Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Epic 2018 Upgrade

Orders Inpatient Provider

January 25, 2019 1

Upgrade Details

• Go Live Date: February 10, 2019

• PLY Available: January 7, 2019

• Orders Upgrade Sessions: January

15,16 & 18, 2019

January 25, 2019 2Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Elements Slide

January 25, 2019 3Johns Hopkins Epic Training v.2018, CONFIDENTIAL

OVERVIEW

January 25, 2019 4Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Rotating Backgrounds

on the Login Screens• The Hyperspace login screens cycles through a series of fun

new backgrounds. Click the or icons at the bottom right

corner to toggle between day and night screens.

January 25, 2019 5Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Specialty Comments Now Stick to

Patient Headers, Patient Lists, and

Schedules

• Click the new specialty sticky note

in the patient header, Patient Lists,

or your schedule to create a

specialty sticky note that's shared

with other clinicians. You can edit

others' specialty sticky notes if you

are logged into a department with

the same specialty.

January 25, 2019 6Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s Possible … Specialty Comments to gather

more information.

Focus on the Patient with

Schedule’s New Look• Absorb patient, case, and appointment information faster using new features including pictures to

help you match names and faces, color-coded statuses to tell you where your patients are in their

visit, and a ring around the photo to show you what part of the hour a visit is scheduled to cover.

• Click your name to view the provider schedule. Click the pushpin to “pin it” to the sidebar.

• Click the date range to change date. Click the calendar page to view the calendar.

• Click the preview checkbox to see the report overview window. Click the preview drop down arrow

to move the overview window to the right or auto-position its location for your screen.

• To gather more information please click the tipsheet Schedule – New Look for Patient Schedule.

January 25, 2019 7Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning

video It’s Possible

… Get Up to Speed

From the Schedule

to gather more

information.

Hide Rarely Used Toolbar

Buttons

• Stow away your rarely used Chart Review buttons with the Personalize Toolbar menu button.

• You can access this button by clicking the wrench or by right-clicking on a button and hide it without using

the wrench.

January 25, 2019 8Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Vibrant Visualizations Make

Patient Information Easier to Review• To help clinicians spot trends in vitals, labs, intake/output, and LDAs Epic made important

information stand out, and made reviewing patient information easier and more intuitive.

• Click View Graph to investigate trends in patient vitals, for example.

• Hover your mouse over data points on the graph or over the vital signs listed on the right hand side

to track trends.

January 25, 2019 9Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s Possible … Patient Summary to gather

more information.

Visualize a Patient’s LDAs in

Reports• When reviewing a patient's information in a

report, you can see the patient's lines, drains,

airways, and wounds on an avatar. You can:

• Hover over an LDA on the avatar or in the list

to see more information.

• Flip the avatar to see LDAs on the other side

of the patient.

• Filter the LDAs that appear by selecting the

LDA categories at the top.

• If you do not see the Avatar click Switch View.

• To gather more information select Avatar

under the More button.

January 25, 2019 10Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s Possible … the LDA Avatar to gather more

information.

ORDERS

January 25, 2019 11Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Order Medications with

Multiple Dosages

• Providers can now place a

single outpatient

medication order with

multiple dosages, such as

a medication that should

have one dose every

morning and a different

dose every evening. This

feature can also be used

for medications that taper

down, ramp up, or

combine scheduled doses

with as-needed doses.

January 25, 2019 12Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s Possible … Ordering Tapers and Ramps to

gather more information.

Order Medications with

Multiple Dosages• The Combination Dosage option is used when there

are several ways medication dosages can be

ordered. For example, a providers might order

Combination Dosage to place an order with:

• Different dosages at different times of day (for

example, take 10 mg in the morning, 15 mg at noon,

and 10 mg at night)

• Different dosages on different days of the week (for

example, take 20 mg every Monday and 30 mg every

Thursday)

• Scheduled doses combined with PRN doses (for

example, take 20 mg every day, and take an extra 10

mg as needed)

January 25, 2019 13Johns Hopkins Epic Training v.2018, CONFIDENTIAL

140 Patient Sig Character

Limit• When using the Taper/Ramp, Combination Dosage, and other

prescriptions the patient sig can easily reach maximum. The

patient sig limit is 140 characters. If this limit is achieved your

medication will not be e-prescribed.

