quite interested in using Epic as an academic and research tool. Several discussions centered around how to use the EHR as a source of data for studies and as an educational resource.• As the payment reform continues to shift from fee for service to value based reimbursement, organizations are beginning to find creative ways to integrate accountable care into the EHR. Organizations are interested in continuing to expand interoperability as a means to facilitate transitions of care.Douglas Bell• Research recruitment rates are dismal -- in a study at Fairview/U of Minn., they had an overall 4% participation rate. Using mychart was the most cost-effective strategy in terms of dollars per enrollee; BPAs were the least.• External services for CDS are starting to work. HealthPartners presented a CDS project for adolescent hypertension that sent data out of Epic via web services at each eligible patient visit and then retrieved advice data that drove 3 BPAs. This was needed because the algorithm needs to use a lookup table for BP based on the patient's age and height.Dong Bi• Epic version 2015 has some exciting new functionality to solve some ongoing problems with Willow build.Top TakeawaysPage 3 of 122 | XGM 2015 Trip Report
Top Takeaways• Willow build is more robust at some other institutions compared to UCLA, providing better service and functionality to the business owner.Samantha Cao• Epic is developing new features at a rapid pace for MyChart and MyChart mobile with integration with MyChart Bedside. We need to really implement questionnaires as soon as possible as many of the benefits offered in using MyChart is realized through utilization of questionnaires.• Epic just released app extensibility which will allow UCLA to brand the MyChart app as the myUCLAhealth app with much more room for customization.Tony Choe• Cogito Data Warehouse simplifies reporting and analysis with a data model that is based on a star schema and built on common health care data model components (Allergy, Billing Account and Transaction, Charge Cost Mapping, Coded Procedure, Diagnosis Event, Visit including ED, Encounter, Flowsheet, Hospital Admission, Immunization Event, Lab Component Result, Medication and Procedure Order, Patient Registry, Received Claim, and Survey Answer).• Predicting severe sepsis and septic shock in the ED can be achieved within 1 hour post ED registration. One organization achieved this by implementing a data mining software for processing predictive algorithms and loading the sepsis flag back into Epic via reverse ETL into Chronicles as SmartData element using Data Link. This then triggers a BPA that drives provider workflow. Awesome - a very creative solution! By the way the data mining software used is an open source issued under the GNU General Public License.William Curtis• The Academic Forums showed that you can modify your epic software to include workflows for students at your company. Bringing the clinical experience with Epic to the students. This is including online training instead of face to face training, this way we can monitor more on the back end billing and diagnosis selection for the users. This will also cut down on questions and class interruptions. Real-time feedback for training environments, with auto resulting labs and Pacs imaging to help them document X-rays.• 2015 updates will have a great impact on our users. Reporting has been updated to better help end users accessing the reporting workbench and updates to the SlicerDicer will help tracking real time data for patients. Quick access to change providers to yourself, New content types for preference list for specialties. Also additions to chart search to select items from a note to right click and search a patients chart for this information will help providers find relative information for that patientAna Esquivel• Mobile App Extensibility: We will be able to add wayfinding to mychart application• MyChart Bedside: Epic is working on new modules - Labor and Delivery and Bedside for Kids. Also deverloping a new application, MyChart Companion, to support the work of care coordinators.Meg Furukawa• The EHR creates the illusion of communication but it does not replace verbal communication between caregivers.• Review, streamline and update paper downtime forms to match CareConnect content and workflows as there are now end users who have never charted on paper or learned how to read cursive handwriting.Sudhir Gogada• Epic has developed new features in the performance and monitoring front with its 2015 product release. These features would enhance our ability to monitor, troubleshoot and resolve performance related issues. Few interesting features to listTop TakeawaysPage 4 of 122 | XGM 2015 Trip Report
Top Takeaways are updates to Top Jobs to include add CPU, reads, journal entries, and block allocation. Inclusion of DB time, Web time, Web crash etc. to RTT monitoring.• A key takeaway for C&P team was to learn about Epic's performance team making a switch to AutoIt tool and also development of test harnesses due to the compatibility issues between XenApp 7.6 and HP LoadRunner. This was informative and enables us to plan for our load testing approach, tool kits for future implementations.Andre Gorski• Most presentations demonstrated hands on solutions to analytics questions/issues i.e. what model to select, how result of an analysis applies to patient care, etc.• Results of some of the predictive models did not vary in a meaningful way. In such case, is better to select a model, than have none and operate without.Nikki Hamm• I truly enjoyed the new App and ability to remain organized and connected with other attendees• The speakers that were chosen brought some interesting insight and information to the sessions.Shadi Kalbasi• Best of eLearnings Sessions.Deidre Keeves• Epic is placing major development efforts into advancing in the mobile app space. Improvements are coming in 2015 version for the following mobile applications: MyChart Mobile, MyChart Bedside, Haiku, and Canto. Many of these can be brought back into UCLA's 2014 version of CareConnect. With mobile extensibility on the uprise, ISS should continue developing mobile strategy that includes a strong API integration platform to maximize use of mobility tools.• Epic is currently developing a new tablet based \"Companion\" app for remote home monitoring and health manager for certain high risk disease populations. UCLA should consider being a pilot site for this innovative tool which may help us to bridge the gap when transitioning from a traditional fee for service model to ACO model.Adam Kestel• BCA is moving to a new interconnect based platform for EPIC 2015, and improves upon its auditing capabilities.• EPIC is releasing new tools to assist with management of the Epic Print Service.Shawn Lee• There is a healthy ecosystem within EPIC customers to overcome deficiencies of EPIC features.• EPIC does its best to accommodate concerns and feature requests from its customers.Stephen Lee• Documentation and defined business processes should be points of focus for OHIA with our data assets growing at a very high rate• Successful implementation of a Data Governance program and cultural shift requires both a top down and bottom up approachKelly Lockett• Epic has rebranded the Spring Advisory Conference as XGM with sessions focusing on technical build and customer networking. Epic is moving all focus groups from UGM to XGM. XGM also provides good opportunity to meet withTop TakeawaysPage 5 of 122 | XGM 2015 Trip Report
Top Takeaways developers in hallway booths and usability testing. They continue to stress their desire to have customer-driven development. Frequent question in sessions was \"What should our area of focus be next?\" Submit ideas at https://ideas.epic.com until 4/9/15. Focus Group voting is available 4/13/15-5/13/15 and is a great opportunity to provide input for desired features.• With UCLA's recent upgrade to 2014, this was our first conference where we were ahead of many customers who remain on an earlier version of Epic. It was nice to attend sessions and provide input on how a certain feature has impacted our customers and relay requests from our business owners to Epic for continued optimization.Mohammed Mahbouba• Epic is focusing on the right priorities in the areas of data, reporting and analytics such as the following: • The ability to incorporate external data into the Cogito Data Warehouse (CDW) as well as Chronicles to make these data available in hyperspace (important for Population Health, ACO, Integrated Clinical Network use cases among many others). • Patient stratification capabilities (registries, risk scores, cohorts etc.) • Moving calculations, measurements, algorithms increasingly from the reporting tools level to the database level opening the the doors for a tool-neutral data infrastructure that enables self-service reporting and analytics. • Cogito Services – Epic staff support for targeted engagements • Cogito Analytics Maturity model to measure and benchmark implementation of Epic provided capabilities • Predictive Analytics including implementing a predictive modeling markup language to make the results of predictive analytics accessible and viewable be users.• Validation of our direction and capabilities: • UCLA is now ahead of most organizations nationwide in establishing data, reporting, and analytics foundation from a mindset, toolset and skillset perspectives. • Many organizations are contacting us to learn from our experience with regards to organizational structure, service model, real-time analytics and Cogito Data Warehouse implementation among many other areas. • We are in a very good position to spearhead the implementation of Epic’s new capabilities such as a Shared Cogito Data Warehouse instance, real-time analytics, and incorporating external data into CDW.Liann Manifong• The Epic 2015 unit map will be extremely helpful for various users, including nurses, ACPs, patient placement, EVS and Transport.• The Epic 2015 discharge milestone functionality will be great to facilitate increased patient throughput.Melissa Maurer• Recruitment was a large topic of discussion, and is one of the biggest challenges in clinical research for several organizations. Leveraging new research functionality with Best Practice Advisories, MyChart, and Reporting have assisted with increasing the speed and effectiveness of patient recruitment with clinical trials.• It is favorable to implement a Clinical Trials Management System (CTMS) that interfaces with Epic. It was interesting to hear how other organizations have created single as well as multi-system research interfaces between a CTMS and Epic.Sheyron McNeil• Focus Group: MyChart EPIC has really out done themselves with their focus on the MyChart module by allowing patients to be more engaged in their healthcare and having more access to their providers from the comfort of their home or on-the-go. Some of the initiatives they have created for MyChart that promotes patient engagement is open scheduling, E-Check In, patient questionnaires, adding self to the wait list, and HealthKit integration with MyChart. The HealthKit integration is a joint effort between Apple software and EPIC. This allows any vitals that's reported on a mobile device via Healthkit app such as blood pressure, weight and pulse to feed into the EMR. Patients will have more access to their providers by scheduling video visits in MyChart and MyChart Mobile. Also, with the usage of the Apple watch, patients are now able to receive results and scheduling notifications. Most of these features are in version 2014.• MyAC10:Patient-Reported Outcomes via Questionnaires in MyChart and Welcome UW Health presented a specialized workflow to collect patient-reported outcomes via questionnaires which is important for patient care. This data is alsoTop TakeawaysPage 6 of 122 | XGM 2015 Trip Report
Top Takeaways important for research, reporting, and marketing. UW Health piloted reported patient outcomes via questionnaires within their orthopaedic program. This involved the integration of MyChart and Welcome applications. First, they created a multidisciplinary team to help with the project, consisting of HIMS, Compliance, MyChart, Admin, Physicians, and IT. To assist with getting data in and out of EPIC, they decided to create questionnaires and have them available via a Tablet at the Orthopaedic clinic. The Tablet procurement process included EpicCare Ambulatory, Cadence, MyChart, Prelude, Welcome. Patients could complete questionnaires via MyChart or in Welcome on a tablet in the clinic. Once the questionnaire series was completed by the patient, an end user would run the RWB report and patient would appear indicating questionnaire complete.Janet Ng• Revision in Epic recommendation regarding the build design for Inpatient (IP) days. Epic is now recommending IP treatment days to be built as multi-days instead of super-day. It will improve the workflow for unexpected hospital admission. This approach may deem appropriate by our users with new 2015 functionalities for auto-completion of treatment days in the back-end, and auto-hold of treatment plans upon hospital admission. UCLA Beacon Team should analyze the new build design and workflow.• Therapy plan enhancements : (1) Combine the name of merged therapy plans; (2) Separate the lead providers for Beacon Treatment Plan and Infusion Therapy Plan - i.e. set up lead providers for separate episode types. This will allow non-oncologists be the plan provider in therapy plans. UCLA build team should require about the possibility of SU the enhancements.Michael Nguyen• Cache shadowing to mirroring conversion discussion and implementation. The mirroring technology should be implemented as par to our disaster recovery solution.• Security for the Cache Database Server plays a vital role on keeping our Epic application safe. Types of text access, how access can be controlled, and how actions can be audited while allowing users to have needed access needs to be addressed in any organization.Dan Noll• The majority of the sessions i attended fell into three categories. One, the topics seemed to be more focused for organizations that were about to go live or about to go through an upgrade. Two, the build is too unique and is catered towards the presenter's organization and doesn't apply to UCLA. And three, UCLA simply does it better.• I thought the Epic presented topics were the best. I found the sneak peek into new 2015 cadence build to be very enjoyable. I wish they had one for ambulatory and that is my main focus. I was a little disappointed that they didn't have a grand \"Town Hall\" presentation as they do at UGM. I love hearing about the global status of the organization. I hear the idea is to split UGM into two and the other half will attend XGM. I hope they bring the Town Hall to both.Nagesh Pai• At this XGM at one of the interoperability forum EPIC released what's new in 2015 version for bridges and interconnect. The FHIR and SMART architecture for mobile applications was one of the announcements from EPIC during this forums. EPIC had a one day workshop related to SMART and FHIR. I have met with EPIC that UCLA is interested in talking further in relation to SMART architecture as we embark on mobile application development and integration.• Virtual desktop was another interesting presentation done by Metro Health. They have realized 2.75 million per year in benefits. The presenter talked about the different hurdles that they encountered and how they overcame those hurdles. Overall a good presentation with a lot of good information. If we at UCLA will take on Virtual desktop project as it is recommended by UCOP it would be good to talk to this presenter from metro health.Top TakeawaysPage 7 of 122 | XGM 2015 Trip Report
