epic visit types

Epic Glossary

Epic clinical applications.

Application for care and clinical documentation in the emergency department

Application for inpatient documentation performed by clinicians and may include notes, flowsheets, assessments, plan of care and medication administration. Used by nurses, nurse practitioners, managers, therapists, physicians, physician assistants, case managers and social workers.

EpicCare Ambulatory

Application for documenting care provided through outpatient visits, telephone calls, e-visits and refill requests.

Application for the ordering of workflows of inpatient orders. Can be used to share order details, sign orders, place orders and find orders.

Epic Ancillary Clinical Applications

Application for any procedure requiring anesthesia

Application for chemotherapy ordering, administration and cancer staging. Used by inpatient and outpatient oncologists, nurses, pharmacists, research and infusion staff.

Application for laboratory information systems. Used by phlebotomists, nurses, techs, pathologists and central receivers.

Clinical Case Management

Application designed to centralize the workflows for case managers.

Application for cardiovascular information system. Used to order and document cardiology procedures and cases.

Infection Control

Application for infection surveillance, which helps detect, monitor and report certain types of infections in the inpatient setting.

Application for the operating room. Helps prepare, schedule and document all information related to surgery.

Application for radiology information system. Used for ordering, scheduling and performing imaging procedures.

Application for documenting perinatal care. Used to document a patient’s entire pregnancy, admit babies and document newborn assessments.

Willow Inpatient Pharmacy

Application for inpatient prescription pharmacy system. Used in the hospital setting for admitted patients, procedures, surgeries and diagnostics.

Epic Access Applications

Application for managing patient movement (admissions, transfers and discharge from units throughout the hospital).

Application for scheduling appointments, creating provider/resource schedules, and keeping schedules up to date with changes.

Health Information Management

Application for managing health information. Used to handle releases of information from a patient’s chart, manage deficiencies as physicians complete notes and sign orders, and facilitate the coding of accounts.

Application for managing the patient database.

Application for managing patient registration over the front desk and over the phone.

Epic Revenue Applications

Access and revenue cycle (arcr).

Group of revenue and billing operational Subject Matter Experts who provide input in the design, build and implementation.

Resolute Hospital Billing & Claims

Application for collecting and reviewing charges, billing facility (hospital) charges to insurance companies and patients, following up on outstanding accounts and collecting payments for services.

Resolute Professional Billing & Claims

Application for collecting and reviewing charges, billing professional (physician) charges to insurance companies and patients, following up on outstanding accounts and collecting payments for services.

Other Epic Applications

EpicCare’s mobile app for the iPad. Designed to give providers secure and portable access to patient charts.

Care Everywhere Interoperability

Epic’s platform that supports the exchange of patient records with other providers outside our system. It ensures that patients’ health data follows them wherever they receive care.

Cogito Enterprise Intelligence (including Star Data Warehouse)

Module for several products in the reporting area. The huge amounts of clinical data that are collected by every part of the Epic system are stored in databases that can be queried to provide all manner of reporting to support care decisions, manage costs, and identify trends.

EpicCare Link

Web-based application that connects community providers (referring physicians, post-acute facilities, physician support staff) with secure access to select patient information.

Epic Hyperspace

Access point for RWJBarnabas Health physicians and staff. This is where Administrative and Clinical data is managed.

EpicCare’s mobile app for the iPhone and Droid. It gives providers secure and portable access to patient charts.

Healthy Planet Population Health

Application that provides a suite of reports, dashboard and workflow tools that allow Care Managers to manage patient populations in and apart from Accountable Care Organizations (ACOs).

Secure online application that allows patients to schedule appointments, view medications and request refills, message their provider for advice, and record their own health data (such as blood pressure and glucose levels).

Other Epic Terms & Acronyms

Best practice advisory (bpa).

An advisory configured by administrators can be triggered based on patient-based factors, among other things, and can be restricted as needed to prevent alert fatigue on the end users’ part. BPAs can appear in the Visit Navigator, Order Entry, and In Basket messages.

Chart Review

Central place in the Epic chart to find all Encounters for a patient.

Credentialed Trainers

People Epic trains and allows to train others.

Epic Together

Represents the RWJBH Epic implementation team, comprised of approximately 450 members.

A clinical contact with a patient. For example, an office visit, an admission, or a triage call. If more than one evaluation or procedure takes place at the visit, it is usually considered one encounter. In billing applications, charges or other transactions can be associated with encounters.

Foundation System

Epic’s standard system, which includes content and workflows based on the expertise and experience of the Epic community and the Epic staff.

Hospital Outpatient Department (HOD)

A specialty department that provides outpatient type care to patients who may or may not be admitted to the hospital. These departments often use a combination of clinical documentation tools from both EpicCare Ambulatory and EpicCare Inpatient. These departments also known as hospital service departments, but hospital outpatient department is the preferred term.

Key Performance Indicator (KPI)

Epic assists customers with measuring KPIs by providing a package of reports related to the business metrics that it considers crucial to monitoring the health of a customer system. Measuring KPIs is part of Epic’s Good Install program.

A series of sections meant to follow a particular workflow, such as an office visit or medication reconciliation. Common examples include the Visit Navigator and the Discharge Navigator.

Activity that allows you to use point and click functionality for HPI, ROS, and physical exam, generating text in your progress note.  OpTime Epic’s operating room management application.

A preconfigured group of orders commonly ordered together for a specific problem or diagnosis. Order Sets may be suggested based on entries on your patient’s problem list, and you can also mark Order Sets you use frequently as your favorites.

Preference List

A set of frequently used orders. Orders can be added to facility preference lists by members of your project team and you can also maintain your own personal preference list to include orders you have pre-related information prior to a patient’s arrival at the hospital. Preadmission helps prevent users from creating duplicate encounters.

Within Epic, any order that is not a medication is classified as a procedure. This includes orders for such things as lab tests, consults, supplies, and imaging.

Release of Information

Epic’s Health Information Management (HIM) application used to track and fulfill requests for patient health information.

Release of Information Activity

The main activity in Epic’s Release of Information application, where you can authorize, fulfill, and document requests for patient health information.

A documentation template. A group of orders and other elements, such as notes, chief complaints, SmartGroup Panels, and levels of service, that are commonly used together to document a specific type of visit. Using SmartSets reduces data entry time so you can focus more time on your patients.

