AMB 400

Question 1

Procedure Records (EAP):

Answer 1

Nearly all clinical and billing applications use procedure (EAP) records, making the procedure master file one of the most integrated master files in Epic. When placing orders, Epic classifies any order that is not a medication as a procedure (referrals to specialties, imaging, labs, immunizations, etc.).

Overall, procedure records are used for:
1. Placing orders
2. Documenting that a procedure was performed
3. Triggering charges

Due to the wide variety of procedures that exist, there will be a range of records needed to accommodate the procedure build. It is your responsibility to configure, and occasionally build, procedure records as efficiently as possible while ensuring the changes you make impact only the appropriate procedures. This is especially important since procedure records are often shared across teams.

Question 2

Levels of the Procedure Hierarchy

Answer 2

Procedure build relies on a hierarchy to give procedures the settings they need. A hierarchy is a collection of records organized in a specific order. This order is then defined as specific to general. Settings at more specific levels in the hierarchy override settings at more general levels.
The procedure hierarchy has three levels:
1. Procedure (EAP)
2. Procedure Category (EDP)
3. System Definitions (LSD)
(These are listed from most specific to most general)

Question 3

Purpose of the Procedure Record (EAP)

Answer 3

Defines unique settings for a procedure.

Question 4

Purpose of the Procedure Category Record (EDP)

Answer 4

Defines shared settings for a group of related procedures.

Question 5

Purpose of the System Definitions (LSD)

Answer 5

Defines shared settings on a system wide level.

Question 6

Settings Controlled by the Procedure Hierarchy

Answer 6

Consists of:
Procedure> Procedure Category> System Definitions

Records in the procedure hierarchy impact defaults, buttons, allowed values, and more!

Default Value: Defines values that are pre-populated in a field.

Item Buttons: Determines the buttons located to the right of a field.

Allowed Values: Determines the available values for a field.

Question 7

The order composer configuration (OCC) record:

Answer 7

Is an important record for procedure build. It defines the following settings:

1. Controlled Items: Defines fields that are required or recommended in an order composer.
2. Summary Items: Defines details that appear in the summary sentence in the orders cart.
3. Display Items: Defines the fields that appear in an order composer.

Question 8

Linking the Procedure Hierarchy and OCC Records Together:

Answer 8

OCC records can be linked to any level in the procedure hierarchy. Like other settings in the procedure hierarchy, only the most specific OCC settings will be used. While OCC records can be linked to procedure (EAP) records, it is not common to do so.

Question 9

If all lab orders should have a default Order Class of “Lab”, where would be the most efficient place to specify that setting?

a. In each lab procedure record.
b. In the procedure category used for all lab procedures.
c. In System Definitions

Answer 9

In the procedure category used for all lab procedures.

Question 10

If all procedures should have a default Priority of “Routine”, where should you specify that value?

a. In each procedure record.
b. In each procedure category.
c. In System Definitions.

Answer 10

In System Definitions

Question 11

For each of the following, determine if the setting is made in the procedure hierarchy or the OCC:

a. Available buttons in the order composer: __________________
b. The fields on the left side of the order composer: _______________
c. The details that appear in the summary sentence: ________________
d. Default values for fields in the order composer: ___________________

Answer 11

a. Available buttons in the order composer: Procedural Heirarchy
b. The fields on the left side of the order composer: OCC
c. The details that appear in the summary sentence: OCC
d. Default values for fields in the order composer: Procedural Heirarchy

Question 12

To properly build records you need to know how they will be used by clinicians. To accomplish this, you need to talk to:

Answer 12

Subject Matter Experts are often providers or other end users who know the real-world contexts of how a record or tool will be used.

Clinical Informaticists have clinical knowledge as well as build knowledge. They can act as a liaison between you and clinicians, ensuring that information and expectations are communicated successfully.

Question 13

Procedure Order Composer Configuration (In Text)

Answer 13

This screen (clincal administration >management options. View system definitions> procedure scheduling, tasks, page down to Procedure Order Composer Configuration): is where OCC records are linked to System Definitions. OCC records are paired with a context to determine when a certain OCC should be used. This ensures that orders have appropriate display, summary, and controlled items based on the patient encounter or the tool being used.