Top TakeawaysRupin Patel• XGM is an fantastic experience for a first timer. Not only it provides an opportunity to learn about the new upcoming features in the next release but at the same time provides an opportunity to interact with others from other organizations on the similar challenges that we face at our organization.• The new upcoming improvements to user security provides the flexibility to limit functionality to a specific section in the user security. Additionally, the new features like the embedded help text, usage report, search box will be great additions to find all info in one place.Ayan Patel• We need to be able to provide actionable analytics. A bunch of charts and graphs do not mean anything unless they translate to organizational change, whether it be a small process improvement or an institution-wide policy. This will allow UCLA to cut costs and improve quality.• Epic is determined to be a complete solution for all functions of a health system: from finance and regulatory to clinical operations and research. We, as UCLA, will need to determine whether we wait for Epic solutions to be developed or purchase non-Epic solutions to resolve immediate needs.Wendy Peters• I was able to see future functionality for the 2015 version of Epic and give my feedback for future enhancements. Having the ability to see what is coming and give ideas for future enhancements is crucial for an organization. If we aren't there to do it another organization will and what's important to UCLA's patients, providers and staff won't be heard.• Seeing the way other Epic customers utilized functionality was very thought provoking. It either gave me a new perspective on how the system could be utilized for different workflows or to address common issues.Saul Ramos• The overall experience of knowing that UCLA is in line or ahead in making the most effective and efficient use of our technology infrastructure investment.• Epic did not have the answer to our problems but learned through customer interactions that we share common problems and growing pains. We share contact information with other customers to share our experiences.Shams Ravi• The target platform for Cache/Epic 2015.1 is RHEL 7. Intel Xeon is the preferred processor.• Epic has developed new features in the performance and monitoring front with its 2015 product release. These features would enhance our ability to monitor, troubleshoot and resolve performance related issues.Aaron Rumney• I learned of new upcoming features to be added to Epic. This helps us understand which direction Epic is going so that we can better prepare for the changes.• I learned many tips and tricks for troubleshooting, along with creative solutions that other hospitals were using for common issues.Eric Schmidt• UCLA is adequately prepared for stage 2 meaningful use. We may see an increase in adoption if we provide more transparency to physicians on their own individual performance through the use of interactive dashboards.• The Analytics council doubled in size this year. The biggest struggle for most organizations still seems to be seamlessly integrating outside data into the hyperspace workflow.Top TakeawaysPage 8 of 122 | XGM 2015 Trip Report
Top TakeawaysMatthew Scruggs• UCLA Health has quickly become a leader in mastering and leveraging EPIC system toolsets in new ways that enhance hospital management and ultimately improve patient care. Our peers as well as EPIC are clearly impressed by the presentations UCLA gave at XGM 2015.• For me, the greatest value of attending XGM 2015 may be the personal connections I made with EPIC employees and peers from other health organizations. These new relationships and the ability to share knowledge and experiences throughout the year will definitely be helpful in my work at UCLA Health.Shehzad Sheikh• FHIR (Fast Healthcare Interoperability Resources) is the new open web service standard developed by HL7.org that could revolutionize the integration with EMRs including Epic. HL7 V2 and V3 RIM messages have always been considered heavy and complex implementations, because of the payload structure and formation, it make it hard to parse and program around the HL7 payloads. FHIR Web APIs are built on most popular and widely adapted web standards using HTTP protocol that are accessible both in JSON and SOAP/XML formats. FHIR is promised to expose most of the HL7 V3 resources as web service endpoints that would not only promote applications integration but drive innovation by encouraging developers to write rich client web apps using the FHIR APIs. At UCLA ISS we are positioning ourselves to be one of the first ones to adapt to this new standard by developing applications around our real-time data needs use cases in a much more standardized way, that would be easy to share and potentially compatible with any other major EMR’s. First set of FHIR Resources will be available in Epic 2015 and Epic will continue to build and make more FHIR resources available in subsequent releases.• App Exchange is coming soon by Epic. App Exchange is an App store for epic customers. Epic customers and developers can submit their apps to share with the community for free or sell it to other Epic customers. The apps can be pertaining to Content, Standalone applications, Visualizations, applications in concert, and reporting and analytics. We at UCLA plan to submit our generic webservice client app that we developed to enable Real-Time Analytics for Hospital Operations.Faisal Siddiqui• It was beneficial to find out the upcoming functionalities of Epic 2015 as well as the industry trends presented by other healthcare organizations. Tool like VDI (Virtual Desktop Infrastructure) being utilized at other organization resulted in hardware cost reduction, increase in productivity and better response time.• By attending several sessions and discussion with other organizations regarding their implementation strategies, challenges and testing approach, I must admit that UCLA is more formalized and process oriented versus most organizations.Stephanie Smith• FHIR standards available in Epic 2015 should help facilitate more efficient implementation of mobile apps.• Group Health took 16 months to implement eHealth Exchange requirements.Joel Stolk• Printing will continue as is, although because of customer pressure, Epic is adding back in locally (not client side) printing. We continue to be at the forefront of printing management for EPS. Citrix printing will not return.• Many customers are taking interest and/or moving toward Red Had Linux on Intel, and away from IBM power/AIX. We've made some connections with other customers moving this way, and will be following their progress.Cromwell Suarez• UCLA was well represented in this year's first XGM; Would like to see more UCLA presenters and showcase our talentsTop TakeawaysPage 9 of 122 | XGM 2015 Trip Report
Top Takeaways• Everyone involved with ISS/CareConnect should be required to attend XGM or UGM, it's a great learning experience and you learn new things from other applications.Angelica Thornton• Communication is key. Communicate with your providers and staff.• Leadership buy-in is essential to Meaningful Use success.Paul Tung• There is a huge increase in interest and focus around analytics for both Epic and their customers.• I think we have a better relationship with Epic than most organizations based on the sessions I attended.Diana Ty• Along with a go-live readiness assessment, a \"staying alive\" readiness assessment is helpful to continue the coordination between teams, consistency in build and approach, enforce communication, possible course correction, and celebration of accomplishments!• In the Ambulatory Focus session, there will be a lot of In Basket enhancements in version 2015 to include: results can be released to MyChart when writing a result note or as part of a QuickAction and an improved look and layout for many In Basket reports. Additionally, Chart Review will allow customization of font styles and colors, along with the rearrangement of quick filters.Vu Vu• Cogito Data Warehouse was highly presented on at this year's XGM. There are a lot of interest in the user community to go to this platform to simplify report development due to complexity of Clarity Data Models.• Epic is sticking with SAP as the main source of Business Intelligence Tools, e.g. reports will continue to be on Crystal (Business Objects) rather than reporting services.Andrew Weaver• Usability and automation were major themes at XGM. The goal is to expand the number of staff that can easily perform functions within Hyperspace. Current initiatives include improving patient estimate functionality, automated rules-based filing order, redesign of the transaction inquiry screens, updated preference lists, and improved payment collection workflows. This focus on usability should also extend to self-service reporting to allow for greater access to data by end users.• Epic considers engaging patients via MyChart a top strategic priority. Involving patients from a financial standpoint can drive the adoption of MyChart. Current MyChart development includes bill pay, payment plan set-up, scheduling, waitlist management, and check-in. These initiatives can serve to increase patient satisfaction while helping to reduce the operational burden on the Front Office and Billing Office.Matthew Yee• It was very insightful to see that Epic has put great effort into creating a robust data warehouse and improved their reporting structure and capabilities. Attendance has more than doubled over the past year to show that analytics is becoming an integral part of healthcare.• There are a lot of creative ways to use Epic and the data that is produced. I was able to see many different tools that other organizations are using to interpret all this information and also some of the pitfalls that other organizations have gone through that we need to avoid.Top TakeawaysPage 10 of 122 | XGM 2015 Trip Report
AcademicDocumenting Medical Student Clinical Experience (LCME ED-2) Using Epic (AF02)William CurtisThe student experience in an EMR system Extracting data from Epic to make sure students are documenting the correct information. Key Points: • Creating student reports to generate scoring for documentation • Creating a student note for documentation sign off • Students to review information to help better assess patients in the futureAcademic Forum Welcome (AF01)William CurtisNew updates for 2015, Canto updates to include Hand off functionality. Adding the the same functionality to a print group associated withthe desktop Epic application. Adding the copy note from the notes activity for easier access. Key Points: • Canto update for Hand offs • Updated To do activity for Canto • Hyperspace summary to include hand offPEARLS: Academic Informatics (AF07)William CurtisAcademic promotions for PI's Key Points: • How to promote? Can we show service/teaching/and help to promote? • Using Userweb posts and updates as an example • Using publications to determineGet Them Home Safely and with Their Medications (AF04)William CurtisThis session was dedicated towards discharging patients and making sure they have the current and correct medications Key Points: • Compound meds need to be work on with out pharmacy • Create a cover sheet for meds, instructions for Pharmacy • adding a flowsheet for pause of care so the correct meds go at the right time.An Active Student Learning Experience (AF03)William CurtisThis session focused on the student experience with a training environment. Updating this environment to look like real life experience. Key Points: • History/orders and BPA's are tested and added • Real time results routing for result messages and orders • using discreet data to track students progessAcademicPage 11 of 122 | XGM 2015 Trip Report
AmbulatoryDesigning Effective Workflows with Workqueues (SAC06)Dan NollEpic talked about the best way to optimize workqueue build. I wish this topic took place before we created ours. This is one of the onlypresentations i plan on revisiting to get more information. Key Points: • Make sure you go in with an idea of what you want to create before you build your workqueue • Ask these questions about workflow: What actions need to be taken? Who needs to take that action? When is that action ready to be taken? When is that action completed or no longer needed? • To prevent lost referrals, you have two strategies: 1) Using rules to get the Ying and Yang to fit together. 2) Using child queues so you have a catch allKeeping the Patient at the Forefront: HIE across Organizations (DAC02)Sheyron McNeilNovant Health organization presented how they use their interface with HISP and eHealth Exchange to maximize the transfer of patientinformation and improve the quality of patient care. Key Points: • Implemented e-health exchange with the VA last year. • Conduct direct messaging via HISP for Surescripts • 1st Organization in North Carolina to join the E-health exchangeImplementing ROI in EpicCare Link (HIM05)Faisal SiddiquiTampa General Hospital implemented ROI in EpicCare Link to provide access to the auditors from insurance companies by maintainingthe same level of security. HIMS staff to control the patient access and granting limited access to the auditors. Key Points: • Utilizes Hyperspace ROI reports • No need to mimic the build • Advantages of implementing ROI in EpicCare link are controlled patient access, limited view, convinient, remote and secureImplementing Healthy Planet for Complex Case Management (ACF01)Ayan PatelHealthy Planet implementation is complex, especially with with so many different types of staff involved. You will need to customizeHealthy Planet to meet your organizations needs. Many solutions are not what we would consider elegant, but rather work arounds. Key Points: • Organizations will need to be creative when implementing their workflows -- out of the box functionality may not be enough • Engage case managers early and leverage them to help improve proccesses and implement work-around solutions • With multiple sites, case management workflows will vary.Helping users find Notes, Results, and Scans (HIM10)Dan NollThis was a session from an organization in Fairview, Minnesota who talked about how they tackled Chart Review. They discussed howthey managed scanned documents and organized their Chart Review tabs.AnalyticsPage 12 of 122 | XGM 2015 Trip Report
Ambulatory Key Points: • UCLA basically does the same process that this group demoed. • They have a filter on most of their tabs that hides documents that were scanned in prior to their go-live. • The auto-routing rules apply when scanning via media manager. Something to note.Getting the More Out of Reporting Workbench (ANC13)Kelly LockettNebraska Medicine presented their approach for Reporting Workbench reports. Discussed transforming column output and use ofextensions, rules, and translation tables. Key Points: • Stressed importance of understanding problem you are trying to solve and your customer prior to report creation • Can use Report Column Catalog in Galaxy to obtain information on extension records. Epic does not have LPP catalog. • Sample build demo'd for rule-based columns and when to use rules.Free Public Health Screenings Made Easy (PAC46)Diana TYYale provided free Public Health Screenings for Prostate Cancer and Head & Neck Cancer. Patients would present to these screenings tobe evaluated by physician, which would determine if a referral is needed to see a specialist. Key Points: • Patients can pre-register online for these public health screenings to help with faster check in process • Same build for screenings across health system for ease of future use for new specialties • Small percentage of patients participating in this screening were referred to a specialist and diagnosed with cancerFlu Vaccination (NAC07)Diana TYNovant Health discussed their flu vaccination clinic build and workflow. Eliminated paper patient questionnaires and allowed patients toschedule flu shot appointments from MyChart. Key Points: • MyChart direct appointment scheduling allowed patients to schedule their flu shots to a generic resource • Paper questionnaires regarding flu vaccines were built as questions attached to the order and administration • Helped streamline efficiency of vaccine ordering and allowed multiple vaccinations to be administered altogetherFG Haiku Canto (FG Haiku Canto)William CurtisUpdates for the use of your Haiku and Canto apps for phones and tablets 2015 Key Points: • Dictation through your phone with voice recognition • capture images and add to documentation from apps • Apple watch for vitals and mychart signupA Hospital’s Response Plan from an Unexpected, Extended Downtime (NAC09)Meg FurukawaThe presenters told of their experience with an unplanned, extended downtime where Epic was unavailable for over 20 hours. Theydiscussed the hospital's response plan, lessons learned, recommendations, and considerations to ensure a successful and safe plan isprepared for an unexpected, extended downtime.AmbulatoryPage 13 of 122 | XGM 2015 Trip Report