A text template for charting that can include text, SmartPhrases, SmartLists, and SmartLinks. Frequently used in progress notes. They can be big or small many paragraphs or just one sentence.

Pre-configured text that can be used to standardize documentation, such as notes, within the system. SmartTools include SmartLinks, SmartLists, SmartPhrases, and SmartTexts.

Subject Matter Expert (SME)

Provides input during the workflow and content review.

Super Users

Local “experts” who provide input related to their area.

Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

• Vaccines  
• Masking Guidelines
• Visitor Guidelines  

News & Publications

Tips and tricks for getting the most out of epic.

Epic trainer Evelyn Chen keeps her instructions simple when she teaches new employees how to navigate the electronic medical record system that spans Johns Hopkins Medicine. There will be plenty of time later for users to tailor the system to their departments and roles. 

“The users are already overwhelmed with the amount of features to learn,” says Chen, who was a “super user” nurse at Howard County General Hospital when it adopted Epic in 2013 and is now a principal trainer for ClinDoc, the Epic module for inpatient clinical documentation. 

Chen is also leading efforts to update the resources that are available, rolling out new tip sheets to help make time in front of a computer more logical and efficient.

Some of the new information will help users prepare for quarterly upgrades to Epic, which will add features and change the look of the templates. All upgrade materials are posted on this  upgrade page  and may include quick start guides, PowerPoint slides, recordings and tip sheets.  (You must have an active JHED ID in order to access the links in this article.) 

The information is divided by provider and role, so cardiology nurses, for example, can click on their designated portal for updates, while other portals are specific for anesthesiologists, chaplains, pharmacists and others.  

Quick start guides (QSGs), which provide overviews of Epic use by role, can be found under Additional Resources within the role-specific pages. QSGs with the blue JHM logo have been updated for 2019.

Where to Find Additional Resources

• An Epic  Tips and Tricks  link can be found by clicking the Epic button on the top left after logging in, and then going to the Help section.
• News about current Epic features coming to production are posted in  Epic News . To receive relevant information by email when it becomes available, fill out the form that can be reached by clicking “page” on the top left of the screen, then the “Alert Me” button. You can also review the  tip sheet  on how to set up alerts.
• Find resources and reports on the Epic toolbar by going to the My Dashboards workspace and selecting the template specific to your role and entity, then linking to resources or running reports. Several roles have Learning Home dashboards that contain specific training materials and links within Epic.

Tips for Personalizing Epic

• Use Epic SmartTools to automate your documentation. SmartLinks pull information from the patient record into the documentation; SmartTexts auto-populate a larger block of text after a few characters are typed. Add the SmartTexts you use most often as favorites. 
• SmartPhrases are similar to SmartTexts, but can be personalized. A new “Personalize” button on the Epic toolbar helps tailor SmartPhrases, order sets and preference lists.
• Refer to this  Personalization Guide  to find a list of tip sheets for personalizing what you use frequently. Then find the relevant tip sheets on the  Tips and Tricks  page. 

Additional Tips

• Make sure to log in to the correct department, because the system’s navigators are designed for the workflow in each specific area. If you log in to the wrong department, use the Epic button and then click “Change Context” to quickly log in to another department without logging out of Epic.
• Document in real time, or as close to it as possible. Real-time documentation is particularly important for clinicians who use flowsheets to record numbers-based data, such as weight or blood pressure, because it ensures that the information is available to the patient’s care team.
• Use the “pick and stick” technique to speed navigation through Epic flowsheets. Click on the “Doc Detail Report” link on the right side of the flowsheet screen. Then left-click to pick the option, and right-click to make it stick. This will automatically advance the cursor to the next flowsheet row, eliminating the need to scroll up and down. This trick is a particular time-saver for nurses, respiratory therapists and others who document frequently in flowsheets.
• Use filters to find information quickly. For example, a clinician can filter the encounters or notes in Chart Review to narrow down the search.
• Use the Chart Search (within a chart, press the control key and spacebar) to quickly search for something in the patient’s chart. To search for an activity or function (in or outside a chart), type a few letters of the name of the activity but don’t press the enter key right away. After a moment, a list of matching Epic activities will pop up. You can also highlight a word with your mouse, right-click and select “Search for Selected Word.”
• Look before clicking to make sure that the correct patient is being documented and that accurate information has been added to the record.
• In orders or medication-related documentation, do not use abbreviations that are easy to misread. For example, IU, for international unit, could be confused with IV. Use of other abbreviations is strongly discouraged.

Related Reading

Epic promotes evidence-based blood use, saving $1.8 million.

Johns Hopkins Medicine is on track to save $800,000 through reduced platelet use, $716,000 through reduced red blood cell use and $296,000 through reduced plasma use for fiscal year 2017 compared with fiscal year 2014, before blood management was incorporated.

Dragon Medical One Brings Voice Recognition to Epic

Dragon voice recognition software is now available in Epic for all Johns Hopkins providers. The software is being deployed as part of the enterprisewide Joy at Hopkins Medicine initiative to improve the quality of life at work for our clinicians, offering a convenient alternative to typing notes on a keyboard or waiting for transcribed dictations.

Johns Hopkins Launches New Precision Medicine Tools

With new tools and resources, Johns Hopkins Medicine is making it easier for clinicians to conduct precision medicine research and use the results to improve patient care.

UIHC Epic Education

Cadence (scheduling/check in/check out).

Cadence is Epic's scheduling module used to schedule and track patient appointments. This includes functionality such as canceling and rescheduling; maintaining provider schedules; utilizing the wait list; and special scheduling workflows involving accident-related appointments and scheduling from appointment requests.

The following documents provide information on Scheduling functionality in Cadence.

