EpicCare Ambulatory Fundamentals — Comprehensive Notes
Welcome to Fundamentals
EpicCare Ambulatory Fundamentals (Epic 2017 Training Companion) provides an introduction to the common tools used by outpatient clinical staff and the Epic system you will build and support. This guide comprises two self-study chapters and a broader set of lessons that cover hyperspace, note-writing, smart tools, ordering/charges, history/problem lists, chart review, In Basket, telephone encounters, interoperability, analytics, and admin tools. It is designed for hands-on practice, with review questions, checklists, and self-assessments embedded throughout. Prerequisites include knowledge of basic computer navigation and completing the CLNAMB001 e-learning on Hyperspace in outpatient settings. After-class content on Galaxy (training-related content) is referenced, along with access to training-related content on Epic’s UserWeb.
The Big Picture of Fundamentals
The Fundamentals course introduces outpatient workflow tools and the system you will configure for clinicians. It includes two self-study chapters:
Documenting Patient History and Problem List
Introduction to SmartTool Configuration (which also involves e-learning and a downloadable workbook)
A companion is intended to be used with live training, your class notes, Galaxy access, and hands-on Epic practice. It provides drive-through review questions and checklists to reinforce learning.
The training emphasizes: Hyperspace workspace concepts, navigation, and usage, along with practical workflows for rooming, charting, closing encounters, and post-encounter documentation and billing steps.
It also covers system personalization and admin-level exploration (to tailor Epic for specialties and projects).
Key Concepts and Structures (Overall)
Hyperspace: Epic’s user interface comprising workspaces, startup activities, and a set of navigable tabs (Activities) within a workspace. A workspace can host multiple activities, while only one can be active at a time.
Workspaces: Types include patient, account, and administrative workspaces. You can have up to five workspaces open (one active at a time; startup workspaces cannot be closed).
Activities: Modules within a workspace where tasks are completed (e.g., Rooming, Plan, Wrap-Up, Notes, Enter/Edit Results, Immunizations, MAR, etc.).
Navigator-based activities: Examples include Rooming, Plan, and Wrap-Up; these are configured with a table-of-contents (TOC) and sections that guide the workflow.
Widescreen view: A configurable layout that groups related tasks into primary activities with detachable sidebars and navigators.
TOC (Table of Contents): The navigator’s outline to jump between sections; in some navigators, each pane has its own TOC.
Flags and event tracking: Visual indicators used to signal patient readiness or events during the encounter (e.g., In with support staff, At diagnostic testing).
LOS (Level of Service): A coding concept used for billing; typical examples include 99213 (established patient, level 3). The LOS can be selected via speed buttons, synonyms, or direct 4-digit code entry.
Pre-charting: A pre-visit preparation workspace that queues orders and diagnoses prior to patient check-in; can be configured to delete if appointments cancel or no-show.
Sign/Close: The Sign Visit action closes an outpatient encounter for billing; if incomplete, the system prompts with outstanding items.
Secure vs. Log Out: Securing bookmarks a patient workspace for another user; logging out closes all workspaces for privacy.
Lesson 2: Hyperspace and Visit Charting Basics
Epic’s Hyperspace and Visit Charting basics cover the Big Picture of how Hyperspace is used in outpatient care, including logging in as a nurse, understanding startup activities, and navigating patient workspaces. A patient workspace is composed of multiple activities; only one can be active at a time, but others may be open. Startup activity workspaces cannot be closed. A key focus is the Office Visit workflow: nurse opens the encounter, documents the reason for visit (Visit Information/Chief Complaint), records vital signs, reviews allergies and medications, updates the medication list, and may order tests. The patient chart is accessed via various methods including the MPS (Multiple Provider Schedule) and the Hyperspace main toolbar.
The Visit Information section is used to document the reason for visit (aka chief complaint). Clinicians can use completion matching, speed buttons, and short forms to speed data entry.
The Vital Signs section documents BP, pulse, temperature, weight, height, and respiratory rate; certain subsections (e.g., OB/GYN Status and Tobacco Use) can be marked as reviewed.