Ambulatory Key Points: • Set up and use an Incident Command Center from the beginning of the outage • A major IT outage should be considered an operational emergency and treated as such • Train staff to know what to do during an outage and conduct periodic drills to make sure they can follow the downtime processesDriving Value: An Enterprise Approach to EHR Benefits Realization (DAC01)Sheyron McNeilLakeland health organization presented their approach for implementing EPIC at an enterprise level. One of their important strategies wasnot to stretch the implementation project out and to use the Big Bang Approach. Key Points: • By not stretching the implementation project, Lakeland was able to shift optimization focus faster. • Their project budget was 60 million, yet they only used 37.5 million. • They implemented several initiatives to promote patient safetly such as preventing adverse drug events and patient base radiation safety program by using BPAs, which help to save on the average cost of care.Needle in a Haystack: Identifying and Matching MSSP Patients (ACF06)Ayan PatelThe patient matching criteria in Cogito is not sufficient. Pre-matching on HIC number is the best approach. Matching is more of an art thanscience. Key Points: • Built-in Epic patient matching does not suffice • HIC numbers have changed • Customize matching crieteria to what works best for your organization, it will never be 100%Designing Effective Workflows with Workqueues (SAC06)Wendy PetersAn Epic TS demonstrated a comprehensive approach to building referral and schedule order workqueues Key Points: • Design: 1. What action needs to be taken? 2. Who needs to take the action? 3. When is action ready to be taken? 4. When is action complete? • He also discussed how to prevent black holes, using rules to get the Yin and Yang together, Using Child WQs to catch all and monitor your parent WQs foe trends. • He demonstrated how Patient WQs could catch patients with non covered services rather than just missing reg items.Customizing the ACO Registry for MSSP and ACO Reporting (ACF07)Ayan PatelReporting help determine which ACO quality measures and metrics need improvement and which population to target. Actionableanalytics. Key Points: • Use Health Management modifiers to include patients in ACO registry • Use Meaningful Use groupers for the registries • Requires both Reporting Workbench and Clarity dataAmbulatoryPage 14 of 122 | XGM 2015 Trip Report
AmbulatoryConnecting Patients across the Care Continuum: The Post-Acute Dilemma (DAC04)Sheyron McNeilTexas Health Resources (THR) connected the medical records of patients in over 120 independent post-acute facilities. Key Points: • The current organization does not have ADT/Prelude or Cadence. Registering patients was done in IDX. • Once the registration was completed in IDX, the information fed into EPIC. This was needed to drop charges for patients. • Due to this workflow, there were several issue identified such as duplicate records.Communicable Disease Screening and Documentation (DAC06)Sheyron McNeilSCL Health implemented a Communicable Disease Screening and Documentation to address the international concerns regarding theEBOLA virus. Key Points: • SCL Health created a questionnaire that would fire a BPA depending on the answers submitted by the patient. • The EBOLA triage screening tool consist of DOC flowsheet and navigators. • Some of the questions include 'have you been out the country', 'where', and 'did you get ill or expose to anyone who was ill.'Checks and Balances: Using Cadence Functionality in Access Initiatives (SAC02)Dan NollBoston Children's Hospital gave their ED department the ability to book appointments into specialties. For example if a patient came intothe ED with a neurological issue, they would book a follow up appointment at the end of the ED visit. Key Points: • This wont work for us because who is going to obtain that authorization? The ED department? No. • This would work well for departments that dont need prior authorization to see patients, if the ED has the time book the appointment. • They did give a nice prompt when selecting Visit Types for schedulers to inform the patents that their appointment is booked with a NP rather than an MD. the prompt is to reassure the patient that the NP is worthy person to care for you.Care Everywhere and the Technology Behind the Scenes (ITF04)Cromwell SuarezDiscussion on technology behind Care Everywhere, including security features, communication standards, and flexibility with connecting toother systems. New standards in the industry and the future of Care Everywhere development. Key Points: • Performance releases: Improve documenta retrieval • Performance releases: Impporve system timeout configuration • Future: Integrating outside data (other vendors) into EpicBeaker Implementation: Clinicians Make a Difference (NAC58)Meg FurukawaThis session described the process that involves clinicians to evaluate workflows, policies, clinical standards, and documentationrequirements for consistency with safe practices as part of a planned Beaker implementation. Key Points: • Need to involve all clinicians who will be obtaining lab specimens early on to make sure the workflows are known • Test each device • For patient safety reasons, printers were at the bedside in all ICUs, and specific printers were mapped for specific rooms on the MedSurg floors to prevent walking around with labelsAmbulatoryPage 15 of 122 | XGM 2015 Trip Report
AmbulatoryUniverses, WebI, and Where They Fit in an Analytics Strategy (ANC34)Vu VuHealthcare partner uses a combination of Universes and WEBI in their BI stack. They currently have universes for Hospital Billing,Professional Billing and some Custom Developed. The universes are exposed to their end users, non - IT. Key Points: • ECI based on WEBI are actionable in Hyperspace • Cubes are built on Microsoft Analysis Services • Microsoft Integration Services is the ETL tool usedADT/Registration Roundtable (FAC04)Cromwell SuarezThis roundtable session discussed recent development projects and plans for the future of ADT/Prelude. Learned about enhancementsand provide feedback for furure enhacements. Discussed new features for 2015: Leave of absence fuctionality, unit map view, eventmanagement enchancement, news feed dashboards for patient placement, mobility for transporters \"red cap\" application integrated intothe apple IOS platform. Key Points: • Prelude: Load insurance from external sources and trigger RTE; Create coverages by single swipe/scan • Prelude: Add insurance information into MyChart by scanning barcode from patient insurance card • Prelude: Kiosk Enhancements to for patients to view average wait times on screen; Welcome tablet enhancements (microsoft surface can also be used)EHR 2.X: Implementation to Optimization (PAC52)Kelly LockettSutter presented on transition from implementation to optimization and the challenges faced. Discussed opportunities to re-alignresources, various optimization methodologies, and utilization of Epic resources. Provided Prioritization Matrix based on level of impact fornew functionality and resources needed. Key Points: • offering remote work, immersion programs, work from within local hospital or clinic, technology pilots, and continued learning opportunities for talent retention • created internal technical team of cross-application experts. Go-to team before reaching out to Epic TS. • frequently revisit prioritization of projects to determine if you should stop, start, or continue based on changing healthcare dynamics.Scheduling Advisory Council and Cadence Gameshow (SAC01)Wendy PetersThis was a very fun and informative session! A game of Jeopardy was played at the front of the room and you learned about existingfunctionality during the process. Key Points: • Patient Arrival Time- Tells patient to come earlier than scheduled time. • Orders Up- 2015 functionality that allows a provider to schedule a patient during order entry • The Epic system was created in the same basement in Wisconsin around the same time that American Girl dolls were created.Using My Panel Metric Dashboards for ACO Measures (ACF02)Ayan PatelUsing Smart Forms to help meet ACO measures and setting up checklists. Use claims data with EMR data to assess patient risk anddisplay it through Hyperspace.AmbulatoryPage 16 of 122 | XGM 2015 Trip Report
Ambulatory Key Points: • Make the assessments needed for the ACO measures easily available to clinicians to complete • For scoring assessments, dynamic scoring requires work arounds • Use claim data and Epic EMR data for patient risk stratificationTop Strategies to Ensure a Successful Go-Live (DAC07)Sheyron McNeilUCLA organization shares their top strategies for a successful big-bang go-live. Discussion included the various themes used to enhanceorganizational readiness, communication strategies, training, super users, dress rehearsals and command center planning. Key Points: • UCLA used the hollywood theme of LIGHTS, CAMERA, ACTION for their go-live • Lights involved branding and communication of the go-live, engagement sessions, and government structure. Camera focused on getting our end users ready for the go-live by focusing on training, deploying superusers, provisioning, and dress rehearsals • Action took place after we went live by having a Command center and Service Now ticketing sytem.Top Strategies to Ensure a Successful Go-Live (DAC07)Diana TYPresented by Ellen Pollack, she provided an overview of UCLA's implementation strategy for branding and communication, engagement,governance structure, and readiness program. Key Points: • Guiding principle set forth by the governance structure helps with standardization and decision making • End user engagement helps with relieving anxiety and at the same time drums up excitement • Set expectations for go-live issues for printing, security, workflow issues, frustration, and staff fatigueTapestry Upgrades: What is new in 2014 (FAC24)Dan NollThis was a panel of three organizations that gave their input on what to expect during an upgrade. The title was misleading as they didn'ttouch on any new 2014 features. Key Points: • All three wish that they should have tested more security based changes prior to upgrade. • With Nova Notes, ACs would mark the notes that may affect workflows which would go to the training team to review. A second pair of eyes looking at the change. • They all utilized Epic's Upgrade assistance program.Tapestry Roundtable (FAC05)Dan NollThis topic came in heavy with the billing and financial bits of tapestry. They showed off new features and abilities with claims,reimbursement, prepayments, automatic claim line splitting, and much more. Key Points: • refund history gives the ability to capture the event of of a refund in the system. • Automatic Claim Line Splitting based on authorizations. • Now you have to have multiple vendors that have different addresses but the same tax IDAmbulatoryPage 17 of 122 | XGM 2015 Trip Report
AmbulatoryTackling Analytics when Transitioning from Paper to Epic (ANC33)Kelly LockettInova Health System presented 10 challenges faced by their reporting team. Each challenge description included manifestation, gut checkquestion, insight and mitigation, and reference to their analysis plan worksheet. Challenges included \"Users asking for data, notinformation\", \"Users may not understand system behavior\", and \"Users will mistake the build team for the implementer of change\" Key Points: • Success with Lean A3s • Always find out what the customer plans to do with the data to make the report meaningful and useful. • Need tracking mechanism and formal process to refer back to when issues with report and/or scope of report arise.Streamlining Provider Training (TAC25)Cromwell SuarezNebraska Medicine shared how it restructured physician training. As a result of this restructure, they've seen a drastic reduction in the timeproviders spend in the classroom, all while properly preparing them to safely and efficiently document care provided. Key Points: • Identified and emilinated duplicate material between ambulatory and inpatient classes; Attended each other's classes • Creation of a provider test out option allowed for provider satisfication with training, decreased time for those with prior Epic experience • Combined classes: Ambulatory/inpatient provider 6 hours, Inpatient Class 5 hours, and Ambulatory class 5 hoursStork Obstetrics (Focus Group)Kelly LockettEpic demonstrated new features planned for 2015 and discussed suggestions for future development. Epic demonstrated Express Lane tostreamline provider documentation based on a chief complaint. Reviewed new Dashboards and OB metrics and 8 specific ideas underconsideration. Session also included breakout discussions groups for specific topics. Key Points: • 2015 features include filtering the flowsheet template tabs based on CER rules, capturing multiple ROM, and documenting sex and respecting naming conventions for fetal demise. • Epic working to consolidate L&D sign in tool with 2014 Inpatient Sign in tool (and ED sign in tool)Staying Alive Readiness Assessment (SARA) (DAC03)Sheyron McNeilYale utilizes it's SARA (staying alive readiness assessment) program to manage ongoing efforts across applications and technologyteams. SARA is an adaptation of their GLRA that was used during the EPIC implementation. This tool allows them to focus onpriorities/projects, while identifying, escalating, and resolving issues. Key Points: • SARA is used to track priorities and projects. It involves strategic planning along with project management. • The SARA meeting consist of Leadership, PMO, IT Directors, All APP managers/ACs, all tech managers, EPIC TS, Business stakeholders, and vendors. • Some of the items that are discuss involves optimization, multiple projects, Upgrades, SUs and RAs.Leveraging MyChart e-Check In (MyAC06)Samantha CaoSutter Health implemented e-check in without the Welcome kiosk and turned features on that patients stated they'd rather do at home thanin the clinic. They turned on demographics, insurance, copay, clinical updates, and questionnaires. They found that this saved 1-6 minutesper patient for doctors/staff if patients completed the e-check in prior to arrival.AmbulatoryPage 18 of 122 | XGM 2015 Trip Report
Ambulatory Key Points: • Should turn on individual features first, then turn it into a e-check in workflow • questionnaires saves the most time so it is an important feature • Need to consider tablets for patients who do not complete the info.Scheduling Advisory Council Introduction (SAC01)Dan NollThis was a game show where the questions and answers highlighted new features in the Cadence world. Key Points: • There is a tool called Open Schedule. Open scheduling allows patients to schedule their own appointments. • Fast Pass/Auto Wait List, you receive a notification about an alternate appointment around the same time or date. also happens when you cancel an appointment. • Orders Up - Allows providers to schedule orders while documenting in a patient chart. allows users to book appointments right in the encounter.Medical Messaging (MyAC07)Samantha Caometro Health and Mount Sinai achieved high passing rates for Meaningful Use Stage 2 Objective P230 by utilizing MyChart functionality.They utilized a post-visit questionnaire strategy and the history questionnaire. Key Points: • Questionnaires needs to be implemented ASAP at UCLA to meet Stage 2 P230 • Ensure that patient questionnaires do not overlap with any other questionnaires being administeredSAC Fishbowl (SAC08)Dan NollEpic reviewed new features coming in the 2015 or 2015+ versions of epic. There are some really great things coming. We were given theoption to vote on changes that should be prioritized. This was a really great session and look forward to reviewing the slides again andeventually using the new features in the future. Key Points: • June 22, 2015 is when the 2015 version of Epic will be released. • MyChart - Get on wait list feature allows patients to put themselves on the wait list. • Lots of updates to treatment plan - Scheduling orders in the treatment plan can look at the meds and calculate the length.Referrals and Authorizations (Focus Group)Wendy PetersIn this session we were able to see new referral functionality coming in the 2015 version and give ideas for future enhancements. Key Points: • In 2015 you will be able to see what WQs a referral has hit and why and what WQ the referral currently resides in. This is something we have wanted for a very, very long time and we receive a significant amount of tickets on this. We need 2015 ASAP! • You can host an Epic Developer for any application to come onsite and work with your organization on ways to enhance the system in the future.Pharmacy Advisory Council Welcome & General Session (PharmAC01)Meg FurukawaAmbulatoryPage 19 of 122 | XGM 2015 Trip Report
