1. One Brigham Circle April 15, 2015 1-2 PM Research Super User Meeting

2. Contents of Presentation Research Super User description and requirements Review of Epic workflow for research Patient timeline Release of Information In Basket Epic documentation Take home information Typical issues and resolution Implementation timeline Resources available

3. What is a Research Super User? Advocate for healthy change Positive about transition into Epic Serves as initial point of contact for Partners eCare and Epic related issues in their local department Provide “at the elbow” support for staff members using Epic Assist with troubleshooting application problems during implementation Identify and escalate issues as needed

4. Research Super User Responsibilities Provide support for your own department as needed. Research Super Users are not required to work extra hours or deviate from their home department or current workload. Research Super Users will be the first point of contact if department end-users have Epic-related questions/issues.

5. Review of Epic Workflow 1. Study flows from Insight to Epic nightly

6. Studies will still go through Insight for proper IRB approval Once IRB approves study the study will automatically flow from Insight to Epic at midnight as long as the study has the following: 1. Protocols with the Overall Status of ‘Active’ 2. Protocols with the following Type of Protocol (Humans Protocol header)  Intervention/interaction  Excess human material  Tissue repository  Secondary use samples/data  Coordinating center/core lab  Cede Review 3. Linked to an Active fund (listed in Agreements Project Details page)  With a project end date greater or equal to today  With one of the fund codes 066, 068, 072(corporate) or 070, 071 (federal) and the budget expense is not equal to zero  With business unit 2200 (BWH)

7. Review of Epic Workflow 2. Associate subjects to the study and setting ‘status’

8. 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 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

9. Review of Epic Workflow 3. Associate research encounters with the study

10. 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 pre-admission visits 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 pre-admission visits to research Note: If you are using CCI space or a Research Core you do not associate encounters to research.

11. Review of Epic Workflow 4. Associate research orders with the study

12. Patient care orders that utilize BWH clinical resources will be entered into Epic and linked to the study.  Medications (including investigational)  Radiology exams  Lab work being done at BWH clinical lab  Diet orders Research orders must be linked to the study to send charges to the Research Billing Review and not sent directly to insurance. Study coordinators are able to place, co-sign and act on all orders other than medications. Study coordinator can place and ‘Pend’ a medication order but then must notify the PI/MD to sign the order prior to acting on the order. When entering an order you must also associate with a diagnosis. Do not use v70.7 code Note: If you are using CCI space or a Research Core you do not associate orders to research.

13. Review of Epic Workflow 5. Research Billing Review

14. In the Research Billing Review the PI or financial delegate will see charges not paid for by CCI and verify they are in the correct billing ‘Bucket’ PIs/financial delegates may change the ‘Bucket’ Once charges are in the correct ‘Bucket’ the PI/financial delegate selects ‘Mark Account as Reviewed’ approving the charges 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 1 3 2

15. How will Epic Research work with CCI? Epic will route research charges; there are two Epic research workflows 1. Non-CCI Epic Work flow: If you are conducting research that uses BWH patient care resources 2. CCI Epic Workflow: If you are conducting research that uses Center for Clinical Investigation (CCI) resources

16. Billing Calendar/Patient Timeline Studies that have a Medicare Coverage Analysis (MCA) have a billing calendar created by the PCRO. (~10% of BWH studies) A billing calendar is a template of charges associated to the study laid out at the intervals specified in the protocol/MCA. A patient timeline is based on the billing calendar template and individualized to each subject with specific calendar dates.  Assists with setting subsequent visits in the appropriate timeframes as prescribed by the PCRO.  Better routes research charges into the correct bucket in the Research Billing Review.

17. In Basket In Basket 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 subjects  Communication with other staff  Send patient charts, results, labs, reports securely  Manage tasks to be done, by who and when

18. Release of Information Epic allows study staff to create ‘Batches’ of patients and release their records to monitors via Epic Care Link. Epic Care Link is accessed by the monitors over the internet so they do not need to come to BWH. Study staff are able to decide which subjects records will be released and the time frame the monitor can access records for. The monitor is able to see entire medical record.  This is confirmed by IRB and is consistent with current practice

19. 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 iduring an outpatient visit. FAM documentation is new to all clinical trials, not only CCI clinical trials. Study-related documentation: Study related charting Study related nutrition instructions Study related flow sheets Study documentation will later be able to be scanned into Epic.

20. Additional Information 1. CCI will still require paper orders – CCI paper ordering process will continue unchanged. 2. F numbers will no longer be used and will be replaced with the Epic produced “Study Code” 3. 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. 4. If subject needs an MRN they must call registration themselves. Study staff will no longer be able to register subjects.

21. Types of Issues End-users will want to know: 1. Why do I need to learn and use Epic? Better patient care Improved checks for a safer patient environment Improved system for ordering and billing Use only one system and one chart throughout Partners 2. How do I do my job? Relate old practices with new practices Use specific examples of how Epic will speed up and ease their work Bridge between software function and workplace function “One patient, one record, one team, one Partners statement”

22. Where Are We Now? March 9-May 29: Application Training Begins Lafayette City Center April 15 and 21: Research Super User Meeting One Brigham Circle 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!

23. Available Resources BWH Center for Clinical Investigation website (CCI) One stop for tip sheets, videos, links, presentations eCare Training SharePoint eCare Training SharePoint Information about Epic training Epic Drop-In Sessions: May 11-May 22: Rotating Locations Individualized info sessions for enrolling subjects and creating preference lists. 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 BWHResPartnerseCare@partners.org