Welcome to Cardiology (Cupid) EMR

training!

Classroom Introduction

Who am I? Brian A. Stambuk R.T. (R) - CUPID / RADIANT

Credentialed Trainer

10+ years Teaching Adult Training3+ years EPIC9 EPIC Implementations RE: Classroom Instruction plus Go-Live Support

Please introduce yourself and tell us what you do here at Alaska Regional, and what you are looking forward to the most (or least) about your new

EHR?

Please Sign In Bathrooms are located … Cell Phones, Pagers Off/Vibrate No Texting, Emailing, Internet surfing Please No “Happy Clicking” Start/End on time Breaks Respect, Listen, Focus, Participate Parking Lot Process

Classroom & Housekeeping Guidelines

“What’s on the Desk in Front of You?”

• Let’s review some of the Training Materials we will be using today..

– Tent Cards – PLEASE RECORD your LOGIN INFO and use that information to practice in the “playground” between now and Go-Live

– Alaska Regional Powerpoint Slides

Printout for Note Taking

– EPIC Time Conventions / “Keyboard Shortcuts” sheet

– Cardiologist Specific PARKING LOT Questions ANSWERED Sheets

“How does this class actually work?”•First, we will be spending class time watching me demonstrate a Lesson on the Overhead. Then each of you will LogIn to EPIC individually to follow along.•QUESTIONS ARE WELCOME!

•Working Together Is Encouraged!

•We operate under the “No child left behind” policy.

•Your Handout Materials cards) are yours to keep and use for note-taking and practice in the playground

•We will be using a training database that contains NO live patient information and is refreshed nightly.

•What questions do you have at this point?

QUIZ!

•True or False – You should remember everything we go over in class today?

•True or False – We will be covering everything you will need to know using the Cardiology (CUPID) application?

•True or False – What you see in the Training Environment today is exactly what you will see when

you login at go-live?•True or False - An Electronic Health Record is always in a

state of growth & improvement?•True or False - There will be a test at the end of this

class?

Today’s AgendaLogin/Default Reports/Alaska Regional EPIC Tool Bar/Screen Anatomy

Section A Reviewing Schedule and Admitted PatientsLesson 1 Reviewing Scheduled and Admitted Patients ListLesson 2 Reviewing today’s Schedule of Patient’s

Section B Reviewing a Patient’s Chart (prior Procedure)Lesson 3 Reviewing a Patient’s Chart Before a Procedure Section C Completing All PRE-Procedural DocumentationLesson 4 Use a Navigator to Complete DocumentationLesson 5 Update the History and Physical Note prior procedureSection D Writing Pre-Procedural OrdersLesson 6 Place pre-procedure orders

Section E Writing a Brief Procedure NoteLesson 7 Write a brief procedure note using SmartToolsLesson 8 Preparing to Discharge PatientREVIEWSection F Managing Orders for DischargeLesson 9 Cosign OrdersLesson 10 Reconcile patient’s Medications at Discharge (MED REC)Lesson 11 Cosign Orders / Write New OrdersLesson 12 Review and Sign Discharge Patient Orders

Today’s Agenda - ContinuedSection G Writing Discharge InstructionsLesson 13 How to Write NEW Discharge Instructions if necessary

Section H Documenting a NON-INVASIVE Procedures RESULTLesson 14 Review results for the ECHO PaletteLesson 15 Document Wall Scoring and FindingsLesson 16 Additional Resulting using Structured Reporting

Section I Marking Studies, Reviewing Tech Info plus Additional Structured Reporting ToolsLesson 17 Review results for the ECHO PaletteLesson 18 Document additional Wall Scoring findingsLesson 19 Additional Resulting using Structured Reporting Findings Tab Section J Documenting an INVASIVE Procedures RESULTLesson 20 Modify the CATH PaletteLesson 21 Document FINDING of Left Heart Cath Procedure

Section K Documenting DIAGNOSITC FINDINGS - (the really “Fun Part!”)Lesson 22 Enter ComplicationsLesson 23 Finalize Results

Lesson 24 Using CORS to Document Stents, Lesions and Interventions

PLUS: Test Questions Overview /EUPA/

Ready? Let’s Get Started!

First, please watch me Demonstrate/Discuss the How’s and Why’s…

Sit Back, Relax, Participate and enjoy the Class!

During each Demonstration/Discussion, We ALL will log into the PC using the information on our tent cards to login to Hyperspace and practice!

Section #A

Reviewing Scheduled and Admitted Patients

What types of information do you review prior to the Invasive Procedure?

Labs, vitas, procedure scheduled, H&P etc.

 

Once you complete your review of the Chart, what sort of documentation might you then need to do or complete?

Interval Note, full H&P if necessary, write pre-procedural orders

Reviewing Scheduled and Admitted Patients

Common Trainee Questions

1. I'm worried about patient privacy. Can anyone with access to a system list open the chart of a

patient on that list?

