COVID 19 Guidance EPIC Tools Supports Jonathan Snider

COVID 19 Guidance: EPIC Tools & Supports Jonathan Snider, MD President, Newton-Wellesley Medical Group NEWTON-WELLESLEY HOSPITAL 1

Covid-19 test order process NEWTON-WELLESLEY HOSPITAL 2

Official Triage Tool • Now available to non-clinical users • If patient meets criteria, will allow you to place actual covid lab pcr order. ▹ No longer a referral • Patient will be scheduled for testing tent. ▹ NOT A WALK UP ▹ Scheduling team will call once the order is placed • Result will flow back to original ordering provider NEWTON-WELLESLEY HOSPITAL 3

Official Triage Tool • Input symptoms, or if asymptomatic choose appropriate indication for asymptomatic screening if applicable • Any of these symptoms will meet criteria NEWTON-WELLESLEY HOSPITAL 4

Official Triage Tool In the Plan section, document plan and any further plan details if desired. You will see recommendation for lab test, referral to RIC, or patient not meeting testing criteria. This is where we have changed from proposing the referral order to the Lab Covid Order itself. NEWTON-WELLESLEY HOSPITAL 5

Official Triage Tool Go to the Best. Practice section to order the COVID-19 PCR test or refer for Respiratory Illness Clinic as appropriate. NEWTON-WELLESLEY HOSPITAL 6

Official Triage Tool NEWTON-WELLESLEY HOSPITAL 7

Place the Order NEWTON-WELLESLEY HOSPITAL 8

Add the day of test desired NEWTON-WELLESLEY HOSPITAL 9

COVID Tent Testing Operations • Once the test order is placed, the tent’s scheduling team will call the patient to schedule testing. Test order results will be routed to the ordering provider in most scenarios. • Document a note pre-populated with answers from the form by using the COVID-19 Triage Quick button. • COVID tent operation dedicated line 617 -243 -6532 • Hours: ▹ Monday – Friday 9 AM – 7 PM ▹ Saturday – Sunday 9 AM – 5 PM NEWTON-WELLESLEY HOSPITAL 10

Result Management • Labs ordered from Partners Occ Health will have results flow to OCC HEALTH COVID RESULT pool • Employees who had their lab tests ordered by clinicians will have results flow to OCC HEALTH Triage pool AND the ordering provider. • Patients who called the Partners Hotline will have their results flow to the PHS Emergency Triage Result Pool • Order originating from a specific Surge/RIC clinic will have results route to a department specific pool. (Included NWH below) ▹ NWP AMB URGENT RESP => PHS EMERGENCY TRIAGE RESULT pool ▹ NWP AMB RESPIRATORY CL=> NWP AMB RESPIRATORY CL RESULT • Anything that doesn’t hit on the lines above for covid orders will go to Ordering Provider NEWTON-WELLESLEY HOSPITAL 11

COVID-19 NEGATIVE Response Workflow COVID-19 Negative Response Workflow NEWTON-WELLESLEY HOSPITAL 12

COVID-19 Positive Response Workflow NEWTON-WELLESLEY HOSPITAL 13

COVID-19 Indeterminate Response Workflow COVID-19 Test Errors (Cancelled/Indeterminate) Workflow NEWTON-WELLESLEY HOSPITAL 14

NWH COVID-19 Results Smartphrases The smartphrase included below have incorporated the PHS Smartphrase previously communicated via PHS Broadcast email. Some have been modified slightly to fit into these recommended workflows. NWH COVID-19 Result Smartphrase Description NWHCOVIDNEGTEL For calling back NEGATIVE COVID-19 test results NWHCOVIDNEGPGLTR For creating a letter for NEGATIVE COVID-19 test results (English as primary language AND active with Patient Gateway ONLY) NWHCOVIDPOSTEL For calling back POSITIVE COVID-19 test results NWHCOVIDTELNOANS For calling back CANCELED or INDETERMINATE COVID-19 test result NWHCOVIDPENDTEL For calling back patients with PENDING COVID-19 test result (typically only used if patient inquiring before result is available) COVIDINSTRISOLATION Home/Isolation Quarantine instructions. These have been included in many of the above smartphrases but can also be used separately if appropriate (i. e. , separate patient letter as incorporated in the workflows provided) COVIDPOSITIVEPATIENTINFOSHEET Caregiver instructions--for patients who have tested positive for COVID and have home-caregivers that need guidance about infection control prevention measures NEWTON-WELLESLEY HOSPITAL 15

