Download Epic Clinical Optimization (ECO) Updates | September 30, 2014

Sept 30, 2014 ECO Release - Summary of Changes
Sept 13, 2014
ECO Themes:
Cardiology Cardiac Surgery CAUTI Immunizations Inbasket MDRO Nursing Navigators Nursing Usability
Order Set Updates (Postop) Patient Story Problem List Restraints Sepsis
Miscellaneous change by application:
ADT Ambulatory Anesthesia ASAP Beacon Clindoc Orders Optime Radiant Willow
Cardiology
Affects: Ambulatory and Inpatient Providers
This optimization project improves usability of specific Cardiology workflows; these improvements will lead
to enhanced clinical documentation. Components of the project included:
 Snapshot & Cardiac Synopsis improvements
 Afib Tool - new
 Cardiac Surgery Orders (with Cardiac Surgery theme)
 LVEF: interface work, measuring, documentation & reporting improvements
 Problem List improvements (with PL theme)
 HF Changes: BPA and tool tip in patient list
 Device Implant – OP/IP navigator & documentation improvements
 Device Interrogation Work flow - new
 Reading Work Lists for Modalities- new (all RAD type procedures: echo, nuclear, CT, PET)
 Ambulatory navigators improvements
Cardiology Usability
Cardiology Device Management
Device Check Job Aid
Sept 30 ECO Release Summary of Changes
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Cardiac Surgery
ECO Theme Folder Cardiac Surgery
Affects: All Clinicians in Pilot Sites Only: WEV, WSH, MSP
Cardiac surgery is one of the most complicated and protocol-driven procedures performed. Patients can
have hundreds of orders, multiple transitions in care, and multiple conditional protocols. As a result, our
current state has led to extensive workarounds and clumsy workflows to ensure safety.
The ECO project team has completed a systematic redesign of management/protocol orders, end-to-end
workflow analysis, preop vs. day of surgery management, medication updates (afib protocol, ICU restricted
meds, etc.) and consistent use of phases of care. The New Heart Surgery order sets have been created to
help provide consistent, quality care for patients, improve nursing communication and ease transitions of
care through med reconciliation.
New Heart Surgery Order Sets to be Piloted at Sacred Heart, Everett and St. Pat’s
Affects: Surgeons, nurses, pharmacists
Region affected: WA, MT (Only WEV, WSH, and MSP)
New Heart Surgery order sets have been created to help provide consistent, quality care for patients,
improve nursing communication and ease transitions of care through med reconciliation. These new order
sets are being piloted at Sacred Heart, Everett and St. Pat’s.
 2854 Heart Surgery Preop
 2855 Heart Surgery Postop – Entire Postop Period
 2856 Heart Surgery Postop – Ventilation and Sedation
 2857 Heart Surgery Postop – After Extubation (to be released when extubated)
When placing Heart Surgery Postop – Entire Postop Period, a BPA will display suggesting additional order
sets that would be placed in conjunction with the postop order set. These include the Ventilation and
Sedation, Heart Surgery – IV Insulin, Electrolyte Replacement – ICU, Heart Surgery Postop – Infusions, and
Heart Surgery Postop – After Extubation. None are required to be placed and could be placed
preoperatively. The banner displays which order sets have already been placed on the patient to easily
determine which order sets should be placed versus which should simply be modified.
When releasing postop orders for these patients, users are encouraged to release orders by order
set. Orders are intended to follow the standard process of releasing all postoperative orders at the same
time with the exception of Heart Surgery Postop – After Extubation. This order set should remain in a
signed & held status until the patient is extubated. Once the patient is extubated, the surgeon is able to
discontinue the entire Ventilation and Sedation order set via med rec by selecting discontinue by order set
and applying the discontinue to all orders in that order set. All other order sets, ex: infusions or insulin, can
be discontinued in the same manner when clinically appropriate. This should significantly improve the med
rec process.
Heart Surgery Order Sets Change Notice
Cardiac Surgery Job Aid
Sept 30 ECO Release Summary of Changes
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Many new orders have been created as part of this work and are outlined in accompanying change notices.
Do Not Give Medication Orders
Affects: Providers, Nurses, Pharmacists
Region Affected: All
 New “do not give” certain medication orders have been created. These orders are medication
communication orders that display on the active orders report. In addition, once one of these
orders is active, if an order for the type of medication not to be given is placed, a BPA will display to
the ordering person and pharmacy stating there is a do not give order for this medication. If the
order is placed anyway, and administration of the medication is attempted, a BPA warning will
display when the medication is scanned stating there is a do not give order for the
medication. Also, the person ordering or administering the medication does not need to know if a
specific medication falls into the ‘do not give’ category that was ordered. Epic logic recognizes all
medications that contain components of the ‘do not give’ order. Once the do not give order is
discontinue, the BPA will no longer display.
Do Not Give Med Orders
Cardiac Sternal Precautions PRE7 modified
Affects: All
Region affected: All
PRE7 Cardiac Sternal Precautions has been modified to include new process instructions and new question.
Cardiac Sternal Precautions PRE7 modified
Cardiothoracic vent weaning protocol RT300 modified
Affects: Providers, surgeons, nurses, respiratory therapists
Region affected: All
RT300 Cardiothoracic weaning protocol has been modified. Old process instructions for SIMV have been
removed. Ministry specific protocols have been added to the reference link for facilities that have provided
protocol documents. Some ministries have also added additional process instructions. Facilities that have
not submitted protocol documents or process instructions will see a process instruction to refer to their
local protocol. Below is a sample of Everett’s process instructions and reference link, other facilities will
vary.
Cardiothoracic vent weaning protocol RT300 modified
Mechanical Heart Implant Order Sets
Affects: Surgeons, nurses, pharmacists
Region affected: All
New Mechanical Heart Implant order sets have been created to help provide consistent, quality care for
patients, improve nursing communication and ease transitions of care through med reconciliation.
 2850 Mechanical Heart Implant Preop
 2851 Mechanical Heart Implant Postop – Entire Postop Period
 2852 Mechanical Heart Implant Postop – Ventilation and Sedation
 2853 Mechanical Heart Implant Postop – After Extubation (to be released when extubated)
Sept 30 ECO Release Summary of Changes
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When placing Mechanical Heart Implant Postop – Entire Postop Period, a BPA will display suggesting
additional order sets that would be placed in conjunction with the postop order set. These include the
Ventilation and Sedation, Heart Surgery – IV Insulin, Electrolyte Replacement – ICU, Heart Surgery Postop –
Infusions, and PCA – Adult. None are required to be placed and could be placed preoperatively. The
banner displays which order sets have already been placed on the patient to easily determine which order
sets should be placed versus which should simply be modified.
When releasing postop orders for these patients, users are encouraged to release orders by order
set. Orders are intended to follow the standard process of releasing all postoperative orders at the same
time with the exception of Mechanical Heart Implant Postop – After Extubation. This order set should
remain in a signed & held status until the patient is extubated. Once the patient is extubated, the surgeon
is able to discontinue the entire Ventilation and Sedation order set via med rec by selecting discontinue by
order set and applying the discontinue to all orders in that order set. All other order sets, ex: infusions or
insulin, can be discontinued in the same manner when clinically appropriate. This should significantly
improve the med rec process.
Many new orders have been created as part of this work and are outlined in accompanying change notices.
Mechanical Heart Pump Order Sets Change Notice
CAUTI
ECO Theme Folder: CAUTI
Catheter-associated UTI reduction is a clinical priority. This theme work addresses a gap in Epic content to
support the removal of indwelling urinary catheters in a timely manner. Project focused on orders and
documentation to improve compliance with removal of catheters and reduce infection risk as outlined in a
newly adopted system-wide nurse driven catheter associated urinary tract infection protocol .
New Doc Flowsheet to support Nurse Driven Indwelling Catheter Removal Protocol
Affects: Ordering providers and inpatient nurses
Region affected: All regions
A new doc flowsheet group has been created and existing orders modified to support a system wide nurse
driven Indwelling Catheter Removal Protocol. The group is available in the Adult PCS, just under
Genitourinary Interventions. It includes three rows, requiring a yes/no answer. The group will be expanded
by default.
Orderables: Insert indwelling urinary catheter and Remove indwelling urinary catheter orders have new
process instructions alerting the provider that the protocol will be utilized by the RN. In addition the
Remove orderable now has a default of per protocol.
A work list task will alert the RN once the insert order is active to assess the need for the catheter every 12
hours.
