EPIC CLN 251/252 Study Set 3 - KW, EPIC CLN 251/252 Study Set 2 - KW, EPIC CLN 251/251 - KW

Name two things that are defined by your role record.

Roles define your default Startup Activity, the Hyperspace toolbar, options under the Epic button, the maximum number of workspaces a user can have open, automatic timeout settings, and whether your user's last login department will default the next time she logs in.

Explain the difference between role and security.

Security determines a user's access to functionality. Role determines where that functionality will appear for a user in Hyperspace.

What function does the Role record perform in Epic?

A role record determines the layout and ground rules of Hyperspace.

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.

How do you duplicate a security class?

Log in to Text as your administrator > From the Training Application Access menu, select Chronicles. > (Hint: The Training Application Access menu is the initial menu after logging in to Text. If you are in text but not on this screen, press PAGE UP until you reach this screen.) > Enter "ECL" at the Database initials prompt. > Go to Enter Data > Duplicate Security Class. > Duplicate the "TRNCLN PEDS IP SECURITY CLASS" security class. > Enter a new ID and write it down > In Hyperspace, use Chart Search to find "Inpatient Security." > Open the new id. > In the Comments field, enter a more specific title such as first year residents > In the Search field on the Security Points tab, enter "notes cosign required" and press ENTER > In front of security point 28 - Notes Cosign Required, click the button to make the security point active. > In the Search field on the Security Points tab, enter "order sets" and press ENTER. > In front of security point 193 - Edit My Order Sets, click the button to make the security point inactive.

13. Click Accept to save and close your record.

Foundation security class

• Epic's Foundation System serves as a starting point for customers, as it is configured with providers, users, roles, security classes, profiles, and other settings that reflect our recommendations and best practices.

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 Class

• One function of the user template is to assign access to activities in Epic. This access is controlled by records in the Security Class (ECL) master file. Security class records can be shared, so assigning them in the template is an efficient way to grant access to groups of users.

• Instead of giving individual security points directly to users, security points of the same type are lumped into security classes, like rings of keys, and then assigned to the appropriate groups of users.

Which type of security controls access to hospital functionality, like the MAR and Doc Flowsheets?

Inpatient Security

Which three security classes does every user need?

Inbasket, Shared, and Reporting Workbench

Explain the difference between a security class and a security point.

A security point grants access to a single piece of functionality; it's like a key. A security class is a collection of security points, like a key ring. Users are linked to security classes either directly or via a template; users are not linked directly to security points.

What function does security perform in Epic?

Security controls access to functionality— what a user is or is not allowed to do in the system.

Who (or what) needs a provider record?

A person or resource if at least one of the following criteria are met:

• 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

Who needs a user record?

Everyone at your organization who uses Epic will need a user record. The User (EMP) master file needs a record for each end user-doctors, nurses, front desk staff, billers, etc. The user record is a starting place for successfully getting staff started with Epic because it acts as a hub where several other important settings are made.

Default login department

A user will be assigned a default log in so that whenever the user logs into EPIC the defaulted log in will occur, but will still have the option to manually choose if needed.

Linkable Template

• User templates (or linkable templates) are records in the User (EMP) master file that allow you to create a single record to maintain shared settings for multiple user records. You create a user template for a particular group of users (for example, medical assistants). In the template, you assign the access to activities, Hyperspace configuration, profiles, and other settings appropriate to that group.

User Record

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

True or False: In the provider record, you can link to the corresponding user record or a user template.

False. The linking is established in the user record. Multiple users may not be linked to the same provider record.

Why do MRI machines and classrooms need to have records in the Provider master file?

The MRI machines and classrooms are scheduled resources.

Give an example of someone who would need a provider record but NOT a user record. Explain why.

A physician in your community who gets referrals from your physicians, but who does not have access to log in to your Epic system.

What are some settings you must make in an individual user record which cannot be set with linkable templates?

Default login department, link to templates, ID/password information

True or False: You can link a user to multiple linkable templates.

True. You can assign more than one template to a user, and that user can choose the template they want to affect them when they log into Hyperspace.

