XGM 2015 Trip Report

SecurityEpic Audit Strategy (SF07)Nikki HammThe Unsession: SER Management forum was held at the same time as this session, so I did not attend.Best Practices for EPCS Two-Factor Authentication (SF02)Nikki HammThe University of Rochester Medical Center is using Yubikey to allow providers to quickly sign their orders. Key Points: • The Yubikey is placed in the USB drive and when activated acts as a keyboard to automatically sign the providers order by typing in his password. • The Providers buy their own Yubikey so they own it, and not the hospital. • The Providers plus non-clinical staff are asking to use this new tool since it's easy and \"Cool.\"Automation of SER Provisioning and Transitions of Care (SF10)Nikki HammAurora Health Care and Novant Health have begun to automate the creation of their EMPs/SERs for newly hired providers in order to savetime, improve build quality, and decrease the data integrity risk due to manual updates. This process causes a reduction of incident ticketsand increase of satified users. Key Points: • This process is also used to create 90% of non-provider EMP/SER records. • SER user creation takes no more than 10 seconds to create 1 record.Automation of Epic Accounts using Identity Management (SF09)Nikki HammGrady Health System was able to use Forefront Identity Manager (FIM) to create/manage user accounts within Epic. The Forefront IdentityManager software has been connected to their HR Database to allow Epic accounts to automatically create once they've been activated inActive Directory. Key Points: • A FIM connector users web services to create EMPs within Epic and assigns templates based on a users job code and department • This workflow is also in place for terminations, Name changes, Position changes, and Password changes.Security Forum Welcome & Dev Preview (SF01)Liann ManifongEpic shared new functionality for security that will be available in Epic 2015 and functionality that has been SU'd back to Epic 2014 Key Points: • Epic is working on removing security points from the shared security class that do not belong there. For example, MyChart security. Future development is being done to remove SSN security and document type security points from the shared security class. • There is a new Hyperspace unified security class editor that has the ability to search security points and has help text for security points. Unfortunately, ADT and Prelude are not on the list of applications in the Epic 2015 release that will be in this functionality. • User EMP snapshot form has hyperlinks to jump to certain masterfiles, such as user role E2R.SecurityPage 101 of 122 | XGM 2015 Trip Report

SecuritySecurity Forum Welcome (SF01)Ashley AbrahamThis was a general class that let us know the new features that we can use in Hyperspace Web in the future. Key Points: • We will be able to search for almost all Security classes in one area under Unified Security Class editor in hyperspace web • We can click on a security point in a Security Class and see Help Text which shows what the security point does. • We can click on a security class and see the users that are linked to the security class.Epic Audit Strategy (SF07)Rupin PatelThis session provided beneficial information on how to implement epic auditing. Reactive vs. Proactive auditing. Framework on asuccessful audit strategy by defining policy, identification of high risk application, and job roles and responsibilities alignment. Key Points: • Reactive Audit - Determine by running reports or analyzing who too much access to a certain acitivities. • Proactive Audit - Determine best audit practices in PRD normal workflow environment, additionally determine what access is really needed. • Define high risk application access. Such as View of full SSN, ability to edit users, schedule or cancel jobs, and limit hyperspace timeout based on the policy.SecurityPage 102 of 122 | XGM 2015 Trip Report

