EPIC Landscape Overview of Modules and Data Stores Sam Martin – Research Informatics Architect Spectrum Health – Grand Rapids, MI Samuel.martin@spectrumhealth.org

Confusion – Making Sense of it Name Game – Applications, Clinical and Operational Modules Show me the Data – Data Stores and Reporting Play Well With Others – Wider Reach

Hyperspace The integrated platform that hosts most Epic applications. Provides a graphical user interface used by most Epic applications, including EpicCare Ambulatory; the platform upon which all Epic products sit.

Applications and Modules Core Clinicals ASAP EpicCare Ambulatory Clin Doc Orders Access Grand Central Cadence Prelude Health Information Management Identity Revenue Hospital Billing Professional Billing Tapestry Claims Ancillary Clinicals Anesthesia Beacon Beaker Clinical Case Management Cupid Home Health Infection Control OpTime Phoenix Radiant Research Stork Willow Ambulatory Willow Inpatient

Core Clinical ASAP = Emergency Department EpicCare Ambulatory = Outpatient Clinical Care Clin Doc = Inpatient Clinical Documentation Orders = Inpatient Orders

ASAP = Emergency Department Care and clinical documentation in the emergency department Users include: ED physicians ED nurses and managers ED techs ED clerks ED charge reviewers

EpicCare Ambulatory = Outpatient Care and clinical documentation provided during: Outpatient visits Telephone calls E-visits Refill requests Users Include: Physicians Nurses Clinical staff

Clin Doc = Inpatient Clinical Documentation Clinical documentation on admitted patients: Notes Flowsheets Assessments Plan of care Medication administration (MAR) Used by many roles: Nurses, nurse practitioners, & managers Therapists Physicians Physician assistants Case managers, social workers, etc.

Orders = Inpatient Orders Application for placing orders on admitted patients: Finding orders Placing orders Editing order details Signing and co-signing orders Printing labels Users Include: Physicians Nurses Clinical staff Ancillary clinical team

Ancillary Clinical Anesthesia = Anesthesia OpTime = Surgery Beacon = Oncology Phoenix = Transplant Beaker = Lab Radiant = Radiology Clinical Case Management = Case Management Research = Clinical Research Stork = OBGYN, L&D Cupid = Cardiology Willow = Inpatient and Outpatient Pharmacy Home Health = Home Health Care

Anesthesia Documentation for any procedure requiring anesthesia. Used by: Anesthesiologist PAT nurses (pre-admission testing) CRNA (certified registered nurse anesthetists) SRNA (student registered nurse anesthetists)

Beacon = Oncology Application for clinical care of cancer patients: Cancer staging Treatment plans used for managing care Chemotherapy ordering and administration Used by: Oncologists Oncology nurses Research staff Oncology pharmacists Used in: Infusion and oncology units

Beaker = Lab Used to document laboratory information: Used By: Collecting and processing samples Lab results Used By: Pathologists Phlebotomists Lab techs Gross assistants

Clinical Case Management Used by case managers to: Identifying patients in need of ongoing care Conduct utilization review Coordinate the care that patients receive post-discharge

Cupid = Cardiology Ordering and documenting invasive cardiology cases and non-invasive cardiology procedures Used by: Cardiologists Imaging techs Cardiovascular nurses Imaging scheduling staff

Home Health Used outside the hospital as providers care for patients in their homes or hospice. Documentation takes place on Remote Client. Used By: Nurses and home health aides Occupational therapists Physical therapists Speech language pathologists Social workers Chaplains Bereavement coordinators

Infection Control Used to detect, monitor, and report certain types of infections in inpatient settings. Used by: Infection preventionists Infection control agencies

OpTime = Surgery Prepare, schedule, and document all information related to surgery and the operating room. Used By: PAT nurses (pre-admission testing) Surgical nurses (pre-op, intra-op circulators, PACU, Phase II) Surgeons Preference card builders Schedulers and billers

Phoenix = Transplant Used in transplant units and centers to document transplants. Used By: Transplant coordinators Transplant surgeons Transplant physicians Transplant care team members Living donor advocates

Radiant = Radiology Used by imaging staff to order, schedule, and perform imaging procedures. Used in imaging departments: CT Mammography/Breast Imaging MRI Nuclear Medicine Ultrasound X-Ray

Research Used for research and clinical trial related needs: Used By: Patient recruitment Flag research patients, encounters, and orders Support for research billing Used By: Study coordinators Principal investigators Research billers Release of information clerks Scheduling/registration Providers

Research – Additional Details Considered an Integrated Area (spans many modules) Creation of RSH records to manage studies and associations Creates a Person-level flag – Research: Active Creates Reportable objects