Covid-19 Screening Process NEWTON-WELLESLEY HOSPITAL 16

COVID-19 Screening Process Phase Workflow Who At Scheduling A required questionnaire will fire in Cadence for all departments, unless visit type is for a virtual visit FD 72 hours out Patient will receive a PG reminder to e. Check-In and complete COVID Symptom and Exposure Screening Patient 48 hours out Patient who are not enrolled in PG or have not responded to PG questionnaire must be called to answer the screening questions. Responses should recorded in Appt Notes FD/MA Date of Service All patients need to complete the screening questionnaire at time of check-in before being seen FD NEWTON-WELLESLEY HOSPITAL 17

COVID Scheduling Questions – Live 5/20 • COVID scheduling questions have been added to ALL visit types (except virtual and telephone). • Scheduling Staff will be prompted to ask the patient a series of questions prior to scheduling the appointment. • Patient responses to this questionnaire will determine next steps NEWTON-WELLESLEY HOSPITAL 18

COVID Banner • Patient’s COVID status should be checked prior to scheduling. • Patients with an unresolved COVID status cannot be seen in the practice. • These patients must be scheduled in a RACC location. • Tip sheet for these changes can be found here. NEWTON-WELLESLEY HOSPITAL 19

RIC/RACC NEWTON-WELLESLEY HOSPITAL 20

Lab and Xray Features of our RIC • Provider does virtual visit but needs ancillary testing in a patient with COVID 19 symptoms or unresolved Co. V status ØX-ray, Lab and CT scan w/ PO contrast ØProvider does referral ØCall 617 -831 -7214 or Use referral order • PUT XRAY or CT or Lab ONLY IN COMMENTS section • We will then use our same process ØWe reach out to Patient and schedule them - meet in lobby – masked – to RIC – alert Rad – gets study – goes home – provider follows up. NEWTON-WELLESLEY HOSPITAL 21

RIC referral Epic Referral NEWTON-WELLESLEY HOSPITAL 22

RIC referral Epic Referral NEWTON-WELLESLEY HOSPITAL 23

RIC & RACC – Recovery Efforts • RIC has moved – 6 south – Referral process same • RIC is NOT an urgent care center – that is what the RACC is. ▹ Abdominal pain work up should be done by you (in RACC), ED, or UCC RACC • Embedded into our RIC • a safe place for YOU to see YOUR patients ▹ Book them via EPIC ▹ Room in the RIC, use the RIC ID/IC process ▹ We will provide PPE for you to see that patient at RACC • Affiliate and Employed • All specialties including primary care • Open for business NEWTON-WELLESLEY HOSPITAL 24

Routine Ambulatory Care for Covid-19 Patients (RACC) Resource Scheduling From the make appt screen, start off by scheduling into the department you normally use, using one of the approved visit types listed below. Approved Visit Types: • NEW PATIENT [100323] • FOLLOW UP [100191] • SICK [100442] • NEW PATIENT [7000000] • FOLLOW UP [7000002] NEWTON-WELLESLEY HOSPITAL 25

Routine Ambulatory Care for Covid-19 Patients (RACC) Resource Scheduling Go back to the Department field on the upper left-hand corner and change it to NWP AMB RESPIRATORY CL. Using the same visit type already selected, for the Provider or Resource, click on the magnifying glass and choose NWH RAC ROOM 01 resource. Both the original provider and the RAC resource will then be displayed. NEWTON-WELLESLEY HOSPITAL 26

Co. V Banners NEWTON-WELLESLEY HOSPITAL 27

Infection: COVID-19 NEWTON-WELLESLEY HOSPITAL 28

Infection: Co. V-Presumed NEWTON-WELLESLEY HOSPITAL 29

Infection: Co. V-Risk NEWTON-WELLESLEY HOSPITAL 30

Infection: Co. V Exposed NEWTON-WELLESLEY HOSPITAL 31

Reference Materials NEWTON-WELLESLEY HOSPITAL 32

Xray and Lab hours and Site rules NWHLAB • dot. NWHXRAY • Use these Smart. Phrases anywhere in EPIC. • dot NEWTON-WELLESLEY HOSPITAL 33

MGH Ambulatory Blueprint NEWTON-WELLESLEY HOSPITAL 34

Links • RIC/RACC lab/Xray Express referral Tip Sheet • RACC Scheduling Tip Sheet • Quick Banner Guide Tip Sheet • Infection Status and Resolution Tip Sheet • Identifying your patients with COVID status • COVID-19 Patient Instructions (dot phrases) • Ambulatory Recovery Page - MGH NEWTON-WELLESLEY HOSPITAL 35