Allergies: Use the Allergies/Contraindications section to add, review, and update each allergy; use a No Known Allergies checkbox if appropriate; allergies marked as High can appear with a yellow background.
Medications: The Medication Review section captures patient’s preferred pharmacy and current patient-reported medications; the Medications & Orders section is used for prescribing and signing orders; the Plan activity links to medication orders and diagnoses; a “Prescription” uses a “sig” (discrete dose instructions composed of Dose, Route, and Frequency fields).
Orders: The process includes pended (unsigned) orders, signing, associating with diagnoses, and the Plan activity’s Order Composer for prescribing and dispensing information; long-term medications have special handling for continued interactions.
Point-of-Care Tests (POCT): Document results in the Enter/Edit Results activity; mark results as Final to trigger a result message routing to the appropriate people.
Workstation prep: Prepare the workstation for the provider (Secure vs Log Out) to protect patient data when moving between users.
Review and update patient charts: The This Visit tab in the sidebar (Visit Summary) provides quick access to allergies, medications, and problem lists.
Diagnoses: Visit Diagnoses (primary diagnosis as the first) vs. Problem List entries; diagnoses can be copied between visit and problem lists; primary diagnosis on a visit helps with billing; various tools (Association grid, Diagnosis Calculator) help selecting more specific diagnoses for billing.
Writing prescriptions: The Order Composer is used to finalize details; a dispensed drug’s dose, route, and frequency are treated as discrete fields; “sig” is split into Dose, Route, Frequency; long-term medications may trigger continuous interaction checks; a long-term flag marks such medications as ongoing within the patient’s medication history.
Documenting the visit: The Notes activity (Notes, Wrap-Up, etc.) is used to write progress notes and patient instructions; you can use SmartPhrases, SmartTexts, and SmartLinks to automate or personalize notes.
Closing an encounter: Sign Visit to close the encounter and trigger billing; if tasks remain, Sign Visit will present a list of required items with links to complete them.
Pre-charting and post-charting activities: The chapter explains the differences between pre-charting and charting on arrived patients; pre-charting has specific rules about deletion if the appointment changes; a separate workflow covers pre-charting in practice environments.
Lesson 3: Note-Writing Tools
Note-Writing Tools describe how Epic supports documentation through SmartTools (SmartTexts, SmartPhrases, SmartLinks, SmartLists) and NoteWriter (Note Templates, NoteBlock macros, and NoteWriter forms). The structure of a progress note is Subjective (HPI and ROS), Objective (physical findings), Assessment (diagnosis), and Plan (treatment and follow-up). Collaboration between clinicians and builders is emphasized to create the right tools for productivity.
SmartTexts: Text templates for notes; can be used for progress notes, patient instructions, letters, and form fields; System SmartTexts are organization-wide; User SmartTexts are department or user-specific; SmartTexts may include Lists and Links.
SmartPhrases: Macros that rapidly insert pre-defined text; invoked with a dot (.) followed by the phrase name; can include SmartLists and SmartLinks; can be created by users and shared; system phrases exist at the organizational level.
SmartLinks: Dynamic placeholders that pull patient or user data into notes; examples include patient name (FNAME), problem list (prob), date of birth (DOB), etc.; Links can be parameterized with values to customize the note.
SmartLists: Configured pick-lists that store discrete data; can be refreshable or embedded; can be multiple or single response; can be connected to other data via the association logic; can be mutually exclusive groups; used to populate objective ROS and assessment data.
SmartTexts for NoteWriter: Note Templates integrated into NoteWriter; NoteTemplates can include embedded macros (SmartBlocks) that generate sections of the NoteWriter forms.
NoteWriter: A more structured, data-rich tool that generates prose text from guided selections; supports procedure documentation and can initiate charge-related actions; includes ROS, HPI, physical examination, and procedure documentation forms.
Note speed buttons: Quick access to frequently used SmartTexts/SmartTexts; you can create a personal set of speed buttons for one or more patient encounters.