Yes, but your organization can run reports to see who has accessed a chart. Special security can also be put in place to require a password to access the charts of certain patients.

Common QuestionsReviewing Scheduled &

Admitted Patients

Section #B

Reviewing a Patient's Chart Before A Procedure

You can also double-click on your Lindsay patient from the schedule to open her chart.

Common QuestionsPlacing Pre-procedure

OrdersCommon Trainee Questions

1. Do the Chart Review reports link to my current lab and imaging software?

Likely, yes. Most of what interfaces are created and available through reports in Chart Review.

2. Is there a way to group similar office visits or lab results without needing to scroll through

areas that I am not interested in?

Yes, you can create a quick filter using the Filter button. This filter allows you to hide values and see values based on your criteria.

Section #C

Completing

ALL

Pre-Procedure Orders

NAVIGATOR Checklist= “ACTIVITY TABS”

With Epic, you can complete all of your pre-procedure documentation for patients that are already admitted from one place. On the left side of your screen is an activity tab named CONSULT

Clicking the Consult tab. You have just opened a NAVIGATOR

Any time you see this Activity Tab List, you know that you are looking at a navigator.

*** The purpose of a navigator is to streamline your workflow and make it easy to complete all of the related documentation (Table of Contents) from one place in your patient's chart. Think of a navigator as a checklist for documentation. ***

Using a Navigator to Complete Documentation

ACTIVITY TAB(s)

NAVIGATOR Checklist= Associated

Table of Contents

The purpose of a navigator TABLE OF CONTENTS is to streamline your workflow and make it easy to complete all of the related documentation.

Think of as an Associated Table of Contents as a

GUIDED

checklist for documentation.

Consult Note

• Writing a Consult Note Using a SmartText

SmartText

Wildcard

Smart Link

Smart List

“LEFT CLICK TO PICK …

RIGHT CLICK TO STICK” …

SmartText

Required items (need to be completed):• Wildcard = *** FREE TEXT INFO i.e. Type or Dictate• SmartList = example: {AKAR MALLAMPATI:21813}

Section #D

Writing Pre-Procedure Orders

Pre-procedure Ordering Workflow

Log in Open patient’s chart

Select Order or Order Set

Review/update default orders

Place additional

orders

Review/assign phases of care

Sign orders Log out

ORDERS MANAGEMENT REVIEW

Pre-procedure Order Sets Types in Epic

Nursing

Lab/Tests

IV Fluids

Medications

Phases of Care?

A way to group orders so you can say when you want them carried out.

It’s the system equivalent to having a separate paper order sheet for each area.

Pre-procedure

(Cath)

Intra-procedure

Post-procedure

(Cath)

Phases of Care

• The order is active immediatelySign

• The order is authorized, but inactive until it’s released

• The order can be released at any future time

Sign & Hold

Phases of Care

WHAT DOES IT DO?? Phases of care communicates to nursing when orders should be released and acted upon.

Phases of Care

Phase of Care Default Action Pt. in Pre-procedure

Pt. in Lab Pt. in Recovery

Pre-procedure Sign & Hold Sign - -

Intra-procedure Sign & Hold Sign & Hold Sign -

Post-procedure Sign & Hold Sign & Hold Sign & Hold Sign

Key Takeaways

• Pre-procedure Order Sets– Phases of care appear automatically– Can save Order Sets as favorites for easy access– Default your order preferences (C.P.O.E. Class…)

• Phases of care – Communicates when orders should be carried out– Sign = Active – Sign & Hold = Authorized but not active– Using phases of care links your orders to a procedure and reduces

phone calls from nursing for instructions

Section #E

Writing a Brief Post-Op Note

and

Updating Hospital Problem List

Writing Notes Workflow

Log in Open patient’s chart

Open NOTES Activity Tab

Write “Appropriate”

NoteSIGNUpdate

Problem List

Mark as Reviewed Log out

• Communication Tool• Billing Requirement

• Drug-Disease Interactions• Best Practice Suggestions (BPAs)

• Pulls forward into Notes • Meaningful Use Requirement

Hospital Problem ListPart A

• Hospital Problems vs Non-Hospital Problems

Hospital Problem ListPart B

Hospital Problem ListPart C

Hospital Problem ListPart D

Mark As Reviewed

• Updating the Hospital Problem List and selecting Marking as Reviewed

Mark as ReviewedCritical Thinking

Verbally verified information with patient or a patient representative

• Hospital Problem List– Communication tool– Billing requirement– Drug-disease interactions– Best Practice Advisories (BPAs)– Pulls forward into Notes– Meaningful Use requirement

Key TakeawaysPROBLEM LIST REVIEW

• Mark as Reviewed– Indicates you confirmed with patient that the information

is accurate.

Section #F

Writing Orders

For

Discharge

Tasks

Log in Find patient’s chart

Procedure performed

Writing Brief Procedure

Note

Med rec: review orders

Med rec: reconcile

home meds

Med rec: placing new

ordersLog out

POST-PROC Discharge Navigator Overview

Must make a decision for every order.

