Control of Startup Activities

Where are Startup Activities controlled for the end user?

Options under the EPIC button and across the toolbar are controlled by the Role record

What is Clinical Adminstration/Text?

• a set of text-based menus that an administrator of clinical software often uses when working in a Putty session for UNIX and Digital.
• Just like Hyperspace, Clinical Administration provides a way to work with the data in Chronicles: adding, editing, and deactivating data.
• it tracks changes to information over time

What is ‘Chronicles’?

• It’s a database.
• All of Epic’s software—not just EpicCare—stores data in Chronicles.
• A database is built using a database management system (programming language).
• Chronicles is built using an M programming language.

How is Chronicles Organized?

It is organized like a Filing cabinet:

• Chronicles = filing cabinet
• Master files = the drawers
• Record = a file folder in drawer
• Contact = a dated or versioned paper form
• Item = a question on paper form
• Value = an answer

What is an INI?

• Epic master files are identified by a label called an INI.

• A master file’s INI is simply a three character initial (INItial).

Examples:

• User master file = EMP (Employee)
• Provider master file = SER (Schedulable Epic resource)
• Patient master file = EPT (Epic patient)

Scenerio in diagnosis master file: 

Six months have passed, and the medication research study on Diabetes Type 2 has been completed.
This diagnosis record should no longer be available as a selection in Order Entry and the Problem List.

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However, it should be available as a selection in the History activity. How do you fix this?

To accommodate these actions, you can make the

record clinically inactive.

This item can be used to mark a diagnosis as unavailable for clinical use. If item is set to “Yes”, the diagnosis will not be available for use in the EMR. The diagnosis will remain available for billing and other financial purposes

What is one of the first tasks in an implementation and forms the backbone of your administrative build?

Designing and building the facility structure

• Without it, we would be unable to determine where patients were being seen, where users were working, and what settings should apply.

What is record #1 in the EAF master file?

It is automatically, and always, the facility record.

• Even though the standard definition of facility is a specific building or physical location, Epic uses the term facility to mean your entire enterprise or organization.

Master Files

Examples: What are these master files?

– EMP, SER, EPT

• EMP (Employee) – User master file
• SER (Schedulable Epic resource) – Provider master file
• EPT (Epic patient) – Patient master file

What is a Service Area?

• Represents the accounts receivable and/or business entities of your organization
• The level to which all revenue and accounts receivable “roll up.”
• It might represent a geographical region, a previously independent organization that your organization has acquired, or simply your entire organization
• Service areas are records in the EAF master file.
• Service area records are linked to the facility record.

What is a Revenue Locations?

• Represent entities that exist within each of your service areas.
• Locations often represent what most people usually think of when they hear the term facility: physical freestanding clinics and hospitals.
• Revenue locations can also represent groups of virtual departments.
• Revenue locations are records in the EAF master file.
• Each location record must be linked to its parent service area

What should you do when creating a revenue location that represents a hospital?

• You must also indicate that the record is a hospital and link it to the ADT (Admission-Discharge-Transfer) system’s hierarchy.
• To do this, you must access the location record via the ADT menu path, and work on the ADT Location Settings screen.

The Department (DEP) master file contains records for the units and departments.

A department record exists for one of the following reasons:

• It’s a place where patients receive care from healthcare providers, like the East Clinic Family Practice Department, the EMH Emergency Department, or the EMH Intensive Care Unit. 
• Patients are scheduled or admitted in such a department every time they have a clinical encounter
• It’s a department that your users choose when they log in to Hyperspace, like the IP Pharmacy.

What are Hospital Outpatient Departments (HODs)?

• Are usually departments within a hospital in which both admitted and ambulatory patients are seen.
• HODs are created just like any other department.
• They must be linked to the appropriate revenue location (usually the hospital) and to the parent hospital area.

What are Virtual Departments?

Sometimes a virtual department is:

• Staffed entirely by clinicians who provide care to patients admitted throughout the hospital (like the Respiratory Therapy department)
• A physical place (like the business office)
• A department that provides patient care and has a physical place, but where patients are never scheduled or admitted (like a hospital pharmacy)

Facts about Virtual Departments:

• Should be linked to a revenue location when appropriate (like the pharmacy department in St. Mary’s Hospital would be linked to the St. Mary’s Hospital location record)
• Do NOT need to be linked to a parent hospital area

• Unlike other types of departments, virtual departments can be linked
• directly to a service area instead of a revenue location. This is especially
• true for business-oriented departments like Enrollment or Customer

Rooms and Beds

• Each room is a record in the ROM master file, and can restrict the level of privacy and available services (medicine, telemetry, etc.) available in the room’s beds.
• Each bed is a record in the BED master file, which can be defined with a level of privacy and the services supported.
• Unlike the more general levels of the facility structure, rooms and beds are created in Hyperspace by an end user with the appropriate ADT administrative access.

Workstations

• Each computer that connects to Epic is a workstation and must be represented by a record in the Workstation (LWS) master file with a unique identifier.
• The Workstation (LWS) master file also contains records for each and every printer that is connected to Epic, including printers used for Order Transmittal.
• Within each workstation record, you link to a department record.
• That department is often referred to as the workstation department.

What are the four types of departments?

