AA

CLN103 – Clinical Workflows & Epic Fundamentals

Introduction

  • CLN103: Overview of Clinical Workflows (May 2025 version)
  • Audience: Clinical Informaticists working with Epic analysts to improve clinician efficiency and satisfaction.
  • Communication outside class: email CITraining@epic.com with → companion/chapter/page, environment, User ID, patient/MRN, and troubleshooting tried.

Prerequisites & Expectations

  • Prior hands-on use of an Epic clinical application.
  • Recommended e-learnings before class:
    • MYC001 – MyChart Patient Portal overview
    • AMB001 – Office Visit Demo
    • CLNINP001 – Overview of Hyperspace (optional)
    • GEN601A – Introduction to Chronicles
  • Training uses current Epic release; expect differences if organization runs an older version.

Using the Training Companion

  • Check version & dates—materials update frequently; see “All Training Companion Change Log.”
  • Two PDFs: “With Answers” for reference, “Without Answers” for class; toggle in Galaxy.
  • Text-box conventions:
    • Critical, Example, Beyond the Basics, Write-It-Down, Foundation System FYI, Setup, Real-World Context.

Practicing Outside Class

  • For self-study: use Study environments; request proficiency self-study status via training@epic.com (Epic W-2 employees only).
  • Download materials from Galaxy, Course Catalog, or EpicU (Training Home → Your In-Progress Certificates).
  • Course materials filterable by application/role.

Access to Certification Environments

  • Request via Training Home → Cert Environment Request (one env/version).
  • Use access.epic.com (or EUaccess) 15 min after request.
  • Icons: Study (self-study), Project (graded projects), Virtual Training (live class only); add to Home with star.
  • Weekly Study refresh: Fridays 22:00 CT / CET.

Troubleshooting

  • See Galaxy article if icons fail to launch; email training team for credentials/password issues.

Course Agenda

Day 1 (08:30–17:00)
• Welcome / Integrated Workflow (+ mid-break)
Day 2 (08:30–12:00)
• Epic Data Structure
• Nova Release Notes
• Environment & Security
• Evaluations (open ×2 weeks)

Integrated Workflow

Foundation: Demonstrates end-to-end patient flow across Epic apps; informs informaticists on optimization opportunities.

MyChart Patient Portal

  • Web & mobile access; schedules, messages, bills, results.
  • Example: Patient “Trixie” messages PCP about cough.
  • Steps demoed: log in, disable 2FA, send brief medical question, logout.

Clinician Response (In Basket)

  • Nurse (Terry 2082##) views message via Open Tasks → In Basket.
  • Messages may route to pools vs individual.
  • Action: Reply advising appointment; message filed to chart.
  • In Basket anatomy: Message Types, Global Toolbar, Folder-specific Toolbar, List, Report Toolbar, Report Pane.
  • Efficiency tools: QuickActions, postpone, filters; overwhelming volume suggests routing review.

Appointment Scheduling & eCheck-In

  1. Nurse launches MyChart via Assistant Bar; patient schedules ‘Family Medicine’ visit.
  2. Insurance added (Aetna #123456789) → MyChart questionnaire.
  3. eCheck-In lets patients update contacts, PCP, insurance, sign docs, complete questionnaires (data becomes patient-entered and requires reconciliation).

Outpatient Visit Workflow

Nurse (Terry) Tasks

  • Configure multi-provider Schedule (add provider Dougie Docson).
  • Rooming navigator: document Reason for Visit, vitals, tobacco review, allergies, select pharmacy (North Clinic), med review, pull questionnaire answers into HPI via NoteWriter.
  • Secure Hyperspace (not logout) for provider.

Provider (Pat 2081##) Tasks

  • Assume note authorship (star icon).
  • NoteWriter: HPI + positive/negative sx; Physical Exam via macro; Assessment & Plan.
  • Visit Taskbar: ADD DX (‘cough’), ADD ORDER (Delsym 10 doses), DX Association, Sign Orders.
  • Complete note, choose Level of Service ‘Est 2’, Sign Visit.
  • Concepts: Level of Service (E/M CPT codes), Express Lane for routine visits.

Emergency Department Visit

Arrival & Triage (Nurse Fran 3000##)

  • ED Manager → Arrival; status auto-tracks events.
  • Triage navigator: Travel Screening, Chief Complaint (cough, fever, SOB) sets status to In Triage.
  • Document vitals (Temp 38.5\,^{\circ}!C), Acuity 3, Destination Waiting, mark Triage Complete → status Waiting for Room.

Room & Treatment Team

  • Move patient to bed → status Waiting for Provider.
  • Treatment Team: assign Attending (Alex). Status → In Process.