New Doc Flowsheet to support Nurse Driven Indwelling Catheter Removal Protocol
CAUTI Tips and Tricks
CAUTI Protocol
Sept 30 ECO Release Summary of Changes
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Immunizations
ECO Theme Folder: Immunizations
Previous town halls, governance groups and ITSM tickets have produced a LONG list of optimization
requests for immunizations for inpatient and ambulatory users. The forthcoming Epic upgrade and the
developing Population Health initiative are likely to satisfy many of the ambulatory requests, but there is a
need to resolve several key usability issues in the interim.
The Sept ECO release will:
 Establish and maintain the Immunization Summary Report as the single source of truth for
immunizations info across the care continuum.
 Improve usability of the Historical Admin Report by updating the template and standardizing the
view for all users.
 Provide screening tools that identify acute care patients in need of influenza and pneumococcal
vaccines, and deploy decision support tools (BPA’s) to assist with ordering those vaccines when
indicated.
o Optimize adult tools
o New PEDS tools
 Provide a screening tool that identifies OB patients at Labor & Delivery who are in need of TDAP
vaccine at postpartum.
Immunizations Job Aid
IP Immunization screening changes - ClinDoc
Affects: Nursing
Region affected: All
We have updated the Adult Pneumococcal and Influenza screenings to comply with CDC guidelines. BPA’s
have been created to guide you to the appropriate vaccination when required based on the answers given
to the cascading flowsheet rows. (See attachments to view the complete screening tools)
IP Immunization screening changes - ClinDoc
IMM Screening Tip Sheet
Updates to the Historical Immunization Template & Immunization Summary Report
Affects: Physicians, Nurses, Mas
Region affected: All- AK, WA, OR, MT, CA
The Historical Immunization Template has been updated with seventeen additional vaccines and
redesigned to list each immunization once with five columns across to document in
Updates to the Historical Immunization Template & Immunization Summary Report
IMM Reports Tip Sheet
Immunization Workflow Enhancements
Affects: Nurses
Region affected: All
Sept 30 ECO Release Summary of Changes
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Immunization screening questions that eventually present orders (when vaccines are indicated) have been
developed for influenza and pneumococcal vaccines. After completing the screening, alerts will clearly
indicate if vaccine is indicated, and lead the user directly to the order. These are particularly useful for
pneumococcal, as there are multiple products available to choose. If vaccine is indicated after screening,
the alert will lead the user to the appropriate choice, taking the guesswork out of which pneumococcal
vaccine should be administered.
Two new patient list columns are available that will help clinicians and managers determine when
immunization workflows are incomplete:
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indicates that immunization screening has not started
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indicates that immunization screening is incomplete
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indicates that an immunization is indicated, but that an order was not written
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indicates that the immunization has not yet been administered
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indicated that all steps are complete
Immunization Workflow Enhancements
In Basket
ECO Theme Folder: In Basket
The September ECO release continues work that was started and released in July, 2014.
 Updating additional In Basket folders
 Action buttons (adding additional buttons, removing unnecessary/redundant buttons, re-ordering
buttons)
 Report/View buttons – adding standard set of reports/views if appropriate
 Updating My Last Notes view
 Implementing quick wins (e.g. add requested columns)
 Per Legal: For Clinical Users, will give user security point to allow them to attach to any user’s In
Basket. Excludes non-clinical users (e.g. Front Desk, Registration, Scheduling, Billing)
 Adding 2 new sections to visit navigators: Instructions & Send Message. This will allow users to
create a new In Basket Review Needed message that is more task based, requires some action vs.
the existing Follow-up section which triggers In Basket CC’ed Chart that will be used more for FYI cc
related topics. This way providers can prioritize and work on Review Needed items without worrying
that it will get lost in CC’ed Chart.
In Basket Attach to any user’s In Basket - Ambulatory, Beacon, ASAP, HIM, Clindoc, Orders, WebApps
Affects: Clinical Users who work in Basket messages
Region affected: All
In the In Basket, Clinical users will be able to Attach to anyone’s In Basket without requiring the user Grant
Access.
In Basket Attach to any user’s In Basket
In Basket Attach Job Aid
Sept 30 ECO Release Summary of Changes
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In Basket Button/Reports/Columns updates – Ambulatory, Beacon, ASAP, HIM, Clindoc, Orders,
WebApps
Affects: All Users who receive the updated In Basket messages
Region affected: All
In Basket Phase II Updates
In Basket Button/Reports/Columns updates – ECO THEME - Ambulatory, Beacon, ASAP, HIM, Clindoc,
Orders, WebApps
MDRO
ECO Theme Folder: MDRO
MDRO theme focused on usability for infection preventionist including optimized patient banner with easy
access buttons and SmartLinks and a new navigator build that will allow for a “one stop shop” for the
Infection prevention staff. Scope of work included:
 Infection Preventionist Workflow: Improve efficiency while decreasing number of clicks to access
more data (i.e. side bar reports)
 Isolation status workflow: Increasing functionality of the isolation banner for more transparent
viewing
 Communications of Transitions of care (internal/external): Improving on the ticket to ride, and
other transfer documentation in order to increase handoff communication.
 Visibility: Increasing the visibility of the MDRO by removing acronyms and replacing with more
comprehensive titles.
Infection Prevention — IP
Affects: Infection Preventionists, Nursing, Providers, Case Managers, Social Workers, ADT, EVS
Region affected: All
Updates to Infection Prevention workflow tools, orders, reports and functionality around the infection
control workflow
Infection Prevention — IP
MDRO Job Aid
Changes to Isolation / Infection Category List used by EVS – ADT / Prelude
Affects: EVS Staff
Region affected: All
Both the Isolation and the Infection Category Lists have been updated as seen below
Changes to Isolation / Infection Category List used by EVS – ADT / Prelude
Sept 30 ECO Release Summary of Changes
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Nursing Navigators
ECO Theme Folder: Nursing Navigators
Navigators throughout the system have provided inefficient and non-standard workflows for RNs.
Build/design is inconsistent and there is often more information than needed within a specific navigator
causing navigator fatigue and un-helpful information sharing. This project will focus on a systematic redesign of RN navigators for consistent look and feel, similar technical solutions, actionable vs. information
sharing options and improving usability for clinician workflows. In addition, the team will create design
guidelines and principles to be applied to future/new navigators, so analysts can build workable navigator
solutions for end-users.
Navigators: Nursing
Affects: Nursing – IP
Region affected: **NOTE- This project will have technology piloted for one week in production from Sept
30th to Oct 6th at Holy Family, St. Vincent and select departments in MT (Medical Oncology) and Alaska (4
North Surgical). All regions will receive the new navigators on Oct 7th unless otherwise communicated.
The Epic Clinical Optimization (ECO) program focused on updates to RN navigators as a theme for the
September release and were specific to inpatient, OB and perioperative navigators. With the overhaul of
navigators affecting various specialties, ECO found a need to create design standards for a consistent enduser experience. Principles used throughout all of the navigator changes include the following Utilizing the Table of Contents within the navigator as action-oriented items for end-users to complete
as part of the workflow
 Re-organizing information topics, reports, etc., to different areas within the navigator (buttons/sidebar
report)
 Reducing scrolling within the navigator to prevent overwhelming the end-user
 Consolidating (when appropriate) similar topics, screenings and workflow needs
 Keeping end-users within the navigator to complete their work and removing table of content items
that jump end-users to a different location in Epic
 Consistent formatting, buttons, colors, icons and naming conventions through all navigators
 Removing duplicative documentation and using the “right tool” for appropriate documentation
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Commonalities
Each navigator will start with a Communication section which will present pertinent data for that
workflow.
Toolbars will be above each navigator with convenience buttons for specific activities
Sidebar reports will be critical working with navigators. New sidebars will launch upon loading of the
new navigators, presenting pertinent information for each workflow. Please do not close the sidebar
while working in a navigator.
Preferred Language and Advance Directives (in the sidebar) display information collected from
Demographics and from Doc Flowsheets. Editable from either.
Sept 30 ECO Release Summary of Changes
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Inpatient/OB:
Inpatient: The original ADT navigator will be available for a short time from More Activities for
reference.
OB: Triage Navigator has been replaced by the Arrival navigator. IntraOp has slight changes to match
the changes made within the OR navigators.
Transfer navigator is being retired. When transferring OUT, complete usual documentation and utilize
the Professional Exchange report. Use new Admit-Arrival navigator when receiving a patient.
Admission:
Specimen Collect and Signed/Held orders are functions available in Communication section.
Required documentation dots (green/red) are now imbedded in the Admission navigator.
Several sections have combined the required documentation elements. All must be addressed to turn
dot green. (Example: Latex and Allergies are now a single section)
History is displayed in a single non-scrolling review. Click buttons to edit. Social history needs
Smoking/Tobacco status, which should be anything other than “Never Assessed”. Mark as Reviewed in
this section counts for all of History.