AmbulatoryThis session presented an overview of the new functionality that will be available to pharmacy, providers and nursing in the 2015 version.Some of the functionality will be able to be SU'd back to 2014, others will require an upgrade. Key Points: • PCA/PCEAs will have discrete elements in the order instead of questions. Institutions can identify which elements should appear on the MAR. • Dispense logic with smart oumos - the system can calcuate when the bag will run out based on documentation from the smart pump and print a label at the appropriate time for the next dose to be dispensed. • Can prevent duplicate warnings for same drug with different doses and indications to decrease alert fatigue.PEARLS: Improving Patient Access & Experience (SAC02)Cromwell SuarezHennepin County Medical Center, Boston Children's increased the ability of patients to access clinics and providers at times that work forthem using Lean thinking and standard project management. It reduced the number of active visit types by 90% using a set of 11 core visittypes and reduced scheduling rules by over 80%. Checks and Balances: Using Cadence Functionality in Access Initiatives Thispresentation examines how new and pre-existing Cadence functionality can help in an access initiative to open up scheduling to a broaderbase of users, while also closing the loop between making the appointment and family/clinic preparedness. See One-Clicks, After VisitType questionnaires, SmartTexts, and In Basket notifications. Key Points: • View issues from multliple perspective: Review current and futre state workflows. • Define patient satisfaction metrics • Visit types that affect apps besides Cadence: Interfaces, MYChart, and Registration work queues and audit resultsPEARLS: Implementation and Early Experience with SlicerDicer (ANC02)Shehzad SheikhNorton health and Stanford children shared their experience with SlicerDicer implementation. Bitmap loading takes 1 hour for them. Theydid the demos with the end users in collaboration with analysts group. Preparing training materials and sharing with users also helpedthem quite a bit. Getting timely approvals from Chief compliance and information allow clinicians to access to patients outside of theirpractice is important. Key Points: • SlicerDicer Adds additional time to CDW ETL, that needs to be considered and tested for SLAs and planning • SlicerDicer Backfill can take significant amount of time so it should be accounted in deployment planning • Targeting correct users for SlicerDicer and preparing a rollout plan ensures success with deployment.PEARLS: Implementation and Early Experience with SlicerDicer (ANC02)Joycee BerinTwo organizations describe their experiences implementing SlicerDicer. This session covers pre-planning, technical configuration, security& compliance, rollout strategy (including training and tips for increasing end user adoption), uses cases, and future vision. Plan aSlicer/Dicer implementation, including strategies for driving end user adoption and tips for a smooth install. Identify the right use cases todrive improvements in patient care with Slicer/Dicer. Key Points: • SlicerDicer backfill loads can take a significant amount of time. Allot enough time in the project plan. • Prepare to field questions on who supports SlicerDicer. Have a defined plan for customer support. • Pop-Up box can be developed by Epic to alert users of PHI data which is very useful from a Compliance standpoint.AmbulatoryPage 20 of 122 | XGM 2015 Trip Report
AmbulatoryPartnering with a Lean Team to Provide Specialty-Specific Optimization (DAC08)Sheyron McNeilSutter Health uses the Lean philosophy to deliver a specialty-specific optimization program that focuses on both office work flow and Epicoptimization. Key Points: • Sutter decided to use the Laen approach to promote an environment that fosters continous improvement, reduces waste, and respect for people. • For their GI department, they fixed overbooking or empty spaces for both their office and precedure schedules. • They also designed a playbook for each department to manage the flow of patient care.Panel: Kiosk Optimization (SAC05)Dan NollGroup Health and John's Hopkins discussed the Welcome Kiosk application. they talked about their challenges and results of theimplementation. I played around with the Welcome application and it works very nicely. Key Points: • Welcome Kiosks are easy to implement compared to other patient satisfaction initiatives • They are very low maintenance. • They turned on the ability for walk-ins and Flu visits to be checked in at the kiosk.Workqueue Management (FAC30)Wendy PetersThis session was mainly for HB/PB workqueues. Key Points: • Workqueues can be assigned and filtered by an owning area • UCLA should consider ramping up the use of dashboards and adding workqueue components to eliminate redudancy • PB/HB will have the ability to see neglected WQs by date last accessed and days since last activity. I am researching if this functionality will be available in SOWs and Referral WQs.See Your Doctor Today! (When Capacity Meets Demand) (ANC11)Sheyron McNeilStanford Health demonstrated a specialized workflow to capture appointment subspecialty thru questionnaire build and leveraged it toimprove scheduling efficiency and patient satisfaction. The issue they were facing with some of their specialty providers is that it took 3months to have a visit with them. Key Points: • Their goal was to ncrease new patient access to outpatient care by understanding capacity and demand. • This will allow patients to see their physician and receive care when it is convenient for the patient. • To improve specialty care access from 30 days to within 7 days they revised provider schedules by adding block types, updated SER records with subspecialties, listed subspecialties on referral and DEP record, and built questionnaires in CadenceAmbulatoryPage 21 of 122 | XGM 2015 Trip Report
AnalyticsInnovative Uses of Epic to Reduce Hospital Acquired Conditions (HACs)_fixed (ANC49)Kevin BaldwinGOAL: Best-practice clinical care supported by behaviors designed to prevent error reinforced by leaders who model, support, recognize,and redirect informed by ongoing measurement/analysis to show what's happening, and ongoing learning about what needs to happennext on the journey will achieve 70% decrease in preventable harm in 4 years Key Points: • bunldes are a set of 3-5 specific evidence-based interventions for a defined patient population that will result in significantly better outcomes and lower risks of harmIntegrating Legacy and Outside Data in the CDW (ANC16)Vu VuDevelopment of data integration initiatives should be driven by use cases. data sources and domains by upcoming use cases. CDWreduces complexity for development and better performance for query runs Key Points: • Use Case 1 - Epic Registries, there are a lot of resources available by EPIC • The reporting repository reports are pulling data from roughly 900 Clarity tables • Patient matching is very slow, difficult and complete match is not available.Leveraging Epic's Data Warehouse as Your Data Warehouse Platform (ANC04)Tony ChoeThis session describes two organizations' experiences with bringing up the Cogito Data Warehouse. Presenters cover the factors thatmade their implementations successful and how they leveraged the infrastructure to deliver value to users. Finally, they discuss futureplans and where the Data Warehouse fits in their enterprise-wide analytics strategies. Key Points: • Extend the Cogito Data Warehouse data model to meet the unique demands of your organization. • Create a process to establish confidence in the integrity of the data in the CDW. • Plan a roadmap for a multi-year implementation effort while maintaining capacity to provide timely data to consumers.Integrating Predictive Models into Epic Workflows (ANC18)Andre GorskiSeveral examples of external analysis that NothShore University HealthSystem performed and how these results are integrated withinreporting work bench. Presentation also includes well documented validation process. Key Points: • Regardless how the analysis is performed, final product is presented to the End User in RWB. • RWB due to its integration into EPIC allows for improved performance by clinical support staff (Patient outreach) resulting in increased patient care. • Able to incorporate local epidemiological data into decision support system.Integrating Predictive Models into Epic Workflows (ANC18)Matthew YeeThis session taught how to integrate predictive analytics projects from Epic’s clinical data into predictive models and then integrated backinto Epic workflows for both inpatient and ambulatory settingsAnalyticsPage 22 of 122 | XGM 2015 Trip Report
Analytics Key Points: • From their workflow, they are able to pinpoint specific regions where certain illnesses are spreading and how to integrate it into their clinics and hospitals to prevent other from contracting it • Patient outreach is important to treat and prevent the spread of influenza, pertussis, and strep throat in neighboring citiesIntegrating Legacy and Outside Data in the CDW (ANC16)Matthew YeeLearn how to integrate legacy and outside data in the Cogito Data Warehouse and how to report across Epic and non-Epic data includingPress Ganey, MSSP, and commercial ACO Key Points: • CDW will increase process time and ease of reporting than using just Clarity • Key to integrating data is formalizing how to deploy CDW and a proper deployment processPEARLS: Implementation and Early Experience with SlicerDicer (ANC02)Matthew YeeThis session was an overview of SlicerDicer and how to pre-plan, configure, implement, and the future vision of SlicerDicer for StanfordChildren’s and Norton’s. Key Points: • SlicerDicer is a good self-service tool for quick high level visual reporting • SlicerDicer is very user friendly, but will create a bigger need for other reports and analysis that are not currently in SlicerDicerIntegrated Analytics for Population Management (ANC15)Andre GorskiAn example of Atrius Health progress in population management. Journey from PDF report, through Excel, to Reporting Work Bench. Key Points: • RWB data incorporates both clinical and external/claims data • Able to push relevant external data into EPIC. • Streamlined ability to initiate \"Outreach Encounter\"PEARLS: Leveraging Epic's Data Warehouse as Your Data Warehouse Platform (ANC04)Andre GorskiPresentation of practical solution to Data Warehouse at Baptist Memorial Health Care. Integrating data from EPIC, Lawson and Legacysystems. Current objective is on financial analytics. Key Points: • Organization was able to turn DW into strategic tool. • Data warehouse resulted in higher user demand and increased storage requirements. • Organization used some 6 sigma tools for design data warehouse.Importing External Claims Data into the CDW (ANC20)Tony ChoeLearn strategies for combining Epic data with external claims data in the Cogito Data Warehouse, along with tools used to report on thisdata.AnalyticsPage 23 of 122 | XGM 2015 Trip Report
Analytics Key Points: • Describe the enhanced reporting capabilities of Cogito Data Warehouse after populating it with third party data. • Compare and analyze various external data sources with CDW data structure. • Develop custom import packages for data migration.Importing External Claims Data into the CDW (ANC20)Joycee BerinDescribe the enhanced reporting capabilities of Cogito Data Warehouse after populating it with third party data. Compare and analyzevarious external data sources with CDW data structure. Develop custom import packages for data migration. Key Points:Deploying Patient Satisfaction Dashboard using the CDW (ANC12)Tony ChoeSee an example of how external data was imported into the Epic Data Warehouse data model to populate a dashboard. The examplecovered is importing Press Ganey patient satisfaction surveys to populate a Patient Satisfaction Dashboard. Key Points: • Raise awareness of the CDW as a repository for external data. • Show the relative ease with which data can be imported. • Reveal the primary technical steps for import development.COO Coffee & Donuts: Real-Time Web Dashboards (ANC26)Joycee BerinLearn how UCLA guides executive leaders with real-time, relevant information through a web-based command center. Operational insightand process improvement are demonstrated using occupancy, perioperative, and ED real-time web executive dashboards – the donuts theCOO consumes with his morning coffee. Key Points:COO Coffee & Donuts- Real-Time Web Dashboards (ANC26)Kevin BaldwinOHIA has developed near/real-time analytic capabilities with data interoperability for non-Epic applications. Key Points: • holistic view including census and ADT, operative services, and emergency servicesPEARLS: Business Intelligence Report Library Design and Use (ANC31)Vu VuThe presenter showed the audience their organization's report library design and use. They built a website based on Sharepoint. Thecaptured much of the information outline in EPIC's report library excel sheet. They were able to catalog RWB reports, but there was notmuch discussion on their ability to catalog Clarity Reports. Key Points: • Children's Hospital Colorado - uses the Cogito Reporting Sharepoint Library • It's possible to Identify Epic Standard reports that have been updated by comparing DLG numbers • Use Epic's Upgrade Tool to determine deprecated fieldsAnalyticsPage 24 of 122 | XGM 2015 Trip Report
AnalyticsIntegrating Legacy and Outside Data in the CDW (ANC 16)Joycee BerinLearn how this organization is effectively integrating Epic data with legacy and outside data sources such as patient satisfaction, lab, andoutside claims including MSSP and ACO. See how UCLA is satisfying business-driven needs around reporting, analysis, qualityimprovement, and population management by leveraging and extending the Cogito Data Warehouse. Key Points:See Your Doctor Today! (When Capacity Meets Demand) (ANC11)Andre GorskiStanford's approach to increase new patient access to outpatient care by understanding capacity and demand. Examples of variousmetrics supporting performance and capacity improvements. Key Points: • Organization uses Regression and ARIMA Time-series to predict future clinic visits/demand. • Temporary increases in demand are addressed by temporary shift in resource. • Dashboard support day to day operations: Clinic managers and Clinic Chiefs know their availability, demand, and gap, which allows them to better plan and mitigate upcoming issuesWelcome What’s New & What the Future Holds for Epic Analytics (ANC01)Matthew YeeThis session gave an overview on new reporting and analytics capabilities in Cogito and I was able to see a preview of Epic’s futuredirection for business and clinical intelligence Key Points: • Discussed the many changes and enhancements within Cogito and reporting tools • Learned the future direction of analytics within EpicWelcome What’s New & What the Future Holds for Epic Analytics (ANC01)Joycee BerinIn this kickoff session for the Analytics Council, hear an update on new reporting and analytics capabilities in Cogito and see a preview ofEpic’s future direction for business and clinical intelligence. Key Points:Welcome What’s New & What the Future Holds for Epic Analytics (ANC01)Kevin Baldwincogito is a combination of dashboards, radar, RWB, slicerdicer, third-party tools, chronicles, clarity, and a data warehouse Key Points: • warehouse releases are version dependent with updates every 3-5 months • slicerdicer is self service data exploration for clinical users • 3 peer groups are live on cogito benchmarking now; UCLA is looking to go live on this as wellWatchstander Dashboard- Identifying Hospitalized Patients at High Risk for Deterioration(ANC19)Kevin BaldwinGoal is to automate situation awareness (Identify-Mitigate-Escalate). Dashboard used to provide real time access to the data in one placeand available to multiple providers and care teams simultaneouslyAnalyticsPage 25 of 122 | XGM 2015 Trip Report