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 rules don't eliminate the need for assigning role and profile records to users. Those records contain many more settings that aren't included in the Workflow Engine.

How does the Workflow Engine evaluate properties?

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.

Rule Hierarchy

Stops the workflow engine from searching past what it needs to after the conditions are met - works in correlation with the profile hierarchy.

Property

• Property= Relevant Information

• Every clinical workspace has many properties, such as 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.

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

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

• A type of rule used to define the activities and navigators available when a clinician opens an encounter in the unified clinical workspace.

• Workflow Engine rules are built in the Workflow Engine Rule Editor.

True or False. Once a rule matches on conditions and carries out directives, the system always keeps looking for more conditions to evaluate.

False. The system will only continue evaluating the rule if the first set of directives specifies "continue afterwards.

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.

What are three aspects of a patient encounter that can be altered based on a rule match?

Some include: Override or Append More Activities menu, Change default activity when a workspace opens, Change available navigators.

How does the system know which Workflow Engine rule to use?

The Workflow Engine rule linked to the most specific level in the profile hierarchy is the rule that will be consulted.

Where do you link to a Workflow Engine rule?

Profile

How do you build a Navigator 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

Navigator: Template Record

• The most general type of navigator record. Within the template record, administrators can define one or more topics, which are groupings of navigator sections. The template, thus, defines a single, complete navigator.

Navigator: Topic Record

• A grouping of related navigator sections. After grouping sections by topic, the topic records are configured within a navigator template record.

Navigator: Section Record

• The most basic building block of a navigator. Generally, a section allows a clinician to complete a particular task, such as document allergies or write a progress note.

If you type a caption of 'Charting' into a Navigator topic record, who will see that in Hyperspace, and in what place will they see it?

It is what the end user sees as the display text in the table of contents for the navigator

True or False: A Navigator template record can be linked to more than one topic record.

True

Fill in the blank: A navigator topic record holds navigator __________ records.

Section

True or False: To create a navigator, you work in the following master files: Section, Topic, and Template.

False. All three of these are different types of records in one master file, LVN.

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.

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.

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 can Profile 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

Which record controls access to activities like Chart Review?

Security Record

Which record gives you access to ordering functionality?

Security Class Record

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

Role Record

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.

Example: SnapShot activity. While both an obstetrician and a cardiologist have access to this activity and find it in the same place in Hyperspace, the obstetrician may want to see OB history reports, while the cardiologist may want to see an EKG Results report. Profiles are the tools that make this flexibility possible.

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

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)

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.

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.

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.

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

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.

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.

What is Clinical Administration/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

Where are Startup Activities controlled for the end user?

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

Keystroke Commands: Go to the next screen within a record.

Page Down

Keystroke Commands: Return to the previous menu.

Page Up

The values entered in the items on this form are specific to this one office visit. An office visit is an example of which part of Chronicles data structure?

Contact

"Diabetes mellitus," is an example of a corresponding what to item, "Reason for Visit?"

Value

The Reason for Visit part of the report is an example of one what?

Item

What part of Chronicles does the ID field represent?

Record

What part of Chronicles does the INI field represent?

Master file

A ________________ is the data that is stored in an item.

Value

Each _____________ stores information about one specific entity in the master file.

Record

An ____________is a discrete field within record.

Item

Each ________stores all of the data about one type of thing.

Master File

A _________ is a date specific snapshot of the data within a record.

Contact

All of the information that you enter in Hyperspace is stored in ___________, Epic's database management system.

Chronicles

Deactivate a value

When you deactivate a value, you're essentially freezing it so that value will no longer appear as a choice on the list. Additionally, you won't affect records that have previously chosen that value.

When you're working in a production environment (actual patients and users), Epic recommends deactivating values instead of deleting values.

1. In the Category List that you need to deactivate, click on the row of that value. Click

Deactivate. (The Active column for that value is now set to No.) If you would like to reactivate it, with the value selected, click Activate.