SystemsPowerShell Tips and Tricks (SRT04)Hector AnguianoEpic would like to see their customers use Powershell. Powershell is a very powerful tool for administration and tasks. Powershell can beused to automate a lot of day to day operational tasks. Powershell requires some time to become proficient. Key Points: • Powershell is great for automation • Powershell is powerful and can be used for administrative and system tasks • Powershell has a learning curvePre-SRT Technical Overview (SRT00)Hector AnguianoOverview of current ECSM systems and upcoming ECMS 2015 systems. Brief descriptions of new features in Epic 2015. Brief discussionon target platform and roadmap. Discussion on changes and revert back features from Epic 2014. (Attached printing) Key Points: • Attached printing was removed from 2014 and returns in 2015. This was a major issue. • Target road map does not discuss about updating the core programming of EPS • Epic is now moving towards Kuiper and Interconnect centric installs.Investigating Performance Issues with RTT and SPA (SRT 27)Sudhir GogadaUnderstood how to identify issues uisng RTT, SPA and investigate to idenfity key issue indicators. Key Points: • RTT exception percentages, Spikes in RTT exceptions, RTT by workflow step • Response time by HS Web, ECP Server and User. Concurrent exceptions denoted by \"||\" • Turn on HSI for deeper investigation on breaking down response timesInvestigating Performance Issues with RTT and SPA (SRT27)Matthew ScruggsOverview of System Pulse capabilities. How to use System Pulse to aid in RCA and performance troubleshooting. Key Points: • System Pulse has some nice \"drill down\" features to aid performance issue troubleshooting. • System Pulse Analytics (SPA) deserve attention and provide valuable tool for performance management.It's Not Me It's You- Caché Systems Troubleshooting (SRT 15)Ashley AbrahamThis session is about to determine what is locked and by whom, and investigate the job that holds the lock. (Part of 2014 functionality) Key Points: • We can use the utility - D ^HULOCK2 to see what is locked • We can also see all investigate the Job that holds the lock with - D ^JOBEXAM and • To verify that the lock is gone we can use this utility - D ^HULOCK2 USystemsPage 103 of 122 | XGM 2015 Trip Report

SystemsIt's not me, it's you: Cache Troubleshooting (SRT15)Mike ArtinoThe session gave an overview about how to troubleshoot Epic Cache locks and how to find the job that contains the lock Key Points: • Utilize Cache and Epic functions • fully investigate the issue to get correct information • Be careful not to break something elseKuiper Forum Part1 (SRT41)Aaron RumneyThis was mostly an introduction to how Kuiper is already used and just a little talk of the newer features to be added. Key Points: • Clarity Console will be added soon in Kuiper • BCA will be added to Kuiper, along with ability to do updates • BCA Web will also be added, updates also.Intersystems Session (SRT10)Saul RamosHear from InterSystems about new and upcoming Caché development and features pertinent to Epic environments. The presentation isfollowed by a Q&A session with representatives. Key Points: • Future Cache developments will enhance system high availability • Cache will be supporting a cluster like configuration • Cache database mirroring is now available to improve disaster recovery time.PowerShell (SRT04)Aaron RumneyWent over various uses for powershell. Started with just basic commands to ensure we have the correct versions but progressed into howto make use of scripts for monitoring or performing repetitive tasks. Key Points: • make sure PowerShell is up to date with newest versions • You are able to open up DLL's to further investigate issues • Learned a few new output commands for sending info out of powershell.Improving Graphics Performance in Virtual Desktops (SRT)Faisal SiddiquiUsing VDI (Virtual Desktop Infrastructure) resulted in cost saving for the organization . Primary benefits include ease of use, quick updatesof applications and security. Major difference noticed in workflows response time after implementing VDI. Key Points: • Virtual Desktops and the role in healthcare • Improving the graphics and enable the application to run on any device • Reduction in hardware load and maintainance costSystemsPage 104 of 122 | XGM 2015 Trip Report

SystemsPowerShell Tips and Tricks (SRT04)Matthew ScruggsSession demonstrating techniques for using PowerShell with EPIC systems. Key Points: • How to create running transcripts of powershell sessions. • How to set and use variables in file specifications with default actions to launch programs and open files. • How to use the \"add-windows\" feature of cmdlets to enumerate .dll options to configure and manipulate EPIC program modules.Powershell tips and tricks (SRT04)Nagesh PaiThis presenter did a demo on all the different way to automate the tasks that are done for SU and an upgrade. The demo walked thruissues that one could come across and the niceties of using a powershell in daily EPIC maintenance tasks. Adding a printer was amazinglysimple when we write and execute these scripts. Key Points: • Powershell is your friend • Use it whenever you can • spread the knowledge on how to write in powershellPowershell Tips and Tricks (SRT04)Adam KestelThis session provided examples of real world scenarios, in which powershell could help troubleshoot. Key Points: • Kuiper is a powershell based platform for managing client systems • Epic allows customers to use powershell to manipulate the client systems software • Provided a live demo on an end to end install of Web Blob using powershellPre SRT Technical Overview (SRT 00)Faisal SiddiquiTechnical team structure and Epic team's involvement and availability for the clients. Issue logging in Sherlock and expected resolutiontimeframe from Epic. Key Points: • Issue prioritization and communication with Epic including the Emergency tickets • Organization architecture set up and recommendations by Epic • Better utilization of Sherlock (Epic's issue tracking tool)Pre-SRT Epic Technical Overview (PRE SRT)Mohammad AsadThis session is for Epic overview and upcoming new functionality Key Points: • We can install PB Cubes • We can install HB Cubes • We can also Excel PivotingSystemsPage 105 of 122 | XGM 2015 Trip Report