SmartBlock macros: Macros that pre-fill a set of fields for a typical examination or procedure; they can be created and shared; rules include age/sex restrictions and support ownership; applying a macro onto existing content does not overwrite existing content.
NoteReader: An NLP-based tool that parses free text and suggests adding discrete data back to the chart; not present in the training environment but described for Galaxy usage.
In-class exercises illustrate creating and applying SmartPhrases, SmartTexts, SmartLists, and SmartLinks; using HPI and ROS templates; building NoteWriter macros; testing with system phrases and custom phrases; refreshing SmartLinks; embedding Lists into Texts; and using NoteWriter to produce a complete SOAP-note style entry.
NoteWriter workflow basics:
Choose a Note Template (SmartText) and switch to NoteWriter via the NoteWriter tab; the NoteWriter can populate the Subjective, Objective, and Assessment/Plan sections via SmartBlocks and linked content.
Replacing the existing content with a macro updates/refreshes accordingly; edits must be done in NoteWriter to reflect in the Note.
Returning from NoteWriter to Notes: Use the Notes tab to review or edit; ensure variables and lists in SmartTexts are filled before signing.
Practical tips:
Use the Insert SmartText field to locate a Note Template; use SmartPhrases to abbreviate or accelerate documentation.
If a SmartText includes a variable (List or wildcard), it can require selection before signing; optional lists reduce rigidity.
SmartLinks can be refreshed by using the Refresh All SmartLinks button to pull updated patient data.
Ensure you understand the distinction between SmartTexts vs SmartPhrases vs SmartLists vs SmartLinks in terms of scope, reuse, and data storage.
Lesson 4: Introduction to SmartTool Configuration (Self Study)
This self-study chapter introduces how SmartTools are built and configured and how to use a workbook and e-learnings to practice. It provides guidance to use the SmartList Manager, create and copy SmartLists, embed lists, and build SmartTexts that integrate these lists and links. It covers:
How to access My SmartPhrases, SmartTexts, and SmartLinks; how to create user phrases and system phrases; how to build and test with the SmartList Manager; testing the build with NoteWriter and the Notes activity; how to embed SmartLists inside SmartTexts; and the logic for mutually exclusive groups.
Building a System SmartPhrase (e.g., a consistent message for calling back a patient four times) and setting its scope to a facility level so that all users can access it.
Building a SmartText that uses a “therapies” List embedded into a sentence with a wildcard; embedding is accomplished via the Insert SmartList option.
The process to build a SmartList with mutually exclusive groups (e.g., OTC options where only one option may be chosen), including default selections and group keys.
Creating a SmartText that includes HPI and ROS content with associated Lists (Foundation System Lists) and linking to diagnosis and medications.
The practical steps to test builds in Notes/NoteWriter and to refresh SmartLinks and ensure data are correctly populated.
Guided exercises 1–8: Differentiating SmartTexts vs Phrases, Exploring SmartLists, SmartLinks, building a system SmartPhrase, building a SmartText and Lists, embedding a SmartList, mutually exclusive lists, and a final embedded SmartText with Recovery/URI-type data.
Guided workflow highlights:
The SmartText Editor workflow: Create a new SmartText, define functional type (e.g., MR Charting, MR NoteWriter), include HPI/ROS content and Foundation System Lists; insert Links and Phrases; ensure the text contains the correct variables and placeholders.
Use the SmartList Manager to locate appropriate Lists; duplicate and edit Lists; embed Lists inside SmartTexts by using the Insert SmartList approach; configure the List’s default selections and ensure the List uses mutually exclusive group logic when needed.
Test your SmartText by creating a patient encounter, inserting the SmartText, and verifying that the links pull correct data (name, age, sex, problem list, medications) and that the embedded List selections are usable.
Build system-level phrases and notes, and publish or assign rights to ensure proper access according to the organization’s security model.
Practical takeaways:
SmartTools are designed to streamline documentation and reduce data-entry errors, while enabling standardized content across clinicians.
The real power comes from combining SmartText templates with Lists and Links to produce complete, data-rich notes with minimal manual typing.
