Better Heath for All

1. VMC Ambulatory - Bridge Training This power-point presentation will highlight similarities and some key differences between the EPIC Ambulatory Health Record at Stanford and at VMC (known as HealthLink at VMC). This is not intended to be a complete guide to the use of EPIC at either site. Created April 2013 Intended for VMC affiliated physicians. Please do not distribute to non-VMC affiliates. Better Heath for All

2. Home-page – very similar between Stanford and VMCSlides: Stanford left VMC right

3. Visit navigator for clinic visit – very similarSlides: Stanford left VMC right

4. Visit Navigator barsSeveral key differences:1. “Procedure notes” tab (VMC only)2. “Med Student Note” - unique area for med students to document, not seen on final note2. “Dx and orders” used at Stanford- VMC has separate “Visit Diagnoses” and “Meds and Orders” tabs 3. “Communication management” tab in visit navigator at Stanford - this function is in left side activity bar at VMCThe following slides will address these differences.Slides: Stanford left, VMC right

5. Progress noteAt Stanford when you open the “Visit Note” tab you get a blank screen that you can use to free text, dictate or add Smart texts to create a note.At VMC when you open the “Progress Note” tab you get a choice of “Create Note” (similar to the Stanford blank screen), but you can also choose “Create Note in NoteWriter” that will open a note composer.Slides: Stanford bottom left VMC top right

6. NoteWriter at VMCNoteWriter will compose written text as you click various buttons indicating signs and symptoms. It is available for a number of common medication conditions and is triggered initially by the visit chief complaint. Slide: VMC

7. Procedure noteAt Stanford you document procedures in the progress note section.At VMC when you open the “Procedure Note” tab in the Visit Navigator the “NoteWriter” screen opens up with a choice of various procedures that HL will assist you in documenting. You can also choose the “ Note” tab to free text or use a Smart Text .You will also need to go to med order tab to order any procedure meds used “during visit” and then release them from the MAR in the activities tab. Slides: both VMC

8. Dx and Orders tab at Stanford:At Stanford this field is used to document the visit diagnosis and to order medications, labs and consults VMC has one tab for diagnosis and a separate tab for orders.Slides: Stanford left VMC right slides

9. Meds and Orders template at VMCYou order the medication, lab, or consult first, then use the “associate” link to open a tool to assign an appropriate diagnosisSlides: Both VMC

10. Medication order screenStanford has the mode of prescription (“Class”) at top - VMC has it at the bottomVMC classes: Normal = eRx, VMC MO = VMC mail order, Print = print, No Print = to document Rxonly Stanford has “Select Pharmacy” and “Sign Orders” buttons on top panel, VMC has these at bottom of templateSlides: Stanford left VMC right

11. VMC Resident SupervisionWhen a resident initially logs in each day they will need to choose a supervising attending “for the day”. This can be changed later if they are working with other attendings. One place to change to a different supervising attending is at the LOS template. Slides: both VMC

12. Signing orders – ResidentsAt Stanford when a resident clicks the “sign” button a grey box pops up to assign an authorizing attending for the orderAt VMC when a resident orders meds or labs, the results will also go to the supervising providers inbasket that was selected earlier in the visit. If you need to change this to a different attending during a visit you can click on the “providers” button on the bottom left edge of the med and order template, then change supervisors on the Providers template. . Slides: Stanford left VMC right

13. Cancelling previously signed ordersAt Stanford there is a link on the Rx and Orders template that will take you to “Previously signed orders” , you can then cancel the orders.At VMC you just click directly on the med or lab order and then click the “Discontinue” or “Cancel” buttonsSlides: both Stanford

14. Communication ManagementAt Stanford the Com Management tab in the Visit Navigator bar allows you direct your note to another providerAt VMC the Communications tab is in the Activity Bar on the far left side of screenSlides: Stanford left VMC right

15. Level of ServiceAt Stanford residents enter into the LOS window “Resident LOS 99999”. The Stanford authorizing provider is entered in the lower box at Stanford.At VMC the residents can fill in “99999” for LOS as a default or they can enter a “real” LOS. This will later be checked by the attending prior to the charge being sent.Slides: Stanford left VMC right

16. Closing encounterAt Stanford when a resident clicks the “Close Encounter” tab the next screen will call for a Cosigning attending. The process is the same at VMC. In order to close an encounter the note must be complete. The chart will automatically route to the co-signing attendings inbasket. If the resident is not able to complete the note they cannot close the encounter and a different means of routing the chart is performed as noted on next slide.Slides: Stanford left VMC right

17. Closing an incomplete visitIf the resident cannot complete all items on the chart they can route the chart to the attending for completion by using the lower part of the Follow-up box. Select the attending in the Recipient box, then close the note by clicking the “x” by the patient name in the header. The chart will route to the attendings CC’d Chart folder in the in basketSlides: both VMC

18. InBasketThe functions are very similar between Stanford and VMCSlides: Stanford left VMC right

19. Out of ContactAt Stanford you enter this field to allow another provider to see your inbasket messagesThis is the same at VMC - you can attach another provider to your inbasket, they will need to click on the “attached inbasket” to view and act on tasksSlides: Stanford left VMC right