Question 14

EpicCare Order Type is used throughout Epic to determine:

Answer 14

How orders should be handled.

Some examples include:

• Order transmittal rules evaluate order type as a property
• Chart Review will sort different orders by order type
• Print groups can change what appears based on order type
• Extensions may use order type to define an action

A user will not be able to sign a procedure unless there is an EpicCare Order Type defined.

Question 15

Order (ORD) records are created when?

Answer 15

When a clinician signs an order for a Procedure (EAP) or Medication (ERX) in an outpatient order mode

These ORD records store information about an order such as date, authorizing provider, status, class, and more! Procedure orders with a status of normal, future, or standing will generate one or more ORD records to store information about the order and the results.

Normal: Normal status orders generate a single ORD record which is released immediately. That record is referred to as a child order and stores information about the signed order details as well as the results for that order.

Future: Future status orders generate two ORD records: a parent and a child order. Both store details about the order. The child order is an exact replica of the parent order but is capable of storing results for that order.

Standing: Standing status orders will have one parent ORD record and multiple child ORD records. Just like future orders, the child records are where result information is stored.

Parent and child orders are all created simultaneously when an order is signed. Normal status orders are released upon signing and acted upon within the same encounter. Future and standing child orders will either be automatically or manually released for further documentation.

Question 16

In a procedure category for assay labs, two buttons are set up for Class. However, when users order the iron assay lab, they see four buttons for Class. How is this possible? (Choose one of the following):

a. The four buttons are defined at the System Definitions level.
b. The four buttons are defined in the OCC attached to the procedure.
c. The four buttons are defined at the procedure level.
d. Two of the buttons are coming from the procedure, and the other two are coming from the procedure category.

Answer 16

C: The system searches for details using the procedure hierarchy, so there must be four buttons defined in the iron assay procedure record. As a note, the OCC does NOT control buttons.

Question 17

There is a lab test with a specified default status. For just this order, you want to hide the Status field in the Order Composer so it cannot be changed by users. How can this be accomplished? (Choose all that apply)
a. Remove the status as an allowed value in the procedure.
b. Create an OCC record that does not include status as a display item.
c. Create an OCC record and set status as a “hidden” item.
d. Link the OCC you created to the procedure.

Answer 17

B and D: Create an OCC record that does not include Status as a display item, and link that OCC to the procedure. Without a display item, Status will not appear to the users.

Question 18

True or False: The “Additional Order Details” dropdown in an order composer can only be set up in an OCC record that you link to System Definitions.

Answer 18

False. OCCs (with an ordering context of Additional Outpatient Order Details in this instance) can be linked to all three levels of the hierarchy.

Question 19

True or False: Default status cannot be defined in System Definitions.

Answer 19

True. Default status can only be defined at the procedure or procedure category level.

Question 20

“Building block” records are:

Answer 20

Additional records needed to complete a procedure’s build.

The purpose of a building block record is to be available for procedures when needed. For example, not all procedures will need a SmartText to provide scheduling instructions or a linked immunization.

Examples:
Question (LQL)
SmartText (ETX)
“Chargeable” Procedure (EAP)
Result Component (LRR)
Immunization (LIM)

Question 21

Question (LQL) (Building block record)

Answer 21

an be linked to:
Procedure
Procedure Category

Question records that appear within an Order Composer have a type of “order-specific” and can be restricted by patient age, sex, or other criteria.
When different questions are linked to both a procedure and procedure category, the builder can configure whether questions from both levels should appear or if only the procedure’s questions appear.

Question records that appear in the Immunizations activity have a type of “immunization question”.

ie. “What symptoms do you notice when you have a reaction?”, should appear in the Order Composer for all food allergy procedures.

Question 22

SmartText (ETX) (Building block record)

Answer 22

Can be linked to:
Procedure
Procedure Category

Typically used for instructions and comments.