Always verify that List data and links are refreshed before signing; verify data privacy and appropriate access as you customize tools for specialties.
Lesson 5: Ordering and Charge-Related Tasks
This chapter covers the architecture of orders in Epic, including ORD records, how orders are created and signed, and the relationship between orders and patient encounters. It also covers medication orders, patient-reported medications, immunizations, CAMs (clinic-administered medications), and charge capture.
ORD records and the data model:
An order is created as a preallocated ORD record that is later filled with data when signed.
The ORD has a unique ID and is connected to the patient record; builders can use Record Viewer to see order details.
When an order is placed, a preallocated ORD record is used; a sign action locks the order and makes it active.
Contacts in an order record: Actions that generate new “contact” sheets within the same order record. Signatures can generate multiple contacts: first the ordering action (ord) and then results (e.g., specimen results).
Order statuses: Normal (single item), Future (to be released later), Standing (multiple items released over time). Standing orders include expiry dates and intervals for auto-release.
Medication Orders and Reorders:
When a patient-reported medication is documented, an order record is created automatically; a dummy prescribing provider may be populated automatically when the provider field is left empty.
Reordering and changing medications copy data from the original order into the new one, including diagnoses associations; end dates adjust and the long-term status can be carried forward.
If changing a medication, if the form needs a different drug form or strength, you should discontinue the original and create a new order.
A “long-term” medication remains current after the end date and continues to interact with other orders.
Dispense as Written: The Dispense As Written checkbox allows selection of brand-name medications when needed; otherwise, generic defaults are used.
CAMs (Clinic-Administered Medications): Orders for medications administered in the clinic (e.g., injections); different Order Modes (Outpatient vs Inpatient) affect MAR integration and charges.
Immunizations workflow: There are two basic workflows:
Patient needs a vaccination: Order it via Medications & Orders, then document administration in Immunizations activity.
Patient reports a vaccination given elsewhere: Document in Immunizations activity (no separate order needed).
NoteWriter and immunizations: The Immunizations activity includes administration entries (lot number, NDC, etc.). A blue flag on the appointment slot can indicate an ordered immunization; the nurse removes the flag once completed.
Express Lane: A navigator that consolidates a common set of orders and activities for faster visits; includes provider-specific rules and may auto-open a SmartSet when a single match exists. It can be used for well-child checks, etc.
E-prescribing: There are workflows to support electronic prescribing through Galaxy and Payer; a separate Therapy Plans feature helps manage chronic therapies and auto-sign multiple orders at the start of therapy.
Charge Capture: The Charge Capture section in Wrap-Up allows practitioners to attach charges to diagnoses; charges are routed after the encounter closes via the Charge Router to the billing system.
Warnings and Advisories: Drug-allergy checks, dose checks, drug-drug interactions, and BestPractice Advisories are used to guide prescribing safety.
Documentation and testing: The course includes exercises to practice order entry, including immunizations, CAMs, lipid panels, HbA1c, and a practical approach to signing and routing orders.
Exercises and practice prompts highlight:
Signing a CAM order and associating it with a diagnosis
Using the MAR to set a CAM administration time and location
Documenting immunization administration details (lot number, NDC) and printing/analyzing AVS and LOS
Creating immunization-reported entries in Immunizations activity
Exploring charge capture and how to attach charges to the appropriate visits
Understanding standing vs future vs normal orders and their lifecycle
Lesson 6: Documenting Patient History and Problem List (Self Study)
This chapter focuses on history and problem lists, critical to the longitudinal care of patients. It explains the difference between visit diagnoses, problem list diagnoses, and medical history diagnoses, and how to populate them across the chart.
History related terms to know:
Medical history: past diagnoses
Surgical history: past procedures
Family history: family health and status (alive, deceased, etc.)
Social history: tobacco, alcohol, drugs, and sexual activity
Birth history and obstetric history (pregnancy) details
Pertinent negatives: diagnoses or conditions not present that are relevant to history
Problem List: A patient’s problem list tracks ongoing diagnoses across encounters; problems that end (e.g., resolution) must be marked as resolved; diagnosing and updating problems is shared among clinicians across encounters.