Latex screening is now imbedded as a link within the Allergy section. Still need to document Latex as
allergy if screening is positive.
Immunization Screening will cause a sidebar report to appear specific to historical immunizations. The
full Immunization activity is available from the navigator menu.
The same navigator is used for both adults and pediatric patients. Pertinent documentation sections
will display according to age of the patient.
Discharge
Navigator will display only the communication section initially. The checklist will open in the sidebar.
Click on items within the Checklist to perform discharge tasks
Checklist will provide information pertinent to each list item. Examples: last filed date, number of
unresolved care plans, etc.
Follow Up and Discharge Instructions are combined into a single section, utilizing a dual-pane mode.
AVS Clinician Name is available for edit directly from Checklist. This adjusts the name of the nurse
showing on the After Visit Summary.
Link to MyChart Signup will only display for adult patients.
Navigators: Nursing
IP RN Arrival Navigator Tips & Tricks
OB Navigators Updates for Perinatal Nurses
Perioperative Navigators
Please see attached link for detailed changes to the following navigators:
 Preadmit (used to be Pre-op Phone Call / Pre-op Visit)
 Preop
 Intraop
 PACU Arrival
 PACU Discharge
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 Phase II
See ECO Theme folder for tips and tricks and job aid documents related to Optime Navigators
Periop Nurse Navigators
Optime Navigators Overview
Nursing Usability: ED Templates
ECO Theme Folder: Nursing Usability ED Templates
Goal of this theme is to streamline and document the assessments below, including narrator and navigator
changes to assist in the standardization process.
 Headache Assessment
 Brief Assessment added Pediatric content
o 0-90 days
o 90 days to 12 years
o 13 plus
 Pediatric Brief Assessment
 Therapeutic Hypothermia Procedure
Nursing Usability ED Template Change Notice
Order Set Updates
ECO Theme Folder: Order Set Updates
The Epic Clinical Optimization program has made changes to postop order sets with a focus on usability.
Teams did not do a ground-up redesign, nor did the team make changes to content. Current postop order
sets will remain in parallel with the new postop order sets for one month or longer. Below is a summary of
the changes to each postop order set and a crosswalk of the old order set name/number and new order set
with an improved naming convention and number.
1. GENERAL section
a. Admission group – no change
b. Code status – no change
c. Discharge path – only used in 3 places; removed.
d. Nursing – consolidated a lot of other groups, removed redundant and unnecessary orders
(such as those handled by standard nursing practice). There are some variations as needed
for specific specialties.
i. Vital signs – post op vital signs are per unit routine, a single order
ii. O2 therapy, pulse ox, incentive spirometry
iii. Notifications - a single order
iv. Activity - standard activity level, and encourage activity
v. Weights
Sept 30 ECO Release Summary of Changes
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2.
3.
4.
5.
6.
7.
vi. Strict I/O – routine I/O done as standard nursing practice based on unit routines
(every shift, every 8 hours, every 12 hours)
e. Drains and Wound Care- standard group used now in all order sets, added ice pack
f. Indwelling Urinary Catheter Management - standard group used now in all order sets,
designed to maintain SCIP compliance.
g. Diet – reduced to NPO and advance as tolerated.
h. Ancillary services – OT, PT, Speech, RT, Nutrition Services
i. Social work and/or case management, per facility.
STUDIES – PACU section
a. Contains lab and imaging needed in PACU, with PACU phase of care. Separated so they don’t
get confused with studies needed postop.
STUDIES – POST OP section
a. Lab and imaging needed postop, needed now, in AM, serially, etc.
VTE PROPHYLAXIS section
a. standard groups used now in all order sets
IV section
a. Removed “insert IV”. Post op patients have one
b. Added “wean IV fluids” to reduce IV’s until not needed.
c. IV fluids – contains all commonly used solutions.
PCA
a. standard group used now in all order sets
b. added banner to appear to indicate when patient is at risk for sleep apnea, from preop
screening or diagnosis
Medications
a. Arranged order to flow from head to toe
b. Removed certain meds based on extremely low utilization (i.e. Nubain, rectal/oral APAP)
c. Most sections are same standard that currently exst (pain, hypnotics, antiemetics, and
bowel)
d. De-paneled NSAIDS (now ketorolac can be ordered without ibuprofen if desired)
e. Stress ulcer prophylaxis was revamped. There are now two sections, Acid Reducers
Scheduled and Acid Reducers PRN with streamlined choices.
Creation of New and Modified Orders
New or modified orders affected include:
 Activity: progressive ambulation postop (ACT4B).
 Apply heat to affected area (NUR261)
 Cold therapy (NUR1)
 Hip abduction (NUR4)
 Provide patient with post breast surgery garment (NUR26)
 Range of motion (ACT12)
 Remove sutures/staples (NUR413)
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 Strain all urine (NUR386)
 Strict I&O (NUR2)
 Weight bearing (ACT13)
New and modified orders
Updated postop order sets
Affects: Providers and clinicians caring for postop inpatients
Region affected: All
Updated postop order sets
Crosswalk Order Sets
Patient Story
ECO Theme Folder: Patient Story
With the September release, we continue the work to improve our documentation and presentation tools
that tell our patients story. Goals include:
 Improve documentation and presentation tools so that the patients story is clear
 Improve tools that support professional processes of care
 Reduce clutter and simplify
September Scope of work includes:
 Skin care management
 OB Professional Exchange
 Newborn/NICU professional exchange report
 Update to Ticket to ride
 Spiritual care professional change report
 Spiritual care accordion report
 Update to interprofessional overview
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Overview Reports – Inpatient
Affects: Clinicians – inpatient
Region affected: All
Various changes have been made to the Interdisciplinary Overview reports. Sections have been added or
removed. Modifications made to existing reports include:
Nursing:
 Removal: Diagnosis (from ADT, non-clinical)
 Addition: Title, Precautions widget, Specimen Collect widget, Ride Contact Info
 Modification: Sticky Notes (see Additional Info)
Provider
 Addition: Title, Precautions widget
 Modification: Sticky Notes (see Additional Info), CDI Sticky update
Respiratory
 Addition: Title, Precautions widget
 Modification: Sticky Notes (see Additional Info)
Therapy
Sept 30 ECO Release Summary of Changes
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 Addition: Title, Precautions widget
 Modification: Sticky Notes (see Additional Info)
CM/SW
 Addition: Title, Precautions widget, Ride Contact Info
 Modification: Sticky Notes (see Additional Info)
Obstetrics
 Addition: Title, Precautions widget
 Modification: Sticky Notes (see Additional Info)
Pediatrics
 Addition: Title, Precautions widget
 Modification: Sticky Notes (see Additional Info)
NICU/Nursery
 Addition: Title, Precautions widget
 Modification: Sticky Notes (see Additional Info)
PCT
 Removal: Diagnosis (from ADT, non-clinical)
 Addition: Title
 Modification: Sticky Notes (see Additional Info)
Additional information:
 Sticky Notes: Various Sticky Note groups will be replaced by newer streamlined ones. Stickies can
contain up to 2000 characters and upon occasion obstruct the view of other pertinent data. New
versions display a subset of information with links to full/editable content
 Title bar: Title indicates the actual report that is open, and has up to 3 “jump” links that will take the
clinician to specific portions of the report.
 Specimen Collect: Displays current status (if documented) and provides button for changing status.
There may be other slight changes, re-sequencing, etc. on specific Overview Reports
IP Overview Reports
OB and NB/NICU Professional Exchange Reports
Affects: Nursing – OB & NB/NICU
Region affected: All
Two new Professional Exchange Reports have been created for handovers of care: OB Professional
Exchange Report & NB/NICU Professional Exchange Report.
Both utilize an Overview style with colored widgets, 3-column format, and better organization of content.
Some of the Overview widgets are being re-used, along with several new ones to help provide the best
perspective of the patient.
 Simplify the exchange of information necessary for safe and holistic care
 Create consistent and effective handover tools
 Minimize the reliance on memory during handover
These are NEW reports, so users who have wrenched changes to their toolbar will have to re-wrench this.
OB and NB/NICU Professional Exchange Reports
OB NB-NICU PER Screen Shots
Sept 30 ECO Release Summary of Changes
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Inpatient: Documenting Skin Infestation
Affects: Nursing
Region affected: All
New Doc Flowsheet row, in the Adult, OB, Pediatric PCS (Patient Care Summary). Skin Group/ Additional
Documentation cascade.