To use a SmartText for a specific purpose, you must assign it the correct functional type.

Question 23

“Chargeable” Procedure (EAP) (Building block record)

Answer 23

Can be linked to:
Procedure

A “chargeable” procedure (a procedure whose record purpose is chargeable) is used to file a charge to an account when an order has been performed, such as a procedure, service, or supply order.

Question 24

Result Component (LRR) (Building block record)

Answer 24

Can be linked to:
Procedure

When a procedure with linked result component records is signed, those components will appear in the Enter/Edit Results activity. This is useful for clinical support staff who document results. Result component records can specify high/low reference ranges and appropriate values.

Question 25

Immunization (LIM) (Building block record)

Answer 25

Can be linked to: Procedure Immunization records are used to document the details of an immunization administration. For an immunization to appear automatically within the Immunization activity, it must be linked to an orderable procedure. Once that procedure is signed, the linked immunization is available.

Question 26

List some of the “Building Block” records a procedure could use

Answer 26

OCC, SmartText, chargeable EAP, result component, order specific question, etc...

Question 27

True or False: If questions are linked to a procedure and procedure category, questions from both levels can display to the user.

Answer 27

True Questions work differently than other items in the procedure hierarchy. If there are questions linked in a procedure and its category, questions from both levels will display to the user. This behavior can be overridden in the procedure record so that only the procedure-level question(s) display.

Question 28

Questions that appear in an order composer have a type of

Answer 28

order-specific question

Question 29

Questions that appear in the immunization activity have a type of

Answer 29

immunization question

Question 30

What determines where a question appears within the order composer

Answer 30

The OCC (controls display items)

Question 31

Which of the following "building block" records can only be linked to the procedure level in the procedure hierarchy? (Choose all that apply): a. "Chargeable" Procedure (EAP) b. Immunization (LIM) c. SmartText (ETX) d. Result Component (LRR)

Answer 31

A, B, and D: These three building block records can't be linked to a procedure category or system definitions. A SmartText (ETX) can be linked to either the procedure or the procedure category.

Question 32

True or False: To document a patient-reported immunization, a procedure record must exist.

Answer 32

False - Patient-reported immunizations only need an immunization (LIM) record and can be entered in the immunization activity.

Question 33

Your users want the question, "Is the patient pregnant?" to appear for all diagnostic imaging tests, when appropriate, based on patient information. What steps should you take to complete this build? (Choose all that apply) a. Create an order-specific question record with the appropriate question. b. In the question record enter appropriate restrictions for age and sex. c. Link the question record to the appropriate procedure category. d. Verify the "questions" display item is in the OCC impacting the procedures.

Answer 33

A, B, C, and D: An order-specific question record should contain the appropriate question and restrictions. It should be linked to the procedure category impacting the diagnostic imaging orders since it is a group of related procedures. In order for a question to appear in the order composer there must be a "questions" display item in the OCC impacting the procedures.

Question 34

What is a Preference List

Answer 34

It is list is a collection of records (medications, procedures, diagnoses, etc.) that allow users to easily find and select the entries they most commonly use. Preference lists can be built by builders for the purpose of simplifying or restricting the options that are available to a group of users, or they can be created on-the-fly by individual users that want to have their own list of frequently-used records. Preference lists are available across Epic's clinical applications. However, the number and type of available preference lists depends on the application. EpicCare Ambulatory can be configured to use preference lists for: Medications, procedures, and order panels Reason for visit codes Common diagnoses Level of service codes Flowsheet templates Supplies ...and more! Two Masterfile's used for building Preference lists: Preference list Editor (EDP) Preference list Composer (LPF)

Question 35

Preference List Editor (EPD)

Answer 35

Lists a collection of non-orderable records. Does not allow you to override details of the records. An EPD preference list is simply a collection of records. Examples include reason for visit, common diagnoses, level of service codes, and speed buttons. The Preference List Editor is used to build preference lists for non-orderable records such as diagnoses, reason for visit, and level of service codes. These preference lists are often used to create a collection of speed buttons. Speed buttons save time, and clicks, and can be created for: SmartTexts Reasons for visit Levels of service Visit diagnoses ...and more!