1. Outpatient
2. Unit
3. Hospital outpatient
4. Virtual

All the physical therapists at your organization work in the EMH Physical Therapy department….What kind of department record is EMH Physical Therapy? Explain why.

• It is a Hospital Outpatient Department.
• It schedules its time with patients, but those patients can include both admitted patients and outpatients.

Users

When is it helpful for an individual user to be linked to more than one user template?

• An end user at your organization has different job responsibilities on different days of the week. For example, he might work as a unit clerk on weekends and a nurse on weekdays.
• Some of the clinical end users at your organization are working on the project team to help with Epic implementation before returning to their normal duties full time.
• Project team members at your organization want to help end users troubleshoot by seeing Hyperspace from their perspective.
• Providers who are assigned an ambulatory template should be assigned a more robust template with inpatient settings after a certain date once the hospital at your organization goes live.

Users

Will having multiple templates affect the user at the same time?

• Only one linkable template record will affect the user at any given time in Hyperspace.
• Settings in multiple linkable templates do not build upon or override each other—the user chooses a template at login, and settings from any other linkable templates assigned to that user are ignored.

How will you know which template or templates to assign to your user?

• By using pre-built user templates released in the Foundation system as an example.
• Use the Users and Security Matrix on Galaxy which includes pre-built templates, security classes, record naming, & numbering conventions.
• You can see which settings are made in each template to help you decide whether a template is appropriate to assign to your user
• An example: You create a user template for a particular group like medical assistants or rad techs., then link their user record to that group’s template.
• If you can adjust it in the future which would affect all the template users

When would it be appropriate to set a user record to “INACTIVE”?

If a user is:

• on sabbatical
• retired (historical)
• passed away (historical)

When linking a user record to a template, what are some

settings still established by each individual user record?

• Default login department, link to templates, ID/password information, ; In Basket
• In Basket allows users to send class (informational) and pool (task-based) messages to various groups.
• Users are made members of these message groups on the In Basket form of their user record.
• The Classifications field on the In Basket form is where you list the messaging groups or classifications the user belongs to.
• user record is the link to a provider record.

What options are available for creating User Records?

1. Linkable Templates
2. Create Single Users
3. Create Multiple Users

•  #2-#3 streamlined by copying settings from an existing record – ‘Copy User Data’ by clicking the Actions button in User Security toolbar.
• Similar to copying user data, you can use the Actions button to copy template data into the user record. This tool allows you to copy data from any Copy template. Template type is set upon its creation.

Can you enable login departments without Cadence or Resolute?

• Yes, without Cadence or Resolute, a user can log in to the departments in the linked provider record.
• For user records that are linked to provider records, the user can choose as a login department any department that is listed in their provider record.
• For user records that are NOT linked to a provider, work on the Provider/Hot Keys form in the user record.
• Then click the ‘Edit Provider Settings for Unlinked Users’ button to enter allowed login department

Where is the link between user and provider records located?

• For users who are also providers, the link between user and provider records is established in the user record.

• A person or resource is considered a provider, and therefore needs a Provider record, if he/she/it meets at least one of the following criteria:

• Credentials to display or a specialty/discipline
• Authorizing and/or ordering provider for orders
• Referred-to or referred-by providers for referrals
• Scheduled with patients or appointments in Epic

What can you do with a provider record in EPIC?

• Without a link to a provider record, users cannot see their scheduled patients
• View schedule glance
• Access to activities (the ability to see pieces of functionality) is determined by user security
• Created in Clinical Administration – Users, Providers ; Providers (SER)

What is configured on Provider Information Screen?

1. Specify an External Name
2. Assign a Provider Type
3. Referral Source Type (Ref Src Type)
4. Scheduling Type
5. Internal/Ext
6. Specifiy Departments for Scheduling
7. List a Specialty

Provider Info screen

Specify an External Name

• provider’s full name as it should appear in professional documents and patient correspondence.
• It also appears when a clinician clicks Mark as Reviewed in some navigator sections.

Provider Info screen

Assign a Provider Type

• provider’s classification in terms of education and services provided.
• It can be used for encounter type conversions, color-coding notes, and filtering BestPractice Advisories.Provider Info screen

Provider Info screen

Referral Source Type

(Ref Src Type)

• This field allows you to designate a provider record as a particular type of referral source (like another provider, or a marketing campaign).

Provider Info screen

Scheduling Type

• This field allows you to distinguish between the different types of providers that can be scheduled

Provider Info screen

Internal/Ext

• Indicates whether the provider is part of your organization (internal) or an unaffiliated provider in the community (external). The default value is Internal.

Provider Info screen

Specify Departments for Scheduling

• The Departments field in a provider record indicates in which departments the provider can be scheduled. Providers can only be scheduled in departments listed in this field.

Provider Info screen

List a Specialty

• The Specialties item can be used when creating ad hoc reports and Workflow Engine Rules

Credentials and Certifications screen

License for Display:

• Field is used to record the license that should display after a provider’s name.
• It will appear in Hyperspace

Proxy Provider Information Screen

Meds Authorizing Provider?

Orders Authorizing Provider?

Inpatient Ordering Provider?

Outpatient Ordering Provider?

NOTE: Unlike the Authorizing Provider fields, the

Ordering Provider fields have a default of Yes, so you

must remember to enter No if the provider is NOT an

inpatient or outpatient ordering provider.

