XGM 2015 Trip Report

FinancialPatient Flow Roundtable (FAC09)Cromwell SuarezThis session showed recent development projects related to Patient Movement workflows and plans for the future. Discussed influencebehavior, reducing cognitive load, mobility, improve staff utilization, and vision & direction. Key Points: • Appx Dicharge Times: Allow users such as MD, Nurses, and ACP to enter in appx discharge time; Track revision to date and when it was last verified • Discharge Milestones: Track specific steps towards discharge; Integrated with inpatient task framework; • Hospital News Feed: Ticket of updates in the hospital; Visibility and Activity in the hospital.Tapesty Upgrades: What's New in 2014 (FAC24)Andrew WeaverPanel discussion provided overview of various customers' experiences with Tapestry 2014 implementation. Key Points: • Nova notes drove the upgrade planning process. End-user work groups were formed around the topics included in Nova notes. Categorizing and assigning Nova notes to owners and then tracking those notes through the review process is very important. • Claims team has seen the biggest workflow impact in version 2014 - print form feature and resubmission within Hyperspace being the most popular new features. • For furture upgrades, all panelists agreed that they should have alloted more time for end-user testing in the upgraded environment. Security testing should be prioritized for future upgrade planning.Tapestry: Keeping Your KPIs on the Prize (FAC39)Andrew WeaverSession covered Epic Benchmarking for Tapestry and the AP Claims Graph Package report. Key Points: • Epic is working on benchmarking through Cogito benchmarking, benchmarking surveys, and the Graph Package report. • Cogito benchmarking is an Epic-wide initiative across all modules. Cogito will aggregate data across Epic customers and push benchmarks back to customers in the form of Radar dashboards. • An AP Claims Graph Package file is now available. It is currently being updated by the Epic Finance Team and pushed out weekly to customers. The goal of the report is to identify issues and trends quickly and operationalize a recurring review process.Tapestry 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.FinancialPage 51 of 122 | XGM 2015 Trip Report

FinancialTapestry 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 IDProfessional Billing Roundtable (FAC02)Andrew WeaverThis session gave an overview of new billing initiatives including patient estimates, new time of service payment collection workflows,MyChart auto-pay payment plans, redesign of the transaction inquiry function, redesign of the enterprise guarantor summary screens, rulesbased visit filing order, automatic claim attachments, direct claim editing, and Financial Pulse reporting which compares metrics to thelarger Epic community. The session also reviewed two new reporting cubes that will be introduced in 2015 - Denials and AccountsReceivable. Key Points: • Version 2015 Goal: Allow schedulers and pre-service staff to easily create estimates by leveraging templates, capturing patient benefit information, and applying automatic self-pay discounts. • Outstanding issues with estimates include the accuracy and reliability of payor benefit information and the manual intervention that is often required by financial counseling staff. • Version 2015 will include a redesign of the transaction inquiry screen that includes group by functionality, a filters bar, and hyperlinks to associated workqueues. These updates make this functionality more intuitive and require less navigation betweenFinancial Advisory Council Welcome & Recent Development (FAC01)Liann ManifongEpic provided an overview of upcoming functionality for ADT and Prelude. They showed screenshots of some exciting development thatwill be available in the Epic 2015 release and highlighted the functionality that is being SU'd back to Epic 2014. Key Points: • In Epic 2015, there will be a unit map that will visually show how the unit is laid out and which rooms are near the nursing stations. • There are new Prelude registration scorecards that will allow registration managers to more easily see staff productivity statistics. • The new bed planning functionality has had lots of development done so the functionality will be more useful for patient placement staff.Patient Flow Roundtable (FAC09)Liann ManifongTo aid in patient flow, Epic has made many changes to assist in the patient discharge process as well as environmental services andtransport functionality. Key Points: • We will be able to create discharge milestones to show things patients need to have done before they are ready for discharge. This will be configurable so we can determine what the discharge milestones should be. • The mobile tranpsort app will be available so transporters can use a small mobile device, like an iPod touch, instead of using the IVR to perform their duties. • Environmental Services will have IVR caller ID so the phone will be associated with the room, which will decrease a few steps EVS staff do today and make the EVS times quicker.FinancialPage 52 of 122 | XGM 2015 Trip Report

FinancialThe 340B Data Journey (ANC51)Dong Bi340B program can drastically cut drug costs, resulting in positive financial impact. Program eligibility and upkeep is complicated andrequires complex data reporting. Key Points: • Duplicate discount prohibition - if drug purchased under 340B cost, cannot get medicaid rebate, cannot use group purchasing contracts • Potential challenges: 1 patient class change from ED (ambulatory) to admission (inpatient). Patient payor change during stay. • Pharmacy must purchase the same NDC to accumulate and buy back at 340B cost. This is difficult due to constant drug shortages.Managed Care Industry Strategic Discussion (FAC48)Andrew WeaverThe purpose of this session was to facilitate a discussion of the Managed Care Industry as it relates to Epic Tapestry software. Key Points: • Population management is a key trend in Managed Care meaning that sharing of information across organizations will be important. • Healthy Planet and Care Everywhere can help to faciliate sharing of information across Epic customers.IT, Revenue Cycle, and Operations: One Big Happy Family? (FAC49)Andrew WeaverThis session reviewed lessons learned from various Epic go-lives. The focus of the presentation was creating the right team, trainingsessions, and organizational alignment to foster a successful transition. Key Points: • Correct ratio of Operations/Revenue Cycle personnel to IT personnel is important. A concentration of current operations staff can lead to an attempt to turn Epic into the Legacy system. • Legacy reporting cannot be duplicated immediately. Focus on building reports that can satisfy the needs of many users first. • Foster a culture of revenue reconciliation throughout the organization. This starts with the providers and should focus on missing charge reports and open encounter reports.Inpatient Professional Charging: Best Practice and New Functionality Overview (FAC25)Andrew WeaverReviewed inpatient charge capture and the reconciliation functionality in Version 2014. Discussed best practices for front-end chargecapture and back-end reconciliation. Key Points: • Build specialty and note specific charge capture preference lists and quick list for physicians' most commonly used charges. • Use a placeholder charge generated upon signing of an inpatient note which will be caught in a coding review workqueue. • The Inpatient Note Charge Reconcilation Report availabe in Reporting Workbench can be configured and added to the physician dashboard. This report will display notes which should have associated charges but for which charges have not been dropped.FinancialPage 53 of 122 | XGM 2015 Trip Report

FinancialGurney, Bed, or Boat? Improving Throughput and Turnaround Times (FAC14)Liann ManifongCommunity Medical Centers shared their experience with implementing Transport and EVS functionality to increase their throughput andturnaround times. Key Points: • Implementing Transport greatly increased throughput times since users were in the same system instead of relying on interfaces between separate systems. • To aid in measuring the increase in throughput, reports were created that showed the linked ADT event completion time. • Turnaround time increase was measured with reports that showed the ADT event backdate interval for discharges and transfers.Grand Central ADT (Focus Group)Liann ManifongEpic provided the list of focus group topics submitted by Epic customers. ADT has 10 votes for changes and the votes are due by May 13. Key Points: • Functionality that will greatly aid patient placement staff is if the new unit map (available in Epic 2015) is integrated into the bed board. • To aid EVS and Transport staff, hospitals have requested to have unit map functionality for the EVS command center and the Transport command center that includes hallways, stairwells, etc. • An ADT optimization request has been submitted to allow EVS requests to be assigned based on shift so staff are not being assigned requests if they cannot complete the request before shift end.Focus Group: Resolute Professional Billing (Focus Group)Andrew WeaverThis session provided an update on recent developments for version 2015 in the area of professional billing including new line level fielditems in the charge entry screen, sorting/organization of charge review WQ rules, multi-line select within workqueues, max deferral limit inworkqueues, automatic subtotaling in the transaction inquiry screen, workqueue links from within transaction inquiry, and remittancescreen changes. The session also included customer proposals for enhancement ideas for the next Epic version. Key Points: • Questions about future reporting capabilities were posed to Epic and they responded that at this time there are no plans to create a robust reporting platform to compete with Business Objects or other vendors. Currently advancements in Epic reporting are • Customers would like to have the ability to run more ad hoc detailed reporting for workqueues to identify trends and patterns. • Customers would like to have Resolute user security maintenance moved to Hyperspace. They would like to have the ability to start with a security template and then add or subtract individual security points to a user record.PB 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.FinancialPage 54 of 122 | XGM 2015 Trip Report