January 25, 2019 14Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Providers Can Turn Any Group

of Orders into a User Order Panel• You can now save a group of orders to your

favorites, as a custom order panel.

• In the Orders activity, place all orders you would

like to make into a panel. Click Options, then

click Create Panel.

• Edit the default settings and name the panel

before you sign.

• These order panels cannot be shared.

• To gather more information please click the

tipsheet link Personalization – Creating User

Order Sets / Panels

January 25, 2019 15Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s Possible … Personal Order Panels to gather

more information.

Providers Can Make Quick Buttons

for Discontinuation and Removal of

Home Meds• Save a few clicks and keystrokes when discontinuing or removing a medication in Home

Medications. When you're removing a med, click the wrench icon in the Remove Order window

to create your own quick buttons to document common removal reasons in one click.

January 25, 2019 16Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Order Searches Get Warmer with

Fuzzy Matching• Order search results are

better, so you're more likely to

find the order you're looking

for even if you make a typo.

To narrow down search

results and see them faster,

try searching for complete

words (not just the first few

letters).

January 25, 2019 17Johns Hopkins Epic Training v.2018, CONFIDENTIAL

LAB ORDERS - BEAKER

January 25, 2019 18Johns Hopkins Epic Training v.2018, CONFIDENTIAL

• When ordering Cytopathology tests, currently there are many different cytology orders available.

• This process will change for ordering providers. They will now only search through 4 cytology orders

depending on what they want.

• Type in cytopath to get the list of possible orders.

• Three Pap smear orders

• Cervical- Reflex HPV, no HPV, with HPV

• Anal Pap can still be ordered under the Non-Gyn Cytology order

• Non-Gyn Cytology

• Specimen search

January 25, 2019 19

Cytopathology Ordering

• Currently when ordering Surgical Pathology labs the source is free text and there are multiple lines.

• Now there will be only one source line, from which providers will have to select the source.

• There will also be a type list, which will default to tissue. Providers can change the type.

• Type refers to how the specimen was obtained.

January 25, 2019 20

Surgical Pathology Ordering

• Fill out the clinical information and

number of specimens first.

• The source and site will cascade

open.

• You MUST fill out the site at the end of

the row.

• To gather more information please

click the tipsheet link Orders –

Dermatopathology Specimens

January 25, 2019 21

Surgical Pathology:

Dermatopathogy / Oral Path Ordering

NOTES

January 25, 2019 22Johns Hopkins Epic Training v.2018, CONFIDENTIAL

A Tidier Notes Activity• Two toolbars now appear to allow

clinicians to take quick actions on

notes.

– The top toolbar shows actions you

can take on all notes

– The bottom toolbar shows actions

you can take on the current note

• Date of Service allows sorting based

on any value from the drop down

menu.

• Note cards, on the left, allows for more

space to view the note.

January 25, 2019 23Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Mark All as Not New Replaces

Time MarkThe concept formerly known as Time Mark has been renamed to more accurately reflect what it

actually does. It's now called Mark All as Not New.

January 25, 2019 24Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Delete SmartBlocks from Notes• To help reduce note bloat and make a smoother

editing experience, clinicians can now delete

SmartBlocks and related content from their notes.

Clinicians can do any of the following to delete a

SmartBlock:

– Delete

– Backspace

– Ctrl+Delete

– Ctrl+Backspace

– Ctrl+X

– Right-click and select Delete SmartBlock

– Type or paste content over fully-selected

SmartBlock Content

• Note: Not all SmartBlocks can be deleted. Example,

the ACP Smartblock cannot be deleted.

January 25, 2019 25Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s Possible …

Notes Personalization #2 to gather more

information.

Use “Copy Previous” to Copy from

More Note Types• Create notes more

quickly by using ‘Copy

previous note’ to copy

content from more types

of notes. For example,

you can copy an H&P

note into a new progress

note.

January 25, 2019 26Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Stop Scrolling in Long Notes

• There is a better way for Dr. Jones to edit his residents' notes. He can now right-click the note

content and click Edit Note to open the note for editing. If he does not like right-clicking, he can

also click Edit in toolbar.