2. Click Save.

• If you see a prompt that tells you that you cannot deactivate the value, it means this particular list is not set up to allow deactivation at this time. When you deactivate a value, you're essentially freezing it so that value will no longer appear as a choice on the list. Additionally, you won't affect records that have previously chosen that value. When you're working in a production environment (actual patients and users), Epic recommends deactivating values instead of deleting values.

1. In the Category List that you need to deactivate, click on the row of that value. Click Deactivate. (The Active column for that value is now set to No.) If you would like to reactivate it, with the value selected, click Activate.

2. Click Save.

• If you see a prompt that tells you that you cannot deactivate the value, it means this particular list is not set up to allow deactivation at this time.

Edit a value

In the Category List that you need to edit, click on the row of the value you want to edit. The fields for that value will be listed below in the Edit Category. Follow the steps

Add a single value to a category list.

1. Open the desired category list.

2. In the Add/Edit category field, type an ID number that isn't already in use.

3. For Title, type the name of your new value.

4. For Abbreviations, the system will suggest one if you press TAB to get there.

5. Click Accept.

6. Click Save

Look up the address of a category list in Hyperspace and Clinical Administration.

* Find the Address in Hyperspace

1. In Hyperspace, hold down CTRL and left-click once in the desired field.

2. The Item Information window appears, showing the INI and item number.

3. To see more information, click More.

* Find the Address in Clinical Administration

1. In Clinical Administration, navigate to the desired item in a record.

2. Press HOME+F8 (presents information in the middle of the screen).

3. Press ENTER to make the information disappear.

INI

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

• A master file's INI is simply a three-character initial (INI). Examples:

• User master file = EMP (Employee)

• Provider master file = SER (Schedulable Epic resource)

• Patient master file = EPT (Epic patient)

Types of Category lists: system, extendible, customer.

System owned = working in the Category List Maintenance activity, you know a category list is uneditable when you see "Release Range: All Categories" under the list name.

Extendible = When working in the Category List Maintenance activity, you will know that a list is an extendible list when you see a message like "Release Range: From 1 to 3".

Customer owned = working in the Category List Maintenance activity, you can identify a particular category list as customer-controlled when you see a message like "Release Range: All Customer Owned".

Category value

When you use the term 'category list,' you are referring to an entire list. Each individual choice on the list is called a category value. Values have certain details associated with them: number, title, synonym, and abbreviation.

Category list

• A category list is a defined set of possible values for a particular item.

• Category lists are used in the system for these purposes:

Standardization of responses for reporting

Speed: Typing time is reduced since you can select from category lists by completion matching

Triggering other functionality in the system (for selected values)

You're working in the Category List Maintenance activity and see this message: "Release Range: All Categories". What does that mean?

It means that the category list is a system (Epic controlled) list, so it is uneditable.

When you delete a category value, what happens in addition to making that value no longer available as a choice on the category list?

Any records that had items pointing to that particular value now appear value-less (empty) but a pointer remains.

What information do you need to access a list in the Category List Maintenance activity?

You need the INI and item number.

Explain: The difference between what security impacts and what a role impacts.

Security grants access to activities and functionality where as role determines where an end user will be able to find the functionality.

Explain: The effect a user's role has on Hyperspace.

• 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.

Does every USER need a ROLE to log into 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).

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.)

Startup Activities

• 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.

Descriptors

Descriptors are the technical names of activities.

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

Role - 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 is Chronicles?

Chronicles is Epic's database management system and is used by all Epic software applications.

Can you edit data in Record Viewer?

No. Record Viewer only allows you to view the information.

When you document on the patient as a clinician, is the data you are entering a value or an item?

A value. The items that a record contains are controlled by Epic. The information that stored for an item is a value.

How do you look up a record using Record Viewer?

1. Log in to Hyperspace as your administrator.

2. On the main toolbar, click Record Viewer.

3. For INI, enter EPT.

4. In the ID field, enter the name of your patient.

What part of Chronicles does the INI field represent?

MASTER FILE

Value

The data that is stored in an item

Item

A discrete field within a record

Contact

Is a date-specific snapshot of the data within a record