Encounter Provider?

Determines if a provider can default in as an encounter provider in ambulatory context

NOTE: This only applies to “quick encounters,” in which

the New Contacts window is skipped because the type of encounter is already defined – an example would be

creating a telephone encounter.

Creating Records Using Importing

What are the 4 steps?

Importing allows you to build a large number of records in a fraction of the time it would take to create them individually

• Export – data out of Chronicles and create a spreadsheet using an exporting tool. The spreadsheet can be blank or have information from existing records on it.
• Populate -Fill in spreadsheet with info to enter or change in the system, copying common values where possible, most time consuming step.
• Convert -The spreadsheet must be converted into plain text (flattened) before data can be imported back into Chronicles.
• Import -Scan the flattened spreadsheet file and import its data into the appropriate master file in Chronicles.

Step #1: How do you Export a Provider Spreadsheet?

• From the Clinical Administration menu, choose Troubleshooting Utilities.
• From this menu, you can export an empty spreadsheet, or you can export existing records into a spreadsheet.
• Looking at the data of an existing record will help you see which items you need to focus on and allow you to quickly copy and paste shared values.

Step 2: Populate a spreadsheet

• A row represents a record
• A column represents an item
• The intersection of a row and column is a value

Step #3 – Convert a Spreadsheet

• Excel files cannot be imported into Epic directly. They must first be converted to plain text.
• Epic representative can help you install the macro you will need to run to flatten spreadsheets.
• You can find the macro on Galaxy: Epic Export Macro Validation Compatible.xla

Step #4 – Import Data

• You can use Chronicles to import flattened import spreadsheets.
• Chronicles can also run a scan of your source file to check for errors in the structure of your data.
• Always scan a source file for problems before importing data into Chronicles.
• Unlike exporting, when entering a source file location for scanning and importing, you must specify the file extension after its name.

Tips/Facts:

Link Provider and User Records

• The link between user and provider records is established in the user record.
• If a user also meets the criteria of a provider, their user record should be linked to the corresponding provider record.
• This allows the system to display the correct provider’s information when a user logs in to Hyperspace.

Tips/Facts:

Link Provider and User Records

• It is also common to use importing to update existing records.
• Can use an import to update user records with a link to their corresponding provider records.
• If done carefully and correctly, using an import to establish this link will take far less time than manually linking each pair of provider and user records.

Inpatient Ordering and Authorizing Providers

In what situations might inpatient orders be entered by someone other than the provider?

• Physician called his patient’s nurse and gave a verbal order
• If the hospital has not yet rolled out computerized physician order entry (CPOE).
• In a pre-CPOE setting, physicians write their orders on paper, and the orders are entered into the system by a clerk or a pharmacist.
• Because of these workflows, the ordering provider is not always the ordering user.
• Inpatient orders have a separate field to track the actual ordering provider.

What are the necessary settings for an inpatient ordering provider?  Why? 

• Needs to have the Inpatient Ordering Provider field set to Yes in their provider record.
• The provider record must also be linked to a user record, because verbal orders are usually sent to the ordering provider’s In Basket to be cosigned, and you have to be a user to receive In Basket messages.

Role Records:

Big Picture

• Role records control the layout and rules of Hyperspace.
• By linking a user template to a role, administrators can apply the same Hyperspace configuration to all users with that template.
• Multiple user templates can link to the same role.
• While each role record usually applies to a group of users who share the same job description, a user’s role is just one setting that such a group would have in common.
• A template is what defines all the settings a user has that are shared by everyone.

What does a Role (E2R) Control? 

1. Which Startup Activities launch
2. The order and arrangement of the Hyperspace toolbar and options under the Epic button
3. Which activities appear under the More Activities menu
4. The maximum number of workspaces that can be open
5. When and how the system times out
6. Whether the user’s last login department will be the default the next time he/she logs in

Does every user need a role in order to log in to Hyperspace?

• Every user needs a role in order to log in to Hyperspace.
• This is true even for users of Epic’s non-clinical applications like Cadence (scheduling) or Prelude (registration).

How does a Role affect activities and tools?

• Startup Activities – Startup Activities are launched immediately upon logging in. The Home workspace opens by default. This is the most important Startup Activity for the person logging in.
• Epic Button and Toolbar Layout – A role controls what appears on the end users’ toolbars and menus.
• Activity Tabs and More Activities menu – A role can control whether activities appear as tabs alongside patient workspaces or as options under the More Activities menu.

What ground rules can a role record set for how Hyperspace behaves?

• Maximum number of workspaces open at one time
• How long a given workstation can be inactive before Epic automatically logs out or secures
• Roles can affect which department is suggested to a user at login

(Hyperspace doesn’t allow more than four patient workspaces to be open at a time. This is a hard-coded limit; it cannot be overridden by settings in a role record.)

Role Rules

Automatic Timeout

• Secure Hyperspace: This leaves any patient charts open and allows a user to log in and begin where the previous user left off. NOTE: Securing is NOT recommended for Inpatient users, since it can cause inappropriate locks on a patient’s record.
• Log out of Hyperspace: This causes any unfiled notes or orders to be automatically pended.
• Shutdown Hyperspace: This not only logs the user out of Hyperspace, but exits the application. Hyperspace must then be re-launched on that workstation before anyone can log in. This option is rarely used.