SystemsPre-SRT Technical Overview (SRT00)Rupin PatelAfter attending the session I realized this is a full overview how Epic software is implemented in a organization. It provides a completeoverview of what is really involved to install Epic from a technical/systems perpestive. Key Points: • Epic is implementing and migrating applications slowly from Hyperspace GUI to Hyperspace Web • Hyperspace Web is turning client side printing to the server side printing, which means that the print queue will need to be built. • PRDSHD environment has been renamed to RPT environment on the Epic Side.BusinessObjects Administration: Best Practices (SRT 05)Mohammad AsadThis session talk about best practice of SAP BusinessObjects. Key Points: • Do not use a vanilla install of BusinessObjects • Split the APS, Split this into many more, optimize memory usage, stop unnecessary services • Platform Search: Don't enable Platform Search for each node.Overview of Hyperspace Performance (SRT21)Mike ArtinoEpic reviewed their findings of the performance of Hyperspace and the future of IE Key Points: • Know your configuration • Plan for the future • explore new options for presentation of softwareHA and DR Options for Client Infrastructure (SRT44)Matthew ScruggsReview different DR strategies for use with EPIC. Hear about using distributed infrastructure across multiple datacenters for HA/DR. Key Points: • Three key methods identified: \"Load Balanced Sites\", \"Active/Passive Sites\", \"Highly Redundant Single Site\". • Some controversy and technical disagreement among EPIC departments regarding best method to use. • Each client organization needs to architect the best solution for their unique situation.Clarity on Oracle Server Updates (SRT13)Mohammad AsadThis session talks about the best practice of Oracle database Key Points: • Epic recommendated purchase Oracle Exadata as more than 10 Epic user using and huge perfomance gain. • We must have to upgrade to Oracle 12c • Epic recommendated to use in-memory for Oracle 12cSystemsPage 106 of 122 | XGM 2015 Trip Report

SystemsData Courier Admin and Analyst Forum Part 1 (SRT03)Ashley AbrahamThis session was about Data Courier preview, dependency calculation, package list filters, and Content Management. The DC tool hasadditional features that will help us resolve, and track issues that we have with Masterfiles, Records, and items sent. Key Points: • Now, Data Courier is able to display all records despite how large the package is. • When sending a package to another environment you see that an item that is grey, it means that the item is disabled in the EGC. • The search functionality has additional options to track sent packages.Data Courier Admin and Analyst Forum Part 2 (SRT06)Rupin PatelThere seems to be a lot of organization that use content management heavily to prevent from any new build from accidentally moving todownstream environment and the content management has limited functionality. Key Points: • Content Management does not have the ability to block record with items is not available and causes a lot of data migration interruption • Due to limited functionality, lot of organization choose not to use the content management activityData Courier Admin and Analyst Forum Part I (SRT03)Rupin PatelThere are some major improvements coming to data courier which will be beneficial to all analyst. Dependency calculation will now bemore accurate for both records and category list. Content Management will now be more streamlined and will be granular by item ratherthan just be records. Additionally, new data entry fields will be added for ticket entry, requeter, RA, and affected records. Key Points: • The improved \"Preview\" offers Enhanced Version Skew Info, New look and feel, keep multiple records open, no more hangtime, Faster record load • The improved \"Dependency Calculation\" will display many more dependencies, INIs sort by initials, and reduced reliance on spreadsheet. Order Set dependencies will exclude old retired data, reduces dependency counts. • Transparent upgrades allows the user to continue to send non-reserved data and automatically pause records from send reserved data to destination environment.Disaster Recovery discussion Panel (SRT51)Shams RaviDiscussions about DR activation and good testing practices. Key Points: • Create and maintain detailed system recovery documentation.E-signature Deep Dive & Demo (SRT26)Liann ManifongEpic shared the esignature pads that are compatible for use with Epic and future development that is being done.SystemsPage 107 of 122 | XGM 2015 Trip Report