Analytics Key Points: • RW report includes options to open hospital chart and to add to list; also includes PAF columns displaying Temp, WBC, and ESR • next steps including utilizing documentation from PCS assessments to automate the PEWS scoreUsing Analytic Forensics to Draw Accurate Conclusions (ANC30)Andre GorskiHistorical view and lessons learn from implementation of analytical tools available at Inova Health System. Key Points: • Being familiar with workflows will improve report/result quality • Validation is an indispensable step in analytics process. • Noise is a signal, do not exclude junk data but evaluate it– what does it say about the problemUsing Analytic Forensics to Draw Accurate Conclusions (ANC30)Matthew YeeIllustrate and encourage users to take a more forensic approach to measure/metric validity, data quality, and workflow factors that maycloud the true process and hinder desired outcomes Key Points: • It is important to get the correct requirements upfront in order to avoid inaccurate data and analysisUniverses, WebI, and Where They Fit in an Analytics Strategy (ANC34)Joycee BerinThis session demonstrates how Universes and WebIntelligence work in conjunction within a Cogito reporting strategy and reporting toolstack. Learn how universes designed by Epic and/or Park Nicollet are supported and used. Demonstrate how the use of reporting tools haschanged and evolved over the years. Describe how functionality overlaps between reporting tools and that one reporting tool cannotdeliver everything. Go through the process that helps to determine how data is delivered and presented for various types of projects; thisincludes opportunities for performance and the evaluation of reporting tools. Key Points:Welcome What’s New & What the Future Holds for Epic Analytics (ANC01)Shehzad SheikhTom Yousik talked about exponential growth in interest in analytics over last 3 years observed by epic. He emphasized the fact thatorganizations successful with using analytics embrace three pillars for analytics Mindset, skillset, and toolset. He also talked about Epic’sinitiatives about Data warehouse of Data warehouses (shared DW) and tools such as SlicerDicer and Benchmarking. Key Points: • Having a data-driven culture and mindset in the organization is one of the key aspects for successful analytics • No show predictive modeling will be included in chronicles 2015 using statistical algorithm. • Epic is working on building predictive modeling framework into chronicles that would make predictive model integration into Epic workflows easySee Your Doctor Today! (When Capacity Meets Demand) (ANC11)Kevin BaldwinStanford aimed to increase new patient access to outpatient care by understanding capacity and demandAnalyticsPage 26 of 122 | XGM 2015 Trip Report
Analytics Key Points: • Stanford patient centeredness = \"Know Me, Show Me, Coordinate for Me\" • historical reference - using the demand seen on same day last year • metrics are reviewed with clinic managesr so they can prepare for upcoming demandReduce Readmissions Using Predictive Analytics and Quality Improvement Interventions(ANC29)Kevin BaldwinSutter Health developed and implemented an evidence-based program to reduce hospital readmissions using the project RED intervention Key Points: • risk factors include patient characteristics, illness risk factors, and hospital course risk factors • daily clarity report from Epic identifies in-hospital patients at highest risk for readmissions and scores indicate level of riskReal-Time Analytics Using Interconnect Web Services (ANC40)Joycee BerinTake a technical deep dive into a near/real-time MSSQL data mart using Interconnect web services, KB_SQL, and Caché routines.Discussion includes the near/real-time Chronicles data accessibility options available in the Epic platform as well as the high-levelarchitecture, opportunities, and challenges. Learn how to differentiate between use cases that require real-time data and those that can beachieved with near-real-time data. Key Points:PEARLS: Using Epic Registries and Reporting Workbench for PopulationManagement_NorthShore (ANC03)Kevin Baldwinchronic disease management is part of larger efforts in population health, with analytics powering close-loop clinical workflows Key Points: • target values depend on age and cormorbidities • NorthShore used BPA alerts, Banners, PAF columns, Health Maintenance, Hyperspace Reports, smartforms, and other functionalityPEARLS: Self-Service Analytics with Third-Party BI Tools (ANC45)Matthew YeeLearn how three organizations put data in users' hands with Qlikview, Tableau, SSIS, and Microsoft Key Points: • SSIS is a good tool to integrate raw data with Microsoft products, but a single dashboard takes 8-10 different SSIS control flows • Tableau is a fast and easy way for data discovery and is drag and drop to create rich visualizations • Qlikview has helped streamline reporting processes across the organization, but it is important to have a strong foundation for Qlikview to run smoothly for all usersAnalyticsPage 27 of 122 | XGM 2015 Trip Report
AnalyticsPEARLS: Leveraging Epic's Data Warehouse as Your Data Warehouse Platform_BMHCC(ANC04)Tony ChoeThe presenters explains their experiences with bringing up the Cogito Data Warehouse. They the factors that made their implementationssuccessful and how they leveraged the infrastructure to deliver value to users. They also discuss future plans and where the DataWarehouse fits in their enterprise analytics strategy. Key Points: • Extend the Cogito Data Warehouse data model to meet the unique demands of your organization. • Create a process to establish confidence in the integrity of the data in the CDW. • Plan a roadmap for a multi-year implementation effort while maintaining capacity to provide timely data to consumers.Universes, WebI, and Where They Fit in an Analytics Strategy (ANC34)Kevin BaldwinWebl is used with Epic Cogito because SAP is continuing to pre-package Webl as a Self Service Reporting Tool, it is relatively easy to setup, and universe content is provided and supported by Epic Key Points: • Epic has standard universes leveraging both clarity and cogito data warehouse models • It is recommended that we expand the use of pre-built basic reports for all universes so they can be used as templates/examples to help users get started • It is recommended to create smaller, multiple universes instead of one with many classes and objectsPEARLS: Implementation and Early Experience with SlicerDicer (ANC02)Shehzad SheikhNorton health and Stanford children shared their experience with SlicerDicer implementation. Bitmap loading takes 1 hour for them. Theydid the demos with the end users in collaboration with analysts group. Preparing training materials and sharing with users also helpedthem quite a bit. Getting timely approvals from Chief compliance and information allow clinicians to access to patients outside of theirpractice is important. Key Points: • SlicerDicer Adds additional time to CDW ETL, that needs to be considered and tested for SLAs and planning • SlicerDicer Backfill can take significant amount of time so it should be accounted in deployment planning • Targeting correct users for SlicerDicer and preparing a rollout plan ensures success with deployment.PEARLS: Implementation and Early Experience with SlicerDicer (ANC02)Joycee BerinTwo organizations describe their experiences implementing SlicerDicer. This session covers pre-planning, technical configuration, security& compliance, rollout strategy (including training and tips for increasing end user adoption), uses cases, and future vision. Plan aSlicer/Dicer implementation, including strategies for driving end user adoption and tips for a smooth install. Identify the right use cases todrive improvements in patient care with Slicer/Dicer. Key Points: • SlicerDicer backfill loads can take a significant amount of time. Allot enough time in the project plan. • Prepare to field questions on who supports SlicerDicer. Have a defined plan for customer support. • Pop-Up box can be developed by Epic to alert users of PHI data which is very useful from a Compliance standpoint.AnalyticsPage 28 of 122 | XGM 2015 Trip Report
Beacon OncologySurvivorship and Oncology History (ONC09)Janet NgFroedtert outlines the process of creating the treatment summary in Epic to work for survivorship care planning. Wellmont Cancer Institutediscusses their development in Oncology History and Treatment Summary. The involvement of oncology experts and leadership areessential to this project. Key Points: • Comprehensive display of Chemo History from Onc Treatment Plan may be achieved with the following custom build. Incorporate Review Flowsheets into Print Groups (LPG 115100 ONCBCN Chemo Flowsheet) that could then be incorporated into SmartLinks and embedde • Diagnosis Grouper may be used to select a diagnosis specific Treatment Summary Template. • Commission on Cancer guidelines has been updated in Sept 2014. The goal to reach 100% by 2019.Strategy and Build for Beacon Protocol Rule-Based Dosing (ONC02)Janet NgStanford shared their experience in building peds protocols using rule based dosing. They also discussed the limitation of rule baseddosing in certain situations. E.g. Some selections required providers’ judgement and evaluation. Key Points: • Multiple ingredient mixture ERX (eg. Ifosfamide/Mesna IVPB) : default only chemo dose using rule based dosing; leave red stop sign for mesna dose (with ordering instruction) • Naming Conversion is important for dose modification template e.g. Etoposide (BSA 0.6: 33/100) • Community library will have extracts of Beacon protocols based on NCCN guideline/template.Protocol Build Strategies for Transitions in Treatment and Patient Movement (ONC04)Janet NgBoth institutions select multi-day in building the Inpatient Protocols. Saint Louis University Hospital has IP pharmacists release ordersevery day using custom patient list, while Boston Medical Center has IP nurses release orders every day using custom worklist. New Epicrecommendation is to build multi-day for IP protocols due to survey result from existing customers. Key Points: • UCLA Beacon Team should analyze the benefit of revising build design for IP protocols to multi-days instead of super-day. • Default Exception Code (LSD 77001) for all treatment plans : “Beacon Treatment Plan Order –Verify Formulary Status” will fire for pharmacy verification queue. CareConnect Beacon team to follow up with Epic TS. • The new approach will be more appropriate once we have the new epic enhancement : (a) system will auto-complete treatment Day, and (b) system will automatically put plans on hold upon admission.Optimizing Clinical Practice, Staffing Productivity, and Epic Reporting Initiatives (ONC03)Janet NgKaiser presents a number of internal studies in optimizing clinical practice and pharmacy staffing analysis using Epic generated reports.Epic previews the new Cancer Population Registry, RWB, and Clarity Reports. Of note, the future enhancement to Discontinue TreatmentPlans from Workbench will benefit UCLA oncology users. Key Points: • Retrospective Analysis after Removal of Mannitol from Protocols. The study has concluded that the incidence of cisplatin induced nephrotoxicity is the same for patients receiving or not receiving mannitol. Follow-up study confirms the practice. • Hepatitis B screening (HepBsAg & HepBcoreAB) has been added to Kaiser Protocols with at least a 10% risk of neutropenia or lymphopenia. CareConnect Beacon Team should follow up with physician informaticist for the evaluation in our practice. • Beacon master report may be used to evaluate if the providers follow the ASCO Choosing Wisely Campaign.Beacon OncologyPage 29 of 122 | XGM 2015 Trip Report
Beacon OncologyOncology Research : Streamlining Protocol Build and Network (ONC11)Janet NgYale-New Haven Health System presents their build process for Research Beacon protocol. Their goal is to have the first draft ready forreview in 7days, and complete in 21 days for PROD migration. Their current status is 8 days for first draft, and 110 days for PROD. Key Points: • Research lab orders are built as multiple communication orders. • The goal is to complete the protocol build before IRB approval. • Use Generic Research ERX for research protocol validation if Research ERX has not been built by Willow.Building Your Beacon Protocol Dream Team for Effective Optimization and Maintenance(ONC07)Janet NgCarle Cancer Center discusses their process to stream protocols and maintain post-live optimization initiatives. Huntsman Cancer Hospitalin University of Utah describes various approaches for Beacon protocol maintenance, and promotes the involvement of clinical staffpharmacists and nurses. Key Points: • Users may prefer less complicated synopsis. Mixture ERX must be setup as main ingredient mixture in order to appear in synopsis • Rename the section will serve as reminder for provider to release the orders. e.g. Provider To Sign and Release This Section. • The New Protocol Request Form should be available to all oncologists in their home web page. UCLA Beacon Team should consider adding the form to HemOnc Provider Dashboard.BMT Update and Networking (ONC08)Janet NgEpic developers present the new enhancements: Checkbox for BMT protocol in the Option tab of the Protocol Builder; Option to make thecycle as Pre-Treatment cycle; Warning to user if the Treatment Plan Day 0 does not match the Day 0 in BMT Episode Transplant Day. Key Points: • Acute GvHD Doc Flowsheet has been developed by Epic. Chronic GvHD is not on top priority for the time being. • A number of BMT Reporting Workbench Reports have been developed. Use Find Episode as search keyword. • BMT Specialty Starter Sets are available.Beaconography and Saving Click (ONC10)Janet NgEpic shares a number of current and future enhancements. Key Points: • Set up requiring Infusion Stopped Times at the Department level. But the medications need to have a duration • Synopsis: LDA Information may be available across encounters; Synopsis may be copied and pasted into progress note. • Sidebar: Provide Infusion Nurses with a Charging Summary; Provide Schedulers with a Treatment and Therapy Plan Overview & Recent Doc Flowsheet Values.Beacon OncologyPage 30 of 122 | XGM 2015 Trip Report
Beacon OncologyBeacon Oncology (Focus Group)Janet NgEpic presents and discusses the potential new enhancement in treatment plan, oral chemotherapy, survivorship, and therapy plan. Key Points: • Potential IMS (Intelligent Meds Selection) for take-home prescription. • Potential enhancement for patient calendar in my chart. • Epic presents the new enhancement in therapy plans including (a) combine names of merged therapy plans, (b) allow separate list of lead providers for different episode types. Beacon Epic TS to check for possible SU to UCLAAchieving Effective Shared Governance in the Cancer Center (ONC05)Janet NgDartmouth Hitchcock reviews their structure of a standing Beacon Validation Group and the benefits of ongoing multidisciplinary cliniciansmeetings. Stanford presents their structure of cooperation from IT and operation with recent accomplishment of converting custom CancerStaging Forms to Epic released AJCC forms. Key Points: • Standing protocol validation sessions are productive. UCLA Beacon Team should continue current practice. • Invitation of multidisciplinary clinicians to the protocol validation meetings are valuable. UCLA Beacon Team should continue current practice. • Epic released AJCC forms are preferred over customized Cancer Staging Forms.Beacon OncologyPage 31 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)Enabling Data Discovery with Clinical Benchmarking and Radar Dashboards (ANC22)Meg FurukawaThis session presented an oveview of implementing the Foundation System clinical Radar dashboards for physicians, and the hospital. Key Points: • Use a batch job to keep the data current • Define the scope fo the dashboard up front • Test in PRD to make sure the dashboards work with real dataImproving Physician Effi ciency and User Experience (PAC31)Kevin BaldwinThe main usability goals are to reduce cognitive burden for the end user, standardize content to promote consistency, develop expertisefor ongoing optimization of Epic user experience, and collaborate with Epic Key Points: • screens, especially for expert users, can be dense if well organized • design software and user interfaces that users will accept and learn willingly, operate safely, easily remember, and find satisfying • successful usabaility studies use effective case scenarios, test cases, and have a supportive lab enivronmentIlluminating Excessive RBC Transfusions through Predictive Analytics (ANC35)Meg FurukawaInpatient blood management has been identified nationally as a critical initiative to improve the quality of care and safety of patienttransfusions and reduce unnecessary costs. Through the use of risk-adjusted regression modeling, excessive red blood cell transfusionsare highlighted through user-friendly, provider-level reporting. Key Points: • Total expected