Skin Infestation: Able to document infestation, such as lice
Additional information: Displays in various reports
Problem List Enhancements
ECO Theme Folder: Problem List
Update to Problem List SmartLinks to remove (HCC)
Affects: Providers
Region affected: All
Problem List SmartLinks are used to import the problem list into provider notes. In February 2014, a change
was made to the problem list to include “(HCC)” on all diagnoses that met criteria for Medicare Hierarchical
Condition Coding. However, the unintended consequence of this was showing this text in all areas where
the problem list is used, including patient facing materials and provider notes. With this change, the vast
majority of Problem List SmartLinks (see attached) will remove (HCC) from the problem description unless
the provider chooses to show the (HCC) text by updating their SmartLinks.
Update to Problem List SmartLinks to remove (HCC)
Restraints
ECO Theme Folder: Restraints
The goal for this theme is to assist clinicians in providing safe & appropriate care to patients in restraints by
streamlining documentation & adding alerts. Scope of work included:
 Documentation/Flowsheets
o Non-violent Restraints
o Violent Restraints
o Seclusion
 BPA for Restraint/Seclusion care plan template
 Worklist task – Q2hr Non-violent assessment
 Patient list columns
 Orders/BPA
Restraint/Seclusion Orders, Documentation and Care Plan — Orders/ClinDoc
Affects: Providers, Nurses, Trained Observers
Region affected: All
BPAs to alert nurses & providers that restraint order has or is about to expire or BPA notice that the patient
has no active order
Sept 30 ECO Release Summary of Changes
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Restraint/Seclusion Orders, Documentation and Care Plan
Alerts for Restraints and Seclusion IP Nursing Tip Sheet
Restraints and Seclusion ASAP Nursing Tip Sheet
Restraints and Seclusion ASAP Provider Tip Sheet
Restraints and Seclusion IP Nursing Tip Sheet
Severe Sepsis Alerting
ECO Theme Folder: Severe Sepsis Screening
In July 22 ECO release, severe sepsis scoring transitioned from Amalga to Epic for those facilities that were
using the Amalga functionality and a pilot for BPA designed to provide early detection of possible severe
sepsis was implemented. With the September release severs sepsis alerting is available to other ministries.
Possible Severe Sepsis Alerts
Affects: Nurses, Providers
Region affected: AK, WA, MT, OR, CA, but not all ministries
Severe Sepsis is defined as meeting: two of the following criteria:
 Respiration > 20
 Heart Rate > 90
 WBC > 12000 or <4000 or bands>10%
 Temperature > 38.3 or < 36
and one of the following criteria:
 SBP < 90
 Lactate >2
These patients are excluded from qualifying for Severe Sepsis alerts:
 Patients < 18 years old
 Patients with comfort care orders
 Patients with a Problem List Dx of Severe Sepsis or Septic Shock
 Patients with a Severe Sepsis Management order
Several features are available in Epic to identify patients who meet the Possible Severe Sepsis Alert criteria:
 Alert icon on Patient Lists: MEWS/Sepsis patient lists are available in the MEWS/Sepsis Scoring
folder for ALL facilities. Also, staff can add the SEPSIS SEVERE column to their own patient lists,
as desired.
 Alert icon in ED Track Boards: My Patients, All Patients, and My + Unassigned
 Alert text pages to nursing: Each facility had the opportunity to define which staff (charge
nurses, rapid response nurses, house supervisors etc.) to notify when patients met the Possible
Severe Sepsis alert criteria. Alert pages are sent no more often than every 24 hours.
 Provider Best Practice Alert pop-up screen: These alerts offer providers a quick way to order
additional tests, such as lactate, or to begin sepsis treatment order sets. If providers select one
of the acknowledgement buttons and then click “accept” or “accept &stay”, the alert will not
present again for 24 hours.
Possible Severe Sepsis Alerts
Sept 30 ECO Release Summary of Changes
Page 15 of 34
Miscellaneous changes by Application
ADT
New WQs for Cosmetic Surgery Patients — Prelude / ADT
Affects: Central Access Services, Access Services and On-site Financial Counselors
Region affected: AK, WA, OR, MT, CA – this does not impact Community Connect
There are new Work queues available in all regions for patients that have been marked as “Cosmetic / NonCovered procedure” during Case Entry in OpTime. Preadmission and admission encounters will fall to this
WQ for review. Once a Stop Bill has been added of “HB Services Package Pre-payment” the encounters will
leave the WQ.
The naming for these WQs is:
 ADT OR ALL VER COSMETIC PATIENTS
 ADT WAMT ALL VER COSMETIC PATIENTS
 ADT CA ALL VER COSMETIC PATIENTS
 ADT AK SA 10 VER COSMETIC PATIENTS
Changes to Isolation / Infection Category List used by EVS – ADT / Prelude
Affects: EVS Staff
Region affected: All
Both the Isolation and the Infection Category Lists have been updated as seen below
Changes to Isolation / Infection Category List used by EVS – ADT / Prelude
AMBULATORY
The following changes affect both inpatient and outpatient. For a full list of Ambulatory changes for
September 30, 2014 click here
Updates to Chart Review
Affects: All End Users
Region affected: All Live Regions
New tools have been added to Chart Review to reduce the time it takes for users searching for information
within the patient record.
A new “MyChart” tab will be added in Chart Review to aid in locating historical transcripts between patient
and providers via MyChart. Additionally, the Patient Email and Refill encounter reports will be updated,
and a “Patient Message Review” button created. Together, these changes will shorten the time it takes for
providers and staff to locate MyChart related documentation within the patient record.
New Quick Filters will also be added to most other tabs for faster searching of notes, encounters, and
orders.
Updates to Chart Review
Sept 30 ECO Release Summary of Changes
Page 16 of 34
ECO Theme Folder: Chart Review Improvement
ANESTHESIA
Anesthesia Multiple Updates – Anesthesia
Affects: Anesthesia Providers
Region affected: All
Multiple Anesthesia Updates:
 Updates: (Preop, Intraop, Postop navigators) Anesthesia Types
 New: PNB & IVRA
 Renamed: “total IV anesthesia” – TIVA
 Removal: (Preop navigator) Anesthesia Meaningful Use
 New: Abx Mar tab
 Updates: (Intraop navigator) MTP Blood administration
 New:
 Dual Signoff
 Transfusion Reaction
 Reaction Symptoms
 Product #’s
 Updates:
 Added new MTP rows to Blood Transfusion report
 navigator) Event
 NG/OG Removed
 Update: (Preop navigator) Erroneous Encounter – Send Message
 Friendly reminder to not include PHI when sending note
 Update: (Preop navigator) History
Anesthesia Multiple Updates
Anesthesia Job Aid
ASAP
ED Guide TB Report and navigator updates
Affects: ED Guides
Region affected: Oregon
The ED Guides will receive a new Track board report and a renamed trigger button in the ED Guide
Navigator.
ED Guide Track board and other ED Guide updates:
 The ED Guide track board report will display new arrangement
 Service area flowsheet row is now triggered by the Provider Confirmed Assistance row
 The new status of Admitted" and "Patient Out of Scope", will displayed in the Guide Status N/A
flowsheet row
Sept 30 ECO Release Summary of Changes
Page 17 of 34


New clinics will be displayed in the “Referred Clinic Type Portland” flowsheet row of the Initial
Contact section of the ED Guide navigator; Oregon City Medical and United Urgent Care and Family
Medicine.
The “Appointment Kept” flowsheet is no longer displayed in the 30 Day dispo section of the
telephone encounter
ED Coder Critical Care Charge Workflow
Affects: All ED Coders
Region affected: All
ED Coders will now be able to add critical care charges to an account from the facility preference list
instead of having the Critical Care E/M row file the charges automatically. This will allow the coders to add
the correct provider to each charge.
1. The Critical Care charge has been added to the ED Coder preference list for each facility
2. The automatic charging function on the Critical Care E/M row has been removed.
ED Coder Critical Care Charge Workflow
ED Coder Critical Care Charges Tip Sheet
Multiple (6) ED Optimization Enhancements for ED Staff
1. ED MD More Activities Redesign
Affects: Physicians, Midlevel’s and Residents
Region affected: All, AK, OC, WM
The ED MD More Activities menu has been reformatted to group similar activities together
2. ASAP Add Acetaminophen Overdose & Pediatric Growth Chart to Scoring Tools Activities
Affects: ED/UC Physicians, Midlevel’s
Region affected: All, AK, OC, WM
3. Add ED Treatment Team to Encounter Summary for Messages in Hospital Chart Completion Folder
Affects: All Users
Region affected: All, AK, OC, WM
4. ED Physician Call Back Pool
Affects: Physicians, Midlevel’s and Residents
Region affected: All, AK, OC, WM
Physicians will now have the ability to identify patients requiring a clinical call back by documenting in the
ED Callback section of the Discharge Navigator. Once a request has been documented the system will route
an In basket message to the ED Clinical Nurse F/U Pool or the ED Clinical Provider F/U Pool. Once in the In
basket Folder the physician can create a new telephone encounter to document the outcome of the
callback. This functionality will only be activated for Emergency Departments who have decided to opt-in
with this enhancement
5. Immunization Screening documentation now available on Triage Summary Report
Affects: All Users
Sept 30 ECO Release Summary of Changes
Page 18 of 34
Region affected: All, AK, OC, WM
The Immunization Screening documentation will now appear in the Triage Summary Report. This
information will in between Immunization History and Medical History.