Systems Key Points: • Previously, only Topaz e-Sig pads worked with Epic. Now, Wacom pads are being tested and some hospitals use tablet PCs. • Some organizations choose to use a combination of models. The tablet PCs are cheaper than e-Sig pads, so hospitals choose to use the tablet PCs in training rooms. ED areas also have tablet PCs since staff are mobile. • Epic is working on e-Sig functionality for mobile devices as well as the ability to pass an entire form to the device instead of the device just having a signature box.Investigating Performance Issues with RTT & SPA (SRT27)Shams RaviThis session provided insight in to monitoring system performance and investigating response times. Key Points: • Key product feature for SPA 2015 was the addition of New Averages options based on Service Area and Location.Features of RTT, Trove and SPA (SRT 31)Sudhir GogadaNew features for effective performance and scalability monitoring in Epic 2015. Key Points: • SPA has new averaging options based on Service Area and Location • Response time categorization by Cache Time, Client time, Network time and server request utilizationPre-SRT Technical Overview (SRT00)Adam KestelProvided an overview of all of the client system platforms. Key Points: • Review of the epic architecture • Review of roles and responsibilities of and ECSM • New design for BCAHow Epic tests performance and scalability (SRT12)Nagesh PaiEPIC tests the performance and scalability across different platform. The results from EPIC tests are published and are available to theorganization by engaging the EPIC TS. They constantly take input from the customers. If there is a configuration that customer needstested contact EPIC and they might have an answer. Key Points: • EPIC test different configurations in there test environment • They take inputs from their customer and can provide guidance to thier customer • They may not have an answer but they will get back to the customer when a certain configuration needs tested.How Epic Tests Performance and Scalability (SRT12)Faisal SiddiquiTo enhance the performance by setting up appropriate architecture and utilizing the recommended hardware. Key Points: • Cache Scalibility Test • Reporting Load Test • Enhance the performance by integrating Xenapp with Load generator toolsSystemsPage 108 of 122 | XGM 2015 Trip Report

SystemsHow Epic tests performance and scalability (SRT12)Shams RaviTools and methodology used by Epic to test performance Key Points: • 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 planHow Epic Tests Performance and Scalability (SRT12)Sudhir GogadaThis session comprised of details on approach, methods, tools used by Epic for testing performance and scalability. This inculded how theresults are communicated to customers in form of Hardware configuration guide. Key Points: • Observations were made that compatibility issues existed between XenApp 7.6 and HP LR • Epic's switch to new testing tool AutoIt along with some Internal test harness toolsHyperSpace Web in the Real World (SRT32)Aaron RumneyWent over how to set up HSW servers. Talked about load balancing concerns and how to use them properly. Key Points: • Load balancer cookie affinity, why it's used and when • Health checks ran too aggressively can cause the balancer to to time out sessions • went over timeouts, tcp profiles, connection aggregation, backup persistance.Hyper-V (Unsession)Hector AnguianoDiscuss Hyper-V and current use in Epic. Discuss how many organizations are using hyper-v for production systems. Discuss benefits ofHyper-V over other hypervisors. Discuss Hyper-V performance. Key Points: • Hyper-V as a target platform • Hyper-V Pros and Cons - Usage in other organizations • Hyper-V performance compared to VmwareHyper-V (Unsession)Matthew ScruggsTechnical round table discussion of using Hyper-V with EPIC systems. Key Points: • UCLA Health is one of nine EPIC customers using Hyper-V in a meaningful way in their EPIC system infrastructure. • Hyper-V was recently added as a target platform for EPIC. • Established new connections at EPIC and with peers in the client community.Features of RTT SPA and Trove in 2015 (SRT31)Shams RaviDiscover new features in Epic 2015 with respect to performance and scalability monitoring.SystemsPage 109 of 122 | XGM 2015 Trip Report