HIMROI in MyChart (MyAC05)Samantha CaoTwo organization implemented ROI in MyChart where patients can submit requests and receive copies of their medical record through theportal. Both organizations learned lessons on defining the charge structure for this service and recommend closely monitoring transmissionof files. This feature offers immediate cost savings and improves patient satisfaction. Neither organization received complaints aboutincrease patient inquiries to their providers. Key Points: • Review lessons learned with our own HIMs when rolling out this feature in the Summer • Charge structure will need to be well defined • Replicate current paper form to expedite approval of build.Pearls - Implementing Release of Information (ROI) in mychart (mychAC05)Ana EsquivelDartmouth Hospital and Dreyer Medical Clincal reviewed their ROI roll out plan. They offered patients and proxies the ability to requestand receive records via mychart. They found a reduction in TAT, increased patient satisfaction and saved money when compared toprinting and mailing records. Key Points: • Dartmouth found a 5% reduction in paper, 7% reduction in toner and 100% reduction in postage. • Dartmouth noted that the \"paper\" method of releasing information took about 17.5 minutes at the desk and 4.5 minutes through mychart. • HIM metrics: 5 staff for ROI to handle 1900 requisitions (200 come from mychart)Optimizing ROI and Scanning processes (HIM12)Mike ArtinoSession talked about provider dissatisfaction, Release of Information reporting problems, and issues locating documents Key Points: • you need well defined procedures • Need to continually update mappings • Need to have sufficient trainingImplementing 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 secureHIMPage 55 of 122 | XGM 2015 Trip Report

InpatientIntegrating 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.Emerging 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 others2014 Bed Planning Update (FAC51)Cromwell SuarezThis session summarized Lancaster General, Ochsner, Bed Planning upgrade to 2014 and Bed Planning enhancements in 2014.Discussed new bed planning views, user customization, ad hoc paging, auto advance request status, and dynamic request division andsorting. Key Points: • Key: Operational and IT Engagement: Set organization goals, training and workshops pre live/post live and include ACP/Supervisors. • Key: Operational and IT Engagement: Take available SU packages and Go Live Support • Key: Operational and IT Engagement: End user labs - engange bed planners, supervisors, and nursingInpatientPage 56 of 122 | XGM 2015 Trip Report

InpatientHaiku 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 esignatureGurney, Bed, or Boat? Improving Throughput and Turnaround Times (FAC14)Cromwell SuarezBy implementing the Epic Transport Module, Community Medical Centers increased its efficiency for patient throughput, EVS turnaroundtimes, and tracking patients throughout their stay. Used a 30-day pilot of using transport requests in the discharge workflow and datashowed that EVS staff were notified in an average of 20 minutes, making rooms available sooner for the next patient. Key Points: • Implementing Epic Transport: Decreased patient throughput timesl accurately track patients • ADT integration with EVS and Transport: Improved efficiency by avg 20 min; • Integrated system: Only 1 source for data instead of 2.Getting 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 systemsGetting 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.Get Going with Patient Movement (TAC22)Cromwell SuarezNovant Health: Patient movement workflows impact many roles and can be a source of complex questions during training and go-live. Howdo you ensure that your organization's patient movement workflows are properly documented, trained, and communicated? Learn aboutsome of the newest resources and best practices regarding patient movement.InpatientPage 57 of 122 | XGM 2015 Trip Report

Inpatient Key Points: • Training Tools: Patient Movement Cards given to staff that fit in pocket during go live • All patient movement workflows were posted online for staff to review • Always ensure that knowledge of patient movement tools is robustEpicCare 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.Epic-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-liveIlluminating 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 genderEnabling 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 dataInpatientPage 58 of 122 | XGM 2015 Trip Report

InpatientEHR 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.ED 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 visitorsBetter 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)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 labelsAuditing 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.InpatientPage 59 of 122 | XGM 2015 Trip Report

Inpatient 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.Universes, 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 usedAn Epic Year of Optimization (PMAC08)Cromwell SuarezNew Hanover Regional Medical Center reviewed the project timeline and tools used in a collaborative approach to optimizing applicationsbetween 2012 and 2014 upgrades. Discussed challenges, competing priorities, and integrated planning that includes clinical informatics. Key Points: • Identify Super Users from each dept as the liaison between IT and Dept • Weekly IT management meeting to dicuss all planning and requests and associated timelines • Have dedicated Epic IT analysts for 8 weeks per project; Continue to utilize Epic User WebA 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 processesA 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 dashboardInpatientPage 60 of 122 | XGM 2015 Trip Report

InpatientEnhancing 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. 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.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.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 fatigueTackling 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.InpatientPage 61 of 122 | XGM 2015 Trip Report

Inpatient 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 hoursStrategy 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.Strategic 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 at 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.Stork 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)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. 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.InpatientPage 62 of 122 | XGM 2015 Trip Report

InpatientRecipe 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 toolTransport 2014 with iPad Mini (FAC22)Cromwell SuarezHackesnsack University Medical Ceneter transitioned their Patient Escort team from TeleTracking to Epic’s Transport module, providingthem with a single integrated system with a symbiotic relationship between admitting, nursing, transport, and EVS. Team decided on theApple iPad Mini, which was small enough to be portable and at the bedside with the transporter, yet large enough to interact easily withHyperspace. Key Points: • Only used wifi Ipads therefore connection was not strong; Plan to use 4g LTE iphone 6 plus for better connectivity • Teletracking vs Epic: Avg completion down from 22 to 19 min • Teletracking vs Epic: Increased number of bed assignments processed by 26%; Reduced total turnaround time by 50%PEARLS: 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 modelingPEARLS: 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 improvementInpatientPage 63 of 122 | XGM 2015 Trip Report

InpatientPatient 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 strategiesMyChart 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.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.KPWhy? - How to use KPI Benchmarking and Dashboards to Improve Operations (ANC05)Kelly LockettMetroHealth presented design principles and build considerations for dashboard creation. Emphasized importance of OperationalChampions.InpatientPage 64 of 122 | XGM 2015 Trip Report

Inpatient Key Points: • Typically users look at dashboard for 2-4 minutes. Make it meaningful. • Dashboard does not display intervals natively. Can leverage ED translation extension in PAF columnInpatient 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 TherapyImplementing 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 moduleReplacing 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.Patient Flow Roundtable (FAC09)Cromwell SuarezThis session showed recent development projects related to Patient Movement workflows and plans for the future. Discussed influencebehavior, reducing cognitive load, mobility, improve staff utilization, and vision & direction. Key Points: • Appx Dicharge Times: Allow users such as MD, Nurses, and ACP to enter in appx discharge time; Track revision to date and when it was last verified • Discharge Milestones: Track specific steps towards discharge; Integrated with inpatient task framework; • Hospital News Feed: Ticket of updates in the hospital; Visibility and Activity in the hospital.InpatientPage 65 of 122 | XGM 2015 Trip Report

InpatientTapestry 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 IDADT/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)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 outreachTapestry 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.InpatientPage 66 of 122 | XGM 2015 Trip Report

InteroperabilitySuccessful National eHealth Exchange Compliance (SFO3)Stephanie SmithPresented by Chief Compliance Officer from Group Health in Washington. Provided the Compliance point of view of an organizationjoining the eHealth Exchange. Key Points: • Importance of ensuring organization is following Care Everywhere's \"Rules of the Road\" and DURSA requirements. • Group Health took 16 months of work group work to ensure compliance with DURSA requirements. • Tips on how Group Health ensured they were compliant with DURSA requirements.Interoperability Technical Forum Welcom (ITF01)Stephanie SmithProvided keys to good interoperability, Epic's initiative surrounding interoperability, and industry news. Key Points: • open.epic.com provides integration opportunities available through Epic. • Fast Health Interoperability Resources (FHIR) will be available in Epic 2015. These modular resources are well suited for mobile applications. • Epic will provide venue for sharing mobile app information.FHIR with Duke Medicine (ITF05)Nagesh PaiDuke has wrapped there applications with FHIR wrappers to easily develop mobile applications for idevices. Key Points: • Duke built an app for pill counters that they demo using FHIR framework • They had a robust infrastructure for mobile applications • They have a good innovation team that has a visibility across the organizationFHIR in the Real World (ITF05)Stephanie SmithSession provided information on the HL7 Fast Healthcare Interoperability Resources (FHIR). This is a standard for supportinginteroperability between health information systems. Session was presented by organizations with experience with FHIR standards. Key Points: • Need governance structure for implementing web services. • FHIR simplifies integration across third party applications • Epic will start supporting FHIR standards in Epic 2015.FHIR in the Real World (ITF05)Mike ArtinoPresentation given by Nebraska Medicine and Duke. Gave an overview of the upcoming HL7 organizations release of a new standardcalled FHIR (pronounced 'fire'). Key Points: • New Standards are always being developed • Utilize the knowledge of the community • newer technologies can be used to overcome old issuesInteroperabilityPage 67 of 122 | XGM 2015 Trip Report