Diagnosis entry types: Visit diagnosis (encounter-specific) vs problem list diagnosis (patient-level); medical history diagnoses can be copied to or from the problem list and visit diagnoses.
Copying diagnoses: You can copy a diagnosis from visit to problem list (and vice versa); you can copy a problem diagnosis to medical history via the History flow.
Data entry patterns and views:
Family history can be viewed in List or Checkboxes views; negative history (Neg Hx) can be added for a problem like Cancer, Diabetes, Hypertension.
You can add comments to a diagnosis and use Status column to indicate life status and comments.
You can copy a diagnosis from a problem list to a visit diagnosis; copy from medical history to problem list; and use the Visit Diagnoses section to attach a diagnosis to an encounter.
Exercise summaries:
Guided steps to document Greg’s medical history (Asthma), surgical history (Appendectomy, tonsillectomy), family history (asthma in mother), and social history (smoking, ready to quit).
Notes on negative history (e.g., meningitis not present), and the concept of sharing problems across the chart for more integrated care.
Review and reflection tasks: Mark sections as reviewed; copy certain diagnoses to problem list; maintain a snapshot of patient data to support ongoing care.
Lesson 7: Reviewing Patient Charts
This chapter introduces Chart Review and Snapshot, which provide consolidated, quick access to patient data as well as the ability to filter and drill into details. It covers Encounters tab, Notes tab, Labs tab, Meds tab, and snapshots of data across visits.
Chart Search and Snapshot: Chart Search is a fast way to locate information across a patient chart and beyond (to other Epic components). Snapshot provides a quick view of demographics, allergies, current meds, problem lists, and smoking status; it links to other chart sections and can open various reports.
Chart Review: The Encounters tab shows all past encounters (office visits, hospitalizations, etc.), Notes tab shows all notes; Labs tab shows lab orders/results; Meds tab shows medication history with current/past/expired status.
Filters and customization: Default filters are often set by specialty; you can customize filters to show My Visits, My Specialty, or My Department; you can adjust what reports buttons appear in the toolbar; you can make tabs default or rearrange your Chart Review tabs per encounter type.
Synopsis: A consolidated view showing data from multiple sources (labs, meds, vitals) over a time window; can graph results; supports patient spotlights (a patient-specific, user-specific list of data to track).
Results Review: A view that aggregates results, enabling lookback ranges and graphing across labs and other results; you can create graphs, show reference ranges, and toggle between grids and graphs.
Growth Chart: Pediatric growth data; offers datasets and reference datasets to compare growth metrics and weight over time.
Access to dashboards: Radar dashboards allow organization-specific dashboards; you can set favorites and share with others.
Review activities and practice: The chapter provides a set of in-class exercises for using SnapShot, Chart Review, Synopsis, Results Review, and Growth Chart. It discusses how to personalize, filter, and optimize chart review workflows and demonstrates how to copy/paste synopsis data and create patient spotlights.
Lesson 8: Using In Basket to Manage Patient Care
In Basket is Epic’s secure internal messaging system for patient care and related workflow. It supports patient calls, Rx requests, test results, and many other message types. It is tightly integrated with patient charts, orders, and the physician/nurse workflow, enabling efficient collaboration.
In Basket layout and views:
Main toolbar, folder toolbar, message list, and message report panes help organize messages by type (My Messages, Opened Patients, Completed Work, Sent Messages, Search Results).
Views allow users to focus on their own messages, patient-centric views, and global search results.
Each folder has its own toolbar and capabilities; right-click can reveal more actions. A global wrench lets you customize the In Basket layout.
Handling messages:
New messages start as New; reading marks as Read; setting to Done removes them from the active view; responsibility messages have a green “ball” indicator and a specific workflow about who is responsible for follow-up.
You can mark messages as Reviewed to show completion without changing the chart, or you can sign notes via Result Notes and QuickNotes.