Nursing Documentation (ED Narrator)

  • Respiratory assessment (crackles, wheezes).
  • Orders tab: place Acetaminophen 650 mg per protocol; auto-acknowledged.
  • MAR: document PRN med, link to CVC via LDA Avatar.

Provider Encounter (Alex 3001##)

  • ED Track Board My Pts; Triage tab review & Mark All Reviewed.
  • Orders Quick List: Shortness-of-Breath panel → CBC, IV, methylprednisolone 80 mg IV, CXR 2-view (pregnancy No, reason cough).
  • Workup tab: review results; document ED Course comment.
  • My Note → NoteWriter ED note; sign.
  • Disposition: Admit; Impression ‘Pneumonia’ added to problem list.
  • Bed Request order: Service General Medicine, Level of Care Acute, Admitting/Attending physician (Chris 2181##).
  • Charge: select Provider Level of Service.

Pharmacist Verification Demo

  • Pharmacist (rxadm) reviews order queue; Verify orders adjusting clinical/dispense details; Verify button stamps.

Bed Planning Demo

  • Bed planner (adtbedpl) uses Bed Planning: Unassigned tab → drag ED patient to Med/Surg bed, set Patient Class Inpatient.

Inpatient Admission

Physician (Chris 2181##)

  • Patient Lists startup default.
  • Admission navigator: designate Problem List items as Hospital problems; Principal Dx Pneumonia (Present on Admission Yes).
  • Admission Orders: Medication Reconciliation → Discontinue home meds; Continue hospital orders.
  • Suggested Order Sets: Pneumonia Admission; fill Admit to Inpatient order (service/unit/LOS/physicians).
  • Labs: CBC, VBG ordered with cost indicators ($ symbols).
  • Additional order: POCT glucose.
  • Sign & Hold – Will be Initiated by Receiving Unit.
  • Create GEN IP Modular H&P note; wildcard navigation (F2); sign; charge capture window appears (Initial hospital …).

Nurse Transfer & Admission (Sidney 2182##)

  • Unit Manager: drag incoming patient to assigned bed; edit details (now, Private room, attending provider).
  • Add self to Treatment Team.
  • Release Signed & Held admission orders (Storyboard banner) → Release → Acknowledge All.
  • Administration: MAR give methylprednisolone; create and link CVC LDA.
  • Brain Sidebar Admission tasks: complete Head-to-Toe, copy vitals; run Flowsheet macros (‘All else WDL’); back-documentation w/ ‘Insert’ column.
  • Vitals documented for 15 minutes ago.
  • Brain Labs icon: switch CBC to Unit Collect, print labels, document collection.

Inpatient Discharge

Physician

  • Discharge navigator: reconcile Problem List (Pneumonia Resolved, Anemia/Asthma Active).
  • Med Rec: Continue all home meds, discontinue inpatient meds.
  • Discharge Order: Disposition Home, Date Today, Time Afternoon. Sign – Print/e-prescribe.

Nurse

  • Discharge navigator customizable (Modify Layout).
  • Check Discharge Milestones & Delays.
  • Preview After Visit Summary.
  • Screenings flowsheet: doc transport need No.
  • Patient Lists → Patient Transport: create request (End Location Discharge, Mode Ambulatory, belongings, phone).

ADT Finalization (Grand Central Demo)

  • Bed planner reviews Today’s Expected Discharges; Discharge Planning Summary shows milestones.
  • Foundation Discharge Milestones:
    • Place Discharge Order (physician)
    • Complete Discharge Med Rec (physician)
    • Request Discharge Transport (unit clerk/nurse/bed planner)
    • Enter Post-Discharge Transport Status (nurse)
    • Case-Management Readiness sign-off
  • Transport workflows via Command Center or Rover mobile; techs can accept, start, complete, report delays, print Ticket-to-Ride.

Informaticist Reporting

  • Tools matrix:
    • Reporting Workbench – real-time/near-real-time lists
    • SlicerDicer – large historic datasets
    • Dashboards – aggregate components (may embed RW/Slicer).
  • Dashboards explored (My Dashboards startup): Flowsheet Macro Usage, Flowsheets Explorer, Rover Usage & Efficiency, Operational Nursing, Capacity Management, Patient Flow Pulse, EVS/Transport Monitor, Unit Bed Huddle.
  • Reporting Workbench exercise: edit ‘ADT Discharge Efficiency’ (change date M-2, add Day-of-Week column, run without saving).
  • Ticket Writing essentials:
    • Usernames (affected & unaffected), login dept, patient info, contact info, repro steps & troubleshooting, impact, record IDs / Session Info, screenshots.