Stork = OBGYN, L&D Used to document perinatal care : Used By: Patient’s entire pregnancy, from her first prenatal visit to her hospital delivery to her postpartum visit Newborn admission Newborn assessments Used By: Physicians (Obstetricians, Gynecologists) Nurses and nurse managers Lactation consultants Unit clerks

Willow Ambulatory = Inpatient / Outpatient Pharmacy Ordering, verifying, preparing, dispensing, and charging for medications in the hospital setting. Used By: Inpatient pharmacists Inpatient pharmacy technicians Outpatient prescription pharmacy that receives prescriptions from: Providers orders in Epic Patient refill requests from MyChart External EMRs (electronically or on paper) Used by outpatient pharmacists and pharmacy techs to fills and dispenses those prescriptions, and register patients.

Access Applications Grand Central = Patient Movement Cadence = Scheduling Prelude = Patient Registration HIM = Health Information Management Identity = Patient Database (EMPI)

Grand Central = Patient Movement Used to manage patient movement in the hospital. Admission Transfers between departments Discharge Used By: Bed planners Transporters Housekeepers Case managers Financial counselors Unit secretaries

Cadence = Scheduling Used for scheduling outpatient appointments. Used By: Central schedulers Schegistrars Front desk staff Referrals users Scheduling supervisors Clinic managers

Prelude = Registration Application for managing patient registration at the front desk or over the phone. Used By: Registrars Hospital front desk staff Outpatient registration staff Schedulers Billing staff

Health Information Management (HIM) Used to manage health information, including: Releases of information from a patient's chart Deficiencies as doctors complete notes and sign orders Facilitating coding of accounts Used By: Release of information clerks Deficiency analysts File room staff Coders Clinical documentation improvement specialists HIM directors Scanning staff and medical transcriptionists

Identity = Patient Database Used to manage the patient database - EMPI – Enterprise Master Person Index. Used By: Chart correction staff Data integrity specialists Patient access Health Information Management (HIM) department

Revenue Claims = Insurance Claims Hospital Billing = Non-Physician Charges Professional Billing = Physician Charges Tapestry = Managed Care

Claims Used to send Professional Billing and Hospital Billing claims to insurance companies and receive electronic remittance payments back. Used By: Billers Payment posters Insurance follow-up Billing office managers

Hospital Billing Used to collect, review, and bill facility (aka hospital) charges to insurance companies and patients. Used in billing offices, patient accounting, and financial services by: Charge review users Customer service and self-pay follow up Payment posters Insurance follow up Billing office managers Finance Claims processers

Professional Billing Professional Billing is used for collecting, reviewing, and billing professional charges to insurance companies and patients. Used in billing offices, clinics or practices, and hospitals by: Charge review and coding users Customer service Payment posters Insurance follow-up Billing office managers Finance Claims processers

PB and HB Charge Examples Physician Charges: PB Expertise Procedure Consult Clinic visit Non-Physician Charges: HB Beds/Room Supplies (gauze, syringes, etc.) Medications Nursing services To recap: both Professional Billing and Hospital Billing cover billing, but different types of charges. PB: physician charges HB: Non-physician charges

Data Stores and Reporting Chronicles – Cache database supports main EHR activity Clarity – Operational reporting and custom datasets (Certification) Caboodle – Star schema reporting environment Business Objects Universes for reporting Extensible schema (Local data added via ETL) AKA: Star, Cogito Cognitive – Cloud-based Data Store Data for machine learning experts Cosmos – largest repository of patient data, contributions from the entire Epic community, Cosmos will include nearly 200 million patients ADP – Aggregated, de-idenfied research dataset (currently Asthma)

Data Stores and Reporting

Reporting Tools Radar – Dashboard tool specific to role Reporting Workbench – Cache database supports main EHR activity Business Objects – Business Intelligence tool Epic supplied universes Locally created universes Crystal Reports– Developer created data extracts (Clarity) SlicerDicer – Identifies de-identified populations with ability to export to Reporting Workbench

Reporting Maturity

Play Well With Others - Interoperability Care Everywhere – Epic-based HIE (Health Information Exchange) provides access at the point of care to the patient's medical records from other organizations that use Epic EpicCare Link – Web-based extension of Epic for outside use FHIR – Fast Healthcare Interoperability Resources, provides a lightweight REST-based access layer for standard HL7-defined data models (OpenEpic) Epic Interconnect – Data exchange and interface methods Cosmos – largest repository of patient data, contributions from the entire Epic community, Cosmos will include nearly 200 million patients ADP – Aggregated, de-idenfied research dataset (currently Asthma)

UserWeb Current Epic customers have access to www.userweb.epic.com Contains product documentation, training material, course schedules, discussion forums and slides/audio from Epic conferences (XGM/UGM)