InteroperabilityFHIR in real world (ITF05)Nagesh Paideveloper friendly. RESTful, clearly presented list data elements. ease of use for mobile development. Key Points: • FHIR is new standard for HL7 messaging • It will be used in conjuction with V2 format for mobile and other technologies • it may take a while for healthcare companies to get on boardEpic Web Services (ITF03)Mike ArtinoWent over features and enhancements that support new initiatives like Smart on FHIR. Key Points: • Utilize Epic library • keep up with latest technologiesCare Everywhere and the Technology Behind the Scenes (ITF04)Stephanie SmithProvided an overview of Care Everywhere, communication overview, maintaining Care Everywhere, and future development. Key Points: • Will be developing a Healthcare Provider Directory. • Developing methods to further integrate outside records into the medical record (i.e. integrated in Chart Review as line item with indicator came from CE). • Developing Record Locator Service for record exchange when patient is not able to communicate where they have been seen before.InteroperabilityPage 68 of 122 | XGM 2015 Trip Report

Meaningful UseWhy We Do MU (MU01)Eric SchmidtSasha and Kevin's introduction to the MU forum. Key Points: • About 23% of hospitals used the flexibility rule to revert to S1 rules. • Electronic submission of CQMs is still optional in 2015. • Consolidation/Integration of MU and PQRS teams is recommended since CMS is making efforts to align these programsWhy We Do MU (MU01)Angelica ThorntonOpening introduction from Epic. Key Points: • Meaningful Use Stage 3 was not yet released. • MU is difficult for everyone. • We can all learn from the successes and struggles of other Epic customers.PEARLS: Transitions of Care (MU04)Eric SchmidtStanford and SSM discuss their experience with transitions of care Key Points: • SER master file cleanup and maintenance responsibility is increased significantly but undertaking this project • The follow-up provider field is often misunderstood, clinicians do not know that this can send documents directly to the follow-up provider • Print the document for patients without a PCPPEARLS: Transitions of Care (MU04)Angelica ThorntonMaximizing transitions of care use by focusing on the patient. Key Points: • Surescripts and direct addresses provided most success..PEARLS: Success with P20 & Attestattion for specialists (MU07)Angelica ThorntonMU Stage 2 success with P230 Key Points: • Leadership buy-in is essential.Meaningful UsePage 69 of 122 | XGM 2015 Trip Report

Meaningful UsePEARLS: Success in All Stages (MU08)Angelica ThorntonSustaining success in the transitioning stages. Key Points: • Individual provider attention. • Regular reporting is effective.PEARLS: Stage 2 Success & Electronic Quality Reporting (MU03)Eric SchmidtNebraska Medicine and Sentara discuss Stage 2 lessons learned Key Points: • Nebraska has extensive pre-audit documentation, which in their experience significantly expedites the audit process (MU Measure \"walkthrough\" documentation) • Nebraska established committees for the following: P205, P215, P224A&B, P230 • Sentara's team for eCQM submission: Application Analyst – Interconnect Administrator – Cache AdministratorPEARLS: Stage 2 Success & Electronic Quality Reporting (MU03)Angelica ThorntonMU Stage 2 successes and lessons learned Key Points: • Communication is key to success in stage 2.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 administeredElectronic Submission of Hospital Quality Measures (MU02)Angelica Thornton Key Points: • MUSC was one of the first organizations in the country to successfully submit quality measures electronically. • Its not as intimidating as it may seem.Electronic Submission of Hospital Quality Measures (MU02)Eric SchmidtThe Medical University of South Carolina describes their experience with the electronic submission process for quality measures. Key Points: • Tracking and management of value sets/element term bindings can be cumbersome • Annual updates to specifications results in regular upkeep • Measures with look-back periods can be problematicMeaningful UsePage 70 of 122 | XGM 2015 Trip Report

MyChart and Mobile AppsPEARLS: 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 resultsMyChart (Focus Group)Deidre KeevesThe mychart focus group reviewed major new development efforts in mychart mobile including: push notifications, fast pass barcodf or formobile e-check in, pay copays, direct scheduling and confirm appointment. They demonstrated future integration between mychart mobile,apple healthkit and healthy planet for high risk population health management where provider can order for CHF patinets to self track BPand weight to an trended episode. Providers wil soon be able to release \"Open Notes\" initiatives into mychart selectively. Key Points: • Epic is releasing the toolkit for organizations to submit self branded mychart mobile apps that are searchable in the app store by organizaiton name and customizable. If UCLA takes this route all web and mobile content could be delivered through one app n • Video visits are being developed for mychart mobile. Organizations with early adoption of video visits are recommending that it will be easier for patinets to use mobile for video visits rather than computer workstation cameras. • Epic is targeting release of mychart iwatch app and tools in conjunction with apple's roll out of the iwatch.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 administeredChronic Disease Management and Expanding Acces Through MyChart (MyAC04)Deidre KeevesKevin Harrell and Matthen Herzog from Oshner Health presented their mychart mobile strategy for fast pass access, as well as theirmychart device integration with fitbit, withings, and healthkit. They reviewed their video integration strategy for mychart questionniares andshared lessons learned from a pilot of allowing patient open scheudling for mammograms.MyChart and Mobile AppsPage 71 of 122 | XGM 2015 Trip Report

MyChart and Mobile Apps Key Points: • Fast pass in mychart was set up using public wait list worklist functionality with cadence to find next day openings and run batch job to send patient the appointment offer. At 5pm the look for open appointments the next day, send request to 2 patients fo • Oshner is running a Track My Health pilot for HTN patients - they collect questionnaire information, med adherance, and vitals flow sheet info including BP (withings cuff), weight, activity (fit bit/healthkit). Info files into flowsheets that are not encounter specfic but rather file into an episode based print group. Team of clinicans runs reports regularly and takes follow up actions. • Track my health flowsheets with device integration should be tested carefully. Stanford has found some issues around unusual filling of data for patients that have multiple active track my health orders.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 dataEPIC web services (ITF03)Nagesh PaiEPIC web services are getting a new look in EPIC 2015 with FHIR and SMART adaptation. EPIC Interconnect can serve as a OAUTH2provider and are late to game but they are making good progress. They will SU all the changes from 2015 to EPIC 2014. Key Points: • SMART on FHIR will make devleopment of web and mobile applications a breeze • EPIC has added many web services that they could do in the applicationsGo Go Gadget: The extendable arms of mychart mobile (MyAC02)Ana EsquivelWith the new MyChart extendable framework, Duke customized the app's appearance and added patient wayfinding in the hospital. Theyadded their own logo and are creating their own mobile app. They described how to integrate native app functionality into the MyChart appand why this approach benefits patients. Key Points: • We can now customize the mychart mobile app. Options include \"epic submitted\" (Epic to customize) and \"self submitted\" (Customized by the institutions/organizations to extend branding). • To use the wayfinding functionality, you will need wifi as it uses GPS and Cisco. Bluetooth is another option. • Implementation of wayfinding was confined to the buildings only and it helped reduce late arrivals and no-shows.Go-Go Gadget: The Extendable Arms of MyChart Mobile (MyAC02)Samantha CaoDuke Medicine presented on how they customized the MyChart mobile app to reflect their own branding. They also implementedwayfinding and pre-login extensibility features. Key Points: • UCLA should invest in software, mobile app, and web development workforce to support all endeavors. • Branding is important • Wayfinding could reduce late visits and no-showsMyChart and Mobile AppsPage 72 of 122 | XGM 2015 Trip Report

MyChart and Mobile AppsGoGoGadget -the Extendable Arms of MyChart Mobile (MyAC02)Deidre KeevesDuke built the organization specific custom mychart mobile application and Epic has released a development kit for other organizations toself brand their own mychart app. The business case for a custom app is to tie all of your patinet web and mobile content into one place soyour customers search by your organization name, not epic. Key Points: • Organizations need to decide whether to have epic submit their custom app to google play/ and apple app store or submit directly from organization. • Duke successfully enabled their custom mychart app with real time way finding interactive maps. Patient can open the app, see where they are on hospital floor plan and get guided assistance to admissions office. Way finding required 3rd party Modea vendor plus epic but works through custom app even when patient is not logged into their mychart account. • Based on new mobile strategy Duke is onboarding new mobile developers to supplement their standard EHR AC positions.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 esignatureThe Road to (Multiple) Linkable Templates: 2012 vs 2014 (SF06)Nikki HammNorthern California Kaiser explained the 2014 append functionality that will allow the ability to append certain security items versus onlyoverriding the security within the linkable template. Key Points: • The System list Editor is the tool that will allow Providers to have acces different patient lists either by workstation, user role, user, or service area. • User's can now have more than one user role which eliminates the need for multiple templates in some cases. • They have also suggested that the change context concept should be used to switch between multiple templates versus loggin out.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. 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.MyChart and Mobile AppsPage 73 of 122 | XGM 2015 Trip Report