RBC units = Probability of transfusion x Expected units/transfusion • Need to look at contextual trends to see what is really going on and to drive out patient variation • Patient characteristics governing transfusion needs include hemoglobin, severity of illness, DRG and genderHealthy Planet (Focus Group)Deidre Keeves20 Organizations are currently live on Healthy Planet and 38 more are installing. Development is in progress to improve epic's ability tohandle external claims data within the cogito data warehouse. Healthy Planet allows for bulk outreach for disease specific conditions or forbulk patient centric cohorts such as ACO patients at at certain clinic with care gaps. Key Points: • GHC in Seattle found a $70 million dollar ROI across a 3 years for their medical advantage population with their Healthy Planet implementation. • Healthy planet can integrate with mychart video visits for remote care manager follow up sessions with patients. • In 2015 version, external claims for ED visits, admissions and procedures can be included to drive utilization dashboards and registries and satisfy health maintenance requirements.Clinical Informatics (MD & RN)Page 32 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)Haiku and Canto (Focus Group)Kelly LockettEpic presented proposed features for 2015 and future versions of Haiku and Canto to get feedback on planned development. Highlightsinclude push notifications, touch ID, Jot (scratchpad), add images to notes and annotate images, InBasket defer (move from mobile deviceto workstation with swipe), and mobile ordering. Key Points: • Inpatient functionality may include IP Handoff and Epic monitor. • Planned development for interface with Apple watch. • Future development includes Finish Up fast, Secure chat, chart search, IB Quick Actions, and esignatureGetting the Most Out of Reporting Workbench (ANC13)Meg FurukawaThis session presented ideas for optimizing reporting workbench reports and how to make them work for you. The presenter discussedways to help you prepare data for submission to outside sources and registries without changing users’ input processes or establishedcategory lists. Key Points: • Always create a copy of extensions unless you are only modifying the parameter in PAF • Identify the scope of the extension to choose the correct one to use • Translation tables can be used to format data destined for third party systemsEpicCare Inpatient (Focus Group)Kelly LockettEpic presented proposed features for 2015 and future versions of EpicCare Inpatient. Lots of attention on Patient Education (consideringlongitudinal view across encounters and workflow integration with MAR and other activities) and Care Planning. They are continuing todevelop their Blood Product tools - need input from customers on what's important for future development...mass transfusions? increasedefficiency? integration with pumps? For physicians, Epic is focusing on complex ordering and administration, problem list, attribution, andhandoff. Key Points: • Voting available 4/13/15-5/13/15 to help Epic identify most desired features for development. Each customer gets 10 votes. Great opportunity to drive development. • Epic is looking for customer volunteers to participate in Brain Trust for Care Planning. Would involve monthly meetings. • Still not enough attention for ancillary areas, but considering new modules for Rehab, wound care, Behavioral Health, RT and/or Nutrition.There’s Gold in Them Thar Charts- Rapid & Dramatic Improvements in Outcomes (PAC62)Kevin BaldwinJohn Hopkins noticed a signature pattern for cluster of non-resolving ailments and symptoms Key Points: • John Hopkins used Epic to aggregate information, conduct longitudinal chart review, and filter to key criteria • John Hopkins was able to significantly improve the quality of life for patients and their families by quickly resolving clusters of non-resolving ailments and symptomsEnhancing Nursing Productivity: Reviewing High-Volume Workflows for Speed (NAC14)Meg FurukawaEpic experts presented suggestions on how to make nursing documentation tools work together to streamline and simplify the large-volume nursing workflows based on best practices.Clinical Informatics (MD & RN)Page 33 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN) Key Points: • Efficency + meaningfullness = productivity. Need input/output simplicity. • A good process can be more valuable than changes to the system • Need to look at how well users use technology, Users need to understand the why of how they need to do things in the system.Inpatient Rehab Facilities and Epic: Current and Future (NAC15)Kelly LockettEpic reviewed workflow and recommendations for Preadmission Screenings, Treatment Team Conferences, IRF requirements, FIMScoring, and IRF-PAI Submission. Epic continues to work with UDS (Uniform Data System) for permission to use FIM language...gettingcloser to agreement, but very lengthy process. Key Points: • Foundation system includes IRF-PAI submission patient summary report. Need to compare to customized version we created at UCLA • Future direction to consider regulatory compliance, usability, reporting, and required documentation • Resources: Bimonthly webcast - next one in April and Userweb thread: Rehab TherapyEmerging Diseases: The Ebola Response from Texas Health Resources (NAC02)Meg FurukawaTexas Health Presbyterian Hospital of Dallas was the first US hospital to treat a patient with Ebola without a previous diagnosis, as well asthe nurses who contracted Ebola. Presenters discuss lessons learned from their experience and the development of the advancedEmerging Disease Screening Tool in Epic. They also focus on the nursing response and nursing insight into treating these patients. Key Points: • The EHR needs to support the nurses at the bedside • The EHR never replaces direct verbal communication between caregivers • If you want to go fast, go alone. If you want to go far, go with othersED Screening for Infectious Disease Surveillance: Beyond Ebola (PAC43)Kelly LockettMount Sinai presented on their implemented workflows using available tools from foundation system and customized build to screen/flagpatients based on recent travel. Also discussed Emergency Management Planning scenarios including use of virtual units for disasterresponse and need for patient tracking system to communicate between EMS and hospital EHRs. Key Points: • similar customized flowsheet build to UCLA. Also using customized patient list columns and BPAs. • emphasized there is no current tool in Epic to track contacts while in ED waiting room or manage visitorsBuilding Specialty-Specific Synopsis Using Agile and Lean Principles (PAC11)Kevin BaldwinThe University of Michigan Physician Builders incorporated AGILE and LEAN principles into their building process. Key Points: • this team used modular flowsheets and an iterative process to make physician build decisions • understanding how physicians think drives the position and organization of lab data • in core folders, rows show even if no data to display but in specialty folders, rows hide when no data to displayClinical Informatics (MD & RN)Page 34 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)Better Methods for Comprehensive Near-Real-Time Harm Reporting (ANC27)Meg FurukawaThis session presented insights and techniques to make patient harm transparent in near-real-time based on the current documentation inEpic.| Key Points: • Can also think of harm as \"iatrogenic vulnerability\" • Goal is to make gaps in care actionablie in near-real time • Predictive analytics are not as valuable as actionable anayticsBeaker Implementation- Clinicians Make a Difference (NAC58)Kevin BaldwinNurses were used in the planning and development of Beaker to ensure patient safety and system usability Key Points: • through a process of workflow analysis, clinician involvement, and effective communication, the Beaker implementation was successful • success was measured in a decrease in mislabeled specimens and safe collection practices at the point of careAuditing the Medication Use Process to Improve Medication Administration Safety (NAC32)Meg FurukawaThis presentation touches on Lancaster General's use of auditing tools to monitor the medication use process and the governancestructure for oversight and accountability. Key Points: • A Med Rec Committee is focused on improving the accuracy of the PTA med list. This hospital has 11.3 FTEs to create/verify the PTA med list including dual source verification if possible. • Must have a standarad workflow for all areas using Smart pumps • Validate the workflows beyond the data - 99% BCMA compliance rate is great but are the barcodes being scanned at the bedside? Watch the human interface with technology.A Comprehensive Clinical Quality and Safety Dashboard (ANC14)Meg FurukawaThis session discussed the development and use of a dashboard for Quality Management. Some of the design and build for thedashboard were presented. Key Points: • Think about ways to be able to upload or display data automatically to reduce manual extraction. • Use just-in-time information instead of batching - keeps the dashboard current • Need a dedicated Quality Management partner to validate and ocntinually improve the dashboardEpic-Alaris Integration: Implementation and Experience 10 Months Later (PharmAC03)Meg FurukawaThis session presented the implementation process for infusion pump integration as well as the current status 10 months after go-live. Key Points: • Need to involve all stakeholders from the beginning • Do not underestimate the need for testing • Monitor end user use and response after go-liveClinical Informatics (MD & RN)Page 35 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)PEARLS: Surveys (NAC50)Meg FurukawaThis session presented ideas for preparing staff for accreditation surveys, tools to use, areas of focus for surveyors and buildconsiderations from a regulatory perspective. Key Points: • Some Epic functionality is a double-edged sword, need to carefully weigh efficiency against compliance with regulatory requirements • Surveyors are much more savvy about EHRs now, especially Epic • Have tools easily available to users so they can see areas needing improvementStrategic Design Group - Case Management ()Kelly LockettEpic reviewed current version of Case Management module. 15 customers currently live. Discussed plans for future developmentincluding improvements to payor communication and discharge placement workflows. Epic focusing on Clarity report development forcase management for avoidable days and readmission tracking. Recorded demo of module available athttps://userweb.epic.com/Thread/30616 Key Points: • 2015 will allow for fax snapshots to keep a copy of what was sent for both UR and DC planning. Storage considerations with this feature. Currently with 2014, only have audit trail, not copy of data sent • 2015 will have improved Review Date Tracking and allow for tracking of DC placement decline reasons • Future plans include report builder feature where end users can create a document in the sidebar by choosing from list of available print groups for better customized reports to payors and accepting facilities.Replacing a Patient Tracking System with Epic Status Boards (NAC46)Meg FurukawaThe presentation described the replacement of a complex patient tracking system with Epic status boards as a communication tool for theoperative areas. The new boards service areas that use OpTime as well as Cadence and Radiant. Key Points: • Build procedure logs to add functionality and flexibility to Status Boards • Eastablish a core team with reporesentation from each affected area. Seemingly small items like colors can be very important to users, pick your battles carefully. • Use icons to save real estate.Recipe for Early Recognition in Changing Patient Condition (NAC36)Meg FurukawaPresenters shared their EMR tool with 22 real-time clinical triggers guiding a patient’s level of care and how the early recognitioon hasdeveloped the nurse’s critical thinking to recognize patients with declining conditions. Providers can now see patients of the highestpriority, intervention outcomes, or changing status in one color-coded glance. Key Points: • Need to identify those elements that should be given a high score so they are acted upon sooner • The overall score can be used to help make appropriate patient assignments and balance workloads • Keep the data visible to everyone - status boards, patient lists, dashboards, and reports. Use the data to help guide best practices - it is a toolClinical Informatics (MD & RN)Page 36 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)Recipe for Early Recognition in Changing Patient Condition (NAC36)Kelly LockettBellin Health presented their design for an early warning tool to identify patient condition changes in real time. Included information ontheir modified MEWS tool used by their rapid response team, nurses, and physicians. Key Points: • Useful information as UCLA begins to plan for Epic Monitor implementation. Leveraged color-coded patient list column for MEWS score and second column to show change in MEWS score. • Shared columns with all providers to allow them to better plan their intervention for a specific patient based on their current condition. • Stressed importance of not over-relying on the score, simply use it to guide best practice. Score is only as good as data entered.Pre-Operative Navigator for a Virtual Clinic (PERIOP11)Kevin BaldwinUCLA Preoperative Evaluation Suite was faced with limited capacity with the goal of screening a higher percentage of patients. Thus, onesolution is to eliminate the requirement for physical patient visit. Key Points: • tools built into the system (PES status tool, status board for PES, cardiac results tab, outside lab results console)Implementing Epic's FDA-Cleared Blood Product Administration Module (Periop13)Meg FurukawaStanford went live with the Blood Products Administration Module (BPAM) after it received FDA clearance. They have started using it inthe ORs. The presenters review the technical build of the module, IT requirements, legal considerations, local decision points, workflowconsiderations for regular versus emergency release, and post-live (Feb 2015) feedback for anesthesia use. Key Points: • Stanford only scans 2 barcodes (DIN and product code) - Blood Bank cannot issue an expired unit. • Dual sign is currently on paper but they are considering a one-person sign-off when the process is electronic • There is a button which brings up the previous blood volume rows for the anesthesiologist to use if the transfusion requirements are too much to use the modulePEARLS: Using Epic Registries and Reporting Workbench for Population Management(ANC03)Vu VuMost of Northshore reporting does not use EPIC Registries, even though the title is based on registries, because they've been on Epicsince 2003. They've developed their own solution for population management. They've extended the CDW with population health relevantdata domains, they call this the EDW. Recently there are efforts to convert to using the Registries to reduce the latency due to relying onEDW. Key Points: • Reports, Epic rules and from Data Warehouse, are heavily used in Hyperspace. • ETL from Chronicles to Clarity, to EDW causes a latency in data. • Limitations with Epic Registries: 1. Groupers; 2. Epic properties; 3. Using comlex algorithms for predictive modelingClinical Informatics (MD & RN)Page 37 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)Mapping the Way: Care Plans and Patient Education (NAC23)Kelly LockettUnityPoint Health presented their approach for individualized care plans, identifying patient education interventions, and using the plan ofcare and patient education activities for interdisciplinary team communication. Using BPAs and task templates to add titles. Allinterventions added and nurse deactivates interventions or points as needed. Key Points: • Many organizations faced with challenge of plan of care used primarily as a nursing tool. Missing interdisciplinary approach.PEARLS- Device Integration_Cedars Sinai (PERIOP09)Kevin BaldwinThis session was a case of integrating people, process, and technology. Cedar Sinai had to identify the appropriate support framework forits devices. Key Points: • Cedar Sinai leveraged OR BioMed for in-OR issue triage • Cedar Sinai also utilized technical documentation and the help desk to improve their support • The anesthesia module was also used for self helpPEARLS- Clinical Support_Community Health Network (NAC25)Kevin BaldwinCommunity Health Network described their long term super user and engagement strategy Key Points: • smaller numbers are more efficient • recommended that attendance is paid for • work with HR to designate a super user rolePatient Education: Moving to 100% (NAC41)Meg FurukawaThis session describes the optimization efforts to manage Patient Education by customizing and automating Patient Education titles tomeet the needs of patients and staff. Key stakeholders collaborated regarding refinement, use, and evaluation to optimize the content ofthe activity using BPAs and collaboration techniques. Key Points: • Task templates and BPAs are good ways to automate patient education • 2015 has better functionality for being able to see patient education that was done in previous encounters • 2015 will be able to add a patient education widget into the Patient Story to quickly see the status of patient educationNursing Advisory Council Welcome & General Session (NAC01)Meg FurukawaThis session presented an overview of the Nursing Advisory Council, from a historical perspective to planned changes to the format in thefuture. New functionality that will be available in the 2015 version was presented along with opportunities to partner with Epic and otherinstitutions to focus on various clinical initiatives. Key Points: • Clinical programs are focusing on high risk areas of fall prevention, pain and delirium • Opportunities exist for us to participate in identifying best practices for handover as well as in the ambulatory arena • White papers have been created to assist with Magnet preparation and clinical informatics strategiesClinical Informatics (MD & RN)Page 38 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)MyChart Bedside (Focus Group)Kelly LockettEpic demonstrated new features currently planned for development for 2015 and beyond for MyChart Bedside, including use ofquestionnaires (i.e. Pt. Satisfaction), pain management integration, customizable diets, and open notes. Currently planned to support 5additional languages: Spanish, Dutch, German, French, British English. 