Systems Key Points: • Categorize response time by Cache time, Network time, Client time and server request utilization. • Few interesting features to list 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.Whats New in Printing (SRT08)Adam KestelSession provided an inside look and the changes and new features for printing with EPS. Key Points: • Epic is releasing EPS Monitor to provide and overview of the EPS servers • They will simplify the EPSM deployment process in 2015 • Epic no longer recommends using EPSM for job routing as it is unstablePre-SRT Technical Overview (SRT00)Matthew ScruggsAn overview of EPIC systems and Infrastructure. Key Points: • No surprises here--the presentation confirmed my understanding of EPIC system architecture • No announcementsTarget Platforms (SRT02)Saul RamosTarget Platforms; Transitional Platforms; Exploratory Platforms; Emerging Platforms. How will these affect my budget and plans when weupgrade to Epic 2015 and beyond? What should I be keeping my eye on for the future? This high-level, rapid-fire session providestechnical directors with information to help answer those questions. Key Points: • Our platform is part of Epic target platforms • Our current infrastructure will be able to support Epic 2015 with some minor upgrades • Our current platform is not part of Epic transitional platformsTechnical dress rehearsal lessons learned (SRT09)Nagesh PaiThis presenters objective for TDR was to test and resolve all the printing problems before the go-live. Reduce the technology problemsduring go-live. Key Points: • Ownership of TDR is within organization • TDR needs month of planning • Do not underestimate work involved in TDR.Under the Hood of Hyperspace Web (SRT35)Aaron RumneyA deeper dive into HSW. This was more technical and dove a bit into the web side with troubleshooting and customization.SystemsPage 110 of 122 | XGM 2015 Trip Report

Systems Key Points: • Future Idea like session redirection • Tools for setup and validation • More tips to help load balancers like keep alive pings and iApp automation.Upgrade ConsoleExperience (SRT20)Mohammad AsadThis session discuss about Clarity Console upgrade Key Points: • Keep all team members in the loop on current progress with upgrade • Understand who owns manual tasks if console issues ariseUsing Epic Archiving to Reduce Cache Database Sizes (SRT25)Michael NguyenThis session focused on archiving older data in the Epic database. Data that has not been touched in a long period of time can be archivedlocally or to the cloud. Key Points: • Data can be archived local disk • Data can be archived to the cloud - Microsoft or Amazon • Minimal impact to performance when retrieving data.Target Platform Roadmap (SRT02)Mike ArtinoSession went over the Epic recommended hardware configurations Key Points: • Budget • Review • PlanWhat's New in Epic 2015 for ODBA's (SRT07)Michael NguyenThis session focused on what Epic has implemented on the technical side for Cache DBA's. It laid out a plan on what it's working on nextfor Cache and Intersystems. It wants feedback from the technical folks on how to improve to make things better. Key Points: • Instaserver will be implemented in 2015.1 • Environment Copy will copy environments in parallel • New tools will also be available in future versionsTarget Platform Roadmap (SRT02)David AkinNew releases in Cache 2015.1 and .2 Key Points: • Cache improved CPU scalablity • Cache improvments in Monitoring • Cache improvments in Mirroring to Shadow and DR serversSystemsPage 111 of 122 | XGM 2015 Trip Report

SystemsWhat's New In Printing (SRT08)Hector AnguianoEpic Print Service now has more features on Epic 2015. Epic Print Service can now be installed using Kuiper. Attached Printing returnsfor EPS. New troubleshooting carepackage utility is available for EPS issues. Key Points: • Epic Print Service can now be installed with Kuiper • Attached printing returns to Epic Print Service 2015 • CarePackage utility allows better troubleshootingWhat's new in Printing (SRT08)Aaron RumneyThis was a big overview first on how printing works now, how it worked in the past and how it is changing in the future. Key Points: • EPSM now manages print queues and load balances • Faxing is getting reworked but for now I should be able to get status back into Epic • Reporting and troubleshooting tips and ideas for the future.What's new in release (SRT14)Nagesh PaiAutomatic shadow environment install, Triggered by install in primary, New journaled global, New shadow daemon, No setup necessary.Banned vs. reserved data Key Points: • upgrade console monitoring • EXC automation • transparent performanceWhat's New in Release (SRT14)Matthew ScruggsOverview of what is coming in EPIC 2015. Key Points: • Breakdown of EPIC Community by Version--(54% of base runs Epic 2014.) • Updates coming for EPIC 2015 are relatively minor. • EPIC Community is clammering for 64 bit code upgrades.What's new in Release (SRT14)Aaron RumneyWent over the new features and direction that Epic 2015 will be going. Reviewed components that would have larger changes and whatthose changes would look like. Key Points: • No more shadow installs • systempulse will have updated console support • Multi-casting, to allow updating more that one environment at a time.SystemsPage 112 of 122 | XGM 2015 Trip Report