MyChart and Mobile AppsROI in MyChart (MyAC05)Samantha CaoTwo organization implemented ROI in MyChart where patients can submit requests and receive copies of their medical record through theportal. Both organizations learned lessons on defining the charge structure for this service and recommend closely monitoring transmissionof files. This feature offers immediate cost savings and improves patient satisfaction. Neither organization received complaints aboutincrease patient inquiries to their providers. Key Points: • Review lessons learned with our own HIMs when rolling out this feature in the Summer • Charge structure will need to be well defined • Replicate current paper form to expedite approval of build.MyChart Advisory Council (MYAC01)Ana EsquivelPresented mychart statistics around number of sites active on mychart and number of patients live on mychart. High level overview ofupcoming consumer features (activation on-line; fast pass; e-check in; open schedule; RTE queries and patient created payment plans.Also highlighted features to \"transform care\" and MU updates. Key Points: • 285 sites live with mychart web portal and 257 with mychart mobile. As of this day, there were 31,458,184 patients live on mychart • BonSecours implemented a text message workflow for instant activation of mychart accounts. • New functionality to improve patient access inclused Fast Pass which offers a waitlist patient an appointment once it becomes available. The appointment will be offered through mobile app and allows the patient the ability to accept or decline.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.MyChart Bedside (Focus Group)Deidre KeevesFuture Bedside developments include features such as push notifications, allowing feedback about staff, specialty customizations, 3rdparty content extensibility, better integration of education records, administrator app tools, pager and inbasket routing for patient requests.IOS version of MyChart Bedside app was released as is available now! Key Points: • Epic recommends a 4 unit roll out of bedside as an adequate pilot size. They caution that smaller 1 unit roll outs may not demonstrate the full ROI of the product. • Organizations live on bedside found great value in creating a \"Hello Bedside\" welcome video using the extensibility framework. This reduced the time it takes from clinical and admin staff to orient the patient to the bedside program.MyChart and Mobile AppsPage 74 of 122 | XGM 2015 Trip Report

MyChart and Mobile Apps • New Bedside features beyond 2015 will include specialty customizations for perinatal areas (such as mom and baby record viewing, and face time with baby), pediatric speciality (with gamification of healthcare for child to unlock entertainment content) andMyChart Welcome Session (MyAC01)Deidre KeevesEpic provided a summary of upcoming development for MyChart, MyChart Mobile and MyChart Bedside. Much development is in progressto optimize the mobile and tablet applications as well as improving customization and usability of the web portal. Key Points: • MyChart Bedside, previously only on Android tablets, is now currently available in IOS for ipad • Custom toolkit is now available for mychart customers to create their own organization branded mychart mobile applications. • Lucy patients can now send visit summaries. Lucy PHR added blue button plus support for CDA documents.Patient Reported Outcomes Via Questionnaires in MyChart & Welcome (MyAC10)Deidre KeevesUW Health presented a MyChart questionnaire initiative for their orthopedics group. The initiative was set up to collect quality outcomedata in conjunction with an orthopedic registry. They piloted questionniare series using a schedule question that is orderable by protocolfrom the scheduler or clinician. Collected outcomes info on ACL, hip and low back pain patients. Key Points: • Used Windows 8 tablets because Epic Welcome is not currently available for ipads or android tablets. The audience gave feedback to epic that IT organizations do not want support multiple tablet device models so effort should be made to align Epic applicat • Patients were given a disclaimer that questionniare answers would be reviewed by providers at their next appointment and that if they should call the clinic if they have any urgent issues. • Tool to help provider: synopsis view can be used to visualize trended questionnaire data, providers can use smartlinks to pull questionnaire data into notes.Patient-Reported Outcomes via Questionnaires in MyChart (MYAC10)Diana TYRoll-out strategy for questionnaires in MyChart and Welcome. Discussed governance structure, considerations of equipment, andworkflow. Key Points: • Involvement of many teams: Ambulatory, Cadence, MyChart, Welcome, Training, Security, Server, Desktop, and Programmers • Layout appearance for tablets versus kiosks are different and requires TS involvement to create the custom kiosk template • Testing on the tablets was extensive and favored testing on multiple tablet modelsPearls - Implementing Release of Information (ROI) in mychart (mychAC05)Ana EsquivelDartmouth Hospital and Dreyer Medical Clincal reviewed their ROI roll out plan. They offered patients and proxies the ability to requestand receive records via mychart. They found a reduction in TAT, increased patient satisfaction and saved money when compared toprinting and mailing records. Key Points: • Dartmouth found a 5% reduction in paper, 7% reduction in toner and 100% reduction in postage. • Dartmouth noted that the \"paper\" method of releasing information took about 17.5 minutes at the desk and 4.5 minutes through mychart. • HIM metrics: 5 staff for ROI to handle 1900 requisitions (200 come from mychart)MyChart and Mobile AppsPage 75 of 122 | XGM 2015 Trip Report

MyChart and Mobile AppsPEARLS: Medical Messaging (MyAC07)Deidre KeevesMetro health & Mount Siani both focused efforts on using mycart questionnaires to improve % of patients that send medical messages ineffort to help providers quality for MU stage 2. MetroHealth sent a post visit questionnaire with 4 or less questions such as \"Did youunderstand information given during your visit.\" Mount Sianin uses history questionnaires sent through mychart before every appointmentand has workstation in office waiting room for any that are not complete. Key Points: • Metro health post visit questionniare pilot attributed to major improvement and brought them up from 7% of providers who met p230 MU medical messaging measure to allow most of their providers to meet the criteria. • Mount Siani implemented pre-visit history questionniare and increased the number of providers who met MU p230 measure for medical messaging from 2% to 100%. • For history questionnaires, existing mychart users recieve survey before their visit. Then office staff prints activation code for new patients to activate and answer questionniare in waiting room. 2 tip sheets given at check in: how to set up mychart & iRelease to MyChart Discussion (HIM15)Wendy PetersThis was an informal, non-scripted discussion on the thoughts and ideas organizations had on Releasing records to patients throughMyChart Key Points: • Patients can request common documents like Immunizations, Disability forms, and the like through their MyChart account. • One organization that had been live on the functionality since 11/2014 said this has been extremely successful for them. It has frred up their HIM department to work on other tasks and they have had a large increase in patients signing up for MyChart. They inform every patient that calls about MyChart and all patients that come in to the department for their medical records. • Wok closely with the compliance department to establish which records can be released via MyChart and how long they are available for.Haiku Canto (Focus Group)Deidre Keeves201 Organizations are live on Haiku/Canto and epic is currently developing enhanced Inbasket tools, push notifications, scheduleenhancements, dictation workflows and secure text messaging. Their strategy is to maximize mobile including use of native phone featuressuch as iBeacon, and camera. \"If it make sense to do it on mobile, build it for mobile.\" Epic has asked to come to UCLA for a developmentemersion trip for Haiku/Canto, we will coordinate this in the fall. Key Points: • Epic is building in parity between IOS and Android platforms. In the future all mobile features will be available on both. • Custom tools are being built for Canto to accomodate orthopedic workflows, telestroke workflows, inpatinet rounding and ordering. • Epic is building provider mobile app compatible with apple watch. They are looking for provider input on what would be most helpful in this development area.Professional Billing Roundtable (FAC02)Andrew WeaverThis session gave an overview of new billing initiatives including patient estimates, new time of service payment collection workflows,MyChart auto-pay payment plans, redesign of the transaction inquiry function, redesign of the enterprise guarantor summary screens, rulesbased visit filing order, automatic claim attachments, direct claim editing, and Financial Pulse reporting which compares metrics to thelarger Epic community. The session also reviewed two new reporting cubes that will be introduced in 2015 - Denials and AccountsReceivable.MyChart and Mobile AppsPage 76 of 122 | XGM 2015 Trip Report