UI Patient Access Center website

Scheduling Workflows

Basic Workflows

• Overview of Making Appointments (CAD052)  - (eLearning: 8.5 min) Book It is used to schedule appointments.
• Creating New Patient Medical Record Numbers (MRNs)  - (Handout) New patients need a Medical Record Number (MRN) created if they do not already exist in Epic.
• Scheduling in Book It  - (Handout) Book It enables staff to schedule using various views and various types of appointments.
• Location Sorting While Scheduling  - (Handout) Solutions can be sorted by distance from the patient's home ZIP code when scheduling.
• Scheduling an Appointment Using “Copy into Book It”  - (Handout) “Copy into Book It” is a scheduling option that may be used to schedule follow-up appointments from existing appointments that are in a “scheduled” or “completed” status. This is commonly used when follow-up orders are not available for scheduling. This activity copies appointment information from the existing appointment into the Book It activity for easier scheduling.
• Scheduling an Existing Patient (No Orders)  - (Handout) Scheduling a basic appointment for an existing patient at UIHC involves patient-level registration, scheduling the appointment, and appointment-level registration workflows. Appointments are generally scheduled from the patient’s Appointment Desk.
• Scheduling a Joint Appointment  - (Handout) A joint appointment is a single visit scheduled with multiple providers or resources using one visit type.
• Scheduling with One Click - (Handout) “One Click” appointments can be scheduled (and often checked in) quickly into the next available time slot.  See department-specific One Click tip sheets here . 
• Scheduling with Panels  - (Handout) A panel is a group of visit types that are typically scheduled together.
• Scheduling Recurring Appointments  - (Handout) Recurring appointments are a series of appointments, for the same patient, which take place on a regular basis.
• Scheduling Sequential Appointments  - (Handout) Sequential appointments are two or more visit types scheduled in the same entry process and can consist of any number of visit types and providers.

Open Access Workflows

• Scheduling a Presurg Evaluation Clinic (PEC) Appointment  - (Handout) Staff have open access to schedule Presurgical Evaluation Clinic (PEC) appointments more than one day into the future. Appointments should be scheduled from an order. For same day / next day scheduling, page 6796 for approval.
• Scheduling for 24 Hour Blood Pressure Monitoring  - (Handout) Schedule a patient for 24 hour Blood Pressure (BP) Monitoring using open access scheduling.
• Scheduling for Clinical DXA Scan  - (Handout) Schedule a patient for a Clinical DXA Scan (bone densitometry) using open access scheduling.
• Scheduling Into Food and Nutrition Services (FNS)  - (Handout) All staff have open-access to schedule a patient into Food and Nutrition Services.  Note:  Please refer to department scheduling guidelines for those departments with a dietician.
• Scheduling for IDx Exam  - (Handout) All staff have open access to schedule clinical IDx Exams. IDx is a system that detects diabetic retinopathy, and the exam is done at IRL only.
• Scheduling MyChart Video Visits  - (Handout) For patients in Iowa with a concern about an infectious respiratory illness (such as the Novel Coronavirus - COVID-19), a video visit can be scheduled after determining appropriateness. The patient must have a MyChart account to complete the video visit.
• Scheduling Preventative Care (Annual Physical) Visits - (Handout) When a patient with a Primary Care Provider (PCP) in our organization is overdue for their annual physical, a pop-up message displays on their Appointment Desk when opened. Anyone can and should schedule these visits following the instructions in the pop-up message.
• Scheduling for Pulmonary Function Test (PFT)  - (Handout) Schedule a patient for Pulmonary Function Testing using open access scheduling.
• Scheduling a Screening Mammogram  - (Handout) Screening mammograms can be scheduled for patients who need an annual mammogram. The following guidelines must be followed: • Patient must be symptom free; transfer to Radiology Scheduling if patient has any breast symptoms: 319- 356-3444. • Do not schedule screening mammograms when in conjunction with other breast imaging scans (e.g. breast ultrasound). • Must be scheduled 12 months or later following the last screening mammogram for patients with Medicare A&B.

Appointment Requests

NOTE:  Information regarding Appointment Request Workqueues is found under the "Workqueues" header at the bottom of this page.

• Creating Appointment Request Reminders - (Handout) Automated reminders can be added to appointment requests.
• Scheduling from an Appointment Request  - (Handout) Orders placed in EpicCare can be scheduled in Cadence. When scheduling from an appointment request, the system automatically selects the appropriate visit type if one is linked. Requests can be scheduled from either the patient’s Appointment Desk or from the Appointment Request Workqueue. Requests can also be linked or unlinked to existing appointments.
• Linking/Unlinking Requests to Existing Appointments  - (Handout) Appointment Requests can be linked or unlinked to existing appointments from the Appointment Desk. This can be done for future or past appointments, including after end of day processing has run on an appointment.
• Making a Canceled Request Schedulable  - (Handout) Unexpired appointment requests that are manually removed from the Appointment Request workqueue can be made reschedulable.
• Order Up Scheduling for Clerical Staff  - (Handout) Order Up, available from a patient's Appointment Desk, allows staff to schedule quickly and easily from an Appointment Request. Only available for some Appointment Requests.

Accident Related

• Accident-Related Encounters (Claim Information Record)  - (Handout) When scheduling or checking in an accident-related appointment, additional information needs to be collected regarding the accident. Claim Information Records keep track of information related to an encounter that is accident-related. A Claim Information Record must be created for the accident and attached to each encounter related to that accident.

Appointment Desk

• Accessing an Existing Patient's Appointment Desk  - (Handout) Accessing the Appointment Desk for an existing patient will require a search by their name/MRN.
• Appointment Desk Components  - (Handout) Most scheduling starts from the patient’s Appointment Desk. The Appointment Desk displays information regarding the patient’s demographics, guarantor, insurance coverage, appointment history, future appointments, schedulable orders, and more.
• Appointment Desk Overview (CAD050)  - (eLearning: 3 min) Video provides an Overview of the Appointment Desk.
• Appointment Desk Patient Messages - (Handout) Patient Messages can be used to communicate scheduling details about a patient. These messages display on the patient’s Appointment Desk sidebar and in Access Storyboards.
• Filtering the Appointment Desk  - (Handout) The Appointment Desk tabs can be filtered to display only relevant information.