January 25, 2019 27Johns Hopkins Epic Training v.2018, CONFIDENTIAL

MEDICATION

RECONCILIATIONJanuary 25, 2019 28Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Medication Reconciliation with

a Side of Manage Orders• All medication reconciliations are now

more intuitive and consistent with the

Orders activity.

• The sidebar is updated automatically as

you continue, modify, and stop orders.

• Place new orders and Order Sets

directly in the sidebar.

• Use the Pend Medication

Reconciliation button to save a draft of

your work just like you do in the Orders

activity.

January 25, 2019 29Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Medication Reconciliation

Ordering in the Sidebar

• All orders and order sets

that are being ordered

must be placed using the

Orders Sidebar. Unless

they are Suggested or

Favorited.

• Use the Sidebar just like

the Orders activity to

order.

• This applies to

Admission, Transfer, and

Discharge Med Recs.

January 25, 2019 30Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Reconcile Discharge Orders

Quickly with a Side-by-Side View• Side-by-side discharge medication

reconciliation gives clinicians a single-

screen view.

• If there was a change to the medication

it will be noted in the appropriate

column. Home Medications are on the

Left, Inpatient Medications are on the

Right.

• Review the information provided in each

row to understand where and when the

patient was taking the medication.

January 25, 2019 31Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s

Possible … Med Rec

Efficiency to gather more

information.

Discharge Medication

Reconciliation Before and After• Medication reconciliation has had an overhaul. The buttons

have changed in addition to the side-by-side view and the

manage orders sidebar in the previous sections.

• Now we will review the button changes. Hover your mouse

over the new button to reveal the name.

• Clinicians can use simple buttons to take actions on the

orders individually, or use the buttons at the top of each

column to apply a reconciliation decision to all unreconciled

orders in the column. As clinicians reconcile orders, they are

color-coded green (prescribe or continue), yellow (modify),

and red (don't prescribe or discontinue) to reflect the

ordering decisions.

January 25, 2019 32Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Current Future

Use a Link Instead of an Icon

to See Order Reports for

Modified Orders • To avoid potential confusion, the order

report icon no longer appears for

modified orders in discharge

medication reconciliation.

• Now, to make things clearer, when a

clinician modifies an order in discharge

medication reconciliation, the order

report icon no longer appears.

Clinicians can click the link for the

original order to see its order report.

• The order report icon still appears for

unmodified orders, as it did previously.

January 25, 2019 33Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Preferred Pharmacy

• The Preferred Pharmacy activity

has been removed from the

Discharge navigator.

• “Select a Pharmacy” button has

been added to the bottom of the

Discharge Orders sidebar.

January 25, 2019 34Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Preview the AVS as You

Complete Discharge

Med Rec

• As you complete discharge

medication reconciliation,

the Orders sidebar

automatically shows you a

real-time preview of the

After Visit Summary, so you

can see which medications

the patient will be instructed

to start, change, and stop

taking.

January 25, 2019 35Johns Hopkins Epic Training v.2018, CONFIDENTIAL

See Orders from a Previous

Admission at Another Facility• Using Care Everywhere, the Restart from Previous Admission

navigator section now shows the inpatient medications a patient

was taking at a previous facility outside of your organization, just

like it does with facilities that are a part of your organization.

January 25, 2019 36Johns Hopkins Epic Training v.2018, CONFIDENTIAL

MOBILE DEVICES

January 25, 2019 37Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Complete Notes at a Later

Time in Haiku Using Dictate Later• Add the .dictatelater SmartLink to notes started in

Hyperspace or Canto to complete speech-to-text

dictations at a later time in Haiku.

• In Haiku go to the Dictate Later folder in the In

Basket to find your note to finish dictating.

• Note: Dictate Later is available only to iOS users.

• To gather more information please click the tipsheet

Haiku – Add Dictation Placeholders to Notes

January 25, 2019 38Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning

video It’s Possible …

Dictate Later to gather

more information.

Discontinue Inpatient

Orders in Canto• To make managing orders during

rounds a bit easier, clinicians can now

view and discontinue active inpatient

orders from Canto. A list of the patient's

active orders now appears on the left

side of the Canto Orders activity.

Clinicians can switch between the

Active Orders list and browsing a Quick

List or preference list from the menu

above the list.