Overview of Epic Data Structure (Chronicles)

  • Chronicles = Epic’s database management system.
  • Hierarchy analogy: Filing cabinet.
    • Master File (drawer, 3-char INI, e.g., EPT, EMP).
    • Record (file folder, unique ID+name).
    • Contact (dated sheet; date-sensitive snapshot).
    • Item (question prompt).
    • Value (answer).
  • Patient (EPT) unique: multiple encounter types as contacts.
  • Record Viewer tool: view (not edit) records; Jump To & Ctrl-F for items; blue hyperlinks drill to other master files.
  • Exercise captured: find DOB (item 110), meds history (17100), etc.; traverse to ORD record for lab results.

Environment Structure & Security

Core Environments

AbbrevPurpose
POCProof of Concept – initial build & unit testing (no PHI).
TSTIntegrated/pre-prod testing (interfaces, workflows).
PRDProduction – live patient data; user-level config only.
SUPSupport – nightly copy of PRD for troubleshooting (PHI present).
  • Build lifecycle: config built in POC → migrated via Data Courier to TST → validated → migrated to PRD.

Security Components

  • EMP (User) – login credentials & settings; can be User, Template, Subtemplate.
  • SER (Provider) – required if user scheduled, orders, documents w/ credentials, or referral entity.
  • ECL (Security Class) – grants/denies functions (app-specific or shared).
  • E2R (User Role) – controls Hyperspace layout, toolbars, timeouts.

LDAP Override (SUP only)

  • Allows analyst to log in “as user” with own password; audited (override ID stamped).
  • Steps: in User Security set LDAP override ID; login using target username + own password.

Nova: Release Notes & Gold Stars

  • Nova (nova.epic.com) centralizes upgrade work, release notes, Staying Current, Gold Stars, projects timeline.
  • Release note sections: Overview, What’s Changed, Build Task, Training Task.
  • Dashboard navigation: Outstanding Work → pop-out → team progress → note comments/Advice.
  • Search filters by application, version, project, team.
  • Staying Current dashboard: adoption percentage, future goals; view notes impacting score.
  • Gold Stars: overall level based on % of adopted items; items grouped by Tier (1–10) and Focus (e.g., Patient Flow, Clinician Efficiency). Drill-down for implementation guidance.

Additional Epic Resources

  • Training Home sections: Important Dates; Training Resources; Visiting Epic; In-Progress & Completed Certificates; Newsfeed.
  • Post-class badges:
    • CLN2020v Empowering End User
    • CLN2023 Analysis of Clinical Tools & Reporting
    • CLN2120v In Basket Configuration
  • Builder tracks: Clinical Content Builder (non-provider) & Physician Builder.
  • Key portals:
    • UserWeb
    • Galaxy (docs; star favourites)
    • weLearning
    • Community Library
    • Data Handbook
    • Epic Health Research Network (EHRN)
  • Glossaries & XGM sessions for informatics best practices.

Completing Your Training Track

  • Refer to Epic’s Training Guide (Community Member vs Consultant edition) for statuses, scoring, maintenance, Good Install & Honor Roll.
  • EpicU diagrams show requirements (solid check = done, dotted = recommended).
  • Support contacts:
    • CItraining@epic.com (content/process)
    • UserWebSupport, Registrations, Exams, ContinuingEpicEducation, etc.
  • Study resources: “Tips for Epic Exams” doc; Sample exams via EpicU/Course Catalog (unlimited attempts, 2/day).
  • Cert environments: request via Training Home; Study vs Project icon guidance; Project envs do NOT refresh.

Daily Review & Study Checklists

  • Comprehensive T/F & multiple-choice recap of Day 1 (Integrated Workflow) & Day 2 (Data Structure, Environment & Security).
  • Key terms list (MyChart, ED Manager, Navigator, Contact, Item, Master File, etc.).
  • Task mastery list (schedule visit, configure schedule, place orders, admit/discharge, find dashboards, use Record Viewer, explain environment differences, etc.).

Key Take-Aways for Informaticists

  • Understand end-to-end clinical workflows across settings; identify where technology can streamline or bottleneck.
  • Use In Basket routing, QuickActions, macros, Express Lanes, and Brain/Flowsheet macros to enhance efficiency.
  • Monitor discharge milestones and patient flow via dashboards and Bed Planning.
  • Leverage reporting tools (Workbench, SlicerDicer, Dashboards) to measure adoption and inform change.
  • Master Chronicles structure and Record Viewer to troubleshoot data issues.
  • Maintain environment hygiene: build in POC → migrate; never build directly in PRD; use SUP + LDAP override for safe replication.
  • Stay current with Nova release notes; target Gold Stars focuses and tiers for continuous improvement.
  • Exploit Epic resources—UserWeb, Galaxy, Community Library, badges—to sustain knowledge and drive optimization.