Appointment Alerts

• Confirming an Appointment Accidentally Canceled by a Patient Using Interactive Appointment Reminders  - (Handout) If a patient erroneously cancels their appointment via text or e-mail when they meant to confirm the appointment and the cancelation has not yet processed in Epic, UIHC staff can intervene and correct this pending cancelation by confirming the appointment for the patient in Epic.
• Documenting a Patient’s Appointment Notification Preferences  - (Handout) Patients can choose to be notified via email and/or MyChart (or opt out of notifications) when any of the following occur: an appointment is scheduled, canceled, changed, or missed (“Appointment Notifications”); an AVS is available; a wait list offer has been sent. These preferences are stored in the patient’s Communication Preferences activity and can be turned on or off by staff per the patient’s preference.
• Documenting Appointment Reminders  - (Handout) Appointment Reminder Preferences indicate how a patient prefers to be contacted to remind them of an upcoming appointment. Up to two reminder types can be selected.
• Patient Updates from the DAR  - (Handout) In case of a clinic delay or similar clinic disruption in which a patient notification is necessary or of benefit, supervisors can send a message for affected appointments from the Department Appointments Report (DAR).

Cancel/Reschedule/Moving Appointments

• Canceling and/or Rescheduling an Appointment  - (Handout) An appointment can be canceled and/or rescheduled from the patient’s Appointment Desk or the DAR.
• Converting Office Visits to Telemedicine Visits for Front Line Staff  - (Handout) There are may be times when it might be necessary to convert current in person appointment to telemedicine appointments, either due to patient condition or provider/ clinic availability.
• Moving Appointments between Providers  - (Handout) Appointments can be moved from one schedule to another in the View Schedules activity.
• Reschedule Report  - (Handout) The Reschedule report can be used to find and contact patients when they need to be rescheduled due to a provider change (eg, template change).
• Using the Follow-up Report  - (Handout) The Follow-up report allows users to track and process incomplete appointments.

Care Everywhere

• Identifying a Care Everywhere Referral  - (Handout) Care Everywhere referral information will display in various activities in Epic and the Care Everywhere activity can also be opened from these activities.

Chart Review

• Opening Chart Review for Front Desk Users  - (Handout) Front Desk users can most easily open Chart Review from Patient Station.

Customer Relationship Management (CRM)

• CRM for Schedule Variance Tracking  - (Handout) When a scheduling variance is identified or perceived to be outside of “ideal” scheduling or check-in times, a CRM is created to document the variance and outcome.

Facilitated Access

• Scheduling a New Patient Visit for a Facilitated Access Patient  - (Handout) “Facilitated Access” patients are patients who have been determined to be offered improved access for new patient visits. These patients will have one of the UI insurance plans. To improve access for facilitated access patients to new patient visits / appointments, these patients should be scheduled within 10 calendar days. If the 10-day window is not accommodated during scheduling, a warning will display alerting the scheduler to schedule within 10 days after selecting the slot. If the scheduler continues forward through the warning and schedules the visit beyond the 10-day window, they are prompted to select a reason.
• Automatic Ticket Scheduling  - (Handout) For some orders, patients can receive a “Ticket” for scheduling. This means the patient can schedule the follow up visit for themself in MyChart or from an email link if they don’t have MyChart. The orders will display in the relevant workqueue as well.
• Bundle Scheduling Tickets (CAD906)  - (Elearning: 4.5 min) If a patient has multiple orders that are appropriate to send as tickets to MyChart, the tickets can be bundled and the scheduling order can be specified when appropriate.
• Bundle Scheduling Tickets  - (Handout) If a patient has multiple orders that are appropriate to send as tickets to MyChart, the tickets can be bundled and the scheduling order can be specified when appropriate.
• Manual Ticket Scheduling (CAD903)  - (Elearning: 8 min) Learn how to send patients with MyChart an appointment request for self-scheduling.
• Manual Ticket Scheduling  - (Handout) Learn how to send patients with MyChart an appointment request for self-scheduling.
• Sending a MyChart Activation Message  - (Handout) The MyChart Signup activity can be used to generate an activation code and email or text it to the patient. This is only available for patients age 12 and older.
• Send MyChart Message from the Appointment Desk  - (Handout) For patients with Active MyChart accounts, MyChart Messages can be sent from their Appointment Desk.
• Documenting a New Call Patient Communication  - (Handout) The New Call feature allows users to record communication with a patient, such as attempts to reach the patient to schedule an appointment.

Patient Care Teams and Sensitive Visit

Patient Care Teams

• Adding a Provider on the Fly  - (Handout) The Provider on the Fly activity allows users to create a provider record when it does not currently exist in the system.
• Marking a Visit as Sensitive  - (Handout) Marking a visit as “Sensitive” will prevent the visit-level documentation from being shared with outside entities. The documentation will not be available through the Iowa Health Information Network (IHIN), Care Everywhere, UI CareLink, or Comm Management, but will be viewable to the patient in MyChart. This functionality is only available for outpatient visits.
• Patient Care Team/EMR Information Sharing Matrix  - (Handout) This matrix provides details on the Epic activities used to share patient information from the Epic system.
• Updating the Patient Care Team During Scheduling, Check In, and Registration  - (Handout) The Patient Care Team activity provides a single access point for managing the relationships a patient may have with a variety of providers involved in their healthcare. The Patient Care Team is reviewed and updated during Scheduling, Check In and Registration. (Other roles have access to edit the Care Team, as well.) In addition, the PCP is verified on the Checklist during Scheduling and Check In workflows when it displays as unverified.

Patient Lookup

• Potential Duplicate Records Window  - (Handout) When creating a new patient MRN (Medical Record Number), the Potential Duplicate Records Window will pop up showing any patients with similar information. Closely review this information to determine if a potential duplicate patient may already exist. If there’s an existing match, then use the existing patient MRN rather than creating a duplicate.

Patient Not Present

• Patient Not Present Appointments  - (Handout) The “Patient Not Present” (PNP) scheduling workflow is used when a Hospital Account Record (HAR) needs to be created for a patient that is not present but for whom billable services are being provided. Examples of when a Patient Not Present encounter would be used include: • Various lab specimens received • Outside tests are performed and sent to the UIHC to be read by our providers, including radiology exams • Optical Shop & contact lens • Pathology specimens for diagnosis/consultation • Other reasons Staff may schedule same-day appointments using the standard scheduling workflow or they may use One Click. One Click must be set up for a department. To schedule appointments for past dates, the standard scheduling workflow must be used.