MyChart and Mobile Apps Key Points: • Version 2015 Goal: Allow schedulers and pre-service staff to easily create estimates by leveraging templates, capturing patient benefit information, and applying automatic self-pay discounts. • Outstanding issues with estimates include the accuracy and reliability of payor benefit information and the manual intervention that is often required by financial counseling staff. • Version 2015 will include a redesign of the transaction inquiry screen that includes group by functionality, a filters bar, and hyperlinks to associated workqueues. These updates make this functionality more intuitive and require less navigation betweenADT/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)FHIR with Duke Medicine (ITF05)Nagesh PaiDuke has wrapped there applications with FHIR wrappers to easily develop mobile applications for idevices. Key Points: • Duke built an app for pill counters that they demo using FHIR framework • They had a robust infrastructure for mobile applications • They have a good innovation team that has a visibility across the organizationFHIR in the Real World (ITF05)Stephanie SmithSession provided information on the HL7 Fast Healthcare Interoperability Resources (FHIR). This is a standard for supportinginteroperability between health information systems. Session was presented by organizations with experience with FHIR standards. Key Points: • Need governance structure for implementing web services. • FHIR simplifies integration across third party applications • Epic will start supporting FHIR standards in Epic 2015.MyChart and Mobile AppsPage 77 of 122 | XGM 2015 Trip Report

PharmacyWillow TS Tips & Tricks (PharmAC15)Dong BiLearned various utilities useful for Willow analyst to troubleshoot and support Willow application. Key Points: • create build team specific LRP with troubleshooting LPGs. • IMS trace utility useful to troubleshoot IMS dispensing issues • MAR scheduling report useful to troubleshoot medication scheduling/due time issues on the MARWillow Reporting: The Medication Usage Universe (PharmAC18)Dong BiMedication Reporting Universe is a robust tools for running ad hoc Clarity reports without requiring SQL knowledge (traditionally requiredfor Clarity reporting) Key Points: • Benefits: usability, flexibility, increase reporting team bandwidth • Medication Usage Evaluation Universe (2014) - useful for inpatient ordering/admin data element searches • Orders Action Universe (2015) - useful for inpatient dispensing and charging data element searchesWillow Ambulatory TS Tips & Tricks (PharmAC16)Dong BiLearned various utilities and build configurations useful to support Willow Ambulatory Key Points: • Use LPP to flag prescription fill if allergy hasn't been reviewed for X days • Labels - use dynamic font sizing, so spacing isn't pushed down based on content • Use LPP to flag fill in progress scripts that have been discontinued, while still fill in progress.What's New in Willow Ambulatory (PharmAC04)Dong BiEpic v2015 for Willow Ambulatory has some new functionality that will bring enhanced functionality to business owner. Key Points: • 2015 - show MyChart patient status in Willow Ambulatory patient header • 2015 - can resubmit refill authorization request to different provider, if first request wasn't responded to • 2015 - can submit refill authorization request when entering new script, instead of waiting for it to run out firstUsing 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 solutionPharmacyPage 78 of 122 | XGM 2015 Trip Report

PharmacyScoring System, System List, and Navigator for Medication Reconciliation (PharmAC06)Dong BiPatient scoring using system list can be used to allow clinical resources to perform med reconciliation on high risk patients first before lowrisk patients. Key Points: • Ideally want to perform med reconciliation on all patients, with limited clinical resources, must get to high risk patients first • Create patient scoring system to identify high risk patients & assign risk scores • Build med reconciliation navigator that displays relevant & necessary clinical data for clinicians to usePharmacy Advisory Council Welcome & General Session (PharmAC01)Dong BiEpic v2015 has some new functionality to provide better functionality and service to business owner. Key Points: • 2015 new PCA ordering functionality with discrete dose fields instead of order questions. • 2015 Smart Pump Dispensing integration utilizing 2 way interface to track when new IV drips bags are needed in real time. • 2015 pull in weight from other encounters, able to specify which DEPs are eligiblePharmacy 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.PEARLS: Patient Scoring (PharmAC08)Dong BiPatient scoring can be used to drive clinical interventions with limited clinical resources, selecting for high risk patients with actionableinterventions. Key Points: • to obtain value from clinical intervention, must be- right action, right patient, right time, right context • For patient scoring system list, better to use visual icons to represent data, than text values • build accordion report in patient list activity, pulls in flowsheet values (clinical intervention stored as comments in flowsheets)Meaningful Medication Warnings: A Plan to Reduce Alert Fatigue (PharmAC19)Dong BiAlert fatigue should be avoided and reduced when possible. There are numerous strategies to accomplish this. Key Points: • Increase allowed therapeutic duplicates in LSD level - data available from Epic • Med warning optimization utility - provides overview data for medication alert configuration targeting. • can assign FIS (interaction setting) by profile, service area, location, or specialtyPharmacyPage 79 of 122 | XGM 2015 Trip Report

PharmacyGreater Precision in Automated Adverse Drug Event (ADE) Detection (PharmAC23)Dong BiIt is possible to use BPA adverse event triggering, that will then send inbox message to pharmacy or pager, to proactively monitor andintervene on adverse drug reactions. Key Points: • triggering actions: administration of certain antidote/reversal drugs with narrow indication of use. • Can send inbasket message to pharmacy - requires active inbasket monitoring. Can send message to pager - doesn't require active monitoring. • Once message received, pharmacist is notified of adverse drug reaction and take appropriate clinical actions, and fill out ADE report.Epic-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-liveAuditing 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 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 processesPharmacyPage 80 of 122 | XGM 2015 Trip Report

PharmacyThe 340B Data Journey (ANC51)Dong Bi340B program can drastically cut drug costs, resulting in positive financial impact. Program eligibility and upkeep is complicated andrequires complex data reporting. Key Points: • Duplicate discount prohibition - if drug purchased under 340B cost, cannot get medicaid rebate, cannot use group purchasing contracts • Potential challenges: 1 patient class change from ED (ambulatory) to admission (inpatient). Patient payor change during stay. • Pharmacy must purchase the same NDC to accumulate and buy back at 340B cost. This is difficult due to constant drug shortages.PharmacyPage 81 of 122 | XGM 2015 Trip Report

Project ManagementSome PIG: Making Time to Innovate (PMAC04)Liann ManifongSeattle Children's shared their experience implementing Epic enhancements and optimizationsand how they organized this effort. Key Points: • In order to allow staff time to work on Epic enhancements, the workload was readjusted and business owners were engaged to ensure they approved of the changes. • There was a cultural change with the Epic analysts to ensure they set aside dedicated time to work on innovation projects and they couldn't use that time to work on production support or other projects. • It's a good first step to implement smaller innovations first and for integrated innovations, ensure you have assistance from other teams that are needed.Preparation and Implementation of BPAM across Applications (PMAC10)Stephanie SmithPresentation of Ohio State University's experience with implementing the Blood Product Administration Module. Key Points: • Conducting Blood Bank observations is key. • AM managed project but would have liked to have a project manager because all of the various teams involved in project. • Migrated back end build to production 8-12 weeks ahead of implementation helped with front end implementation.Maximizing SU/Upgrade Testing and Nova Functionality (PMAC07)Faisal SiddiquiMaximizing SU/Upgrade Testing session presented by one of the hospitals with limited modules implemented. They discussed how theyplan their testing for upgrade with limited resources and how it helped their organization to minimize the workload of testing. Key Points: • Effective Test Plan by identifying the proper resources and scope • Identifying the Critical/High level workflows • Eliminate redundancyKeys to Success through Epic Initiatives (PMAC01)Mike ArtinoUniversity of Mississippi presented and talked about how they leverages some of Epic's other services to meet goals. They utilized Epic'sconsulting services to get a handle on their Days Aging. Key Points: • Review workflows • Have well defined goals • Meet regularly to keep track of progressCOWPATTy (Certainty Occurs When People Accurately Track Time) (PMAC11)Stephanie SmithPresentation by UCSF on how they track resource time for projects. They have built a custom system called Northstar that staff enter timeworked on projects throughout the day. This data is then fed into management and leadership reports. Key Points: • Good for staff to enter time worked on tasks when done working on the task for the day and not waiting until the end of the day. • Data from the custom Northstar system is entered into PM tool called Innotas. • Team hours are tracked on a high level for leadership and managers track the details of the time spent.Project ManagementPage 82 of 122 | XGM 2015 Trip Report

ReportingCentralizing Your Report Request Process: Two Case Studies (ANC17)Stephen LeeChildren's Hospital Colorado and UNC Health share how they both centralized their report request processes. Key Points: • Both groups suggest using an online user report request questionnaire that covers all types of requests • UNC communicated their new process to customers by adding a Submit Report Request button in their email signatures, notifying the entire health system via email, and announcing at a user group meeting. • Analyzed their list of requests to see which Universes would be most useful to create for usersWelcome 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 easyImplementation and Early Experience with the CDW (ANC08)Ayan PatelEngage end users and train them. Realize that there are different skill levels between users. Visualization is an important step. Key Points: • Varying expertise amongst end users • Give power users access • Provide outside sources to end users even if they are not integrated into CogitoIlluminating 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 genderReportingPage 83 of 122 | XGM 2015 Trip Report