QuickActions: Personal or system QuickActions speed common tasks, such as generating result notes, letters, or secure messages; you can create QuickActions for recurring workflows like “Call pt with result” and route to a pool.
Pools and Classes: Pools (task-based) share one message among all pool members; Classes (informational) go to each recipient separately, enabling different actions.
OOC (Out of Contact): Create an OOC to designate delegates during planned or unplanned absences; delegates can access and act on messages and attach to the OOC user’s In Basket; you can delegate access permanently as well.
Attaching to In Basket: You can grant permanent access to other users’ In Baskets, and accept access to others’ baskets; you can detach at any time.
QuickNotes and QuickActions in In Basket: QuickNotes can be used to communicate in a patient encounter; QuickActions can automatically file results as appropriate; you can test QuickActions by creating demo actions and routing tests.
My Open Charts reminder: The system can remind you to close open encounters to trigger billing; you can create and manage open chart reminders.
Admin and reports: Administrative tools provide access to support reports, which show order lineage and message routing details; “Record Viewer” is used to view records without locking them for editing.
Lesson 9: Telephone Encounters: Patient Clinical Calls
Telephone encounters document phone conversations between clinical staff and patients. They provide flow diagrams for non-medication and medication-related calls and define a workflow that connects front desk, nurse pools, and providers.
Telephone encounter workflow:
Receptionist takes the call and routes to the Nurse Pool; the nurse identifies the patient, confirms contact details, and creates a Patient Call Back or Telephone Encounter.
If medication-related, the encounter can route as Rx Request; the nurse or provider may pend an order in Medications & Orders and route for signature.
The nurse documents the call details (reason for call, onset date, patient’s phone numbers, the contacts with the patient) and may create a QuickNote or Result Note for follow-up.
The provider can sign or modify the Rx Request, respond to the Rx Request with a Rx Response, and route documentation back to the nurse.
Refill workflow: Refill requests can be initiated via In Basket; a nurse might create a Refill Encounter, document the patient’s request, route to the provider for signing; the provider can approve the refill or route back with instructions.
QuickNotes and QuickActions: In a telephone encounter, a QuickNote can be created to document a common intervention; a QuickAction could file into the encounter as needed.
Patient calls and routing: Routing rules determine routes (Patient Call vs Rx Request) depending on the reason for call; after routing, the provider may sign the encounter and update the chart accordingly.
Best practices:
Use patient lookup when possible; copy call text into the encounter when appropriate; document the outcome in the encounter and in the orders if needed.
Use Card View for fast handling of calls; create and use QuickActions for common call scenarios; follow up with result notes or letters as appropriate.
Lesson 10: Interoperability: Care Everywhere
Care Everywhere (CE) is Epic’s interoperability platform enabling exchange of patient data with other Epic sites and external providers. CE supports two main workflows: Pull (requesting outside records during care) and Push (sending data to another facility or receiving unsolicited documents).
Pull workflow: A clinician queries outside records for a patient, selects outside organizations, and submits the query; decision logic includes matching patient demographics and obtaining authorization if required; CE returns outside records into the local Epic chart.
Push workflow: A patient’s information can be sent to another facility as part of a referral or discharge workflow; CE accepts incoming documents automatically.
Review outside information: CE provides multiple tabs—Summary, Documents, Lab Results, and Other Results—so clinicians can review outside data and reconcile with local data.
Reconcile Outside Information (ROI): This activity allows clinicians to compare outside data with local data, acknowledging matches and conflicts; the ROI shows items at the top (outside) and bottom (local) and provides an option to discard remaining items after reconciliation.
MyChart and registries: Outside data may come from MyChart patients; CE can interface with immunizations registries and pharmacy data. CE supports harmonizing data such as allergies, meds, problems, and immunizations.
Practical example: A new patient (Quincy) with prior records from River Hills and Glacier Edge; run a query, verify demographic match, obtain authorization if required, view outside records in Summary/Documents/Lab/Other Results tabs, and reconcile.