Provider Schedule

• Interpreting Provider Schedules (CAD060)  - (Elearning: 5 min) The Schedules view in Book It and the View Schedules activities show the schedule for a provider.
• Interpreting Provider Schedules and Making Minor Changes  - (Handout) Schedulers can access the provider schedule during the scheduling workflow using Book It. The provider schedule can also be accessed without being in the middle of the scheduling workflow using the View Schedules activity. Both activities allow users to schedule and make short-term edits or exceptions to a provider’s schedule.
• Making Minor Changes to Provider Schedules (CAD016)  - (Elearning: 11.5 min) Make minor changes to a provider's schedule, including setting time and individual days on hold and unavailable, and editing slots.
• Running the Template Audit Trail Report  - (Handout) The Template Audit Trail Report displays changes made to a provider’s template, including the type of change made, date and time of the change, and user who made the change. The report can be run from within the Edit Template or Edit Template for Single Day activities, or through the Epic button.
• Updating the Encounter Provider  - (Handout) The Schedule Provider Change button allows the user to update the Encounter Provider from the Schedule.

Quick Care and Urgent Care

• Marking an "Open Scheduling" Time Slot "Unavailable" for Quick Care and Urgent Care  - (Handout) Under certain circumstances, Quick Care and Urgent Care front desk staff may need to mark “Open Scheduling” time slots “Unavailable” so that patients cannot self-schedule into them.
• One Click Scheduling for Quick Care and Urgent Care  - (Handout) Front desk staff at Quick Care and Urgent Care locations schedule patients upon their arrival to the clinic using “One Click” Scheduling.

Scheduling with Referrals

Referrals website

Surgical and Procedural Pre-Authorizations

DDC, Dermatology, HVC, Neurosurgery, OBGYN,Orthopedics, Ophthalmology, Otolaryngology, Surgery, Urology, and Vascular Surgery

• Scheduling Procedural Appointments from the Schedule Referrals Workqueue  - (Handout) A referral record is automatically created from a case or procedure order. Procedure orders that require appointment scheduling will appear on the Schedule Referrals workqueue.

Incoming and Internal Referrals

Note: Incoming and Internal Referrals content has been moved to the web page below.

Incoming and Internal Referrals website

Registration

• Adding Guarantor Account Notes During Scheduling  - (Handout) When there are changes to a patient’s insurance information, if the patient already has a guarantor record, schedulers may add a Guarantor Account Note to collect the insurance information. This information will fall to a PFS Registration Workqueue so the insurance can be updated later.
• Cadence Registration (Appointment-Level & Patient-Level)  - (Webpage) Registration is reviewed and updated during scheduling, check in, and check out. Appointment-Level information is specific to the appointment or visit, such as bill area and referring provider. Patient-Level information pertains to the patient regardless of the appointment (ex: patient demographics).
• Overview of the Snapboard  - (Handout) The Snapboard is most commonly used to view, edit, and schedule appointments.
• Changing an Appointment from the Snapboard  - (Handout) Date and Time of appointments, Appointment Notes, Providers/Resources (for example, if the CRC Check-In Desk was forgotten), and Appointment Lengths can all be changed from the Snapboard by using the right click menu.
• Using the Wait List  - (Handout) The Wait List is used to track patients who either have an appointment in the future but want to be seen sooner, or do not have an appointment in the future but want to be contacted if there is an opening.

Workqueues website

• Canceling a Request from the Appointment Request Workqueue  - (Handout) Requests on the “Active” tab of the Appointment Request workqueue can be manually canceled.
• Deferring within Workqueues  - (Handout) Users may defer a list item within a workqueue for a given length of time. This moves it to the Defer tab of the workqueue. At the end of the given length of time, the list item (e.g. account or transaction) will return to the Active tab of the workqueue.
• Filtering Workqueues  - (Handout) Workqueues can be filtered and saved as favorites to provide quick and easy access to the most commonly used workqueues.
• Reviewing Workqueue List Basics  - (Handout) To find patients that have referrals and need to be scheduled, the Referrals Workqueue List is used to quickly find these patients.
• Transferring Requests in the Appointment Request Workqueue  - (Handout) Requests in the Appointment Request workqueue can be manually transferred from one departmental workqueue to another. A reason for can also be entered to clarify why the order is being transferred.
• Working Front Line Patient Workqueues  - (Handout) Front line Patient workqueues are worked by staff on a daily basis to correct errors on appointments that must be fixed.

Return to  Cadence (Scheduling/Check In/Check Out)

Return to Epic Resources

Improving Patient Scheduling Outcomes with Epic

Co-authored by Brennan Turner, President and Co-Founder of The Joiner Firm .

Scheduling patients can be a deceptively complex process. While the idea of a patient selecting a time slot seems simple enough, there are several questions to consider:

• Does the patient have general questions or specific symptoms that may require an appointment with a specialist?
• Does the patient have an existing relationship with a provider?
• Is the patient new to the healthcare system?

As you can see, a clinic’s scheduling process is important in ensuring that appointments are scheduled accurately.

Appointments scheduled incorrectly are not always identified right away. In many instances the patient has already arrived, or the appointment is canceled at the last minute. This makes it difficult to ensure schedules are full and the provider’s time is maximized. When appointments are scheduled correctly the first time, there will be fewer last-minute cancellations and visit volume will increase.

Improving patient scheduling is key. The implementation of decision tree functionality can ensure that the patient is seen by the right provider at the right time. An effective decision tree can remove barriers to patient access, increase patient satisfaction, decrease revenue loss, and ensure effective time management. Decision trees are an Epic functionality that utilize rules and logic to aid a scheduler in navigating complex scheduling scenarios. Much of the decision tree logic runs in the background, unbeknownst to the scheduler, and references specific patient data within Epic to guide the scheduler through the scheduling process.

Epic is a leading Electronic Medical Record (EMR) software that stores all patient data, ranging from patient demographics to medical history. Since it is an electronic database, healthcare organizations can leverage this patient data against their specific clinic workflows through the implementation of decision trees.

An effective decision tree can remove barriers to patient access, increase patient satisfaction, decrease revenue loss, and ensure effective time management.

Sendero sat down with Brennan Turner , a senior Epic Cadence consultant with The Joiner Firm , who we recently partnered with at a large healthcare provider to improve their clinic-specific scheduling workflows. We discussed the functionalities and benefits of scheduling with Epic decision trees:

What are Epic decision trees, and how can they help improve the patient scheduling process?