ReportingIdentification of High Risk Commercial Patients for Population Management (ANC07)Stephen LeeDiscussion of a new predictive mathematical model to identify high risk patients and the potential savings from using this model Key Points: • Their new model \"takes the average\" of a conservative model and aggressive model, which allows they to have high sensitivity and specificity • No predictive model is perfect and there are often trade offs when you use different ones • Small savings per member lead to large total savings if the population is big enough. However, savings per member vary greatly based on assumptions in analysis.How to Use KPI Benchmarking and Dashboards to Improve Operations (ANC05)Stephen LeeThis is a session on how to design Epic dashboard components to help improve your operations based on MetroHealth's experiences. Key Points: • Follow design principles (in presentation) when building dashboards • Don't make dashboards too complicated or cluttered • Utilize Foundation as a starting point to cut down on the work needed to build the componentGetting 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 systemsGetting the Most Out of Reporting Workbench (ANC13)Joycee BerinSee how Reporting Workbench can help you prepare data for submissions without changing users' input processes or establishedcategory lists. Learn how one customer transformed columns using Reporting Workbench templates and extracts to submit to UHC andthe American Joint Replacement Registry – and created custom internal metrics like pre-operative readiness. Key Points: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.ReportingPage 84 of 122 | XGM 2015 Trip Report

ReportingEnabling 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 dataCOO 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: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:Clarity on Oracle Server updates (SRT17)Saul RamosPresenters give updates on performance testing of Clarity on Oracle Database. Topics include migration tips from 11g to 12c, scalabilitytesting, and some really cool new features in Oracle Database 12c. Hardware upgrades are also discussed, including the transition fromIBM Power 7 to Power 8 as well as pros and cons of migrating your Clarity environment to Oracle Exadata hardware. Key Points: • We need start planning the Oracle 12c upgrade • Oracle will increase DB support next year for older versions • Oracle 12c upgrade has been tested by EpicImporting External Claims Data into CDW (ANC20)Paul TungWeill Cornell gave their account of importing external data into CDW. They where trying to satisfy the needs around claims data for theircare manager program, ACO, and Compliance (payer side). One of the big issues they encountered was conforming the data andmatching patients across different data sources. They ended up creatign their own custom matching process instead of leveraging thebuilt-in patient match component in CDW. Key Points: • Work with the Clarity TS closely when you are importing data • Check on Epic User Web for the latest documentation (They did not) • Categorize and Prioritize data that you will import around use casesReportingPage 85 of 122 | XGM 2015 Trip Report

ReportingBusiness 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 effortBusiness Intelligence Report Library Design and Use (ANC31)Stephen LeePark Nicollet and Children's Colorado show their SharePoint BI library and how they designed it Key Points: • PN has different views for different uses (customer, development, deployment, upgrade, enterprise). We may want to take a similar approach to our library • CHC leveraged Epic released Sharepoint materials to build their Cogito report library • Visualizations to show what content is in your report library is helpful in understanding what you use most as an organization (as shown in CHC's presentation)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 anayticsBusiness 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 enhancementsUniverses, 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 usedReportingPage 86 of 122 | XGM 2015 Trip Report

ReportingPEARLS: 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 fieldsCOO Coffee & Donuts: Real-Time Web Dashboards (ANC26)Vu VuThe presentation showed Real Time dashboard. The dasboards pulled data straight out of Chronicles and displayed in a web browser.Dashboards are refreshed at every 5-15 minute intervals, which provides relatively fresh data to decision makers. Key Points: • Interconnect needs to be setup for data to be retrieved from Cache • UCLA's COO loves the donut (dashboards) • UCLA's real time dashboards are viewable on mobile devicesIntegrating 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.Getting More Out of Reporting Workbench (ANC13)Vu VuThe benefits of RWB are: 1) real-time 2) actionable 3) data within Hyperspace 4) contains direct links in hyperspace, Key Points: • Extensions are powerful (LPP) (1000s built by Epic Already) • Rule based columns (\"Rule Maintenance\") is powerful, use to introduce logical rules in reporting • UHC Extracts can be built from RWB, for specifications availablePearls: Implementation and Early Experience with the CDW (ANC08)Vu VuCDW enables Self-Service reporting and analytics. Microsoft SSIS is the primary tool used for ETL of data from Clarity to CDW. Placing aBI tool like Tableau on top of CDW gives fast performance. SlicerDicer is dependent on the CDW. Key Points: • RedGate (3rd party) was used for Validation of data type from Clarity to CDW • Uses Tableau for presentation of CDW data • Uses Hadoop in production (2/2/15)ReportingPage 87 of 122 | XGM 2015 Trip Report

ReportingAnalytic SQL for Improved Reporting on Flowsheets and Orders (ANC 37)Paul TungThis presentation was given by a very enthusiatic BI Analyst from Swedish Hospital in the greater Seattle area. He went over some tricksand shortcuts that he developed over the years in SQL programming to solve complex reporting needs in both Oracle and SQL Server Key Points: • Leverage aggregation and windowing functions when you code with SQL to save you time and improve accuracy. • There are Distinct differences between PL/SQL and tSQL that depending on the use case can make a huge difference in amount of code and work an analyst will have to create. • Push the work of aggregating and filtering to the layer that is built specifically for that type of work - the database layer.COO Coffee & Donuts: Real-Time Web Dashboards (ANC26)Tony ChoeAn organization 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: • Describe a way to approach building a sustainable process to scope out information technology-related projects. • Describe a way to reconcile metric defining in a multifaceted academic medical center environment. • Examine how to use a data platform to make data-driven decisions.PEARLS: Optimizing Report Distribution and Performance (ANC50)Joycee BerinThis session focuses on report distribution and performance. Hear how Piedmont improved report performance by unsubscribing userswho don’t view reports and how Rockford is distributing reports in a way that makes sure reports are complete, ensuring both ETL andreport performance are optimized. Key Points:Welcome 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: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 solutionReportingPage 88 of 122 | XGM 2015 Trip Report

ReportingUniverses, 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:Technical Considerations for Patient Satisfaction Data in CDW (ANC12)Ayan PatelPatient satisfaction data (Press-Ganey) can be imported into Cogito. It is then tied to Epic data and can be reported on. Key Points: • Set up regular Press-Ganey XML extracts • SSIS package needed to ETL XML file into Cogito • Qlikview Dashboard is an effective way to display the imported Press-Ganey dataTackling 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 hoursReal-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.ReportingPage 89 of 122 | XGM 2015 Trip Report

ReportingPredicting COPD Readmissions (ANC32)Tony ChoePresenters show a readmission model that uses EMR data from Clarity along with geospatial variables and natural language processingapplied to chart notes. Walk through the process of using machine learning to predict readmissions – from collecting novel variables, tobuilding and tuning the models, then measuring the expected cost per readmission prevented. Key Points: • Describe how to build a predictive model and assess its accuracy. • Describe how to collect non-traditional data to improve models. • Describe how to assess the ROI of readmission models.PEARLS: 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 modelingImplementation and Early Experience with SlicerDicer (ANC02)Ayan PatelSlicerDicer implementation is fairly straight-forward and can be a very useful self-service BI tool. Even eliminating the need for somereporting workbench reports. Key Points: • SlicerDicer backfill load will take a long time on the initial load • SlicerDicer can be an actionable self-service BI tool • You can use SlicerDicer to highlight issues in the Epic BuildPEARLS: Self-Service Analytics with Third-Party BI Tools (ANC45)Joycee BerinHear how these three organizations put data in users' hands with Qlikview, Tableau, SSIS, and Microsoft. Identify the types of questionsthat warrant self-service analytical tools. Step through how to develop a dashboard, including discerning what information is needed in asingle view. See examples of end users manipulating data via Qlikview, Tableau, SSIS & Microsoft solutions.Integrating Epic Analytics Registries with Reporting Workbench (ANC25)Ayan PatelRWB has many advantages of being a real-time actionable BI tool. You can use Epic Registries and Metrics to optimize RWB reports. Thepresentation goes over different techniques to optimize RWB reports. Key Points: • Leverage existing RWB templates as a starting point • Use Epic Registries and Metrics to optimize RWB reports • Use static report content for large reportsReportingPage 90 of 122 | XGM 2015 Trip Report