Role Rules:

Use Last Login Department

• Normally, the login department you are presented with after entering your User ID and password is the Default Login Department. It is set in the user record.
• The role, however, can override this setting and have the system use the last department selected as the default

How do Profile Records differ from Security classes and Role Records?

Big Picture

• Profile (LPR) records allow the details of Hyperspace to differ for different users, particularly users with different specialties.
• Security classes and security points grant access to activities and functionality that a user needs
• Role records determine where a user finds activities in Hyperspace.

Profile Records Facts

• At least one profile (linked to System Definitions) will affect any given user, but up to six can work together in customizing that user’s experience.
• Profiles are used by Epic’s clinical applications only.
• There are over a thousand settings that can be made in a Profile (LPR) record, on over 300 screens.
• Examples:

1. The reports available in the SnapShot and Summary activities
2. The tabs and filters in the Chart Review activity
3. The preference lists users see when they search for new orders

What do Profiles control?

• Profile (LPR) records configure options within activities a user can access.
• If a user has the appropriate security point(s) to access an activity, the system looks to the profiles to determine how that activity looks and what options are available within that activity.
• If you don’t have the security point to use an activity, then it doesn’t matter how your profiles are configured in regards to that activity. 

Review:

Which record controls what appears in the Startup Activity and Hyperspace toolbar?

Role Record

Review:

Which record gives you access to ordering functionality?

Security Class Record

Review:

Which record controls access to activities like Chart Review?

Security Record

Profile Records:

Configure an End User’s Options within Activities

Examples

• The Chart Review Tabs screen is where tabs are listed in the order they will appear in Hyperspace.
• The SnapShot screen is where you specify the default report that shows up in the SnapShot Activity
• The Inpatient Orders Preference Lists screen is where the bed icon lists in the Preference List Browser come from.
• The Outpatient Orders Preference Lists screen establishes which house icon lists will be available.

What is typically Profile #1?

• Profiles control over one thousand settings. Some of these settings might be the same between different groups of users.
• Rather than building many profiles with identical settings, the most general settings can be established in a profile linked to System Definitions.
• The profile linked to System Definitions contains settings common to an entire organization (Profile #1).

What is the Profile Hierarchy?

• Profiles can actually be linked to six different levels in what’s called the profile hierarchy.
• Epic looks at each of these levels to create a special collection of settings called a compiled profile.

Profile User Template
Profile EpicCare Security Class
Profile Department 
Profile Rev. Location 
Profile Service Area 
Profile System Definitions

Where can Profiled be attached?

• A profile record can be attached directly to a user template.
• That profile then affects every user record linked to that template.
• Unlike security classes and roles, which are only attached to a user or user template, profiles can also be attached to other records at different “levels.”
• A user can be affected by up to six different records in the Profile (LPR) master file to accommodate job role, duties, or location

Where do you attach Profile Records  to accommodate job role or duties?

• User/User Template: This is used for profile settings specific to a specialized group of users.
• EpicCare Security Class: This is used for profile settings common to people with the same job duties or scope of practice. For example: all ambulatory physicians or all pharmacy technicians.

Where do you attach Profile Records  to accommodate location?

• Login Department: This level is used to accommodate settings common to people who have different job duties but who work in the same department.
• Login Rev. Location: This level is used mainly for settings shared by everyone who works in a particular hospital or clinic, regardless of their job duties.
• Login Service Area: This level is used mainly for settings shared by everyone who works in a particular region or group of hospitals and/or clinics, regardless of their job duties.
• System Definitions: System Definitions (LSD) is a place to make global, system-wide settings. This profile record applies to every clinical user in your system.

How do you identify the profiles affecting a user?

• The Session Information – IB Link report can show you which profiles ar currently affecting a user.
• The report can be found via the following path: Epic Button > Help > Help Desk Reports > SESSION INFORMATION – IB LINK
• Under the EpicCare Profile Information heading, you find a list of which profiles are linked to the different levels in the hierarchy. You also see an ID number for the compiled profile – the combination of settings from all levels. (pg 8-15)

How Do the Profiles Affecting a User Interact?

Profiles compile item-by-item

• Epic compiles settings across profiles on an item-by-item basis, not screen-byscreen.
• If you set a particular item on a screen in a user template-level profile but leave the rest of the screen blank, the system takes the one setting from the user template-level profile and looks to the other levels for the remaining settings
• values in the more specific profile level take precedence over the more generic settings

How Do the Profiles Affecting a User Interact?

Multiple response items are all-or-nothing

• All the values for a multiple-response item come from the most specific profile record
• Epic takes all the values from the first profile in the hierarchy that has any value. The system does not combine the values across all attached profiles.
• Note that related groups (items that are arranged like “tables” in text) also work as described here. If you enter a single row of values in a table in one profile, it will override the entire table of values in a profile lower in the hierarchy.

How Do the Profiles Affecting a User Interact?

Some Settings Affect Other Settings

On the Patient Summary screen, there are two related fields:

• The Startup Buttons field is limited to the values in the Available Reports field.
• If a profile has nothing listed under Available Reports, then you can’t enter anything under Startup Buttons.
• If two or more items in a profile directly affect each other, set all of the related items in the same profile record.
• Allowing the system to compile related items across multiple levels of the hierarchy can cause unwanted results.