Brennan Turner : Decision trees are scheduling tools in Epic that utilize a set of predetermined questions and logic to guide a scheduler to correctly make an appointment with a clinic, without having to know the specific scheduling rules of each department. This tool can improve scheduling accuracy by making sure the right visit type, provider, and location are selected the first time, with an overall benefit of lowering no-show and cancellation rates.

How does this improve patient satisfaction?

What impact does this have on training of new staff?

Brennan Turner : Scheduling rules are often either stored in a repository, written on a sticky note, or live within the knowledge of seasoned schedulers. This can make it difficult for new staff to schedule appointments accurately, causing frustration for the patient, the clinics, and the providers. With the decision-making process being built within Epic and automated through decision trees, there is less clinic-specific information a scheduler needs to learn.

Decision tree design considerations for healthcare organizations

An effective decision tree is not a one-size-fits-all solution. Each organization needs to consider their unique requirements and operational needs:

Considerations for Clinics

Decision trees can provide a high degree of automated control to ensure that patients are being scheduled for the right visit at the right time with the right provider:

• Clinic level payor restrictions can be built to filter out certain insurance types. The decision tree uses logic in the background to determine if a patient’s primary insurance is accepted at a clinic.
• Age restrictions can also be built at the clinic level if there is a certain age group that the clinic does not see. As noted above, a pediatric clinic can set an age restriction to only accept new patients over 2 years of age.
• Clinics with subspecialists or unique programs can also utilize decision trees to aid in scheduling accuracy. For example, a clinic with a weight-management program can ensure qualifying patients are scheduled in the right time slots with the right subset of providers.

Considerations for Physicians

Every physician, regardless of their practice, serves a unique panel of patients. Decision trees can help maintain unique workflows through monitoring patients’ reasons for office visits.

To ensure that patients’ concerns are not only identified prior to the visit, but also scheduled properly, a decision tree can be built to “flip” an appointment type to the proper visit type. A series of questions can be asked by the scheduler to determine if the original visit type is correct. For example, a patient with multiple concerns may need a little extra time, so the decision tree can suggest offering an extended office visit vs. a standard office visit. Additionally, a patient could call in with a specific concern that warrants its own specific type of visit, such as ADD/ADHD care.

Considerations for Implementation

Implementing decision tree functionality is no light undertaking; it involves detailed conversations across the clinic to verify that no details are overlooked in the process. To ensure that decision trees are inclusive of the entire clinics’ workflows, meetings need to be held with clinic management, subject matter experts, front desk personnel, and anyone else that may be involved in the scheduling process. It is very important at this step to get everyone past a theoretical understanding of what Epic can do and get them to critically think about how this application will affect their scheduling if they were to solely rely on it to accurately reflect their clinic processes.

Epic decision tree design is a complex process involving detailed scrutiny prior to the build and implementation phase. Sendero’s partnership with Epic allows for technical analysts to obtain the necessary clinical considerations and focus on building an effective program. We can liaise with a clinic and focus on communication, process alignment, and project execution.

Interested in learning more about Sendero’s expertise in this area? Use the form below to reach out to one of our consultants.

By Christina Speros and Harris Neuens

Decision trees can improve scheduling accuracy by making sure the right visit type, provider, and location are selected the first time, with an overall benefit of lowering no-show and cancellation rates. Brennan Turner, President and Co-Founder of The Joiner Firm

More Case Studies

A large non-profit healthcare provider experienced significant growth through mergers and acquisitions, now providing services to more than five million patients. As a result, the organization faced a multitude of overlapping strategic and departmental initiatives.

After the merger of two large Texas-based healthcare systems, a need existed to change to one electronic medical record (EMR) system across the enterprise.

After a healthcare system went through a merger, they launched a project to consolidate Find a Doctor websites to improve the patient experience.

A large healthcare system was notified that it is now required to report compliance as one entity, rather than separate small business units. Through existing relationships, the client learned of Sendero's experience with PCI Compliance and requested assistance.

About the Author

Harris is a Consultant in our Dallas office with industry experience in healthcare and financial services.

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Epic Simple Visit Coding: 7 Optimization Tips

Meet Leigh Ann Braswell. She’s been in HIM for more than 25 years. She’s led high-functioning coding teams within enterprise-level health networks. She’s spearheaded a conversion to Epic’s EHR across 30 hospital sites—some at the same time! And she’s an absolute wizard at Simple Visit Coding, a feature already built into Epic that automates high-volume, low-risk accounts.

Leigh Ann also loves to help others. That’s why she recently shared her wisdom in a lively webinar, “Making the Most of Epic Simple Visit Coding.” It attracted quite a large crowd—and attendees had lots of compelling questions.

Lehigh Ann unpacked these 7 tips that HIM directors can use right away to maximize Epic Simple Visit Coding, overcome the nationwide shortage of medical coders, and kick their revenue cycle into high gear.

• Know the Epic Simple Visit Coding Criteria

Epic uses these four high-level Code Capture Rules you can implement for Simple Visit Coding:

• Diagnosis coding
• Pulling diagnosis from upstream sources. This can include provider orders, referrals, registration, charges, visit diagnoses, or previously coded accounts (recurring series) based on your compliance policies.
• CPT/HCPCS pulled from charges/CDM upstream.
• Accounts that fail coding validation errors will route to a work queue.

When building rules to process coding validation errors, Leigh Ann uses the provider order as a single source of truth. “If the order wasn’t directly entered into Epic itself, it’s definitely a training opportunity for frontline staff,” she says.

Another helpful tip: Make sure your most skilled human coders operate the error work queue. Doing so will boost coding accuracy. “Out of 30 hospitals, on a good day maybe we had 10 – 15 errors for all  Simple Visit Coding accounts,” she says. “That’s because the rules were built correctly.

• Use Simple Visit Coding on Day 1 of your Epic Go-Live

You can start Simple Visit Coding right away. However, many organizations want to see how it works before making a full commitment. No matter when you start, it’s wise to begin with specific accounts. The best early candidates are lab, outpatient therapies (physical, occupational, or speech therapy), lactation, massage therapy, and other accounts that don’t require an interpretive report.

• Identify the best candidates that can help you expand Simple Visit Coding.

