Practice Playbook: How to Get Ready for Epic Why Epic? Epic is the premier electronic health record system for Mount Auburn Hospital (MAH) and MACIPA. Based on an in depth analysis of different EHRs, MAH and MACIPA users felt it was the best record for us. It allows the creation of one chart that is accessible at the hospital and practices. Epic, through its health information exchange capabilities, also allows us to access and exchange information with other health systems that are using Epic as well. Epic’s superior patient portal allows patients to access information in their electronic chart and interact with their providers online including scheduling visits. Epic also gives us advanced population health and reporting capabilities that will allow us to better manage the overall health of our patients. Practices are encouraged to attend the MACIPA Practice Operations monthly meeting that occurs at 8:30am the 4th Thursday of every month for updates. Please refer to agenda sent out ahead of time for Epic-related information.

Prepare the Chart Concise and accurate patient records improve quality and efficiency of care. Cleaning records in your legacy system leads to efficient data conversion into Epic and less clinical cleanup at Go-Live. Use the checklist below to ensure that patient records are ready for Go-Live! Remember that when you go live, practices and the hospital will all be on the same instance of Epic, and the content of your chart will be visible to all other clinicians when accessing the same patient’s chart.

 Review duplicate patient records One patient, one record! -

Make sure there aren’t duplicate patient records in your system.

 Update problems on the Problem List The Problem List in Epic should only include active, long-term issues the patient is dealing with on an ongoing basis. For example, it includes chronic health problems like asthma, diabetes or high cholesterol. -

Remove any one time reason for visits or acute hospital problems such as influenza or a broken bone. These are documented on the Hospital Problem List, Reason for Visits or Diagnoses, but not included on the Problem List. Make sure each problem on the Problem List is associated with a diagnosis. In many cases a diagnosis will evolve over time as more information comes to light or the disease progresses. If this happens change the associated diagnosis (and ICD code) of the existing entry. When a problem is no longer active, it should be resolved. Past problems are documented in the Past Medical History section rather than the Problem List. Remove any duplicate problems on the Problem List.

 Clean up the medications list The current Medications list should include medications a patient is taking or has taken. -

Make sure the medications list is up to date. Remove any duplicate medications. Where possible in the legacy system, indicate the status of medications – taking, discontinued or expired. Note end dates for discontinued medications. Where possible in the legacy system indicate that a medication is long term for medications that persist over time.

 Review and confirm the allergies list The Allergies section includes a listing of a patient’s current allergies to medications and procedure-related components. Your organization will decide whether you include food and/or environmental allergies. -

Ensure patients’ allergies are on file and up to date. Remove duplicate allergies. In Epic you can document the type (allergy, contraindication, intolerance, unspecified), severity (high, medium, low) and reaction (e.g. anaphylaxis or itching) so please update as appropriate in your legacy system.

 Ensure immunizations are up to date Immunizations in Epic are documented with the date administered and immunization status. -

Update this information in your legacy system if and when appropriate. Remove any duplicate immunization documentation.

 Update Smoking History Patient smoking status and history are documented in the Social History section in Epic. -

Review the patient’s smoking status and ensure it is recorded discretely. Record patient start/quit date, ready-to-quit information and smokeless tobacco use information if and when appropriate in your legacy system.

 Clean up Medical History The Medical History section includes a patient’s past diagnoses, both patient reported and as set problem list entries or encounter diagnoses. -

Update this information in your legacy system if and when appropriate.

 Verify patient contact information Up-to-date contact information will improve patient communication and streamline the MyChart signup process. -

Confirm each patient has a current email address on file. Verify and consolidate phone numbers and addresses.

 Remove any inactive patient coverage information Ensure that patients only have active coverage information listed and terminate coverages that are no longer active.

 Work down any backlog in your patient accounts Transitioning to Epic means that you’ll be transitioning to new billing and coding software. Epic’s most successful customers have a defined strategy in place for working down accounts in the current system (everything from coding, AR, charging, and authorizations) as they transition to using Epic. Minimizing the volume of accounts that need to be worked in your current system as you approach go-live allows your staff to transition to Epic more quickly, because the amount of time they spend working in two systems is reduced.

Be Technically Ready  Review the One IS hardware specifications for ordering new hardware before making any purchases. Your PCs will need widescreen flat panel monitors, either 23” and 1920x1080 resolution or 24” 1920x1200 resolution, and 32-bit color. The operating system and memory size on your computer should have Windows 7 x64 and at least 4 GB of RAM, per OneIS specifications. In addition, you will need to identify at least one workstation per practice that can be used for Epic’s business continuity functionality in the event of an unplanned downtime. This workstation should be in a central location and be operating Windows 7 x64 with at least 6 GB of RAM.

 Don’t sign contracts for third-party IT systems beyond 2016 before checking with the One IS team. The One IS team will evaluate third-party contracts on a case-by-case basis. Please reach out to Rob Hoscheit ([email protected]) with questions.

 Promote cyber security. Always follow One IS security guidelines, which includes encrypting PHI, using a secure email server, not sharing passwords, and installing anti-virus software on your computer. In addition, ensure that your smartphones and tablets are password-protected and encrypted.

Know the Dates on the Horizon  Epic go-live!   

February 14, 2017 – Wave 1 – Primary Care and Endocrinology May 20, 2017 – Wave 2 – Surgical Specialties and Mount Auburn Hospital August 1, 2017 – Wave 3 – Remaining specialties

 Training will begin 6-8 weeks prior to go-live Practice managers will receive information about how to register their physicians and staff for training approximately 4 months prior to go-live. Training begins 6-8 weeks prior to go-live, and is required for all staff that will use Epic.

 Special vacation considerations surrounding the go-live date To ensure that your practice can continue operating as normal while transitioning to Epic, be judicious about staff and provider vacations around the time of go-live. Staff will attend training and complete go-live readiness activities leading into go-live, so please consider limiting vacation 6 weeks leading in to go-live (training activities will start 6 weeks before go-live). There is an expected period of adjustment while staff learn the new system, so please also consider limiting vacation 6 weeks following go-live. Please refer to the go-live wave dates above to determine where your practice falls in the schedule.

 Look for the 6 Month Playbook Six months before go-live, you’ll receive an updated Playbook that includes the following information:     

When your staff can begin to access the Playground environment to start practicing in Epic How to access the Mount Auburn Help Desk What cross-department and centralized scheduling mean for your practice A preview of centralized scanning workflows that will be piloted at two practices And more!