Question 36

Preference List Composer (LPF)

Answer 36

Lists a collection of orderable records. Allows you to override details of the records. Such as default selections, additional questions that appear in the order-composer, or pre-written comments and instructions. Examples include medications, procedures, and order panels. The Preference List Composer is used to build preference lists for orderable items and override the values set in medication and procedure records. Often the same order will be added to a preference list multiple times, with different default values, to saves clinicians time and clicks.

Question 37

Types of Orders (LPF) Preference Lists

Answer 37

1. System preference lists are lists intended for use by groups of users in your facility. System preference lists (LPF) can be specified at any level of the profile (LPR) hierarchy or facility structure. Administrative settings determine what types of preference lists are enabled, how they appear, and how they can be used. 2. User preference lists are specific to an individual clinician. A clinician specifies orders that are commonly used. Depending on the clinician's security and on system settings, users can modify their user preference list from the Preference List Composer or from an order entry activity. 3. Frequent Orders preference lists are lists created by the system for individual clinicians when they place an order at least four times with the same order details. These lists will hold up to 100 orders and present clinicians with the orders that they most often sign at their current (EAF) location. LPF preference lists appear on the Browse, Preference List, and Facility List tabs of the Order and SmartSet Search window. NOT DATABASE

Question 38

Flowsheet macros

Answer 38

Enable users to complete their flowsheet charting more efficiently by pulling in commonly documented values simultaneously. Macros can be created by the build team, and users can also create their own. For real-world build, you would consult the clinicians that use this flowsheet to learn the values they most commonly document

Question 39

Flowsheet Structure

Answer 39

**Template (FLO)**: contain collections of group and row records. In the Flowsheets activity, they display as tabs. You can search within the activity to look up additional templates. Templates can also be embedded in a navigator section when specified in a section's navigator configuration (VCN) record. You'll learn about this in the next chapter. **Group (FLO)**: are used to organize and collect row records. They help divide the flowsheet into logical sections. **Rows (FLO)**: are the distinct questions or fields in the flowsheet in which users enter data.

Question 40

FLO Record Types:

Answer 40

Since groups and rows are both in the FLO master file it is important to define Row Type when creating an FLO record. Flowsheet Groups have a row type of "Flowsheet Group". Flowsheet Rows can have a variety of functional purposes and available features. In ambulatory settings, "Data" is the most common row type and is used for entering discrete information about a patient. Naming conventions are important! To easily identify if a FLO record is a group or a row, make sure you create records with clear naming conventions. FLO record prefixes: 'Group: G Row: R A flowsheet row (FLO) with a Row Type of Custom Formula can do mathematical calculations. In training, a custom formula row has been pre-built for you. You just need to add your new row to the formula. The custom formula can look to row records that have a Value type of Numeric Type or Custom List. For custom list rows, each Value needs a numeral as its Abbreviation. When writing a Custom Formula, list row record IDs as either {Row ID} or [Row ID]. Using parentheses around a number will only be recognized as a number and not a record ID.

Question 41

Cascading Flowsheet

Answer 41

Is a flowsheet that hides many more groups and rows that could appear if users needed them! The "trigger row" will un-hide, or cascade, a separate group corresponding to that selection. To configure cascading, follow two basic steps: 1. Set initially hidden groups or rows as Start Removed in the record they are linked to. 2. Configure logic in a row record that will trigger when the hidden groups or rows should appear. This row is often referred to as the "trigger row". Note: The term "trigger row" is used to refer to a row that contains cascading rules. Groups that should be hidden will be marked "Start removed"

Question 42

If you wanted to mark the flowsheet group as "Start Removed", which record would you open to find that setting?

Answer 42

The template record.

Question 43

If you wanted to mark the flowsheet row as "Start Removed", which record would you open to find that setting?

Answer 43

The group record.