6. New SmartText for Inpatient Vitals with Pain Rating
Affects: All Users
Region affected: All, AK, OC, WM
The creation of a SmartText to use within Provider’s Notes, that would include the patient's vitals as well
as the patient’s last recorded Pain active and resting Pain Rating, as well as the Min/Max vital range over a
24 hour period.
ASAP Provider Change Notice
ED Guide Follow up Inbasket Messages Triggered by Flowsheet Events
Affects: ED Guides
Region affected: Oregon
ED Guides can now have improved functionality that will allow them to automate ED Follow up message
types to existing ED Guide pools when they are due.
ED Guide F/U Inbasket Messages Triggered by Flowsheet Change Notice
ED Guide Call Back Tips and Tricks
ED Clinical Follow-Up Inbasket Messages Triggered by Flowsheet Events
Affects: ED Physicians, ED Nurses
Region affected: All (If your Ministry has opted in)
During the discharge workflow the provider now has the ability to auto generate Inbasket messages to
department specific ED Physician and Nurse Follow-Up Pools through use of the ED Call back section of the
ED Discharge Navigator.
ED Clinical Follow-Up Inbasket Messages Triggered by Flowsheet Events
ED Clinical Call Back Tips and Tricks
ED Post-Visit Follow-Up Event Based Inbasket Messages
Affects: All ED Users
Region affected: All (This functionality is available only if your Ministry has opted in at this time,
instructions below on more info if your ministry is interested)
ED users can now use pools to manage post-visit follow up calls and make telephone encounters. A new
Inbasket message type: ED Post Visit F/U has been created and configured to be sent to department
specific Follow-up pools based on the ADT discharge events of Discharged, or Dismissed. In addition the
system has been configured not to generate this message type if a provider has already requested an ED
Clinical call back by a physician or nurse, or if the patient has a status of Deceased.
ED Post-Visit Follow-Up Event Based Inbasket Messages
ED Post-Visit F/U Call Back Tips & Tricks
Multiple ED Optimization Enhancements for ED Staff
1. ED Sticky Note Communication Tool
Affects: All Users
Sept 30 ECO Release Summary of Changes
Page 19 of 34
Region affected: All: AK, OC, WM
The ED Sticky Note Communication tool will be used for non-clinical communication between the physician
and treatment team. The “Sticky: Provider” note will be used for Treatment Team to Physician
communication while “Sticky: Treatment” note will be used for Physician to Treatment Team
communication. When a note is entered by the Treatment Team an icon will appear in the “S” column on
the My Patients, All Patients and My Patients + Unassigned Track Board Views. When a physician enters a
note for the Treatment Team the icon will not activate on the Physician Track Boards.
2. FYI Track Board Column Shows Home Health and Hospice FYIs
Affects: All Users
Region affected: All: AK, OC, WM
ED Staff will now see the “”HH Agency” and “Hospice” FYI types used by the respective caregivers in the
track board FYI column. Previously these could only be seen on the patient banner and in the FYI activity.
3. ED Telephone Encounter Navigator and Menu Updates
Affects: All ED Staff that uses the telephone encounter functionality
Region affected: All: AK, OC, WM
ED Staff now have a slimmed down ED-specific version of the telephone navigator. When accessing a
telephone encounter either through Post-Visit Callback In Basket Management or through the Epic button
the view should match the screenshot below. It includes activities such as Chart Review and Snapshot as
well as a shorter navigator. The workflow for each ministry and role may differ but the navigator, activities
and menu items will be the same for all users.
4. Sepsis PAF
Affects: All ED Users
Region affected: All: AK, OC, WM
Adding a new Sepsis PAF column to the All Patients and My Patients track board views. New column will
appear between the Results and the Comments columns.
ED Sticky Note Communication Tool & Others
ED Nurse/Tech/BH Narrator and Navigator Changes — ASAP
Affects: All ED Nurses, Techs, and ED Behavioral Health Staff
Region affected: All
ED Techs now have External Catheter LDA in ED Narrator
ED Nurse/Tech/BH Narrator and Navigator Changes — ASAP
ED Telephone Navigator for MDL, PSMC and AVZ
Affects: PSMC, MDL, AVZ
Regions affected: WM, AK
The staff at Seward, Valdez and Deer Lodge will have a slightly different view and workflow when
completing an ED telephone call back.
ED Telephone Navigator for MDL, PSMC and AVZ
Infectious Screening Tool for Emergency Departments
Affects: Nurses and Physicians
Sept 30 ECO Release Summary of Changes
Page 20 of 34
Region affected: All
The Infectious Screening Tool will be available in the Triage Navigator and the ED Narrator. The screening
will be viewable on the Triage Summary, Nursing Assessment and Patient Care Timeline reports.
Infectious Screening Tool for Emergency Departments
Infectious Screening Tool with International Travel Questions for Emergency Departments
Affects: Nurses and Physicians
Region affected: All
The Infectious Screening Tool with International Travel questions will be available in the Triage Navigator
and the ED Narrator. The screening will be viewable on the Triage Summary, Nursing Assessment and
Patient Care Timeline reports
Infectious Screening Tool with International Travel Questions for Emergency Departments
BEACON
Streamlined Workflow for Treatment Plans with Continuous 5FU Pump Orders
Affects: Providers and staff who apply and use 5FU Treatment Plans
Region affected: All
Continuous fluorouracil “pre-cycle” has been removed.
Convert to Inpatient Help is now found in each treatment cycle as a Physician Communication order.
During visit pump connect and Home infusion pharmacy prescription orders are both listed within each
cycle under Chemotherapy category with wildcard under comment to indicate selection of one continuous
5FU order is required prior to signing.
Streamlined Workflow for Treatment Plans with Continuous 5FU Pump Orders
Cosyntropin Infusion Therapy Plan – Lab Corrections
Affects: All providers and staff who use the Cosyntropin Infusion Therapy Plan
Region affected: All
Labs in the Cosyntropin Infusion Therapy Plan have been replaced with a communication to place regionspecific labs that will function as expected in each region. In the past the labs in the plan have not
functioned properly due to non-standard labs for these various tests being used. Instruction users to place
labs specific to their region will correct this
Pediatric Oncologists will have a Pediatric-specific navigator section
Affects: Pediatric Oncology providers in Alaska and Spokane
Region affected: AK, WM
Pediatric focused History section will now be on the navigators. Will switch to an adult history section at
age 18
Pediatric Oncologists will have a Pediatric-specific navigator section
Helper navigators will be available for Providers
Affects: All Oncology Providers
Region affected: All
Sept 30 ECO Release Summary of Changes
Page 21 of 34
The Helper navigator will be available for providers. This will include the anti-coagulation navigator and the
procedure navigator. This will also include the Results Console.
Additional information: Regarding the Procedure navigator, orders will be placed in Order Entry, and then
accessed in the procedure navigator for documenting on. The charges for the procedures will then be done
in the charge capture section.
Three New Options Available for Patient Care Team Relationship
Affects: All users
Region affected: All
 Research Coordinator
 Research Investigator
 Research Nurse
Three New Options Available for Patient Care Team Relationship
View Access to Research Studies Activity - Beacon
Affects: All clinical and scheduling users
Region affected: All
All clinical and scheduling users have at a minimum view access to the Research Studies activity after
clicking ‘Research: Active’ in the patient header. (Note: This does not impact users who already had a
higher level of access for the Research Studies activity.)
View Access to Research Studies Activity - Beacon
Addition of Physician Procedures Section in Charge Capture – OP clinics - Beacon
Affects: Physicians, Billing & Business office Staff
Region affected: WA, OR, MT
Physicians in Beacon OP clinics do not have an appropriate place to document procedure charges.
Therefore, a new section will be added to the charge capture navigator section titled ‘Physician
Procedures.’ The new physician Procedure section of charge capture will only be available when the
physician is logged into an Outpatient context. This will provide a consistent list and location for OP
physician procedure charging.