• Tap the X icon to discontinue inpatient

orders.

January 25, 2019 39Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Sound is Coming from

Inside the App• Clinicians who receive push

notifications on mobile devices can now

be notified with a sound or a vibration

that they have a new push notification

while the app is open. They no longer

need to actively check to see if they

have new notifications if, for example,

they've left their phone's screen on

while it's in the pocket of their scrubs.

• Let clinicians know that if they want to

turn off sounds or vibrations for in-app

notifications, they can do so in the More

> Notifications > User Preferences.

January 25, 2019 40Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Customize Ringtones for

Different Epic Notifications • Providers can distinguish between notifications of different types on their mobile device.

• They can customize Epic ringtones by going to More > Notifications > Settings, click on a type

of alert (admission, case event, discharge, etc.), then click Notification Sound and choose the

ringtone sound they would like.

January 25, 2019 41Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Result Criticalities Now Appear in

Notification Message Titles in Limerick• When a result notification appears on the Apple Watch with Limerick, the criticality of the result,

such as Normal or Abnormal, is now included in the title of the message, rather than in the body of

the message itself.

• The criticality of a result appears as an icon in the notification message (Image 1). The criticality

appears in the title of a message when viewed in the notification center (Image 2). If the Apple

Watch's battery is low, result criticalities do not appear in the notification message at all (Image 3).

January 25, 2019 42Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Annotate Generic Body Area

Templates in Haiku or Canto • Create quick visual notes

for a procedure using the

new Diagram Annotation

option (1) in Media

Capture. Choose a

popular template, search

for another available

template, or start with a

blank canvas (2) and

annotate away (3). Your

annotations are saved in

Note Entry, Media

Manager, and Chart

Review.

January 25, 2019 43Johns Hopkins Epic Training v.2018, CONFIDENTIAL

CAPACITY & ADVANCE CARE

PLANNINGJanuary 25, 2019 44Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Link Documents to

Health Care Agents• Keep power of attorney and other supporting documents organized by linking them to the health

care agent they're for. Head to the Capacity & Advance Care Planning navigator to attach a

document or see already attached documents. This is especially helpful for patients with multiple

agents or many advance care planning documents.

• If “Active?” is checked, uncheck it, attach the document, and then check “Active?” again.

January 25, 2019 45Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Decide What Information You

See About Health Care Agents

• In the Capacity & Advance Care Planning activity, click the wrench in the Patient Contacts section

to add or remove columns from your view.

January 25, 2019 46Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Capacity Status• There is now a ‘Patient

Capacity’ column providers

can add to their Patient

Lists.

• In the Capacity and

Advance Care Planning

activity, in the Patient

Capacity section there is a

comment box. It is

recommended NOT to use

this section. The best

place to document

capacity information is still

in a note.

January 25, 2019 47Johns Hopkins Epic Training v.2018, CONFIDENTIAL

PEDIGREE

January 25, 2019 48Johns Hopkins Epic Training v.2018, CONFIDENTIAL

If It Runs in the Family• In the Pedigree activity, providers

can see a representation of the

known family tree that includes all

documented family conditions

alongside details like relative age

and condition-specific comments.

• A patient's pedigree is populated

with data from the existing History

activity. History and Pedigree are

fully integrated, so updates made in

one activity appear in the other.

• Personalize your view to see just

the conditions and details that

interest you.

• The activity is accessible through a

link on the History tab.

January 25, 2019 49Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an eLearning video It’s

Possible … Pedigree to gather more

information.

SEXUAL ORIENTATION &

GENDER IDENTITY (SOGI) January 25, 2019 50Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Preferred Name Display Change

in Patient Header

• The “Preferred Name” column, currently used in the header, will no longer appear separately. The

preferred name will now appear in quotes after the legal name. This preferred name may include a

preferred first name or a preferred first and last name.

• The patient header and the workspace tab will show the following format:

<Last Name>, <First Name> “Preferred name”

January 25, 2019 51Johns Hopkins Epic Training v.2018, CONFIDENTIAL

To be consistent across the entire system, labels and wrist

bands will also follow this format starting 2/10.