Question 44

Flowsheet Smartlinks

Answer 44

A common clinician request is to include flowsheet data in a note. This data can be pulled into a note using a SmartLink. Two SmartLinks commonly used pull in flowsheet data are: .FLOW: Pulls in flowsheet data for specified rows and groups from the current encounter. Displays selected values. .FLOWABBR: Pulls in flowsheet data for specified rows and groups from the current encounter. Displays selected abbreviated values.

Question 45

Row type

Answer 45

Defines the purpose for an FLO record. Some examples include: Data, Flowsheet Group, Custom Formula, etc...

Question 46

Value type

Answer 46

Defines the type of information you can enter in a row.

Question 47

You have a flowsheet that cascades immediately when the criteria is met. Instead, you want a window to appear to verify the assessment you want to add to the flowsheet. How can you accomplish this? (Choose one of the following): a. Change the cascading Method to "Add without prompting users". b. Change the comparison operator to "equals, with prompt". c. Change the Abbreviation for the "yes" value in the custom list. d. Change the cascading Method to "Prompt users".

Answer 47

D: The cascading method determines how the system reacts when cascading occurs and whether the user is prompted or not.

Question 48

Advanced Navigator Build

Answer 48

Clinicians in different specialties need to review and document different information during an encounter. As a clinical builder, you can configure navigators to fit the needs of these specialties. Customizing navigator sections with Navigator Configuration (VCN) records, will show or hide sections with Extension (LPP) records, and the steps needed to create a dual pane navigator.

Question 49

Navigator Configuration (VCN) Records

Answer 49

They control how a section (within the Navigator LVN (Remember Template/Topic/Section)) record looks and behaves. In many cases, navigator configuration records serve as a "bridge" between the section and another record or activity. In other cases, navigator configuration records can control a section's behavior, available options, or appearance. Without a VCN, navigator sections have very few configurable option

Question 50

Navigator Configuration Section Types

Answer 50

Each navigator configuration record has a section type, which determines what configuration options are available. Navigator configuration records can only be linked to sections with a similar type. Here are some examples of common configuration types: * Flowsheet: Configure a navigator section to display a flowsheet template. * Print Group Report: Configure a navigator section to display a report that is either expanded or collapsed. * SmartForm Flowsheets: Configure a navigator section to display a SmartForm (LQF). * Medication Documentation: Customize options for the Med Documentation section, which is used for medication reconciliation. * Activity Link: Create "jump to..." sections that take you to other activities in the patient's chart. * Meds & Orders: Control the details that appear in the Meds & Orders section based on the specialty. ...and many more!

Question 51

Embed Flowsheets in a Navigator

Answer 51

Specialties like using flowsheets to collect data specific to their discipline, but asking clinicians to open the Flowsheets activity and search for an appropriate template interrupts their workflow. Using a navigator configuration record, you can link a flowsheet to appear within a navigator section, making the documentation process much smoother.

Question 52

Duplicate a Navigator Section for Displaying Flowsheets

Answer 52

Epic releases hundreds of standard navigator sections. In many cases these navigator sections are hard coded to behave a certain way. Epic has also created sections that are intended to be duplicated and modified. These Epic released sections have appropriately predefined settings, like the Prog ID and View Path, that are essential for a section to function properly. Builders who want to create a new section should only do so by duplicating an Epic-released section. This ensures that the Prog ID and View Path is accurate. Avoid editing the Prog ID or View Path unless you work with an Epic Technical Services (TS) staff member.

Question 53

Topic Level Override

Answer 53

In the previous scenario you created a navigator configuration record and linked it to your section. As a result, all navigators using that section will see the changes configured by that VCN. This is appropriate when all the clinicians using that section want those changes, but what if only some clinicians want those changes? For example, consider a navigator section used for medication documentation. Most departments that use that section want the same settings for it, so a VCN record with those settings is linked directly to the section. The pediatrics department, however, wants different settings than everyone else. In order to give the pediatrics department the settings they want, without changing the settings for everyone else, a VCN needs to be built and linked to a navigator topic instead of the section. A VCN linked to topic will override a VCN linked to a section. As long as the pediatrics department has a unique topic that contains the medication section, linking a VCN to that topic will make the change for only them!