Use Record Viewer to Find Profile Settings

• To see the values for items in a particular profile record, you could open the record in text to search for values for each of the relevant items.
• However, you can stay in Hyperspace and quickly view the items and values in a record by using the Record Viewer tool.

How do you determine the best level to deliver changes to profile settings?

The following questions will help you identify the best level to deliver changes to profile settings:

• What setting needs to change?
• Which users need the change?
• What do the users who need the change have in common?
• What’s the most general hierarchy level that could deliver this change?

Settings Controlled by Profiles:

Chart Review Filters

The default filter is set up on the Chart Review

Excluded Encounter Types screen in Clinical Administration

1) For Convenience

List the encounter types that should be filtered from the

Encounters tab of Chart Review by default, for the

convenience of the users.

Note: This filtering can be temporarily overridden by a

user. To do this in Chart Review, the end user clears the

Default filter check box.

2) For Security

List the encounter types to be hidden in Chart Review.

Note: Other documentation from these types of encounters can be seen on the other tabs of Chart Review (like the Meds or Labs tab).

Settings Controlled by Profiles:

Chart Review Filters

Chart Review Encounter Reports screen

(pg 8.34-35)

1. Contact Type
2. Report
3. Preview report
4. Description Code
5. Report to use if not defined above
6. Description code to use if not defined above

Settings Controlled by Profiles:

Chart Review Tabs

• In a profile record, you can configure the tabs that appear across the top of the Chart Review activity.
• As well as the tab that opens by default when the Chart Review Activity is opened.
• The first tab listed on the screen will be the leftmost tab in Chart Review.

Settings Controlled by Profiles:

Database Lookup

• Profiles can control whether a user is limited to only selecting orders from a preference list for medications or procedures.
• This setting can be configured for outpatient, inpatient, or both.
• For each item, you can turn off database lookup for medications, procedures, or both

Settings Controlled by Profiles:

Preference Lists

• Profiles can be attached to one set of outpatient preference lists and one set of inpatient preference lists.
• These settings are established on the Outpatient Orders Preference Lists screen and the Inpatient Orders Preference Lists screen.

Settings Controlled by Profiles:

SnapShot and Summary Reports

• Groups of users are interested in different information, so each group needs to seedifferent reports.
• The Patient Summary screen determines which buttons and reports will be available in both Summary and SnapShot.
• It also determines the default report for display in the Summary activity.

Question: How can you define the default report buttons that appear for an end user in the SnapShot activity?

Answer: List the reports that should be default buttons in the Startup Buttons field on the Patient Summary screen in the profile.

Profile Linking Locations

System Definitions-Level Linking

pg 8-40  (246)

• The Foundation System comes with System Definitions (LSD) linked to a profile.
• Go to: Clinical Administration > Management Options > View System Definitions > Activity, Workspace
• The System Definitions-level profile is linked at the top of the second screen.
• System Definitions, Profile Settings screen

Profile Linking Locations

Service Area-Level Linking

pg 8-40  (246)

• Service Area records (EAF) can link to a profile.
• The revenue location linked to your login department is also linked to a service area.
• To look at a Service Area record, go to: Clinical Administration > Facility Structure > Facility/Service Areas
• A profile can be linked on the first screen.
• Service Area record, Demographics screen

Profile Linking Locations

Location-Level Linking

pg 8-41 (247)

• Location records (EAF) can link to a profile. Your login department is linked to a revenue location.
• To look at a Location record, go to: Clinical Administration > Facility Structure > Locations
• Like service areas, a profile can be linked on the first screen of a location record.
• Location record, Demographics screen

Profile Linking Locations

Department-Level Linking

pg 8-42 (248)

• Department records (DEP) can link to a profile. The department that matters is the one you log in to.
• To look at profile linking in a Department record, go to: Clinical Administration > Facility Structure > Departments/Units
• Like System Definitions, a profile can be linked on the second screen.
• Location record, EpicCare Dept. Info screen

Profile Linking Locations

EpicCare Security Class-Level Linking

pg 8-42 (248)

• EpicCare security classes (ECL) can link to a profile.
• To look at profile linking in a security class record, go to: Clinical Administration > Security Management > EpicCare Security
• Like System Definitions and a department, an EpicCare security class links to a profile on the second screen.
• EpicCare security class record, Allowed Security Points screen

Profile Linking Locations

User Template-Level Linking

pg 8-43  (249)

• A user template can link to a profile.
• You can see what profile is attached to a user’s template by opening that user in the User Record Editor (EMP) in Hyperspace and going to the EpicCare form.
• User Record Editor, EpicCare Information form

Scenario: Pharmacists, pharmacy techs, and pharmacy managers all work in the same department, but each have different security classes. The pharmacists and the pharmacy techs use the same Summary reports.

The pharmacy managers need an additional set of reports.

At which level of profile should you configure the Summary reports for each of these groups of users?

• Because they all share a login department, the pharmacists and the pharmacy techs can get their reports from a department-level profile.
• The pharmacy managers should get their reports from a security-level profile.
• This record is in the system, but at this point, no user can see it. In order for your report to appear to users in Hyperspace, it must be linked to a profile.