Addition of Physician Procedures Section in Charge Capture – OP clinics - Beacon
CLINDOC
New Discharge Medication SmartLinks
Affects: Providers
Region affected: All
Discharge Medication SmartLinks have been consolidated and updated to be more appropriate for
Discharge Summary, SNF Transfer, and Discharge Readmit usage. With this change, a more consistent and
appropriate list of medications will be available for clinicians to include in the various discharge documents
that are written. Old discharge medication SmartLinks will be retired and redirected to the new set of
SmartLinks.
Sept 30 ECO Release Summary of Changes
Page 22 of 34
Of note, the new Discharge Medications SmartLinks will create a HARD STOP inside a note (with ***) if
medication reconciliation has not yet been completed. This may create new workflows for some clinicians
and providers, but yields the most accurate list for patients
New Discharge Medication SmartLinks
Discharge Med SmartLinks Additional Information
Inpatient: Documenting Skin Infestation
Affects: Nursing
Region affected: All
New Doc Flowsheet row, in the Adult, OB, Pediatric PCS (Patient Care Summary). Skin Group/ Additional
Documentation cascade.
Skin Infestation: Able to document infestation, such as lice
Additional information: Displays in various reports
Stroke Resource enhancement requests - ClinDoc
Affects: Nursing
Region affected: All
During visits to our ministries/facilities the Stroke Resource users requested enhancements. We have:
Added “non-verbal” and “word salad” as selections in the Speech category list
Stroke Resource enhancement requests - ClinDoc
Updated NAS scale row information - ClinDoc
Affects: NICU/Newborn Nursing
Region affected: All
To assist with scoring the Neonatal Abstinence Score the Row Information boxes were Updated with the
instructions for appropriate scoring
Updated NAS scale row information - ClinDoc
Resp Therapy NEO RT Assessment request - ClinDoc
Affects: Respiratory Therapists
Region affected: All
Adding the Apnea and Bradycardia group and the NICU SPO2 Trending group to the NEO RT Assessment
flowsheet and removing the NICU SPO2 Trending group from the IP RT Procedure Monitoring flowsheet
Resp Therapy NEO RT Assessment request - ClinDoc
Update RT Overview Widgets - ClinDoc
Affects: Respiratory Therapists
Region affected: All
The RT Overview widgets for Respiratory Orders and RT Labs will now look ahead 24 hours for new orders
Update RT Overview Widgets - ClinDoc
Charting enhancements - ClinDoc
Affects: Nursing
Region affected: All
During visits to our ministries/facilities some enhancement requests were mentioned. We have:
Sept 30 ECO Release Summary of Changes
Page 23 of 34
Made the “Level of Consciousness” row will remain open for easier access
Charting enhancements - ClinDoc
Full SBIRT Assessment added to IP - ClinDoc
Affects: Nursing, Case Managers/Social Workers
Region affected: All
The Full SBIRT/AUDIT/DAST assessment has been added to the Behavioral Health Department Admission
Navigators and to the Inpatient Nursing and Case Managers/Social Worker list of “wrench-able” Flowsheet
tabs
Full SBIRT Assessment added to IP - ClinDoc
NB Blood Screens Flowsheet Row additions
Affects: Nursing – NB/NICU
Region affected: All
Newborns are sometimes still admitted to our nurseries at the time that their 2 nd and/or 3rd Newborn
Screening test is needed. Additional rows have been added to reflect documentation of the second and
third Newborn Blood Screen procedure within Infant Screens Group on the NB/NICU Profile if the
newborns are still inpatients. These results will also be viewable from the NB/NICU Professional Exchange
Report & the Newborn Screens Review report.
NB Blood Screens Flowsheet Row additions
New SmartLink for Inpatient Encounters
Affects: Providers
Region affected: All
New SmartLink available in Inpatient context for users to pull the first encounter weight, the most recent
encounter weight, and the calculated difference
New SmartLink for Inpatient Encounters
Rehab Plan of Care Smart text Rebuild — ClinDoc
Affects: Rehab staff and all users who read Rehab Therapists Plan of Care Notes
Region affected: All
Rehab Plan of Care Smart texts have all been rebuilt to exclude headers and will now only pull in last filed
values for the groups that contain goals. Strength and ROM have also been added where appropriate.
9/30/2014
LDA Types: Remapping
Affects: All inpatient
Region affected: All
Several of the existing LDA’s had less than ideal mapping to LDA type. This has been remedied. This is a
subtle change, with most of the effects in reports. Part of this work entailed build 3 new “types” for
mapping: Chest Tube, Arterial Sheath, and Urinary Catheter. Reviewed all LDA’s for appropriate mapping,
and changed where appropriate.
LDA Types Remapping
Sept 30 ECO Release Summary of Changes
Page 24 of 34
Pediatrics: IP – Sedation Level
Affects: All inpatient
Region affected: All
Ability to easily document the sedation level (Pasero Opioid Sedation Scale) from within the Pediatric PCS,
and the Vital Signs screen (Pain group)
Pediatrics Sedation Level
Patient List Sticky Notes
Affects: All inpatient
Region affected: All
When opening a sticky note for editing while in Patient List, it is sometimes difficult to validate that the
sticky is opened on the correct patient. Header has been added to the underlying sticky displaying behind
the edit window. Displays the name of the patient, MRN, age and gender along with the name of the
specific Sticky note.
Patient List Sticky Notes
Ticket to Ride report – IP
Affects: All inpatient
Region affected: All
Several important data elements have been missing, or difficult to determine if missing.
 Isolation and infection columns will now always display, even if nothing present.
 New alerts section to help with potential mood/violence issues and skin infestations
 Precaution orders will display (which includes Neutropenic)
 Better use of screen/paper real estate, using full 3 columns. Most patients will now fit on a single
page. However, a header has been placed on the report so that if there are multiple pages, basic PHI
will be on each
Ticket to Ride report – IP
Set Inpatient Charge Capture Filter to Display Pro-fees for Providers.
Created Dividers to Improve Display and Organization of folders within Inpatient Professional Charge
Capture Preference Lists
Affects: All Providers
Region affected: All – AK, WA, OR, MT, CA
Currently, all filed charges including nurses medication orders display as the default filter in the “my
charges” section of Charge Capture for providers. This results to having a huge list of filed charges for
providers to review. Filter option for our providers to either display or hide Pro Fees is not currently
configured. This will set the Pro Fees to be the default filter
Set Inpatient Charge Capture Filter to Display Pro-fees for Providers.
Sept 30 ECO Release Summary of Changes
Page 25 of 34
ORDERS
Update to Specialty Bed orderable — Inpatient Orders
Affects: Physicians, Nurses, Clinical Staff
Region affected: All
Updating EQ111 Specialty Bed order to be a generic specialty bed orderable, with only one question of
“Specialty bed type”, a hard stop for the free text answer
Update to Specialty Bed orderable — Inpatient Orders
Addition of Problem Oriented Notes to Provider Navigators - Orders
Affects: Providers
Region affected: All
Access to Problem Oriented Notes has been added to the Admission, Discharge, and Transfer navigators for
providers. Beneath the current problem list activity will be 2 buttons that allow launching of problem
oriented notes into the sidebar or in the main window. The generate note button at the bottom of the
activity will create an H&P note if opened from Admission navigator, a Progress note if opened from the
Rounding or Transfer navigator, and a D/C Summary if opened from the Discharge navigator.
Addition of Problem Oriented Notes to Provider Navigators - Orders
Sleep Apnea BPA - changes to NURSE BPA – Inpatient orders
Affects: Nursing
Region affected: All
In the July ECO release, a new Sleep Apnea Risk Management BPA was introduced. To review:
This BPA fired based upon answers in the Sleep Apnea Risk Assessment Doc Flowsheet, as follows:
1. Answer to “Have you been diagnosed with Sleep Apnea” = yes
2. Total score of sleep apnea questionnaire (STOPBANG) >= 5.
This causes a pop up to notify the provider and placed a sleep apnea teaching topic to Patient Education.
However, patient education was added to the discharge information (AVS) based on a STOPBANG score of
3 and this was confusing to patients. That has been remedied. The teaching topic will now be placed for a
score >3, similar to the AVS criteria. However, the popup to notify the provider will only appear with a
score >=5 or the answer “yes” to the diagnosis.
Provider Sleep Apnea BPA - Inpatient orders
Affects: Nursing
Region affected: All
In the July ECO release, an new Nursing Sleep Apnea Risk Management BPA was introduced.
This is a new BPA for PROVIDERS only (except anesthesiologists).
This will have been released as a pilot on September 9 at WSH and WHF. If successful, it will be released on
September 30.