13 organizations are currently live and typically turn on all featuresat go-live. Emphasized importance of considering goals for implementation when determining pilot units. Key Points: • Planned feature for Open Notes to allow providers to decide which notes will be shared with patient. • Focusing on specialty areas for future development including L&D (mom and baby info side by side) and Peds (age appropriate interface). • Bedside Quaterly Forum occurs 4th Friday every 3 months. Next forum is 4/24/15 1-2pm CST.Mission Possible-Impacting CMI LOS and Care Coordination with EHR Tools (NAC19)Kevin BaldwinCommunity Medical Centers uses widget tools to make the medical and discharge plans transparent (MD documentation, casemanagement redesign, leverage the team) Key Points: • case managers were able to do easy screening via PAF columns • RN required admission documentation automatically generates a referral to case management • all interdisciplinary team members can see what the status of the patient's discharge isPEARLS: Improving Patient Access & Experience (SAC02)Cromwell SuarezHennepin County Medical Center, Boston Children's increased the ability of patients to access clinics and providers at times that work forthem using Lean thinking and standard project management. It reduced the number of active visit types by 90% using a set of 11 core visittypes and reduced scheduling rules by over 80%. Checks and Balances: Using Cadence Functionality in Access Initiatives Thispresentation examines how new and pre-existing Cadence functionality can help in an access initiative to open up scheduling to a broaderbase of users, while also closing the loop between making the appointment and family/clinic preparedness. See One-Clicks, After VisitType questionnaires, SmartTexts, and In Basket notifications. Key Points: • View issues from multliple perspective: Review current and futre state workflows. • Define patient satisfaction metrics • Visit types that affect apps besides Cadence: Interfaces, MYChart, and Registration work queues and audit resultsPEARLS: Implementation and Early Experience with SlicerDicer (ANC02)Shehzad SheikhNorton health and Stanford children shared their experience with SlicerDicer implementation. Bitmap loading takes 1 hour for them. Theydid the demos with the end users in collaboration with analysts group. Preparing training materials and sharing with users also helpedthem quite a bit. Getting timely approvals from Chief compliance and information allow clinicians to access to patients outside of theirpractice is important. Key Points: • SlicerDicer Adds additional time to CDW ETL, that needs to be considered and tested for SLAs and planning • SlicerDicer Backfill can take significant amount of time so it should be accounted in deployment planning • Targeting correct users for SlicerDicer and preparing a rollout plan ensures success with deployment.Clinical Informatics (MD & RN)Page 39 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)EHR 2.X: Implementation to Optimization (PAC52)Kelly LockettSutter presented on transition from implementation to optimization and the challenges faced. Discussed opportunities to re-alignresources, various optimization methodologies, and utilization of Epic resources. Provided Prioritization Matrix based on level of impact fornew functionality and resources needed. Key Points: • offering remote work, immersion programs, work from within local hospital or clinic, technology pilots, and continued learning opportunities for talent retention • created internal technical team of cross-application experts. Go-to team before reaching out to Epic TS. • frequently revisit prioritization of projects to determine if you should stop, start, or continue based on changing healthcare dynamics.Medical Messaging (MyAC07)Samantha Caometro Health and Mount Sinai achieved high passing rates for Meaningful Use Stage 2 Objective P230 by utilizing MyChart functionality.They utilized a post-visit questionnaire strategy and the history questionnaire. Key Points: • Questionnaires needs to be implemented ASAP at UCLA to meet Stage 2 P230 • Ensure that patient questionnaires do not overlap with any other questionnaires being administeredBeaker Implementation: Clinicians Make a Difference (NAC58)Meg FurukawaThis session described the process that involves clinicians to evaluate workflows, policies, clinical standards, and documentationrequirements for consistency with safe practices as part of a planned Beaker implementation. Key Points: • Need to involve all clinicians who will be obtaining lab specimens early on to make sure the workflows are known • Test each device • For patient safety reasons, printers were at the bedside in all ICUs, and specific printers were mapped for specific rooms on the MedSurg floors to prevent walking around with labelsStork Obstetrics (Focus Group)Kelly LockettEpic demonstrated new features planned for 2015 and discussed suggestions for future development. Epic demonstrated Express Lane tostreamline provider documentation based on a chief complaint. Reviewed new Dashboards and OB metrics and 8 specific ideas underconsideration. Session also included breakout discussions groups for specific topics. Key Points: • 2015 features include filtering the flowsheet template tabs based on CER rules, capturing multiple ROM, and documenting sex and respecting naming conventions for fetal demise. • Epic working to consolidate L&D sign in tool with 2014 Inpatient Sign in tool (and ED sign in tool)Clinical Informatics (MD & RN)Page 40 of 122 | XGM 2015 Trip Report
Clinical Informatics (MD & RN)A Hospital’s Response Plan from an Unexpected, Extended Downtime (NAC09)Meg FurukawaThe presenters told of their experience with an unplanned, extended downtime where Epic was unavailable for over 20 hours. Theydiscussed the hospital's response plan, lessons learned, recommendations, and considerations to ensure a successful and safe plan isprepared for an unexpected, extended downtime. Key Points: • Set up and use an Incident Command Center from the beginning of the outage • A major IT outage should be considered an operational emergency and treated as such • Train staff to know what to do during an outage and conduct periodic drills to make sure they can follow the downtime processesPharmacy Advisory Council Welcome & General Session (PharmAC01)Meg FurukawaThis session presented an overview of the new functionality that will be available to pharmacy, providers and nursing in the 2015 version.Some of the functionality will be able to be SU'd back to 2014, others will require an upgrade. Key Points: • PCA/PCEAs will have discrete elements in the order instead of questions. Institutions can identify which elements should appear on the MAR. • Dispense logic with smart oumos - the system can calcuate when the bag will run out based on documentation from the smart pump and print a label at the appropriate time for the next dose to be dispensed. • Can prevent duplicate warnings for same drug with different doses and indications to decrease alert fatigue.Clinical Informatics (MD & RN)Page 41 of 122 | XGM 2015 Trip Report
CommunicationUse the Right Tool at the Right Time to Get the Right Result (PMAC03)Cromwell SuarezJohns Hopkins Medicine: Learned how to adapt and integrate Microsoft Project, week by weeks, one-page project manager,champion/SME deliverables, and face-to-face time. They showed how they adapted the tools and used face-to-face communication as abinding agent. Key Points: • Blended style of PM: MS Project, Week by Week Tracker, Status Report, SME deliverable, and face to face meetings • Determine an escalation process or SOP • Project schedule should be transparant across the systemIntegrating Epic and Clinical Training for New Hire Hospital Nurses (TAC14)Cromwell SuarezPresenters from Allina shared a process for merging Epic training and clinical practice training for hospital nurses which resulted inadvanced outcomes, reduced time spent in the classroom, decreased non-productive time, and increased learner engagement. Key Points: • Eliminated paper manual training books and sent electronically which saved over $400k • Used integrated training with HR (Epic and Nursing Workflow) • Included real life simulation in training with real actors (A day in the life of our nurse)Helping Users Find Notes, Results, and Scans in Chart Review (HIM10)Cromwell SuarezFairview Hospital shared how various roles collaborated to optimize Chart Review so that users could quickly find all documents, whetherthey were interfaced, scanned or directly entered. Key Points: • Created tab filters to allow easy sorting (e.g Notes, Lab, Imaging, Procudures, Cardilogy, etc.) • Identify and create new naming convention (e.g Transfer Summary: D/C Transfer Summary; UR Note: Utlization review) • Used common naming conventions for direct entered, scanned, and transcribed documents.PEARLS: Improving Patient Access & Experience (SAC02)Cromwell SuarezHennepin County Medical Center, Boston Children's increased the ability of patients to access clinics and providers at times that work forthem using Lean thinking and standard project management. It reduced the number of active visit types by 90% using a set of 11 core visittypes and reduced scheduling rules by over 80%. Checks and Balances: Using Cadence Functionality in Access Initiatives Thispresentation examines how new and pre-existing Cadence functionality can help in an access initiative to open up scheduling to a broaderbase of users, while also closing the loop between making the appointment and family/clinic preparedness. See One-Clicks, After VisitType questionnaires, SmartTexts, and In Basket notifications. Key Points: • View issues from multliple perspective: Review current and futre state workflows. • Define patient satisfaction metrics • Visit types that affect apps besides Cadence: Interfaces, MYChart, and Registration work queues and audit resultsCommunicationPage 42 of 122 | XGM 2015 Trip Report
Executive LeadershipKeeping the Patient at the Forefront- HIE across Organizations (DAC02)Kevin BaldwinNovant Health utilized DIRECT messaging via a HISP for their interoperability strategy Key Points: • Novant Health successfully connected to the VA using Care Everywhere and Community Connect • Novant Health is now onboarding the Social Security Administration • Novant Health avoids point-to-point interfaces in order to scale as efficiently as possibleBusiness Intelligence Director Roundtable (ANC47)Vu VuRoundtable for Directors, Managers, and Chiefs. Dr. Mahbouba made several comments regarding UCLA's usage of CDW. Much of thediscussion revolved around the CDW. Key Points: • EPIC Services provides Project Management resources for implementation, e.g. SlicerDicer • New data models are being covered by periodic releases of newer versions of CDW • EPIC is very interested to get feedback from the user community to prioritize development of features and enhancementsBuilding Your Beacon Protocol Dream Team for Effective Optimization and Maintenance(ONC07)Janet NgCarle Cancer Center discusses their process to stream protocols and maintain post-live optimization initiatives. Huntsman Cancer Hospitalin University of Utah describes various approaches for Beacon protocol maintenance, and promotes the involvement of clinical staffpharmacists and nurses. Key Points: • Users may prefer less complicated synopsis. Mixture ERX must be setup as main ingredient mixture in order to appear in synopsis • Rename the section will serve as reminder for provider to release the orders. e.g. Provider To Sign and Release This Section. • The New Protocol Request Form should be available to all oncologists in their home web page. UCLA Beacon Team should consider adding the form to HemOnc Provider Dashboard.Communicable Disease Screening and Documentation (DAC06)Diana TyBPA would trigger for patients that had been traveling to targeted areas with communicable diseases, such as Ebola. Key Points: • Triggering the BPA must align with the operational workflow for effeciency • Collaborate quickly with application teams and clinical teams to understand scope and build requirements • Statistics are useful to evaluate the outcomes of BPA and changes in workflowCOO Coffee & Donuts: Real-Time Web Dashboards (ANC26)Joycee BerinLearn how UCLA guides executive leaders with real-time, relevant information through a web-based command center. Operational insightand process improvement are demonstrated using occupancy, perioperative, and ED real-time web executive dashboards – the donuts theCOO consumes with his morning coffee.Executive LeadershipPage 43 of 122 | XGM 2015 Trip Report
Executive LeadershipDriving Value: An Enterprise Approach to EHR Benefits Realization (DAC01)Kevin BaldwinThis session reviewed the governance structure and benefits realization for EHR ROI Key Points: • $60M projected vs. $37.5M spent on EHR implementation due to savings on implementation labor costs • defined healthcare ROI as Return on Lives • savings estimated at over $22 millionA Comprehensive Clinical Quality and Safety Dashboard (ANC14)Meg FurukawaThis session discussed the development and use of a dashboard for Quality Management. Some of the design and build for thedashboard were presented. Key Points: • Think about ways to be able to upload or display data automatically to reduce manual extraction. • Use just-in-time information instead of batching - keeps the dashboard current • Need a dedicated Quality Management partner to validate and ocntinually improve the dashboardKeeping the Patient at the Forefront (DAC02)Diana TyFocus on Care Everywhere and direct messaging through HISP to avoid point-to-point interfaces Key Points: • Replaced 98 interfaces along with 20+ different EHR systems • Rollout strategy for 358 clinics within one year • Challenges remain to engage Community Connect proiders and clinicsPost Acute Dilemma (DAC04)Diana TyTexas Health reviewed their workflow for community based nursing homes. Centricity IDX is used for registration, scheduling, and billingfor their patients. The provider will either have scheduled or on-the-fly visits. In order to get their note to the facility, providers would bringa small printer and fax, or copy the note into the EHR. Key Points: • Visit navigator was customized for easy medication reconciliation • There is no easy way to get the note back to the host facility • The internet is variable in many facilities, so providers often carried their own broadband cardsStaying Alive Readiness Assessment (DAC03)Diana TyAlong with a go-live readiness assessment, a \"staying alive\" readiness assessment is helpful to continue the coordination between teams,consistency in build and approach, enforce communication, possible course correction, and celebration of accomplishments! Key Points: • Continuous coaching is needed to enhance problem solving skills and reinforce teamwork • Focus for staying-alive readiness applies for projects currently in flight • Coordination between application teams and leadership is critical for steady stateExecutive LeadershipPage 44 of 122 | XGM 2015 Trip Report