Scenario: When the physicians at your organization review an office visit encounter with a cardiologist, they want to see a different report than they see for most office visits.

How could this be accomplished?

• In the Chart Review Encounter Reports table, add another line for the contact type of Office Visit, but include a specialty of cardiology.
• Then list the special report under the Reports column.

Report and Print Groups Master Files

Big Picture

• Each record in the Report (LRP) master file points to one or more records in the Print Group (LPG) master file.
• Each print group retrieves and displays a particular set of information from Chronicles.
• The specific reports that appear in an activity are typically determined by settings in a user’s profile.

Print Groups: Three Styles

Plain Text

Rich Text

Native HTML

• A print group’s style determines where the print group can be used, its formatting options, appearance, and what additional functionality (such as hyperlinks) it can contain.
• As a rule, a report will only contain print groups of one style.
• Every print group in a report should be plain text, rich text, or native HTML.

Plain Text Reports

• Plain Text is the oldest style of print group supported by Epic.
• It supports minimal formatting.
• Labels printed from Epic can use the Plain Text style.
• The Session Info report you’ve viewed a few times already in class is another example of a Plain Text report.

Rich Text Reports

• Rich Text reports contain more formatting than Plain Text reports, such as different font choices and the ability to display information in multiple columns.
• These reports can contain hyperlinks to other reports and images, and links that perform actions in the system (such as acknowledging or cosigning orders).
• The most common style for reports
• Find reports with this style in Chart Review, Summary, and just about any activity in Hyperspace. Ex: Encounter report

Native HTML Reports

• Native HTML reports support even more advanced formatting and functionality than Rich Text reports.
• SnapShot reports and accordion reports are examples of Native HTML.
• Example: Summary activity, Comprehensive Flowsheet accordion report (Native HTML)

Editing a Report

Customizable

Two options:

• Edit the print groups that make up an existing report
• Create a new report (possibly by duplicating an existing one) and make it available to a group of users
• must determine if the change is appropriate for everyone who currently uses that report.
• If the change is appropriate, you can simply edit the existing report.
• If only some users should see the change, then see the topic Creating a New Report

Editing a Report

“How to”

pg 10-18

1. Determine how a report needs to change.

• What information is missing? What information needs to be removed?

2. Identify the report record you want to edit.

• What is the record name and ID of the report?

3. Determine the type and style of the report.

• Where in Hyperspace can the report display? What style of print groups does the report use?

4. Identify (or create) the print groups that need to be added (if any).

• Use the Report & Print Group Assistant if you know the print group you want is already being used in another report at your organization.
• Access print groups that meet your needs from the Epic Data Handbook or with a Galaxy search. Be sure to pick ones that match the type and style of your report.

5. Edit the report, adding and removing print groups as needed.

6. Confirm that the report is linked in the appropriate profile to affect the

desired users.

Report Editing

Report Definition screen

• This is where you list the print groups that make up the report.
• The order that you list print groups on the Report Definition screen is the order they will appear to your end users in Hyperspace.
• When adding a new print group, determine where it should appear in relationship to the other print groups that are already present.

Linking Reports to make them Available

• Log into text: Clin Admin> Management Options> Profiles> Chart Review, Summary Report> Patient Summary Screen
• The Patient Summary screen can make reports available from the Summary activity and the Snapshot activity in Hyperspace.
• The Report Type of any reports you enter on this screen will determine whether they can be seen in Snapshot, Summary, or both.

Building a Template

• Build in Hyperspace using Template Editor (LVN) – Create a new navigator record using the prefix “T” to represent “template” in its name
• Add existing topics, A template must contain at least one topic to function.
• Sections can’t be added to a template directly.
• Add a section by typing in the “Search for a section” field at the bottom of the appropriate topic, or click the Add button to the left of that field

Scenario: Sometimes you will need to create a new record in the Report (LRP) master file.
For example, an existing report might be shared by two groups of users and one group might need a change. If you edit the report, the change will apply to both
groups. Instead, you need to create a new report.

Create a New Report?

Two options:

• Duplicate an existing report and edit the new version. (Do this if the new report is simply a variant on the original, or otherwise very similar to an existing report.) pg 9-19 (273)
• Create a new report from scratch. pg. 9-20 (274) (Do this if there is no existing report you can start from.)

What are most commonly used Report Types?

• Chart Review – Visit Detail: Viewed in the Chart Review activity on the Encounters tab.
• Episode Report: Viewed in Chart Review on the Episodes tab.
• Patient SnapShot: Used in the SnapShot activity.
• Patient List Report: Can be used in the Patient Lists activity. When you select a patient, a report of this type appears in the bottom-right of the activity. (See Inpatient Summary Report below.)
• Inpatient Summary Report: Can be used in the Summary activity, the Patient List activity, or the Order Review activity. Note: Do not confuse
• this report type with #3 – Patient Snapshot (which will not work in the
• Inpatient Summary activity).
• Order Completion: Used in order transmittal reports. These reports are specified in order transmittal rules.
• Inpatient Clinician Order Entry Report: Used in the Inpatient Order Entry activity

Describe how to view the names and ID numbers of print groups in Hyperspace when logged in as an end user.