SystemsWhats New in System Pulse (SRT 22)Sudhir GogadaSession had key points on improvements made to monitoring using System Pulse 2015 Key Points: • Alerts - SNMP and System maintenance report, Top jobs has CPU, reads, journal entries, and block allocation • RTT using DB Time, Web Time, GRefs, Block reads and Web Crash • Performance and Storage - queue, data filing, dashboard refresh, Purging IIS logsWhat's new in System Pulse (SRT22)Mike ArtinoReviewed the key features and strengths of the system pulse feature. Also learned about some of the new features that will be coming. Key Points: • Continuous Monitoring needed to maintain a healthy system • Monitoring is highly configurable • Can be more proactive towards issuesWhat is new in system pulse (SRT 22)Nagesh PaiSNMP protocol is available in system pulse. resolve and snooze in batches. weekly static reports via email. Key Points: • lots of good changes in system pulse. • monitoring and archiving now has Error and timeout details and Stats – requests, data sizes, processing time. • monitoring of BCA clients is also availableSecurity for the Cache Database Server (SRT49)Michael NguyenThis session focused on security for Cache databases. It explains the challenges of granting security to text based users and how tocontrol it. Key Points: • What text access is needed? • How can sessions be audited? • How can captive menu's help?Pre-SRT Technical Overview (SRT00)Michael NguyenSession was an overview of what Epic is doing now and into future. It lays out a road map of the Epic application and where it is heading. Key Points: • Target platforms are laid out • Follow target platforms to keep consistency • Stay of ahead of the curve to receive best supportPre-SRT Technical Overview (SRT00)Saul RamosSome features and performance improvement for Epic 2015.SystemsPage 113 of 122 | XGM 2015 Trip Report

Systems Key Points: • Epic double the system performance with Epic2015 • More enhancements for System Pulse • Updated target platform listPre-SRT Technical Overview (SRT00)Shehzad SheikhEpic presenter gave a general Technical and Architectural Overview of all the entire Epic software. Some of the key things to mention:Epic doesn’t support Cache active active clustering because it has caused performance issues. Pool manager is now called warp drive. Ithelps keep hyperspace running in background in the Citrix client for high traffic area. BCA technology ensure business continuity in caseof major technical issues or disasters. Epic offers multi factor authentication that can be a combination of finger print, proximity badges,user names and passwords. Key Points: • Transparent upgrade is a new option that can minimize downtime during upgrade cutovers. • Epic synthetic IO load generator can generate load for IO testing to check SAN testing. It can simulates the load from cache server to storage. • RTT - response time turnaround. Helps understand user response time.Provisioning Services and EPIC Updates (Unsession)Matthew ScruggsBreakout session and technical discussion with peers re: Citrix PVS and use with EPIC. Key Points: • Other organizations are using Citrix PVS, primarily for VDI. • Tips and techniques for image management and coordinating HyperSpace Web and Microsoft updates.Real-Time Analytics Using Interconnect Web Services (SRT39)Hector AnguianoInterconnect/Webservices use case for pulling information from Prod in near real time. Real time bed information and ER capacity.Available for multiple platforms including mobile devices. Developed with Executives in mind. Key Points: • Interconnect/Webservices gateway usage for pulling information real time • Real time information for ER departments • Executives can make decisions to improve customer satisfaction and wait timesReal-Time Analytics Using Interconnect Web Services (SRT39)Aaron RumneyPresentation by Scott showing how his OHIA team put together a real nice interface for management to see the flow of the hospital. Key Points: • You need a development team that understands the languages • Real-Time is really a 5-15 minute window because of refreshes • Available on mobile devices alsoSystemsPage 114 of 122 | XGM 2015 Trip Report

