← Back to Work Sample

Epic Cadence, Visual Workflow Diagrams

Five core process flows for Northeast Regional Health Cadence optimization initiative

Patient Appointment Scheduling Flow
End-to-end flow for booking an appointment in Epic Cadence: from patient contact through reminder confirmation, covering both phone and MyChart self-scheduling channels. Hold pool rules and no-show risk scoring are integrated inline.
Trigger / start
Process step
Decision point
Success / pass
Failure / error
Info / log / deferred
Milestone
Completion
Patient Contact
Phone call to scheduling center or MyChart self-scheduling initiated
Channel?
Phone vs. MyChart self-scheduling
Phone
Scheduler Verifies Identity
Name, DOB, address, last 4 of phone. MPI match confirmed.
Select Visit Type
Search using DEPT-TYPE-DUR naming convention. Apply scheduling rule group filter.
MyChart
Patient Identity Verified
Epic two-step MyChart verification. MPI match automatic.
Self-Schedule Visit Types Shown
Only visit types flagged "MyChart self-schedulable" in rule group are displayed.
Slot Available in Template?
Check hold pool rules: standard, urgent hold, same-day hold, care-gap hold
Yes
Appointment Booked
Slot reserved. Cadence records created. Appointment confirmation sent.
No Slot
No Slot Available
Template full. Overbook requires supervisor auth or wait list entry.
Add to Wait List (WLE)
Patient added to bump list. Automated notification when slot opens.
No-Show Risk Scored
Epic predictive model scores appointment. Risk above 40% adds to confirmation WQ.
Automated Reminders Sent
72 hr email + 24 hr SMS/voice per patient preference. MyChart reschedule link included.
Appointment Kept?
Kept
Check-In and Visit Complete
Appointment marked arrived/completed. Template utilization count incremented.
No-Show
No-Show Logged
Counted in no-show by visit-type report. Slot offered to bump list via overnight batch.
Recall / Reschedule WQ
Entry created for outreach. Patient contacted within 5 business days per clinic policy.
Referral and Authorization Flow
Closed-loop referral workflow from external provider referral submission through appointment scheduling confirmation. Covers HL7 REF^I12 inbound processing, referral workqueue triage, and outbound SIU^S12 confirmation back to the referring provider.
Trigger / start
Process step
Decision point
Success / pass
Failure / error
Info / log
Completion
Referral Submitted
External provider sends HL7 REF^I12 or e-Referral via CommonWell / fax capture
Bridges Receives REF^I12
Receiving app "NRH_REFERRAL_IN". Parse PID (patient), PRD (referring provider), OBR (service requested).
MPI Match Found?
Match patient identity in Epic: name, DOB, MRN
Match Found
Referral Order Created
Epic auto-creates referral order linked to patient MRN. Routes to Cadence referral WQ by specialty.
No Match
Bridges Error Queue
Message routed to error queue. Analyst review SLA: 4 hours. Manual MPI lookup or patient registration required.
Scheduler Picks Up Referral WQ Entry
SLA: 48 hours from receipt. WQ entry shows referring provider, specialty needed, diagnosis, insurance.
Prior Auth Required?
Check payer rules for requested visit type / procedure
Auth Required
Auth Request Initiated
Authorization team submits to payer. Appointment held pending auth. Auth status tracked in Epic.
Auth Approved?
No Auth Needed
Proceed to Scheduling
Schedule directly. No auth hold needed.
Patient Contacted, Appointment Booked
Scheduler calls patient. Appointment created in Cadence and linked to referral order.
Referral Order Closed
Referral order marked complete with appointment link. WQ entry resolved.
Outbound SIU^S12 Sent
Bridges fires SIU^S12 to referring provider's EHR confirming appointment date and time. Closed loop complete.
Referral Capture Complete
Logged in referral tracking dashboard. Contributes to 92% capture rate target.
Cadence Change Management Lifecycle
Every Cadence configuration change: visit type additions, template modifications, and scheduling rule group edits follow this lifecycle. No exceptions, regardless of perceived impact. The CAB process and TST validation step are the safeguards that prevent incidents like the Cardiology outage.
Trigger
Process step
Decision point
Approved / pass
Rejected / rollback
Documentation step
Completion
Change Request Submitted
Clinic submits ServiceNow form: affected component, business reason, preferred go-live date
Analyst Impact Assessment
Review linked rule groups, other visit types using the template, active WQ entries, shared configs across clinics
CAB Review Required?
Minor low-risk changes may use expedited path with supervisor approval
CAB Required
CAB Decision
Bi-weekly CAB reviews: approve, deny, or return for more info
CAB Approved
Expedited
Supervisor Approval
Documented in ServiceNow ticket. Proceed to build.