• Go to Help > Help Desk Reports.
• Double click on the Report & Print Group Assistant report to enable assistance.
• (As an administrator, you can also go to Reports > Show Report and Print Group IDs.)

Describe one feature of a Native HTML report that is not found in a plain text report.

Possible answers:

• You can arrange the print groups into columns
• There are hyperlinks to other activities or reports and you could attach a comment.
• In general, Native HTML reports are more colorful and interactive than Plain Text reports

What four patient workspace settings is the Workflow Engine configured to control?

1. Activity tabs (to the left of the patient chart)
2. More Activities menu (formerly known as the action menu)
3. Navigators
4. Sidebars (when using widescreen view)

Workflow Engine

Conditions and Directives 

• Set of conditions (“if” statements) and directives (“then” statements).
• The conditions evaluate properties about the user, the patient, or the type of encounter (admission, office visit, etc.).
• After matching on conditions, the directives then arrange the patient workspace.
• Every clinical workspace has many properties, like encounter type, patient age, and provider specialty.
• Each property used in the Workflow Engine is defined by a property record in the Properties (LRC) master file. Epic programmers build these records.

Condition = “If…” Statement

Nested Conditions

The “If…” portion of a rule (condition) specifies which properties and values the

“then…” portion applies to. The rows that start with “if” evaluate properties.

• These nested conditions allow for a more refined search.
• When evaluating a rule, the system looks to the top condition first.
• If a condition is not true, the rule skips any conditions nested under it. It moves down the rule to the next value for that condition, or the next entirely new condition

Directive = “Then…” Statement

Directive: Continue Afterwards

The “then…” portion of the rule (directive) tells the Workflow Engine what to do

if the rule matches the conditions specified in the “If…” portion.

• Normally, once a rule matches on a true condition, it executes whatever directives are there and then stops processing the rule. It’s done searching.
• However, if a set of directives says “continue afterwards,” then the system will continue reading the rule and processing conditions and directives.
• Directives found later in the rule can add to previous directives.
• If later directives found by continuing afterwards conflict with previous directives, the later directives will trump the previous.

Workflow Engine Rule

What steps should you take before you edit a rule?

• Observe an active rule
• Determine the rule affecting a user
• Write rule corrections on paper
• Open a new rule contact

• Find appropriate tools 

Workflow Engine Tools

• Edit Rules Tab: use toolbar buttons to create rows of information, called nodes. Depending on the kind of node you create, different active fields appear at the bottom of the Editor for you to fill in
• Directive: Add Navigators: This toolset directive allows you to add activity tabs and a single navigator for a patient workspace.
• Using the Add Navigator tool can make multiple navigators available within a patient workspace. Add Navigators is also used for building multi-template navigators (navigators within navigators).
• The Activity Name and Caption fields allow you to add a specific name for your navigator which will display to the end user (such as “Admission” or “Rounding”).
• The Template column allows you to specify desired navigator templates.

Workflow Engine 

Tools: Override Navigators Activity

• There are two options for adding navigators: override and append.
• If you select the Override option, the specified settings appear in place of any navigator activities added by previous Add Navigators directives. This is the recommended option.
• If you select the Append option, the specified settings appear in addition to any navigator activities added by previous Add Navigators directives

Workflow engine Rules

Creating new Rules

• When you create a new rule record, the first contact is automatically deactivated.
• Any new contacts created for that rule are also automatically made inactive.
• You can activate the contact you are editing by clicking Activate on the Workflow Engine Rule Editor toolbar.
• Only one contact in a rule can be active at a time.
• Activating a contact automatically deactivates the other contact that was active.

True or False.   If the patient encounter does not match conditions in a Workflow Engine rule, the system looks for a rule in the next level of the profile hierarchy.

False.

• Settings found in the Role and compiled profile for the patient encounter will be used.
• The system will not look for additional Workflow Engine rules at other levels in the profile hierarchy.

How can administrators configure Epic’s electronic medical record to fit different job roles or specialty workflows?

Navigators

Designing and implementing navigators involves the 

• Visit Navigator Template (LVN) master file which includes 3 types of records: templates, topics, and sections
• Workflow Engine rule (LOR) master file 

Navigators

Identify Record Names

What is crazy keyboard shortcut?

To find out the names of records used, hold down Ctrl+Alt+Shift with your left hand.

With your right hand press and release F12, and then press and release F10.

What questions should you ask before building a new navigator?

• When do clinicians need this navigator?
• How do I make this navigator apply in those situations?
• What workflows do clinicians have in those situations?
• Is there an existing navigator template that could meet those workflow needs?
• If I need to build a new template, what topics does it need?
• If I need to build a new topic, what sections does it need?

When is a User Record necessary?

• Anyone who needs to log in to Hyperspace needs his/her own user record.
• Determines login IDs, passwords, default login departments, security (access to functionality), and many other settings.

Security Points

• Security points are individual keys to pieces of Epic functionality.
• Each activity (like Chart Review) is associated with one or more security points. If a user has the security point, he has access to the activity. If he does NOT have the required security point, then he will not be able to launch the activity.
• In most cases, the user won’t even see the activity, or it might appear as grayed out.
• Security points are typically referred to by the type of security class they are
• found in (Inpatient, EpicCare, Emergency, Shared, etc.) and a number.