ReportingLeveraging Epic's Data Warehouse as Your Data Warehouse Platform (ANC04)Ayan PatelCogito has a lot of potential to be used as a the enterprise data warehouse. The ability to import legacy data and ACO data (and otherexternal sources) is vital to the success of Cogito. Key Points: • Use the claims dimensions in Cogito to populate ACO claim data • End users may not be able to directly understand Cogito dimensional model • Leverage out-of-the-box billing and claims cubes from EpicIntegrating Epic Analytics Registries with Reporting Workbench (ANC25)Vu VuThis presentation showed that registries can improve performance in RWB. It also reduces consumption of resources in the applicationand provides simpler report setup and maintenance. To do this registries must be created and stored in Hyperspace. Key Points: • It's important to chose the right Report Template to initiate the process • Registries took a report that ran in 60 minutes and reduced the run time to about 60 secs. • RWB templates, static is much faster than dynamic.Integrating 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.KPWhy? - How to use KPI Benchmarking and Dashboards to Improve Operations (ANC05)Kelly LockettMetroHealth presented design principles and build considerations for dashboard creation. Emphasized importance of OperationalChampions. Key Points: • Typically users look at dashboard for 2-4 minutes. Make it meaningful. • Dashboard does not display intervals natively. Can leverage ED translation extension in PAF columnPEARLS: Implementation and Early Experiene with SlicerDicer (ANC02)Paul TungThis session was given by Norton Healthcare and Stanford Children's. The gave an overview of their current process and an look at theirlessons learned during the implementation of SlicerDicer. Key Points: • Make sure you define what problem you're trying to solve using SlicerDicer • Implementation of SlicerDicer can also shed some insight into build issues • Plan for SlicerDicer Backfill time and upgrade interdependenciesLeveraging Geospatial Information to ID Patient Risk and Improve Outcomes (ANC41)Stephen LeeA great presentation on how to operationalize public health concepts into clinical care (in particular social determinants of health)ReportingPage 91 of 122 | XGM 2015 Trip Report

Reporting Key Points: • Clinical recommendations can be more effective if clinicians understand the environments/areas in which their patients live • Idea for operationalizing: Patients can be flagged for certain SES and location based risks to tip off clinicians about what patients need • Data integration from multiple sources is key to making this idea happenLeveraging LEAN to Improve (ANC10)Stephen LeeOHSU shows how they worked with a Lean specialist to improve reporting processes in their Clinical Informatics department Key Points: • Clear communication with internal customers regarding the status of their report request is important • Regular PI focused huddles should be set up • Defined and documented processes are crucial in streamlining operationsPEARLS: Business Intelligence Report Library Design and Use (ANC31)Joycee BerinReview how two organizations use a SharePoint-based BI Library. First, Park Nicollet gives an overview of the library design, discusseshow customers can identify reports that are available, and gives examples of how the library is used to track report development,deployment, upgrades, and integration projects. Then, Children's Hospital Colorado discusses how it leverages a SharePoint framework insupport of its Epic upgrade, as well as future plans for use of this tool. Key Points:PEARLS: Implementation and Early Experience the CDW (ANC08)Paul TungThis session was hosted by Rush and Yale. The two organizations gave their accounts of implementing Cogito Data Warehouse. Yalehad a more mature environment where they had external data in addition to CDW, but there was no mention of conforming data, MDM, orEMPI to make the data useful. Key Points: • Yale - Branding helped with their deployment stategy - their EDW was named HELIX. • Yale ended up using Tableau for visualization and data exploration. • Rush - Lessons Learned - have a rollout approach with formal group training clases and in-depth training classes for a particular area.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.ReportingPage 92 of 122 | XGM 2015 Trip Report

ReportingPB 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.Focus Group: Resolute Professional Billing (Focus Group)Andrew WeaverThis session provided an update on recent developments for version 2015 in the area of professional billing including new line level fielditems in the charge entry screen, sorting/organization of charge review WQ rules, multi-line select within workqueues, max deferral limit inworkqueues, automatic subtotaling in the transaction inquiry screen, workqueue links from within transaction inquiry, and remittancescreen changes. The session also included customer proposals for enhancement ideas for the next Epic version. Key Points: • Questions about future reporting capabilities were posed to Epic and they responded that at this time there are no plans to create a robust reporting platform to compete with Business Objects or other vendors. Currently advancements in Epic reporting are • Customers would like to have the ability to run more ad hoc detailed reporting for workqueues to identify trends and patterns. • Customers would like to have Resolute user security maintenance moved to Hyperspace. They would like to have the ability to start with a security template and then add or subtract individual security points to a user record.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.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 IDReportingPage 93 of 122 | XGM 2015 Trip Report

ReportingTapestry: Keeping Your KPIs on the Prize (FAC39)Andrew WeaverSession covered Epic Benchmarking for Tapestry and the AP Claims Graph Package report. Key Points: • Epic is working on benchmarking through Cogito benchmarking, benchmarking surveys, and the Graph Package report. • Cogito benchmarking is an Epic-wide initiative across all modules. Cogito will aggregate data across Epic customers and push benchmarks back to customers in the form of Radar dashboards. • An AP Claims Graph Package file is now available. It is currently being updated by the Epic Finance Team and pushed out weekly to customers. The goal of the report is to identify issues and trends quickly and operationalize a recurring review process.IT, Revenue Cycle, and Operations: One Big Happy Family? (FAC49)Andrew WeaverThis session reviewed lessons learned from various Epic go-lives. The focus of the presentation was creating the right team, trainingsessions, and organizational alignment to foster a successful transition. Key Points: • Correct ratio of Operations/Revenue Cycle personnel to IT personnel is important. A concentration of current operations staff can lead to an attempt to turn Epic into the Legacy system. • Legacy reporting cannot be duplicated immediately. Focus on building reports that can satisfy the needs of many users first. • Foster a culture of revenue reconciliation throughout the organization. This starts with the providers and should focus on missing charge reports and open encounter reports.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.Bed, EVS, and Transport Tracking: From Niche to Enterprise (FAC34)Cromwell SuarezStanford Health successfully replaced a best of breed bed management system (Teletracking) with Epic 2014 functionality and managedthe change impact to thousands of users. Key Points: • Key: Complete Patient Movement matrix to assist with identifying end user workflow impact, testing scripts and training. • Strengthened team collaboration: Multi-disciplinary benefits, improved knowledge of end to end integrated workflow • Better visibility of bed status, EVS and transport requestsReportingPage 94 of 122 | XGM 2015 Trip Report

ResearchPEARLS: 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.Balancing Research IT Needs and Responsibilities: Who Does What, When? (RAC02)Melissa MaurerCincinnati Children's Hospital Medical Center discussed an enterprise data initiative to create a \"Unified Data Request Form & IntakeProcess\" for all core hospital projects working on research efforts. They found that the majority of research requests were similar to thoseasked of operational/clinical teams. Standardizing these requests helped to reduce the problem of multiple requests and ensure commondata definitions across the organization. Key Points: • Create clear and standardized processes for requesting data • Establish yearly oversight to ensure compliance and adjust processes as necessaryBalancing Research IT Needs and Responsibilities: Who Does What, When? (RAC02)Douglas BellTalk by Cincinnati Children's CMIO. Shares responsibility for research data availability with biomedical informatics (BMI) dept (KeithMarsolo). BMI handles larger data sets, IS handles smaller, one-offs, which they can do more efficiently. BMI group has a copy of claritythat gets refreshed each night Hospital and research foundation part of same coroprate entity; Pros: possible to share definitions acrossorganization; cons: investigators try to go around you In response to request shopping from a few investigators, developed a unified datarequest form and intake process: sharepoint form with click through reminding requesters of their responsibilities for use and care ofenterprise data. Used for both research and QI data requests (probably 1/3 research). Of 1942 requests since inception: 50% done by IS,8% BMI, 40% finance, 2% Anderson Center Key Points: • Research support is organized in many different ways use among different Epic customer • Role of IS in research can be big or small • Apparently very substantial staff devoted to data pulls: 15 FTE in IS and 25 in BMI (latter are also building the PCORI, ACT, etc. research data network systems)Building Automated Data Registries Based on Patient Study Enrollment (RAC17)Melissa MaurerDiscussed how the Institute for Clinical and Translational Science (ICTS) at the University of Iowa has automated the process of buildingresearch data registries. Their team developed an SCI-Link (Specimen and Clinical Information Link) system to build automated researchdata registries from subjects enrolled in studies defined in Epic. Key Points: • Generalized data elements needed for research through study-related information • Created ETL mapping templates • Took 4 years to implementResearchPage 95 of 122 | XGM 2015 Trip Report