SystemsTarget Platform Roadmap (SRT02)Nagesh PaiThe target plat form is following the recommendation that EPIC has for infrastructure to deliver a fast experience to the user. Theorganization who followed the target platform benefit by having less downtime. Key Points: • Target plat form reduces the downtime and delivers a good user experiences of EPIC systems • Redhat linux for EPIC deplyment is growing • hyperspace on IE had lot of issues because of change in microsoft strategy to move away from IEReview of Unplanned Downtimes in 2014 (SRT43)Mike ArtinoThis session discussed reasons for unplanned downtimes in 2014 and how quickly or not they were resolved Key Points: • Have a clear plan documented • Have the key decision makers available at all times • Communicate with the end-users to keep them informedWorking with Cogito Data in System Pulse Analytics (SRT50)Shehzad SheikhSystem Pulse Analytics is a great tool for system administrator to monitor, analyze and plan for various parts of Epic solutions. It isaccessed through userweb and system performance data is sorted at Epic through secure VPN tunnel. Epic recently added clarity ETLstats and trends to this application. The system account to setup system pulse for clarity only needs access on performance metric tablesin Clarity. Key Points: • In future will include BOE reports stars and license usage. CDW ETL Stats and SlicerDicer stats, SQL server performance counters, and RWB • It would allow benchmarking with other Epic customers to see if our systems are performing on par, below or above average. • This tool can also help us with capacity planning, licensing, and budgeting for future based on historic trending and growth of our systems.Security for the Caché Database Server (SRT49)Rupin PatelThis session provided an overview on how to manage Text access, ability to audit, protect data at rest, understand cache security andunderstand EpicConnect. Access to certainly functionality on the text side should be very limited to the Epic Technical Staff. Providingaccess to application analyst is the organizations decesion. Key Points: • Epic suggested that a user with programmers prompt has the ability to \"Set/View/Kill\" data including PHI data. They recommend that only Epic has the programmer prompt and lookit access. • EpicConnect is an application that communicated between Epic and organizational Epic implementations. This application allows Epic to grab data and standard code when in need. Services are enabled individually. • Cache auditing is on by default. Can enabled additional auditing events if needed.SystemsPage 115 of 122 | XGM 2015 Trip Report

SystemsSecurity for the Caché Database Server (SRT49)Ashley AbrahamThis session was about on how to manage text access, understand cache security, and also understand Epic Connect. Key Points: • We can setup Auditing for the Cache and Lookit tools. • We can setup EPIC CONNECT to run checks on Epic employeeSRT Welcome (SRT01)Adam KestelIntroduction to the SRT session layout and structure Key Points: • Unsessions provide an open forum discussion between other customers and Epic.Systems Roundtable Welcome (SRT01)Matthew ScruggsThis session provided orientation for SRT Key Points:Systems Roundtable Welcome (SRT01)Aaron RumneyThis was just the welcome where they introduce Epic and what Roundtable hopes to achieve. Key Points: • Socialize and meet others that do what you do. • Ask questions about how others do tasks different and why. • Learn what is coming down the line so that we can better prepare for the future.Target Platform Roadmap (SRT02)Faisal SiddiquiArchitecture and hardware set up/requirements to reduce the unplanned downtimes and enhance the workflow response time by usingsystem pulse tool. Key Points: • Use recommended architecture and hardware to enhance the performance • Minimize unplanned downtime • Possiblility of using Sparten with upcoming Epic 2015 later versionTarget Platform Roadmap (SRT02)Matthew ScruggsEPIC roadmap definitions and management strategy was overviewed. Comparitive information and statistics re: current EPIC systemdeployments across their entire client base were presented. Technical trends and directions were discussed. Key Points: • EPIC now classifies Platforms as \"Target\", \"Transitional\", \"Exploratory\", and \"Emerging\". • Largest percentage of EPIC Community uses VMware Virtualized or Physical platforms.SystemsPage 116 of 122 | XGM 2015 Trip Report