Security Classes:

Why is having multiple types of security classes beneficial?

The large number of security points that exist. One massive security class with all the security points for a user would be complex and extensive. Assigning that user one security class of each type, however, is easier to maintain. Organizing security classes into types makes security configuration a lot more manageable.

Current and future security changes. New security points are easier to accommodate and organize in specific types of security classes than they would be in a generic security class

Ease of maintenance. When security-related issues arise, administrators can pinpoint where to make changes based on the type of access that is incorrect.

Flexibility of security class assignment. Your end users can have different needs for certain types of security classes while still sharing other types of security classes.

What reasons might the Foundation security class not meet the facility needs?

One doesn’t exist: For example, there is no Foundation EpicCare security class for medical students using EpicCare Ambulatory

Too general: For example, the existing MODEL AMB RESIDENT EpicCare security class might not be appropriate for both first-year residents and other residents.

Scope of practice differences: For example, the MODEL IP NURSE Inpatient security class does NOT allow nurses to adjust the ongoing schedule of a medication order (they must request that a pharmacist do so).

Phased rollout: For example, if an organization was going live with only Willow Inpatient Pharmacy and the electronic MAR, the nurses in the hospital would need a very different security class than the standard MODEL IP NURSE.

Use a Report to Search for Security Classes

• An administrator can open the user template record to determine which security classes are assigned to a particular user
• There is a report in Hyperspace which the end user can view and forward via link with an In Basket message.
• Follow this path: Epic button;Help;Help Desk Reports
• Here you can see security information for your pediatrician on one screen

Edit Security Classes in Hyperspace

Determine Which Security Point You Need

Use tool Epic Security Point Dictionary. It can be found on Galaxy, Epic’s online documentation portal. The spreadsheet includes IDs, names, and descriptions for all the security points available to any given class.

Add A Security Point to a Security Class

Near the upper right of the spreadsheet, paths for Hyperspace and Clinical Administration direct you to the appropriate locations for editing security classes.

Edit Security Classes in Text

Scenario: Andy’s current EpicCare security class is the Foundation System record TRN## PEDS AMB SECURITY CLASS. This record is close to what you need for the pediatricians at your organization, but you need to make a few adjustments for it to be perfect.

Cannot edit Foundation System records, you will duplicate the EpicCare security class and tweak the copy.

No security points will need to be removed, but security to edit the Allergies activity will need to be added.

Check Chapter 6-18 for instructions

Security Level Factoids

• Every security class record can be assigned a security level. Security level is usually found on the first screen.
• Each security class record has a level associated with it. This number can be between 0 (or null) and one billion.
• The security class linked to your user record gives you a security level for that type of security class. For example, if Sandy Administrator’s user record were linked to the security class in the preceding screen shot, she would have an Inpatient security level of 100000.
• If your user record is not linked to a given type of security class, your level in that type of security is 0.
• You cannot assign a user (including yourself) a security class that has a level higher than your own level for that type of security class. For example, if Sandy Administrator’s Inpatient security class had a level of 100000, she would not be able to assign an Inpatient security class with a level of 100001 or higher.

More Security Level Factoids

pg 6-24

The presence of security levels can occasionally be troublesome:

• When you, as an administrator, are editing your own user (EMP) record you assign yourself a security class with a lower level (for example, 2000) than your normal security class (of 4000). You will not be able to later reassign your original security class because your current level is only 2000.
• If you accidentally delete a security class in your own user record, then your security level drops to 0 for that type of security class (making it difficult to reassign yourself any security class of that type).

Where do you need to go to change the EpicCare security class for Andy and the rest of your pediatricians?

• Log in to Hyperspace as your administrator.
• Open the User master file by clicking User (EMP).
• In the User Selection window, choose Edit template record.
• Open your TRN## PEDIATRICIAN template.
• Accept the highlighted contact.
• Click the EpicCare form.
• n the Default Security Class field, enter ;???? security class ####

Accommodate Security Exceptions

with Subtemplates

pg. 6-28 diagram

A user can be linked to up to seven subtemplates. Subtemplates can add to or override settings in a user’s template.

Subtemplates function according to the following rules:

• Subtemplate settings trump contradicting settings in the linked template.
• Subtemplates rank from one to seven, where one is given the highest priority.
• Settings in higher priority subtemplates trump contradicting settings below

Which three security classes does ever user need?

In Basket, Shared, and Reporting Workbench

Security Class Scenario:

Your organization wants its hospital charge nurses to have administrative access to the Patient List activity (Inpatient security point 1 – Patient List Administrator). Otherwise, their access should be the same as that of other inpatient nurses (who use the MODEL IP NURSE Inpatient security class). How would you efficiently take care of this need?

• Duplicate the MODEL IP NURSE Inpatient security class, and call the duplicate something like IP CHARGE NURSE.
• Add to the duplicate the desired security point. Link all of the charge nurses’ user records (or a charge nurse user template) to this duplicate security class.

You are trying to build a subtemplate, but the items you want to set are grayed out.

What did you forget?

You forgot to put those items in the ‘Defined’ column of the Items Defined form.

Which type of record should you create to give a group of residents the same role, security, and profile settings?

Template Record