Executive LeadershipDriving Value: An Enterprise Appraoch to EHR Benefits Realization (DAC01)Diana TyLakeland Health presented their implementation strategy on \"speed to value\", which focuses on reduced implementation costs with back-to-back go-lives. This helped with shifting focus to optimization sooner. KPI's were recorded to help with preventing readmissions forCHF, ADF, core measures, INR reminders, and radiation safety. Key Points: • Need to engage in businses owner buy-in for successful go-lives. • Executive support is critical. • Reporting to executive board assists with engagement.Top Strategies to Ensure a Successful Go-Live (DAC07)Sheyron McNeilUCLA organization shares their top strategies for a successful big-bang go-live. Discussion included the various themes used to enhanceorganizational readiness, communication strategies, training, super users, dress rehearsals and command center planning. Key Points: • UCLA used the hollywood theme of LIGHTS, CAMERA, ACTION for their go-live • Lights involved branding and communication of the go-live, engagement sessions, and government structure. Camera focused on getting our end users ready for the go-live by focusing on training, deploying superusers, provisioning, and dress rehearsals • Action took place after we went live by having a Command center and Service Now ticketing sytem.Keeping the Patient at the Forefront: HIE across Organizations (DAC02)Sheyron McNeilNovant Health organization presented how they use their interface with HISP and eHealth Exchange to maximize the transfer of patientinformation and improve the quality of patient care. Key Points: • Implemented e-health exchange with the VA last year. • Conduct direct messaging via HISP for Surescripts • 1st Organization in North Carolina to join the E-health exchangePartnering with a Lean Team to Provide Specialty-Specific Optimization (DAC08)Sheyron McNeilSutter Health uses the Lean philosophy to deliver a specialty-specific optimization program that focuses on both office work flow and Epicoptimization. Key Points: • Sutter decided to use the Laen approach to promote an environment that fosters continous improvement, reduces waste, and respect for people. • For their GI department, they fixed overbooking or empty spaces for both their office and precedure schedules. • They also designed a playbook for each department to manage the flow of patient care.Executive LeadershipPage 45 of 122 | XGM 2015 Trip Report
Executive LeadershipStaying Alive Readiness Assessment (SARA) (DAC03)Sheyron McNeilYale utilizes it's SARA (staying alive readiness assessment) program to manage ongoing efforts across applications and technologyteams. SARA is an adaptation of their GLRA that was used during the EPIC implementation. This tool allows them to focus onpriorities/projects, while identifying, escalating, and resolving issues. Key Points: • SARA is used to track priorities and projects. It involves strategic planning along with project management. • The SARA meeting consist of Leadership, PMO, IT Directors, All APP managers/ACs, all tech managers, EPIC TS, Business stakeholders, and vendors. • Some of the items that are discuss involves optimization, multiple projects, Upgrades, SUs and RAs.Top Strategies to Ensure a Successful Go-Live (DAC07)Diana TyPresented by Ellen Pollack, she provided an overview of UCLA's implementation strategy for branding and communication, engagement,governance structure, and readiness program. Key Points: • Guiding principle set forth by the governance structure helps with standardization and decision making • End user engagement helps with relieving anxiety and at the same time drums up excitement • Set expectations for go-live issues for printing, security, workflow issues, frustration, and staff fatigueExecutive LeadershipPage 46 of 122 | XGM 2015 Trip Report
FinancialADT/Registration Roundtable (FAC04)Cromwell SuarezThis roundtable session discussed recent development projects and plans for the future of ADT/Prelude. Learned about enhancementsand provide feedback for furure enhacements. Discussed new features for 2015: Leave of absence fuctionality, unit map view, eventmanagement enchancement, news feed dashboards for patient placement, mobility for transporters \"red cap\" application integrated intothe apple IOS platform. Key Points: • Prelude: Load insurance from external sources and trigger RTE; Create coverages by single swipe/scan • Prelude: Add insurance information into MyChart by scanning barcode from patient insurance card • Prelude: Kiosk Enhancements to for patients to view average wait times on screen; Welcome tablet enhancements (microsoft surface can also be used)2014 Bed Planning Update (FAC51)Liann ManifongLancaster General and Ochsner shared their experience implementing the new Epic 2014 bed planning view. UCLA has not yet migratedto the new bed planning view since it did not meet our needs, but hopefully we can take advantage of the lessons learned that LancasterGeneral and Ochsner shared. Key Points: • Lancaster General shared an issue encountered in the conversion of pending records to switch from the classic bed planning view to the new view. They recommended working with Epic TS on this to ensure the conversion doesn't take too long. • To better prioritize and group bed requests, Ochsner created many origin grouper records so patient placement would see the most important requests at the top of the list. This build was quite intensive as there are many rules that have to be created. • Epic is releasing functionality in Epic 2015 that allows sorting patients within a group based on any field. This functionality will be SU'd back to Epic 2014 in the next couple of months.CRM: New and Lesser Known Uses for Tapestry (FAC43)Andrew WeaverThis Tapestry session reviewed the following: Use Cases for CRM Auto-Generation Functionality, CRM Auto-Generation ConfigurationSteps, and CRM Quick Wins Key Points: • CRM can be used for outreach and education for patients. For example, CRM can flag routine services performed in an Urgent Care facility or Emergency Room. CRM can create a task to follow-up with the patient to discuss lower cost options for care. • Within CRM, topic grouping can limit the available topics showns to users so that they will only see topics that are relevant to their workflows. • New CRM functionality allows claim codes to trigger CRM auto-generation.Clarity Cubes (FAC12)Andrew WeaverThis session reviewed experiences and lessons learned with implementing the PB Transactions cube for reporting. The cube connectswith Excel via Pivot Tables and allows for easy slicing and dicing of Clarity data by end users. Key Points: • The cube allows widespread self-service reporting by all users who have experience with Excel Pivot Tables. • Training is very important because users need to understand the logic behind the metrics that are being pulled into reports. • The cube allows for easy sharing of best practice template reports by the user community.FinancialPage 47 of 122 | XGM 2015 Trip Report
FinancialCapitalizing on Plan Mapping Years after Go-Live (FAC10)Andrew WeaverThis presentation was given by the Baylor College of Medicine which is an ambulatory focused organization. They initiated this planmapping exercise 4 years after their initial go-live due to issues with duplicate plans and increased registration denials. They created anautomated process to bring in plan information from Experian and automatically update insurance plans in Epic. Key Points: • Automate the solution and then let the system do the work. • Wherever manual intervention was required, they built rules to drop item into workqueues. • A structured, phased roll-out including testing, training, and feedback with each phase worked best because of the complexity and uniqueness of each payor.Bed, EVS, and Transport Tracking: From Niche to Enterprise (FAC34)Andrew WeaverThis session described the process of re-engineering bed planning, transport and EVS systems at Stanford Medical Center. The solutioninvolved a cross-functional team across Epic Module teams to build out workflows within Epic 2014. Key Points: • They spent a significant amount of time shadowing the current state, but intially missed some line level managers who could have provided valuable feedback. • Creation of new Clarity/RWB reports specific to bed planning, transport, and EVS was a key component for success because it allowed users to become confident in the new system capabilities and access information that was previously avaiable in the Legacy system. • Managing expectations was important. Several features of their Legacy system were unused and therefore not necessary in the new build. However, this initially caused some uneasiness among users.Financial Advisory Council Welcome & Recent Development (FAC01)Andrew WeaverThis session provided an overview of new Epic development and initiatives including: ongoing upgrade assistance, operational check-incalls with customer leadership, Epic version 2015 which will be released in June, Grand Central (new name for ADT), patient estimatesand automatic estimates, streamlining of patient payment collection, rules based filing order, EMV updates for credit cards, alternativereimbursement models, and cost tracking. Key Points: • At this point in time, the majority of organizations in attendance have upgraded to Epic 2014. • ADT will now be named Grand Central and will include a unit map, discharge planning tool, and mobile transport tool. • MyChart bill pay can be a very beneficial way to increase self pay payments and can be a low effort install.ADT/Registration Roundtable (FAC04)Liann ManifongThis session provided more detailed information about the functionality changes that will be available in Epic 2015 and which changes arebeing SU'd back to Epic 2014. If the functionality is being SU'd back, Epic provided the SU reference numbers. Key Points: • Functionality will be available in Epic 2015 to pause registration times if a user changes workspaces from the registration workspace. For example, if a user is in registration for a patient and then jumps into another patient's registration. • The patient WQs will have functionality that allows managers to assign encounters to staff for them to work on. • Epic 2015 will have functionality to create an insurance coverage on a patient's record with a single swipe/scan from an insurance card.FinancialPage 48 of 122 | XGM 2015 Trip Report
FinancialFinancial Advisory Council Welcome & Recent Development (FAC01)Cromwell SuarezWelcome and introduction to Financial Advisory Council. Preview of upcoming development for Resolute Professional Billing, ResoluteHospital Billing, Prelude Registration, ADT, and Tapestry. Key Points: • Leave of Absence Feature (Hold bed and charges) knowing patient will return • Bed Planning will have a Unit Map for 2015 • Mobile Transport using Iphone/Ipad feature integrated with EpicADT/Registration Fishbowl (FAC55)Cromwell SuarezEpic experts were available to answer questions collected during the Roundtable and other Prelude sessions. Key Points: • Guest asked if there was any plans for instant messaging in Epic. Answer: None at this moment, but can use 3rd party applications such as Microsoft Communicator. • Guest asked will there ever be facial recognition for registration. Answer: Not at this time. • Guest asked about taking picture of insurance card and integrates to Epic. Answer: Not at this time, but working on barcode to interface with Epic.ADT/Registration Fishbowl (FAC55)Liann ManifongEpic answered questions submitted from various organizations related to ADT and Prelude. These questions covered multiple topics,including the new Epic 2015 insurance card scanning functionality. Key Points: • Epic said they have made it possible for the registration checklist to be a right side toolbar pull out so staff can view the checklist and keep registration open at the same time to allow staff to not have to change screens between registration and the c • There are many great new reports that will be available in Epic 2015 for both ADT and Prelude. • Epic is working on the ability to integrate insurance card scanning functionality with MyChart for patient satisfaction.ADT Transfer Center Design Discussion (FAC44)Cromwell SuarezIn this session, we learned about Epic's transfer center module that will be released in future development. Group discussed why transfermodule was needed and specification wish list to Epic R&D team. Key Points: • Would like a Telephony System (Voice Recording) and Create Telephony Encounter • Integrate Critical Care Transport to build • Would like streamline workflow; integrate Care Everywhere; Community outreachADT Transfer Center Design Discussion (FAC44)Liann ManifongEpic has started gathering requirements for the transfer center module and provided the key needs they have documented so far. Thissession allowed Epic customers to share the things they need in a transfer center module. There is no timeframe yet for when this modulewill be available, but it definitely will not be in the Epic 2015 release.FinancialPage 49 of 122 | XGM 2015 Trip Report
Financial Key Points: • Epic knows it is extremely important to track timestamps for everything done in the transfer center, including paging physicians, receiving medical clearance, obtaining financial clearance, etc. • Epic is looking at a way to integrate phone recordings into the transfer center module. • The new transfer center module will include development for reports since reporting is a large component for transfer centers.ADT Reporting Deep Dive (FAC37)Cromwell SuarezThis Epic-led session explored ADT reporting available for end users and project team members. 2014 dasboards that we can use todayand 2015 optimization in the works for Patient Access and Bed Planning end users. Key Points: • 2014: Dashboards: Discharge efficiency, analyze turnaround by origin unit, customizable unit groups, reporting by shifts (EVS/transport, Bed Planning Turnaround by shift • Future: Capacity Management Cogito Services: Patient Placement can have a standard dashboard and reports to assist with capacity management. • Future: Capacitiy Management Analysis: Receive metric data and analysis fo those metrics to help facility understand their capacity management trends; also benchmarking compared to other Epic community members.ADT Reporting Deep Dive (FAC37)Liann ManifongEpic 2015 will have many more useful ADT reports, dashboards and components, such as for transport and discharge milestones. Someof the Epic 2015 reporting functionality has already been pushed back to Epic 2014. Key Points: • Epic 2015 will have more graphical reports to show transport times and progress. • A discharge efficiency component can be created to show how many patients had the discharge order written by a certain timeframe as well as other key discharge activities being done in a timely manner, such as printing the AVS. • We are able to provide shift reporting for EVS, transport and patient placement. This allows us to compare statistics between the day shift, swing shift, and evening shift.Bed, EVS, and Transport Tracking: From Niche to Enterprise (FAC34)Liann ManifongStanford shared their experience transitioning their patient placement, EVS and Transport staff from their legacy system (TeleTracking) toEpic. They have noticed huge increases in throughput by having all staff in one integrated system. Key Points: • Before switching to Epic, the patient movement tracker and workflow visios should be updated to show the changes caused by having EVS and Transport in the same system instead of users having to go to a separate system. • It is extremely important for users to understand the patient location and how it integrates with Transport. • Users that create transport requests should be engaged earlier in the implementation process.FinancialPage 50 of 122 | XGM 2015 Trip Report
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