Your list of accounts will depend on your health system, the type of services you offer, and your payer and state requirements. Common outpatient service lines to implement in addition to the early adapters listed above include

• Cardiac rehab
• Cash-flat services (massage therapy, calcium scoring, etc.)
• Dietary or nutritional counseling
• ED left-without-being-seen
• Esophageal motility studies
• Outpatient dialysis
• Pulmonary function tests
• Radiation oncology
• Vaccine-only visits

For certain services, you may need to build rules. For example, screening mammography accounts include an interpretive report, but they don’t require an order. So, you can build rules in Epic that trigger a specific diagnosis for breast cancer screening account when a certain charge is present.

• Work closely with your IT team.

As you expand your Simple Visit Coding capabilities, your IT team will play a vital role. The ideal state: Ask them to build Simple Visit Coding in a support environment first so you can identify any errors. Also, conduct regular audits to make sure your system captures and codes everything correctly.

• Calculate your ROI.

Leigh Ann shares an example of a health system that moves 75,000 outpatient visits to Simple Visit Coding. That will create an estimated labor savings of more than $147,000, equivalent to 2.4 FTEs. “Imagine if you could train those coders on day surgery, inpatient coding, or move them to ProFee coding,” Leigh Ann says. “It’s a great opportunity to train your current staff, and most coders would love the chance to move up.”

• Seek a solution with robust analytics.

Healthcare organizations who choose to partner with DeliverHealth for Simple Visit Coding benefit from Power BI dashboards with in-depth analytics that go beyond what Epic provides. The DeliverHealth platform pulls in Epic data for outpatient claims, so you can track metrics like percentage of Simple Visit Coded cases, Simple Visit Coded denial rate vs. your overall denial rate, and how close you are to achieving an Epic Gold Star, an accomplishment that gives organizations a major marketing boost.

• Expand your horizons.

Once you optimize Simple Visit Coding, you’ve set the foundation for implementing additional efficiencies, including autonomous coding for radiology, which can deliver up to 95% accuracy.

Leigh Ann provided more informative tips, including how to handle combination code rules. You can catch all of her insights in the full webinar. Listen Now .  And if you want to get started with Simple Visit Coding using DeliverHealth’s innovative platform, contact us today .

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template team header

We met with five members of the Ambulatory Capacity Management team—Kim Pacheco, Amy Barrus, Marcie Weiszbrod, Staci Taufer, and Ryan Watts—to talk about their standardization efforts, their improvement benchmarks, and their love of back-end functionality.

In health care, a template is a provider’s schedule

determines the pace of each visit, as well as the number and type of patients a provider is seeing. When Epic first rolled out in 2010, very few employees understood its endless capabilities. That led providers, clinic managers, medical directors, and other front-line staff to get creative with their use of the software, which in turn produced severe scheduling inconsistencies.

Did you know we have an Access Team?

U of U Health's Access Team is a group of functionality experts whose purpose is to make providers’ and schedulers’ lives easier.

Thanks to the access team’s efforts, Epic now makes it easier for schedulers to get the appointment right the first time, removing some of the opportunity for human error. “Clinic staff are the experts in which providers see specific types of patients,” says Marcie Weiszbrod, Ambulatory Access Specialist. “That knowledge must be condensed onto a single piece of paper that schedulers can follow. Anybody who’s worked in a call center or as a scheduler knows it’s stressful work. You have to remember lots of details–for example, three providers in the same specialty do something different–while providing prompt and accurate service to the patient.”

A good template creates better days.

The access team’s work to improve Epic allows schedulers to automate certain criteria: visit type, patient type, appointment length. The team also works with individual providers to create a smoother schedule that allows for downtime. Recently, they worked with a new OB/GYN provider who complained of an erratic schedule: some days were spotty, while others were overwhelming.“ On a good day, she had three return OB patients, whereas on a bad day, she had five new GYN patients all scheduled back to back,” Weiszbrod says. The team programmed a limit of new vs. return patients that allowed the provider to grow her patient volume while spending the time she needed with each patient.

Reducing clinician burnout was what Director Kim Pacheco had in mind when she built the access optimization team. “When we meet face-to-face with a provider to talk about templates, we’re on their side,” Pacheco says. “If their template ends at 5:00 PM, we wonder how we can get them home so they can have a life outside of work. Once the provider understands the back-end functionality of Epic, it sparks creativity for new ideas, too: ‘What about this group of patients? Is there a way we can make their experience better?’”

Before the team worked to improve templates, Ambulatory Access Specialist Amy Barrus says the most common remark they heard was, “Don’t touch my template!” Now, providers understand the benefits of a team to support. Barrus tells providers, “Don’t try to build the system functionality yourself—let us build it for you. We can improve your schedule so that you can achieve your goals.”

Four key components of template optimization :

1. Find yourself overbooked? Reflect reality.

“Reality is always our goal,” Kim Pacheco says. “Don’t just build a template for the sake of building it. That’s how you get overbooked or double-booked, or end up seeing one patient for an hour and another for only 15 minutes. Your template should reflect the reality of your day. If you don’t arrive until 9, don’t open your template until 9:15. If you have a meeting every Monday from 8:00 – 12:00, block that out from the beginning.”

2. Use the system functionality.

“There can be more than one visit type per session per provider,” Ryan Watts says. “If return patients get 40 minutes instead of 60, make that a specific visit type. If a post-surgical follow-up usually lasts 20 minutes, standardize it. That way the scheduler doesn’t have to wonder what duration to use with different visit types.”

3. Build in breaks.

“Every staff member and every provider needs to eat lunch and use the bathroom,” Amy Barrus says. “Building in breaks means you’ll be ready and refreshed for the next session of patients. It also creates a buffer if you or your staff gets behind.”

4. Create a baseline for standardization.

“We like to do 240-minute or four-hour sessions,” Marcie Weiszbrod says. “That creates predictable schedules for providers while increasing access for patients.”

The Access Team’s advice for new providers:

A one-size-fits-all solution doesn’t exist..

The access team works with new providers to build a template that can adjust as they get more comfortable. “We’re not setting these templates in stone; you won’t have to use them for the rest of your career,” Barrus says. The access team will help establish a template with longer blocks of time and then reduce appointment times to a more realistic clinic flow.

Keep your access as open as you can.