ResearchCreating a Scalable, Multi-System Research Interface (RAC13)Melissa MaurerUNC has successfully created a unified, multi-system research interface between two clinical research management systems. This effortincluded both a custom built CRMS from UNC (used for non-oncology research), and OnCore which is a commercial product of Forte(used for oncology research only). Their team designed a master study database which provides a hierarchy of data sources between allsystems which integrates information back and forth between all systems. Key Points: • UNC is currently not interfacing with billing protocols at this time • Go-Live timeline was a large challenge • Automated compliance: If users are inactive after 30 days, automatic process from IRB to inactive the user record in EpicIntegrating an External Clinical Decision Support Tool for Adolescent Hypertension (RAC11)Melissa MaurerHealth Partners of Twin Cities, MN created a Clinical Decision Support (CDS) tool to track adolescent hypertension/blood pressure. Theteam first determined what data content stored within Epic would be relevant for the CDS, used these clinical variables to create analgorithm, and developed Best Practice Alerts to trigger if blood pressure is elevated. Key Points: • UCLA would benefit from creating advisories in Epic to track this information for specific research studies • Research protocols can be built and accessed directly from these advisoriesIntegrating External Tools for Genetics and Bioinformatics (RAC10)Melissa MaurerInova and CHEO explained their strategies for incorporating web-based software applications into their Epic workflows. Key Points: • Inova shifted questionnaires into their research database, and uploaded their CRF data from Epic. The clinical data is then uploaded to hybrid cloud infrastructure and linked to biologic data • CHEO enters clinical data into a centralized database. Built a navigator section in Epic to upload data from the systemOncology 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.Achieving Research Billing Compliance (RAC16)Melissa MaurerJohns Hopkins created a research FYI flag to ensure that all research patients are accurately identified in the patient header, which in turnplaces the account in a research review workqueue. They apply the National Clinical Trial Number and the V70.7 diagnosis at the claimlevel which drives their research billing review logic. They created a Clinical Research Billing Compliance (CRBC) department that receivesall charges for patients identified for review.ResearchPage 96 of 122 | XGM 2015 Trip Report

Research Key Points: • The CRBC team reviews 100% of the charges for patients identified in research • Billing calendars are being created in Epic • This will assist UCLA with learning alternative ways that might help us tweak our approachPEARLS: 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.Using MyChart for Research Recruitment and Patient Preferences (RAC04)Melissa MaurerYale created research-specific sections within MyChart. They utilize a specific \"research\" tab for clinical research being created, whichincludes information about clinical trials that the patient is enrolled in or may be interested in. If the patient identifies a clinical trial that theymay be interested in, the study team will receive an In Basket message to follow-up with the patient based on their feedback. Key Points: • Future-state considerations after ResearchConnect goes live • Expanded functionality for patient awareness/management in clinical trialsResearch (Focus Group)Melissa MaurerThe focus group went through new features that will be available in the 2015 version, as well as a preview for future enhancements to getcustomer input. The design discussions included improvements around research records, research billing/dashboards, protocols, andMyChart. Key Points: • A new \"clinical\" study status is being created for research study records • Research billing functionality will improve with the ability to filter at service area and location • MyChart will include a \"research studies\" tab for enrolled patientsResearch Advisory Council Welcome & What's New (RAC01)Douglas BellReviewed New 2015 features related to research, esp: - Beacon protocols in non-cancer studies (won't integrate w CTMS in '15 butworking on it) - Research Opt-in question at registration - Mychart outreach for studies - potentially multiple studies (\"direct to patient\") -Research coordinator dashboard; RC alerts for cancelled appointments - Research mgmt dashboard - Slicer-dicer for identifyingpotential study patients (identified, with IRB approval) Key Points: • something that looks like innovation opportunity could turn into a future Epic feature = can be a good path after tech demonstrated to work • Epic is starting its own I2B2-based research data network: Led by OSU, developing i2b2 ETL scripts that will work against Cogito DWResearchPage 97 of 122 | XGM 2015 Trip Report

ResearchResearch Advisory Council Welcome and What's New (RAC01)Melissa MaurerEpic discussed the upcoming enhancements for research in the 2015 module. There are major improvements with the research record,which include field-by-field control, extensible reporting groupers that can be named and standardized for reporting, and the ability toinclude direct links in the research record to clinical trial sites. Key Points: • Study record enhancements in the research record, along with additional fields available in the research studies activity • Consent documents will have the ability to be linked to research studies and be maintained within Epic • Separate episode types will be created for non-oncology studiesResearch Informatics Service Models (RAC03)Melissa MaurerPresenters from Ohio State shared their approach to a web-based research submission form that streamlined a way for researchers toinput their requests. A rating scheme and stakeholder committee helped them to know how to prioritize requests. Also during this session,UPMC presented their service model created for the purpose of tracking research requests through an online submission form. Therequests are reviewed for regulatory compliance with IRB submission, and all projects are tracked through HP Project and PortfolioManagement Center. Key Points: • Both organizations do not implement a CTMS, so all requests are driven solely through Epic • UCLA has a coverage analysis process through CTAO similar to UPMC's submission formResearch Project Analyst Roundtable (RAC23)Melissa MaurerEpic hosted this session to go over the new features coming in 2015. I attended this session to learn about enhancements and providefeedback for future development. Key Points: • Additional fields and groupers in the research studies activity that support interface capabilities • Added and/or improved adjudication tools for the research billing review report • Discussions around Epic building a CTMS directly within EpicStandardizing Clinical Findings with LOINC and SNOMED CT (RAC09)Melissa MaurerThe University of Nebraska Medical Center shared the work they have done to map flowsheet clinical findings to a standard data modelusing LOINC and SNOMED CT reference standards. This data was then used to support both research and quality initiatives. Key Points: • Discussed how to merge data from the EHR into integrated, interoperable research and public health datasets • Research data integration and query management tooling through i2b2 and SQLResearchPage 98 of 122 | XGM 2015 Trip Report

ResearchStrategy 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.Study Auditor Access via EpicCare Link (RAC20)Melissa MaurerEpic presented workflows and enhancements behind using EpicCare Link to provide study auditors access to the charts of patients onstudies they are monitoring. This session served as a high-level overview of EpicCare Link and the process starting from requesting anaccount to allowing monitors to view specific charts. Key Points: • HIM release to inspector workflow allows manual release of research-related information (orders, encounters) • Monitors can view patients on research specific studies • Future enhancement around capping on the number of accesses or length of access duration for the monitorPEARLS- Integrating External Tools for Genetics and Bioinformatic_Inova (RAC10)Kevin BaldwinEpic is being used as more than an EHR in the research world. Researchers are beginning to build data quality into the intake process. Key Points: • questionnaires are entered into the research database • most survey information is completed online and uploaded into the research database • clinical data is uploaded to hybrid cloud infrastructure and linked to biologic dataResearchPage 99 of 122 | XGM 2015 Trip Report

SecurityUnsession: SER Management (N/A)Nikki HammThis was an open forum to allow users to ask SER workflow or build specific questions of each other or the Epic Developer. Key Points: • A standing SER Forum has been requested to allow Epic Users from different hospitals to discuss workflow issues and share best practices. • UCLA is majorly ahead of many hospitals in regards to their SER setup, knowledge, and skills.The Road to (Multiple) Linkable Templates: 2012 vs 2014 (SF06)Nikki HammNorthern California Kaiser explained the 2014 append functionality that will allow the ability to append certain security items versus onlyoverriding the security within the linkable template. Key Points: • The System list Editor is the tool that will allow Providers to have acces different patient lists either by workstation, user role, user, or service area. • User's can now have more than one user role which eliminates the need for multiple templates in some cases. • They have also suggested that the change context concept should be used to switch between multiple templates versus loggin out.Security Forum Welcome & Dev Preview (SF01)Nikki HammThis session basically gave an overview of some of the new developments that are to come in the future. Ex: Security class editor acrossapplications, User Snapshot wrench capability, Subtemplates per environment, Default security class hyperlinks, Expanded User lookupscreen, report group category, Epic employee status check, Shared Security Class security point removal Key Points: • Default Security Classes have hyperlinks and can be access directly from User Security. • The new Security Class Editor will allow updates to several classes cross applications • The User Snapshot will have a wrench aspect to allow Security Leads to select specific sections and the order.Overview of Patient Access Reporting (SF08)Nikki HammThis session as geared towards Patient Access and did not apply to my team. Key Points:Making Users and the Audit Team Happy (SF05)Nikki HammPenn Medicine discussed their new automated workflow to request new user accounts and provider records within Epic. The new workflowhas increased their productivity, allowed them to successfully pass audits, and provided a better enduser experience overall. Key Points: • Continual discussion, review, and buy-in was required from the key stakeholders before the automated process was successful • A new web-based form was created and linked to their HR database to automatically populate users IDs and demographics into the form. • Completion of the form creates an incident ticket for their Security Team to complete the manual build of EMPs and SERs.SecurityPage 100 of 122 | XGM 2015 Trip Report