Build in TST Environment
Analyst makes configuration change in test environment. Build steps recorded in SharePoint config tracker.
Clinical Lead UAT Review
Clinic lead or super user validates change in TST. Written sign-off in ServiceNow ticket required.
UAT Passed?
Pass
Schedule Go-Live Window
Maintenance window for high-impact; off-peak for low-impact. Rollback steps confirmed.
Promote to PRD
Config tracker updated pre/post. ServiceNow status: Implemented.
Fail
Rework in TST
Analyst addresses UAT feedback. Re-submit for UAT review. No PRD promotion until pass.
Post-Go-Live Communication
ServiceNow email to affected clinics. Teams message to team leads. 7-day feedback form sent.
Change Complete
Analyst reviews feedback within 48 hours. Ticket closed. Metrics monitored for impact.
Incident Response and Root Cause Analysis
Cadence incident response flow from first report through resolution and post-incident review. Based on the Cardiology scheduling outage RCA described in the work sample: 29 minutes downtime, root cause identified in 13 minutes, fix promoted in 15 minutes.
Trigger
Process step
Decision point
Resolved / success
Failure / escalation
Documentation / log
Milestone
Closure
Incident Reported
Scheduler calls help desk. Scheduling failure, patient access impacted. P1 ticket opened.
Cadence Analyst Paged
On-call analyst notified within 7 minutes. Remote login to Hyperspace via Citrix.
Triage in Cadence Activity
Check scheduling rule groups for affected department. Check Bridges interface status. Check recent change log.
Root Cause Identified?
Configuration change, interface failure, or Epic application issue?
Identified
Build Fix in TST
Replicate configuration state in TST. Apply fix. Validate scheduling works. Confirm no side effects.
Promote Fix to PRD
Emergency change. Document in config tracker. Notify CAB Lead with post-facto ServiceNow ticket.
Clinic Confirms Restored
Scheduling team validates appointments booking normally. P1 downtime clock stopped.
Not Identified
Escalate to Epic TS
Log Epic support case with Hyperspace version, error details, and change log screenshot.
Workaround Activated
Downtime procedures extended if Epic TS resolution exceeds 60 min. Paper schedule log activated.
Post-Incident Review (Within 5 Business Days)
Timeline documented, root causes identified, corrective actions assigned with owners and due dates. Shared with IT leadership.
Corrective Actions Implemented
Access changes, alerting, and training updates completed. P1 ticket closed. RCA added to quarterly governance review.
Disaster Recovery and Downtime Runbook
Step-by-step scheduling disaster recovery: from Epic outage declaration through downtime operations, restore confirmation, and post-restore reconciliation. RPO: 4 hours. RTO: 2 hours. Annual DR drill required to validate timings and train new staff.
Trigger
Process step
Decision point
Recovery / pass
Escalation
Documentation / log step
Milestone
Operations restored
Epic Downtime Declared
IT operations confirms Epic unavailable. Scheduling supervisors and clinic leads notified via phone tree.
Activate Downtime Schedule Printout
Use 7:00 AM or noon printout (whichever is more recent). Covers next 8 hours of scheduled appointments per clinic.
Downtime Operations Active
Schedulers work from paper. New patient requests logged on paper callback log: name, DOB, phone, visit type requested.
Urgent Appointments Triaged
Clinic lead makes real-time decisions. Urgent patients directed to walk-in or urgent care. No Epic entry during downtime.
Epic Restore Signal Received?
IT operations confirms Epic accessible. Test scheduling before notifying all staff.
Restored
Epic Restore Confirmed
Cadence analyst test-books a dummy appointment in TST to confirm scheduling rules active. Notify scheduling supervisors.
Extended Downtime
Extended Downtime Protocol
Generate second downtime printout. Escalate to IT leadership. Patient callback list actively managed. Volume overflow plan activated.
Post-Restore: Enter Missed Appointments
Data entry team enters paper callback log into Cadence within 4 hours. MPI duplicate detection run before committing entries.
Bridges Interface Restart
Verify all SIU and REF interfaces reconnected. Replay messages from Bridges error queue (up to 4 hours of backlog).
WQ and Template Reconciliation
Compare WQ counts to pre-downtime snapshot. Verify provider templates intact for next 14 scheduling days. Flag gaps to clinic admins.
Stakeholder Notification
ServiceNow incident updated with restore time and reconciliation summary. Scheduling supervisors confirm normal operations before P1 closed.
Normal Operations Restored
All appointments reconciled. Interfaces green. P1 incident closed. DR drill findings documented if applicable.