Lesson 11: Analytics: Value from Data
Analytics covers Reporting Workbench, Crystal Reporting, and SlicerDicer, with a focus on population health analytics, dashboards, and data-driven decision support.
Tools:
SlicerDicer: Self-service data exploration on populations; examples include comparing hypertensive patients who are diabetic across age groups; building population queries by selecting demographics, diagnoses, labs, medications, registries; exporting to Reporting Workbench for deeper analysis.
Reporting Workbench: Central reporting tool for clinicians and administrators; run reports, view results, and push results to favorites; templates exist and can be customized; reports can be published to users’ favorites.
Crystal Reporting: Another reporting tool not shown in detail here; included as part of the analytics suite.
Dashboards (Radar): Organization-wide dashboards that can be configured to share metrics with specific roles; dashboards can link to training guides and tips sheets.
Concepts:
Patient base, groupers, analytic registries: Groupers are sets of related data (e.g., a statin medications grouper); Registries contain metrics and data collected about diseases or health conditions; groupers and registries enable scalable reporting across many patients.
Population-based reporting: Build reports that capture data across patient cohorts; use Run as User, filters, and precise criteria to get target populations.
Data freshness: RW uses real-time or daily data depending on data source; SlicerDicer typically uses near-real-time data depending on configuration.
Exercises and practice: Samples cover creating a public Reporting Workbench report, duplicating an existing report, defining search criteria and logic, testing builds, publishing to favorites, and modifying X-type reports. It also covers using SlicerDicer to query, splitting populations, and exporting to RW for deeper review.
Practical guidance:
Always consider patient base and registries when designing reports; use groupers to simplify long lists of criteria; use standard report templates for consistency.
Dashboards can be used to disseminate key metrics to providers and staff; use My Reports for ad hoc reporting and My Dashboard for at-a-glance views.
Data governance matters: Ensure that reports respect privacy and security; publish only to appropriate user groups; consider security constraints when sharing reports.
Lesson 12: "Admin Hat" Exploration: Specialty and Project Team Tools
This chapter shifts focus from user-level workflows to specialty-driven and project-team tools for EpicCare Ambulatory. It covers flowsheets, navigators, NoteWriter templates, and system preference lists. It also introduces several administrative tools that can help investigators and builders tailor Epic to their organization.
Specialty Starter Sets: A collection of tools designed to support a specialty (including preference lists, profiles, navigators, NoteWriter templates, SmartSets/Order Sets, and SmartTexts). Starter Sets are helpful as a starting point but require validation and customization to fit a specific organization.
Flowsheets and Time-Out flowsheets: Flowsheets capture discrete data in a table-like format; time-out flowsheets are used for verification steps before procedures (to confirm patient identity, body part, procedure, etc.). Cascading flowsheets can auto-collapse or reveal additional rows depending on selections.
Navigator-based activities: Episode (for care episodes) and Prep for Procedure; Quick Navigators; Role-based access to different navigators. The layout of navigators (and which sections they include) can be customized, including which TOC exists in the navigator; some navigators do not have Quick Navigators and rely on standard flows.
Customization via the Wrench and Customize: Personalize options to move items to Epic Button Menu; pin favorites to top; adjust tab order and width; set default views for particular departments or encounter types.
Special demonstrations across subsystems:
Exercises on specialized flowsheets for time-outs and data capture.
Administrative tools for flowsheets: Flowsheet Debug Print Group to show print groups and audit trails.
SnapShot and Synopsis: Observations on how snapshots differ across specialties; customizing default reports across departments.
Report Assistance: How to request support or adjust the look and feel of a report; enabling print group IDs to debug reports.
Navigator Templates: Compare different navigators (Rooming vs Plan) for different departments; use hotkeys to switch between navigators to illustrate engine-driven templates.
SnapShot and Synopsis interactions in different departments (e.g., Ophthalmology vs Family Medicine) and how department context affects available reports and views.
Administrative tasks and tools:
Record Viewer: View an order or patient record without locking; requires order IDs.
Session Information Report: A debugging tool to see IDs for print groups and to validate report content.