Question 54

CER Rule

Answer 54

Extension records can evaluate information on their own but can link to CER rules for more complex evaluations. Filter extensions (LPP) are used to make sections appear under certain conditions and will often reference a CER rule to determine the criteria.

Question 55

Extension Records (LPP)

Answer 55

Extension records with a type of visit navigator filter can be linked to navigator sections to cause them to appear or be hidden.

Question 56

True or False: VCN records can be linked to a navigator section directly or to the topic that contains that section.

Answer 56

True

Question 57

Which record can control what displays within a navigator section as well as its behavior? (Choose one of the following) a. Extension (LPP) b. Topic (LVN) c. Rule (CER) d. Navigator Configuration (VCN)

Answer 57

D: The Navigator Configuration record is used to embed records like flowsheets or reports into a navigator section, as well as change things like button options, button captions, help text, default selections, and more!

Question 58

What combination of records can be used to determine when a navigator section appears in a patient's workspace? (Choose all that apply) a. Extension (LPP) b. Topic (LVN) c. Rule (CER) d. Navigator Configuration (VCN)

Answer 58

A and C: Extension records can be linked to CER Rules to evaluate information and filter navigator sections.

Question 59

When creating a dual pane navigator, each pane requires at least one ___________. (Choose one of the following) a. Extension (LPP) b. Topic (LVN) c. Rule (CER) d. Navigator Configuration (VCN)

Answer 59

B: Topic (LVN)

Question 60

True or False: A navigator configuration record linked to a section will impact all templates using that section, unless it is being overridden by a navigator configuration record linked to a topic.

Answer 60

True

Question 61

Navigator sections can only link to navigator configuration records of the same ___________. (Choose one of the following) a. Master file b. Class c. Type d. Value

Answer 61

C: Type determines available screens in a VCN as well as where it can be linked.

Question 62

SmartSet Structure and Records

Answer 62

SmartSets help clinicians work through common encounters quickly and efficiently by putting multiple items for an encounter in one place. These items include SmartTexts, diagnoses, orders, level of service codes, and more! By using a SmartSet, common encounters take fewer clicks and have fewer documentation errors. SmartSet Structure - Clinician's Perspective From a clinician's perspective, a SmartSet consists of sections, which contain subsections, which contain selectable items. SmartSet Records - Builder's Perspective From a builder's perspective, a SmartSet (PRL) contains sections, which link to SmartGroups (OSQ), which link to items.

Question 63

BestPractice Advisories (LGL)

Answer 63

BestPractice Advisory (LGL) records are used to evaluate data and suggest or restrict SmartSet build. BestPractice Advisory records, or BPAs for short, ensure that clinicians have the appropriate SmartSet build for each unique patient.

Question 64

Suggest and Restrict a SmartSet

Answer 64

You can increase the usefulness of a smartset by causing them to be suggested or restricted based on information from the encounter at hand. Ie. Reason for visit diabetes.... smartset suggested is for diabetes Male child : can not select prenatal smartset

Question 65

Smart Group

Answer 65

only links items that have a similar purpose

Question 66

CER Rules

Answer 66

CER rules are records in the CER Masterfile. CER rules evaluate data and return either TRUE or as FALSE. For ambulatory build they commonly evaluate information about the patient and where they are being seen, such as age, reason for visit, lab results, medications, history, department or provider specialty, and more! Note that CER rules are different than workflow engine rules or order transmittal rules. CER rules are made up of criterions that contain three basic components: properties, operators, and values.

Question 67

CER component: Property

Answer 67

The data point that is being evaluated. A CER rule can contain multiple properties. Examples: reason for visit, department, family history.

Question 68

CER component: Value

Answer 68

The data stored for a given property. Think of it as the "answer" to a property. Examples: 18, pediatrics, diabetes.

Question 69

CER component: Operator

Answer 69

The relationship between a property and a value. Examples: equals, not equals, greater than, less than.

Question 70

CER component: Criterion

Answer 70

A line within a CER rule consisting of a property, value(s), and operator.