This is similar to the nursing BPA as far as criteria. It will fire, upon opening the chart, for
Sept 30 ECO Release Summary of Changes
Page 26 of 34
1. Answers in the Sleep Apnea Risk Assessment Nursing Doc Flowsheet, as follows:
a. Answer to “Have you been diagnosed with Sleep Apnea” = yes
b. Total score of sleep apnea questionnaire (STOPBANG) >= 5
2. Age > 18
3. No active order for “Sleep Apnea Risk Management”
A pop will appear as follows:
Provider Sleep Apnea BPA - Inpatient orders
Duration of transfusion prompt added to Blood Transfusion-NICU orderset - Orders
Affects: NICU Providers
Region affected: All
Duration (in mins) prompt will be added to platelet order placed from within the orderset Blood
Transfusion-NICU (5267). This prompt will be optional
Type and screen order change on Blood Admin- NICU orderset - Orders
Affects: NICU Providers and Blood Bank staff
Region affected: CA
The existing type and screen orders for the NICU blood admin (5267) orderset will change for the California
ministries.
Type and screen order change on Blood Admin- NICU orderset - Orders
Activity order change for OPH Retina post op ordersets- Orders
Affects: Ophthalmology providers
Region affected: All
Activity orders for the Retina Postop sets are being reverted to their previous state to include specific
positioning requirements for this surgery.
Activity order change for OPH Retina post op ordersets- Orders
Blood Bank orders added to PED Cardiac ECLS Maintenance [2421]
Affects: Pediatric providers
Region affected: WA
Orders for type and screen, blood products and product availability have been added to the Blood Bank
orders added to PED Cardiac ECLS Maintenance orderset. Previously, providers placing ECLS/ECMO orders
have had to go to several different ordersets if blood products were needed.
Blood Bank orders added to PED Cardiac ECLS Maintenance [2421]
Add OWF’s epidural (ERX 74700041 to PRL 2799)
Affects: OWF- OB/GYN physicians, L&D nursing, and Pharmacy
Region affected: Oregon
OWF uses medication order, sufentanil 0.5mcg/mL & ropivacaine 0.1% epidural, exclusively for L&D
epidurals, but the only option for OWF OB providers currently is the custom epidural builder.
Additional information: ERX 74700041 has been added to PRL 2799 and the PRL is currently in Test
Release. This was moved to Beta for Pharmacy Informatics Review and will be fully released and moved to
PRD with the 30 Sept 2014 ECO Release.
Sept 30 ECO Release Summary of Changes
Page 27 of 34
Change to Cosign Requirements for CMS Two Midnight Rule. Inpatient Orders
Affects: Resident physicians, Mid-level providers – Nurse Practitioners and Physician Assistants
Region affected: All
The CMS regulation requiring co-sign of an “Admit to Inpatient order” for the above providers has been in
effect for nearly a year. In July, we enacted a tool that requires co-signing for that order (Admit to IP,
ADT1). Although the rule was required only for Medicare patients, we were unable to implement that due
to technological limitations, and a co-sign was required for all IP admission orders. This caused extra work
for these providers in order to prevent significant reimbursement losses for the system.
Change to Cosign Requirements for CMS Two Midnight Rule. Inpatient Orders
OPTIME
Improved Base Procedures RWB Report — OpTime
Affects: OR Managers, Preference Card Builders
Region affected: All
Improvements have been made to the RWB series OR Base Procedures by Service, which is used to identify
surgical procedures (ORP) authorized to a particular location. These reports now display authorized
locations and services, dates of creation and last change, and essential data maintained on the base
procedure including linked surgical history record and procedure level.
Improved Base Procedures RWB Report — OpTime
Wound Class Definitions — OpTime
Affects: Surgical Services IntraOp Registered Nurses
Region affected: All
A new button has been created for the Intraop navigator toolbar for Wound Class definitions. Wound
classes are clearly defined and available for reference in a popup window for the circulating nurse.
Wound Class Definitions — OpTime
Request Outside Records During Preadmit Testing — OpTime
Affects: Preadmit Testing Clinics
Region affected: All
Staff in preadmit testing clinics will now have access to Request Outside Records (Care Everywhere) within
scheduled appointments, matching current access from within the surgical case. This will be located under
More Activities.
Request Outside Records During Preadmit Testing — OpTime
Pick List Supply Data Available for Preference Card RWB Reports — OpTime
Affects: OR Managers, Preference Card Builders
Region affected: All
Four new report columns are available to pull supply information from pick lists in Reporting Workbench
preference card reports
Pick List Supply Data Available for Preference Card RWB Reports — OpTime
Sept 30 ECO Release Summary of Changes
Page 28 of 34
Improved Staff Search ( Preop / PACU / Phase II ) — OpTime
Affects: Periop RNs
Region affected: All
The Staff sections in Preop, PACU and Phase II navigators have been improved to allow out-of-area and
non-configured staff to be documented through a separate “Database Lookup” field. The standard lookup
field has been further restricted to filter out surgeons and anesthesia providers, who are not typically
documented here.
Improved Staff Search ( Preop / PACU / Phase II ) — OpTime
Reporting Workbench report name change - OpTime
Affects: Users of the Reporting Workbench (My Reports) tool
Region affected: All
Operating room Infection control report name change.
 Old name: PAMC Infection Control Report
 New name: OR Infection Control Report – PHS
Case Print Report - OpTime
Affects: Operating rooms that use the Collaborative Build Case print report for picking cases
Region affected: All
The case print report will now include:
 Supply comments
 Drug amount and comments
 Updated footer with the patient’s name, MRN, and page information
**PLEASE REMEMBER: These papers will now need to be shredded and not just recycled in normal trash as
they will contain PHI.
“OR Case Special Needs” report update - OpTime
Affects: OpTime surgery schedulers; users of “OR Case Special Needs” report (#1070821196
Region affected: All
This report will now contain the information entered in the “Case Notes” field, in addition to the “Special
Needs” field, used by surgery scheduling
“OR Case Special Needs” report update - OpTime
Chart Review “Surgery” report update - OpTime
Affects: Users viewing the Surgery report (Case Information) in Chart Review
Region affected: All
The “Implants” section of the Surgery report (Case Information) in Chart Review has been updated to
include the item’s Model/Catalog number and the implant action.
Chart Review “Surgery” report update - OpTime
New WQs for Cosmetic Surgery Patients — Prelude / ADT
Affects: Central Access Services, Access Services and On-site Financial Counselors
Region affected: AK, WA, OR, MT, CA – this does not impact Community Connect
Sept 30 ECO Release Summary of Changes
Page 29 of 34
There are new Work queues available in all regions for patients that have been marked as “Cosmetic / NonCovered procedure” during Case Entry in OpTime. Preadmission and admission encounters will fall to this
WQ for review. Once a Stop Bill has been added of “HB Services Package Pre-payment” the encounters will
leave the WQ.
The naming for these WQs is:
 ADT OR ALL VER COSMETIC PATIENTS
 ADT WAMT ALL VER COSMETIC PATIENTS
 ADT CA ALL VER COSMETIC PATIENTS
 ADT AK SA 10 VER COSMETIC PATIENTS
Blood Bank Navigator for Spokane, WA Periop RNs — OpTime
Affects: Periop RNs
Region affected: WHF & WSH
Since the Spokane, WA region uses an off-site blood bank, a specialized navigator was launched for WHF
and WSH in January, 2014 to assist with their unique workflows. This tool will now be available within
surgical encounters to periop RNs at these ministries under More Activities > Blood Bank. For reference
purposes only, it provides a centralized place to view blood orders, results and transfusion history. The Shift
Note section is used only by blood bank staff, to communicate directly with providers. Periop staff should
not use Shift Notes.
Blood Bank Navigator for Spokane, WA Periop RNs — OpTime
Notify provider order added to the Blood Transfusion – Adult (2267) orderset
Affects: Providers
Region affected: All
An order for when to notify a provider for conditions related to blood transfusion administration orders is
being added to the Blood Transfusion – Adult orderset
Notify provider order added to the Blood Transfusion – Adult (2267) orderset
Optime (Intraop) Safe Surgery Checklist Updates
Affects: Optime Intraop RN’s
Region affected: All
Added 2 new questions to the Safe Surgery Checklist – Time Out
 Anticipated length of case discussed
 Critical unexpected steps discussed
Formatting consistent in Briefing, Time Our & Debriefing
Optime (Intraop) Safe Surgery Checklist Updates
Optime(Preop/Preadmit) History Reorg
Affects: Preop & Preadmit RN’s
Region affected: All
History reorganization broke out by Systems with new added questions
Optime(Preop/Preadmit) History Reorg
New NPO Status review question for intraop nurses— OpTime
Affects: OpTime users of the Intra-op navigator
Region affected: All
Sept 30 ECO Release Summary of Changes
Page 30 of 34
New question regarding NPO status review in the Intraop Navigator
New NPO Status review question for intraop nurses— OpTime
Pre-op Checklist changes— OpTime/Inpatient/ASAP
Affects: Users of the Pre-op (Pre Procedure) checklist
Region affected: All
The blood questions have been moved together. The beta blocker FlowSheet rows from the "Interview
Complete" section have been added. There are two new questions regarding the prep the patient
performed at home.