Support Reports: Behind-the-scenes reports that show order lineage and routing details for troubleshooting.
Change context: Switch department contexts to see how navigators and default views differ across departments.
Change and test access: Grant or manage persistent attachments to In Baskets; attach a user’s In Basket as part of coverage and delegate workflows.
Managing doctors’ and groups’ In Basket access: Use the Attach feature to grant or accept In Basket access to attachments; revoke as needed.
Exercises for Subgroups 1–3 (paired work):
Subgroup 1: Time-Out flowsheets and embedded flowsheets; using Time-Out with cascades; embedding flowsheets into navigators.
Subgroup 2: Navigator-based activities: Episode and Prep for Procedure; Quick Navigators; comparing navigation layouts; hotkeys to switch between navigators; testing pregnancy episodes and OB navigators.
Subgroup 3: SnapShot and Synopsis: Compare ophthalmology vs family medicine; view default and available reports; working with print group IDs; cross-department configuration and context switching.
Final guidance:
The Admin Hat explorations emphasize tailoring documentation, ordering, review tools, and workflows by specialty; they highlight that a project team’s goal is to validate and tailor Epic tools to meet the specialty’s needs while balancing security, patient safety, and billing considerations.
Appendices and Review Materials
Appendix A: Answers to end-of-chapter Review Questions (for reference). The Answers include mappings of Epic concepts to practices such as:
SmartTools components (SmartText, SmartPhrase, SmartLink, SmartList)
Encounter types, ORD records, and how to connect orders to diagnoses
History vs Problem List vs Visit Diagnoses data propagation
Key tasks like creating an addendum, signing a visit, and closing an encounter
Appendix B–E: After-Class Practice, Certification FAQs, and Required Self-Assessment materials that cover access to UserWeb, certification environments, exam structure, scoring, and how to manage ongoing certification (CEE, NVT, and expiration rules).
The overall training material emphasizes that the self-study guides complement live sessions, and the certification materials require hands-on practice in a dedicated certification environment or a Galaxy-provisioned training environment.
Summary of Core Concepts Across Lessons
Hyperspace: Workspace-centric navigation; multiple workspaces; startup activities; Widescreen View and navigators.
Note-Writing Tools: SmartTexts, SmartPhrases, SmartLinks, SmartLists, and NoteWriter; macros (SmartBlocks) for rapid documentation; use of HPI, ROS, EXam, and Plan in NoteWriter; Note templates vs Note Texts; navigation and data-entry shortcuts.
Ordering/Charges: ORD records, order signing, and the relationship to patient encounters; doses, sig, and discrete fields; long-term and standing orders; CAMs and immunizations; charge capture and the Charge Router; Warnings and BestPractice Advisories.
History/Problem List: Medical/Surgical/Family/Social histories; pertient negatives; copying diagnostics across Visit Diagnoses, Problem List, and Medical History; data views and editing; reviewing and marking as reviewed.
Chart Review: Snapshot, Encounters, Notes, Labs, Meds; Results Review and Growth Chart; use of filters and the Me filter; customizing reports; patient spotlights; data-driven decision support.
In Basket: Message lifecycle (New, Read, Done, Reviewed); pools and classes; QuickActions; OOC; grant/permanent access; Card View and bulk actions; Rx Request/Response; result notes and QuickNotes.
Interoperability: Care Everywhere pull vs push; ROI to reconcile outside information; CE data sources; review outside data in Summary, Documents, Labs, and Other Results tabs.
Analytics: Role of SlicerDicer, Reporting Workbench, and Dashboards; population health; groupers and registries; customizing and publishing reports.
Admin Tools: Flowsheets, Time-Outs, navigators, and specialized templates; System Preference Lists; debugging with Print Group IDs; Record Viewer; support reports; cross-department navigation and context switching; training for specialty tools.
If you want, I can convert any section into more compact bullet-point summaries or expand specific lessons with step-by-step workflows and LaTeX-formatted equations for any numeric examples (e.g., LOS codes like , vitals formatting in , etc.).