“Keep your access as open as you can,” says Ryan Watts, Ambulatory Access Specialist. “If you’re waiting for the perfect patient calling for a perfect time slot, it’s difficult to fill your schedule. Our advice is to hold slots for particular types of patients for a set time, and then open them up to different patients or visit types.”

Get to know your scheduling staff.

Consider visiting the call center or schedulers to meet them. Your scheduling staff is the first contact a patient will have with you. It begins to set patient expectations about your office: how easy it is to see you, how responsive you are, etc. “Let the schedulers put your face and your name together,” Weiszbrod says. “Tell them a few things about yourself. That creates a personal connection with your scheduler, who can build a connection between you and that patient you haven’t even met yet.”

Don’t go it alone–use the team.

“Don’t go it alone and try to become a template expert yourself,” says template optimization team manager Staci Taufer. “We’re here—you can rely on us.”

Kim Pacheco

Staci taufer, marcie weisbrod.

Why do some organizations thrive during a crisis while others flounder? Iona Thraen, director of patient safety, joined forces with her ARUP Laboratory colleagues to learn how the world-renowned national reference lab adapted to the pandemic. Leaders created a culture of safety by putting innovation, learning, and patient-centered care at the heart of all their efforts.

Finding evidence to change the status quo isn’t easy; thinking about evidence in terms of how it persuades—whether subjective or objective—can make it easier. Plastic surgery resident Dino Maglić and his colleagues followed their guts and saved money by improving the laceration trays used to treat patients in the emergency department.

Chronic conditions do not pause during a pandemic. When faced with delaying the care of over 1,000 patients with neurological conditions, Susan Baggaley, Neurology Vice Chair and Ambulatory Chief Value Officer, and Vivek Reddy, Neurology Vice Chair and Inpatient Chief Value Officer, rapidly developed a new virtual visit workflow.

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What’s the difference between a visit and an encounter?

Can you please clarify what’s the difference between a visit and a patient-provider encounter?

( @hmouhtar moving this to a new thread since it’s an OpenMRS data model question.)

You can start reading here for example: Visits, Encounters and FHIR

… but there’s many many more threads, discussions, wiki pages and self-documenting code snippets that give hints as to what visits and encounters are in OpenMRS.

My layman take: a visit is made of a succession of clinical encounters occurring between its start date and its end date. Clinical data is recorded during those encounters: observations, conditions, diagnoses, allergies, drug orders, lab test orders, etc etc,. They are all attached to the encounter during which they were recorded.

An OpenMRS encounter represents a point in time interaction (a clinical transaction) that may contain any combination of orders, observations, form data, notes, encounter diagnoses, etc.

A visit is a collection of encounters that align with a clinical event (e.g., one or more encounters occurring during a patient’s visit to the clinic last Thursday) and can span days or weeks or more (e.g., an inpatient visit that started two weeks ago and comprises dozens of encounters containing daily notes & orders).

Thanks for the explanation, appreciate it! @burke

@hmouhtar some more on the topic actively discussed in the community recently:

Ten Benefits to Epic Scheduling Optimization

When patients call a health system to schedule an appointment, they expect the same experience whether they’re talking to primary care, neurology, or pediatrics. And they expect to be able to get an appointment that meets their preferences for location, date, time of day, and provider.

In theory, this should be an efficient process, but it usually isn’t. In a large organization, different departments and medical practices typically maintain different sets of scheduling rules. These rules often change and, in some cases, are only documented on paper.

👉 Download Your Free Guide to Scheduling Optimization

When scheduling policies and procedures are siloed and decentralized, errors can occur, appointments are missed or skipped, and revenue is lost. This results in a poor patient experience and frustration for staff and providers.

Enterprise Scheduling Optimization

Fortunately, there’s a better way. Using existing functionality within Epic Cadence, an Enterprise Scheduling Optimization Project (ESOP) can help organizations efficiently guide patients to the ideal appointment based on their preferences, resulting in fewer no-shows and better schedule balance, among other benefits.

In our new guide to scheduling optimization , our Epic experts explain how health systems can improve efficiency and increase revenue by getting patients to the right provider at the right time in the right location using automation and questionnaire-driven Decision Trees in the Epic scheduling solution.

An ESOP requires specialized technical expertise from outside consultants and an investment of time and effort from internal staff, but the ROI on these projects can be significant, helping clients achieve the following 10 goals:

• Reduce cancellations, no-shows, and re-visits . Ensuring that visits are scheduled where and when patients want them improves the patient experience, provides for a more predictable schedule, and leads to increased visit volume and practice revenue.
• Reduce number of visit types . This decreases the complexity of scheduling visits with specialty practices, streamlines the scheduling process, and gets patients’ appointments on the books faster.
• Reduce scheduling inbound call length . This allows staff to schedule and confirm an appointment date, time, and provider with a patient in less time, improving the patient experience and decreasing the likelihood of being put on hold.
• Reduce time to Third Next Available Appointment . This common KPI metric is a reflection of expected patient wait time. Decreasing this number increases the likelihood that a patient can schedule an appointment when desired, which improves satisfaction and retention rates.
• Increase first-call resolution . Enable patients to schedule or reschedule an appointment, or otherwise get answers to their questions, without having to hang up and call a practice directly and/or call back when the practice manager is in the office.
• Increase visit volume . With patients less likely to no-show or cancel, practices can conduct more visits in the same amount of time. Increased volume improves efficiency, which in turn improves revenue capture.
• Increase resource utilization . Increased visit volume allows practices to better utilize physical equipment, such as MRI machines or blood labs. Meanwhile, efficient scheduling enables highly skilled clinical staff to “practice to their license” while low-acuity visits types are router to NPs and PAs.
• Reduce insurance claim processing time . Decreasing complexity in scheduling workflows means that patients are more likely to be scheduled for the right appointment at the right time with the right provider. This streamlines claims processing, as errors or missing information are less likely.
• Reduce claims denial rate . The accuracy of information captured when an appointment is scheduled – such as visit type, provider name, and new vs. returning patient – decreases the likelihood that claims are incorrect and therefore likely to be denied.
• Increase revenue capture . The combination of accurate coding, reduced denials, and increased visit volume all enable a practice to capture more revenue.

At Healthcare IT Leaders, our Epic experts have a track record of success with optimizing and centralizing scheduling for large provider organizations throughout the United States. Download our free guide to learn more .

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