Pre-op Checklist changes— OpTime/Inpatient/ASAP
Update to “Demographics” navigator section— OpTime
Affects: OpTime users of the OpTIme navigators
Region affected: All
The “Demographics” section now has a link to allow updates to patient information
Update to “Demographics” navigator section— OpTime
Adult PACU Doc Flowsheet – Update to Pain/Comfort Group
Affects: PACU RNs
Region affected: All
Change: To comply with Joint Commission requirements and Standards of Care, the Pain & Comfort section
of the Adult PACU doc flowsheet has been updated to pull in the correct CPM Group which includes rows
for Pain Management Interventions, Response to Pain Intervention and Sedation Level:
Adult PACU Doc Flowsheet – Update to Pain/Comfort Group
RADIANT
Add ‘Contrast’ to Naming in PRL 1321 (CATH LAB MEDICATIONS)
Affects: Physicians, nursing, and radiology personnel who order cath lab medications
Region affected: All
PRL 1321 currently only contains radiologic contrast products used in the cath labs, but the naming does
not indicate the presence of contrast. OSQ (CATH LAB MEDICATIONS - 113339) was edited to clearly
identify a section for contrast to reduce confusion. The OSQ name Cath Lab Medications was retained to
allow for future addition of non-contrast medications.
Additional information: The revised language contained in PRL 1321 is currently in Test Release status and
was moved to regional Beta environments for reviewed and testing by Willow Billing analysts. It will be fully
released and moved to PRD with the 30 Sept 2014 ECO Release.
Addition of CVA Line Type and Power Injectable Questions on IMG4337 and IMG558 - Radiant
Affects: All users
Region affected: All
Sept 30 ECO Release Summary of Changes
Page 31 of 34
Per DI Council and IPIW request, FL CENTRAL VENOUS ACCESS DEVICE PLACEMENT [IMG4337] and US
GUIDED VASCULAR ACCESS [IMG558] now have two additional questions when ordering via Orders or
Ancillary Orders regarding the type of CVA line and power injectable:
Addition of CVA Line Type and Power Injectable Questions on IMG4337 and IMG558 - Radiant
Update to Default List in Encounters-on-the-fly Button for Radiant Departments - Radiant
Affects: All users
Region affected: All
In order for the Radiant Departments to be able to access certain types of encounters that they are not
able to now, the restrictions on our departments have been removed. This will now allow our users to
access various types of encounters if needed.
Update to Default List in Encounters-on-the-fly Button for Radiant Departments - Radiant
Update to ECG Orderables Result Display in Cardio Tab - Radiant
Affects: All users
Region affected: All
In order to better organize and create a standard appearance within the Cardio Tab in Chart Review, the
ECG orderables now have the same layout display when resulted as the other orders within that tab. The
Order-Level/Encounter-Level documents have been moved below the
Update to ECG Orderables Result Display in Cardio Tab - Radiant
Update to Provider Display in Footer for External Results Report - Radiant
Affects: All users
Region affected: All
Due to confusion with the provider information in the footer of the external results report, this has been
reorganized to display all reading providers with their appropriate read dates as well as the CC’d providers
below the reading and signing providers.
Update to Provider Display in Footer for External Results Report - Radiant
Update Chart Review Display for Resulted Exams/Orders in Imaging and Cardio Tabs - Radiant
Affects: All users
Region affected: All
In order to standardize the look of resulted exams similarly to lab, the Imaging and Cardio tabs will now
show a different display only in appearance for resulted exams. The data displayed remains the same.
Once the resulting process has begun, the exam changes to display a widget format for the result
information.
Update Chart Review Display for Resulted Exams/Orders in Imaging and Cardio Tabs - Radiant
Go Live for LVEF Data Entry in LVEF Results Console - Radiant
Affects: Technologists
Region affected: All
For the on-going Cardiology Optimization project, the LVEF Results Console will be going live with new data
standards when inputting the results. The external result entry within the console will no longer allow:
negatives, free text, numbers below 5 or above 95.
Go Live for LVEF Data Entry in LVEF Results Console - Radiant
Sept 30 ECO Release Summary of Changes
Page 32 of 34
WILLOW
Deleting 4 Lovenox (enoxaparin) Medication Records — Willow
Affects: All Ordering Providers
Region affected: All
4 Lovenox (enoxaparin) ERX (medication records) are causing errors in the system, especially when being
ordered for outpatient use. These records will be deleted from the system on 9-30-14. Please remove these
records from all system preference lists & user preference lists prior to this date. The ERX being deleted are
441005, 441002, 441003, 441004. Here is a grid of the ERX being deleted & its equivalent ERX to use in its
place:
Deleting 4 Lovenox (enoxaparin) Medication Records — Willow]
Prescription combination ERX with greater than 325 mg of acetaminophen will no longer be prescribeable for outpatient use
Affects: Ordering Providers
Region affected: All
The FDA recommended that manufacturers of prescription combination products limit the amount of
acetaminophen to no more than 325 mg in each tablet or capsule by 1-14-14. In order to comply with this
mandate all prescription combination product ERX containing greater than 325 mg of acetaminophen will
be changed so they cannot be prescribed for outpatient use. Please ensure the ERX with > 325 mg of
acetaminophen are removed from all system and user preference lists prior to 9-30-14
Prescription combination ERX with greater than 325 mg of acetaminophen will no longer be prescribe-able
for outpatient use
Addition of diltiazem infusion orderable & order set changes— Willow
Affects: Ordering providers, pharmacists
Region affected: All
A diltiazem infusion orderable ERX is under development. Order sets and panels containing diltiazem IV
infusions will be updated with the dilitazem infusion orderable. Affected panels: 115924 (IP Med Diltiazem
Open Heart Panel), 129004 (Calcium Channel Blockers)
Affected order sets: 1600000051 (ED Narrator Code and Trauma Mixtures), 1600000010 (ED Dysrhythmia
Treatment), 3040000075 (CTS IP Surgery Postop), 304000261 (CTS IP Thoracotomy Post Op), 3048000251
CTS IP VATS Post Op), 340000312 (IP CTS Cardiac Surgery Post-op).
Addition of diltiazem infusion orderable & order set changes— Willow
Remove Bar Code from Pharmacy Labels for Premixed Products
Affects: Nursing, Pharmacy
Region affected: All
Patient-specific pharmacy labels, attached to premixed IV products, will no longer contain bar codes
Remove Bar Code from Pharmacy Labels for Premixed Products
Sept 30 ECO Release Summary of Changes
Page 33 of 34
Require Rate for Large Volume IV Fluids - Willow
Affects: Physicians, Nurses, and Pharmacists
Region affected: All
Large volume IV fluids will now require a rate, before that order can be signed.
Require Rate for Large Volume IV Fluids - Willow
Moving to charging for scanned NDC vs. dispensed where applicable - Willow
Affects: No change to user workflow
Region affected: All – including Community Connect Sites
Pharmacy Charges: Implement charging for scanned NDC versus dispensed NDC when scanning occurs. No
changes to how process is currently functioning for those departments and/or scenarios where scanning
does not take place.
Misoprostol is preferred for cervical ripening in OB Admit – Labor and Induction order set — Willow
Affects: OB providers, OB RNs, Pharmacists
Region affected: All
Misoprostol is preferred pharmacological agent for cervical ripening. Vaginal and PO routes will both be
available in OB Admit – Labor and Induction order set.
Dinoprostone will be removed from order set. Its availability on local preference list is determined per
facility decision.
Misoprostol is preferred for cervical ripening in OB Admit – Labor and Induction order set — Willow
Removal of "empty container" ERX's from mixture records— Willow
Affects: Pharmacist, pharmacy technicians and nurses
Region affected: All
 Situation/Background:
 Empty containers ERX’s currently are present in several of our mixture records and they no longer
provide any function in our ERX records.
 These records were previously used in our mixture records to guide our pharmacy staff which was
the appropriate container to mix a medication in
 Assessment:
 167 ERX records were included in the list because they contained any “empty containers” records in
the ingredient section of the mixture record.
 29 ERX records were excluded since these ERX records belong to orderables and the removal of
empty container in these records can break the functionality of the ERX orderable
 Recommendation:
 Empty container ERX’s have been removed from the majority of our mixture records to keep our
records in line with recent build practices
Sept 30 ECO Release Summary of Changes
Page 34 of 34