If a physician does NOT select any of the buttons for a current inpatient medication,

the order is automatically discontinued upon discharge.

Likewise, if a physician does NOT click any of the buttons for a prior-to-admission

medication, that order is resumed upon discharge.

Lastly, if any orders are left unreviewed, the nurse cannot print the After Visit

Summary.

Post-Procedure OrdersWork Flow Critical Thinking

REMINDER

Doc’s need to choose whether to prescribe any of the inpatient orders for your patient to continue to take when they go home. For the patient-reported meds that they already take at home, you as the Doctor need to decide if they should resume taking them or discontinue them.

What types of orders might require your cosignature?

Answers might include:

Verbal orders given to a nurse

Orders that a nurse placed per protocol

Orders from a mid-level provider

Overview Questions Managing Orders

Guidelines and policy drive whether clinicians can sign orders written on behalf of

others. Make sure you are as Reading Physicians are familiar with AKAR policies.

In addition to cosigning orders from the navigator, physicians can also cosign their

orders from reports in Patient Summary and In Basket. In Basket is covered in a

future lesson.

Lesson Review Questions – MED REC > General OVERVIEW

Where do these patient instructions pull in from?

The Discharge Orders Order Set(s) or Individual Orders Entered

What is the second step of the med rec process?

Reviewing the current orders and making a decision about what should happen to them.

While doing Step 1 of Med Rec, I want to group my medications based on the class of the med. How can I do that?

Review Orders for Discharge tab in Med Reconciliation > Sort by > Pharmaceutical Class

What is the indicator that all the medications have been reviewed?

The “shopping cart” header turns green, and it reads "All Orders Reviewed."

What's the third step in the med rec process?

Writing new orders.

Can you write new inpatient orders and new outpatient orders?

Yes.

Part 1 of 2

Lesson Review Questions – MED REC > General OVERVIEW

Part 2 of 2

What icon denotes an inpatient order? An outpatient order?

A bed indicates an inpatient order. A house indicates an outpatient order.

The final step will be reviewing and signing your orders. If you're ordering meds that the patient should take at home, what other step do you need to remember to do to help the patient?

Select a pharmacy.

Medication Reconciliation

• Transfer Medication Reconciliation will have a fourth section plus contain all the tools you need to transfer a patient with new orders to the floor or Receiving Department.

Reconciliation Complete?• How do you know if Med Reconciliation is

complete?Completed!

Section #G

Writing Discharge Instructions and

Any Additional Orders

ORDERS Overview

Orders Activity

Tab

MANAGING Order Sets

Placing New Orders• Signed and held orders • Order Sets

– Can be SAVED User (specific) Order Sets

Discharge InstructionsDischarge instructions are entered as orders

Must be completed prior to discharge

Discharge NoteLike before, you should complete a discharge or progress note on the day of discharge

Discharge SummarySection in the Discharge Navigator pulls in a discharge default note type

Discharge Documentation

Discharge DocumentationDischarge step… Use…Discharge Instructions Discharge Order Set in

Discharge Medication Reconciliation

Discharge Note A SmartText template or NoteWriter in the Notes activity

Discharge Summary Discharge Summary section in the Discharge Navigator Table of Contents

Section #H

Documenting a

NON-Invasive

Procedure Result

Jeff (tent card patient) underwent an Echo Complete exam. You need to review the measurements entered by the technologist and document that Jeff’s Echo Complete was normal.

You will then result a TEE exam for Lucy (tent card patient). The exam revealed regurgitation of the tricuspid valve, decreased left ventricle cavity size, and mild tricuspid stenosis.

You will use Structured Reporting to document all of this information.

STRUCTURED REPORTING Overview

Point and Click Documentation…

RESULTING TABs Overview

LUCY

FINDINGS TAB OverviewPoint and Click Documentation

Section #J

Documenting

INVASIVE Procedure

Results

USING the READING WORKLIST

RESULTING TABs OverviewInvasive Exams

Point and Click Documentation

Point/Click and DRAW Documentation

Associated Entry Overview

• Attend Provider Personalization Labs to learn how to make your note writing workflows as efficient as possible – Save commonly used SmartTexts as favorites– Create your own user SmartPhrases

A Quick Reminder …

• Attend Provider Personalization Labs to learn how to make your pre-procedure ordering workflow as efficient as possible – Save commonly used Order Sets as favorites– Create your own user Order Sets with defaults– Save order defaults in your preference list

REVIEW – CARDIOLOGIST - OVERVIEW

TEST Questions

QUIZ!!

Question Items 1 to 10

Challenge Yourselves

How many can you answer?

WHAT QUESTIONS DO YOU HAVE??

THANK YOU for your

ATTENTION and PATIENCE

ENJOY GO-LIVE!

Sincerely,

Brian A. Stambuk R.T. (R)

Instructor

Seafair PIRATE!

Seattle, WA

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