SystemsReview of unplanned downtimes in 2014 (SRT43)Matthew ScruggsReview common causes of unplanned downtime amongst the EPIC Community. Lessons learned Key Points: • Majority of EPIC downtime is related to infrastructure (79% due to Network, Data Center, Client, or Storage) • Over half of the EPIC Community experienced some downtime in 2014. • Preparation and DR Readiness are key to minimizing downtime. EPIC stands ready to assist.SystemsPage 117 of 122 | XGM 2015 Trip Report

TrainingUse 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 systemHelping 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.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.Using Natural Language Processing to Improve Medication Management (ANC 43)Paul TungPartners Healthcare gave a presentation on how they are using a custom in-house built NLP engine to improve their medicationmanagement. Key Points: • The top 3 challenges for using NLP in real-time scenarios is Interoperability, Integration with EHRs, and Clinical Decision Support • Make sure that you speak up and annunciate while giving presentations • This was a home grown NLP. We would more likely use a commercial or modified open-source solutionTarget Platform Roadmap (SRT02)David AkinNew releases in Cache 2015.1 and .2TrainingPage 118 of 122 | XGM 2015 Trip Report

Training Key Points: • Cache improved CPU scalablity • Cache improvments in Monitoring • Cache improvments in Mirroring to Shadow and DR serversPB Fishbowl (FAC53)Andrew WeaverThis session was an open question and answer session with Epic team. Key Points: • A new training initiative in 2015 will be the Epic Badge. Earning Badges will consist of training that goes beyond basic Epic Certifications. The training for Epic Badges can be completed without traveling to Epic. • In the future, Epic wants to determine how to track and report cost data within the system. However, there is no set timeline for this initiative. • The group would like Epic to begin to develop more reporting around workqueues with the ability to view workqueue history beyond the current seven day view.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 dataBusiness Intelligence Report Library Design and Use (ANC31)Paul TungPark Nicollet gave a presentation about the Report Library they created. They used SharePoint as the platform for their reporting library.This helped when they merged with HealthPartners. Key Points: • Reporting Library allows you to track data lineage, impact analysis, and report usage • You can reduce or eliminate duplicate report development by having a report library. • MetaData is the key - collecting and analyzing metadata will save you a lot of time and manual effortPEARLS: 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 fieldsTrainingPage 119 of 122 | XGM 2015 Trip Report

TrainingTop 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.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 hoursPEARLS: 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.TrainingPage 120 of 122 | XGM 2015 Trip Report

OtherUserWeb, including Nova, Sherlock, and GalaxyCategory: Strategic DesignLiann ManifongEpic shared some functionality they are working on for Nova, Sherlock and Galaxy. Key Points: • Epic is working on the ability to allow staff to log in to the UserWeb using their organization's Windows username and password. This does require the organization to do some configuration. • FYI release notes are going to be hidden from Nova and will no longer show up. • Epic provided search tips for Galaxy and encouraged everyone to attend the Galaxy Web-Ex, which is done on a periodic basis, to get more tips and tricks.Printing at Outreach and Community Connect Affiliates (Unsession)Category: PrintingLiann ManifongOrganizations that have rolled out Epic for use at affiliates or community connect shared their printing struggles and what they are doing toaccommodate printing. Key Points: • There is not really a good process in place yet for how to handle printing at affiliates or community connect sites. • The two options being used right now are Epic affiliate printing (aka dynamic Citrix relay printing) and print proxy service, which is the most widely used option. • Epic is still working on the best way to handle this since there is great demand to be able to print at offsite clinics or community connect clinics/hospitals.Beaker AP Optimization and Enhancements Opportunities (LAB07)Category: LabFaisal SiddiquiUpcoming enhancements in Beaker AP including worklist improvements, patient snapshot view including customization of snapshot andlinking it with LPR. Snapshot is more integrated with other Epic modules. Key Points: • Improvements in Pathologist worklist and optimazation of Outstanding List • Enhanced Patient's Snapshot view and integrated with other modules like Radiant, OpTime and patient encounters • Auto result and shared specimen enhancementsOtherPage 121 of 122 | XGM 2015 Trip Report