Presenter Joey Sadlon BWH Epic Research System Support Analyst April 30, AM Shapiro Breakout Room Clinical Trials Information Session

Join session to ask questions 1. Text BWHClinicalT850 to to join session 2. Text your question and your name If I do not have time or am unable to answer your question I will follow up via with you.

Contents of Presentation Partners eCare and Epic overview Who will be utilizing Epic What does Epic do Walk-through of Epic functionality Financial Delegate Preference Lists Release of Information In Basket Epic documentation Take home information Implementation timeline Resources available

Partners eCare and Epic Partners eCare refers to the initiative to implement a shared electronic health record (EHR) system at all Partners HealthCare centers by 2017 This includes academic medical centers, hospitals, physician offices, rehabilitation centers and home health providers Epic software, once fully-functional, will support more than 60,000 clinical and administrative professionals. Partners eCare builds upon the industry-leading software to complete its initiative: “one patient, one record, one team, one Partners statement” Epic Go-Live May 30, 2015

What Research Will Use Epic? Studies will use Epic if: 1. They have subject interventions utilizing BHW clinical resources 2. And/or use the CCI space (ACC/CTC/9AB) Studies NOT using Epic functionality: 1. Data analysis 2. Observational 3. Retrospective 4. Non-interventional studies Systems NOT using Epic: 1. LabCorp. 2. BRACC Labs 3. Research Cores 4. Research Labs

What does Epic do? Epic is the software platform which will encompass the following: Ordering Resulting Patient management Communication Billing/charging The research aspect of Epic: links encounters and orders to research Pulls these linked charges into your Research Billing Review Allows delegation of where to send charges PRIOR to being sent to proper entity (study fund or insurance).

Epic Research Workflow

Review of Epic Workflow 1. Study flows from Insight to Epic nightly Studies will still go through Insight for proper IRB approval Once IRB approves study the study will automatically flow from Insight to Epic

Review of Epic Workflow 2. Associate subjects to the study and setting ‘status’ NOTE:  Subject status MUST be set to “Enrolled” for Epic to properly route billable charges NOTE:  Subject status MUST be set to “Enrolled” for Epic to properly route billable charges 1. When a subject is associated to the study they must be assigned a “status” 2. Subject status must set to “Enrolled” for billable items to be ordered in Epic.  “Enrolled” in Epic means the subject will have patient care charges associated with the study Visits with only non-billable services (e.g., room only) can assign other statuses to a subject

Review of Epic Workflow 3. Associate research encounters with the study Research encounters are any visit, test, exam, procedure, etc. that has research related charges or care. Research encounters must be linked to the study to send charges to the Research Billing Review and not sent directly to insurance. Encounters must be linked prior to the encounter being ‘closed’. If an encounter is not linked and is closed and the charge went to insurance incorrectly then the correction is made in Insight by a Patient Care Correction. There are 3 types of encounters to link to research: 1.Linking upcoming appointments to research 2.Linking HOV, ED or inpatient visits to research 3.Linking preadmissions to research There are 3 types of encounters to link to research: 1.Linking upcoming appointments to research 2.Linking HOV, ED or inpatient visits to research 3.Linking preadmissions to research

Review of Epic Workflow 4. Associate research orders with the study Patient care orders that utilize BWH clinical resources will be entered into Epic and linked to the study. There are two ways to enter orders: 1. Entering orders into scheduled encounter. 2. Enter orders by creating an “orders only” encounter. Orders entered for research must be linked to research to properly route charges to the Research Billing Review. NOTE:  Outpatient non-medication orders may be entered and acted upon by study coordinators.  Outpatient medication orders may be entered and “Pended” by study coordinators but must be signed by ordering provider prior to action.  Inpatient orders must be entered by ordering provider. NOTE:  Outpatient non-medication orders may be entered and acted upon by study coordinators.  Outpatient medication orders may be entered and “Pended” by study coordinators but must be signed by ordering provider prior to action.  Inpatient orders must be entered by ordering provider.

Review of Epic Workflow 5. Research Billing Review Charges from linked encounters and linked orders are routed to the Research Billing Review for review after services are provided; this is the verification to ensure correct billing In the Research Billing Review the PI or financial delegate will see charges and verify they are in the correct billing ‘Bucket’ PIs/financial delegates may move the charge to the correct ‘Bucket’ Once charges are in the correct ‘Bucket’ the PI/financial delegate selects ‘Mark Account as Reviewed’ approving the charges

Financial Delegate Will be point person for research billing review. Financial Delegate will be indicated via Insight (Do not need IRB approval for this). Financial delegate may be any study staff or non-study staff that is listed in Insight. If RBR is not completed within 7 days of service provided, the PI and Financial Delegate will receive escalation s. NOTE:  Any study staff member is able to complete the Research Billing Review, not only the Financial Delegate NOTE:  Any study staff member is able to complete the Research Billing Review, not only the Financial Delegate Joseph SadlonSundry12345

Preference Lists Used to help facilitate ordering of clinical services for the research protocol. Useful for studies 1. With very complicated order sets 2. Studies where multiple people enter orders Study staff can create their own preference lists then share them with other staff members over Epic.

Release of Information Epic allows study staff to create ‘Batches’ of patients and release their records to monitors via EpicCare Link. EpicCare Link is accessed by the monitors over the internet so they do not need to come to BWH. Study staff releasing information decide the following: 1. Which subjects records will be released 2. Time frame the monitor can access records for

InBasket InBasket is the communication and task management tool available in Epic. Functions research WILL use:  Notification when a subject presents to the ED  Notify PI/MD that a medication must be signed in a chart Functions research CAN use:  Communication with other staff  Send patient charts, results, labs, reports securely  Manage tasks to be done, by who and when

Epic documentation Document in EpicDocument Outside of Epic Routine clinical care documentation: As required for hospital inpatient, outpatient or infusion visit. Medication administration via EMAR This will include Facility Administered Medications (FAMs) which are medications administered during an outpatient visit. Study-related documentation: Study related charting Study related flow sheets Study related notes

Take Home Information F numbers will no longer be used and will be replaced with the Epic produced “Study Code” HR is having a “Training Freeze” for new employees May 4 th to June 26 th.  Research teams should have an interim plan in place. If subject needs an MRN they must call registration themselves.  Study staff will no longer be able to register subjects. RPDR will continue to exist and will pull information from Epic as well as BICS and LMR. LMR will be view-only with link from Patient Chart in Epic BICS will be available in as view-only from Partners Application

Implementation Timeline March 9-May 29: Application Training Begins Lafayette City Center April 30: Clinical Trials Epic Info Session Shapiro Breakout Room, 9-11AM May 5: CCI Town Hall for Epic One Brigham Circle, 2-3PM May 11-May 22: BWH Research Epic Drop-In Sessions BWH Main Campus (rotating locations) May 30: Epic Go-Live!

Available Resources BWH Center for Clinical Investigation website (CCI) Epic research tip sheets, videos, links, presentations Partners eCare Training Website Partners eCare Training Website Information about training Epic training materials News and updates on Partners eCare Epic Drop-In Sessions: May 11-May 22: Rotating Locations Individualized info sessions for enrolling subjects, creating preference lists or other topics to prepare yourself and your study for Epic Go-Live. You must register for a date/time via CCI Education Course ListCCI Education Course List Weekly Epic Office Hours: Tuesdays 2-3PM 221 Longwood Ave. ACC Conference Room (RF 372) No registration needed Questions can be directed to Joey Sadlon at