Labels and Wristband formatting:

Last, First Middle Suffix “Preferred”

Example: Smith, John Frederick Jr “Jonny”

Gender ID and Pronouns in the

Header• Johns Hopkins Center for Transgender Health (JHCTH) has the

ability to update their patient’s preferred pronouns. This is

functionality that others will have at a future date but not as part of

this upgrade.

• Gender ID and Preferred Pronouns will only be highlighted if gender

identity does not match legal sex.

January 25, 2019 52Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Better Support in Epic for

Nonbinary Patients• Legal Sex has a new option of

Nonbinary.

– All order sets, order groups,

NoteWriter forms, navigator

sections, etc. that display

based on legal sex will also

display for nonbinary.

– Example: Providers will have

access to both male and

female versions of order

sets/assessments/etc. for

nonbinary patients.

January 25, 2019 53Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Smartforms, SmartLinks, and Flowsheet documentation will

reflect pronouns according to gender identity.

SOGI Coming Attractions • Epic 2018 has additional features that allow clinicians and non-clinicians

to capture sexual orientation, gender identity, and sex assigned at birth

information in demographics or on a SOGI SmartForm.

• In addition, the SOGI SmartForm allows documentation of the patient’s

pronouns.

• This is currently documented by Johns Hopkins Center for Transgender

Health (JHCTH) for their patients

• After our workforce has completed appropriate cultural competency

training, these features will become operational across the enterprise in a

future upgrade.

Stay tuned for further information!

January 25, 2019 54Johns Hopkins Epic Training v.2018, CONFIDENTIAL

SURGEONS

January 25, 2019 55Johns Hopkins Epic Training v.2018, CONFIDENTIAL

See Availability at a Glance in

the Schedule Explorer• Click Schedule Explorer on the top toolbar.

• The Schedule Explorer is the place to go to

find the best time to schedule a case or just

take a quick look at your upcoming

schedule. Use any combination of search

criteria to find an available time or a provider

without creating or opening a case. Save

your favorite searches and jump right to the

Snapboard.

• If you are ready to schedule or need to

shuffle some cases around follow your

current workflow.

• To gather more information please see the

tipsheet Surgeon – Schedule Explorer.

January 25, 2019 56Johns Hopkins Epic Training v.2018, CONFIDENTIAL

One Stop Shop for Pre-Op Orders • When surgeons create an electronic case request order, a list of recommended pre-op orders

based on Procedure Pass protocols now appear in the sidebar during Prep for Case.

• Surgeons can place these orders along with their other orders, helping to avoid any unresolved

Procedure Pass tasks later on in their workflow. Click Add order.

January 25, 2019 57Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an

eLearning video

It’s Possible …

Order Checklist

to gather more

information.

MISCELLANEOUS

January 25, 2019 58Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Get Caught Up on a Patient’s

Care with the Event Log• The Event Log now appears in the

More button in inpatient encounters.

• Use the Event Log when you need an

overview of all care that's taken place

during a patient encounter. The Event

Log contains information about:

– Labs

– LDAs

– Notes

– Lab results

– Patient transfers

– MAR actions

– Flowsheets

– Events like codesJanuary 25, 2019 59Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Meet Your Match with

Provider Finder• Do you want more control when searching for follow-up providers on discharge? Provider Finder includes

new filters and sorting options, has an improved look and feel, and appears in more places, so it's simpler

than ever to find the right match for patients.

January 25, 2019 60Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Watch an

eLearning video

It’s Possible …

Provider Finder to

gather more

information.

A New Look for In Basket Messages• In Basket folders now

have an updated look

and feel.

• A sidebar with patient

information is available,

along with new tabs with

extra information

including Help, My Last

Note, Meds/Problems

and more.

January 25, 2019 61Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Reduced Clicks for Clinicians Who

Second Sign Orders from In Basket• To save you time when

providing a second

signature for orders from In

Basket, Accept is

automatically selected

when you open the

Second Sign activity.

Simply click Sign to accept

the orders and jump back

to In Basket.

January 25, 2019 62Johns Hopkins Epic Training v.2018, CONFIDENTIAL

Useful Resources

• Upgrade Materials Library

• Training Portal

• “Learning” Button to access Inpatient Provider

Learning Home Dashboard

January 25, 2019 63Johns Hopkins Epic Training v.2018, CONFIDENTIAL