Epic Bridge

How doctors open this guide

Faster routes from Census

1. Select and verify the correct patient, then click Epic Intake beside Add Data. This opens the Epic → somaNotes snapshot instructions directly.
2. If Add Data is already open, click Set up the interim Epic snapshot phrase near the top of the window.
3. For a bookmark or typed address, use /help/epic-smartphrase. No patient information is stored on this help page.

Epic → somaNotes — one living .SOMA36

The marker scaffold is safe to copy. The six angle-bracket lines are instructions, not installed SmartLinks: replace each one by inserting the named SmartLink object through Epic's picker. Pasting raw @TOKEN@ text is never a successful install. NOW, ID, VSRANGES, MEDS, HPROBL, and LLCBC3 were observed in Avera, but their rendered shape and time semantics remain uncommissioned until you confirm them.

The clipboard copy intentionally contains no raw @TOKEN@ strings. Insert every SmartLink object manually, then remove every angle-bracket instruction before rendering. A blank result, literal token, bare @@, or surviving instruction fails that sensor.

Install and commission the core

1. Open SmartPhrase Manager. Create SOMA36 (no leading dot), or open your existing SOMASNAPSHOT and replace its body. Paste the marker scaffold.
2. At each angle-bracket line, delete the instruction and use Epic's Insert SmartLink picker to insert that named object. Do not type or paste the @...@ representation.
3. Render the phrase in the exact inpatient note context on a training patient. Copy the rendered packet into the Epic 36h cockpit.
4. Review the visible source chunk, then choose Confirm semantics for each sensor only after its content and stated time/current-state behavior match. Identity and generated time are mandatory activation gates.
5. If an optional sensor is blank, literal, or wrong-shaped, leave it failed and remove it from the phrase until corrected. One optional failure quarantines that sensor; it does not authorize guessing.

Daily capture

1. In somaNotes, select the destination patient first and verify the displayed name and MRN.
2. In that same patient's Epic chart, render your one living phrase in the commissioned context. Review it before copying.
3. Return to somaNotes → Add Data → Open Epic 36h cockpit. Click the paste target and press Ctrl+V.
4. Add Results Review, MAR, imaging, micro, and signed-note chunks as separate foreground pastes. Correct any suggested lane before preview.
5. Choose Preview 36h, review stale/quarantined source, and acknowledge every required item. A patient switch clears the entire capture and requires a fresh start.
6. Choose Commit effective data. Keep the cockpit open until both dated rows and Note Evolution say committed; if one leg fails, use the same button to resume only unfinished work.

Work-PC transport probe — find the real boundary

1. A · Epic → Epic: copy a harmless training-patient line and paste it into a disposable Epic text field. If this fails, stop: Epic or workstation policy blocks clipboard use at the source.
2. B · Epic → Notepad: paste into Notepad running inside the same Citrix/VDI desktop as Epic. If A works but B fails, the virtual-desktop clipboard policy is the boundary.
3. C · Epic → somaNotes: open somaNotes in a browser inside that same desktop and use the cockpit's focused Ctrl+V target. If B works but C fails, compare whether the browser is outside Citrix and move it inside the same clipboard boundary before escalating.
4. D · native helper: Shuttle Two will offer a paired hotkey transport for approved Windows installations. The helper must run inside the same Windows/Citrix clipboard boundary as Epic; do not install or run an unsigned or locally unapproved binary.

Shuttle One needs no Epic-side build and no helper: direct foreground paste is the available path. Shuttle Two is the next transport layer, not a prerequisite for completing the clinical workflow.

Preview, commit, and recovery

Preview is write-free. The server recomputes the exact 36 elapsed-hour projection and shows included, stale, quarantined, and conflicting source before anything is saved. Stale and quarantined text never reaches clinical parsing or Note Evolution.

Commit freezes the reviewed source. It first secures one immutable capture, then writes each clinical date independently, then projects only accepted evidence into Note Evolution with capture-linked provenance. A retry reconciles that ledger and runs only failed or unfinished dates/fragment projection; it does not duplicate completed work.

Progressive sensors — one next move

The cockpit recommends exactly one missing domain at a time. Public names below are candidates, not promises about Avera: broad labs (LAB24 or RESULTRCNT), I/O (IOBRIEF), imaging (RISIMP24H), and microbiology (MICRORESULTSLAST24HOURS). Keep each candidate UNVERIFIED IN YOUR BUILD until it renders in the same Epic context and you confirm its semantics. MAR and signed-note sensors remain local-build discoveries.

Department SmartText upgrade ticket

Once the living phrase works, send this narrower request to the Avera build team instead of asking them to implement guessed names.

How to read this

The three-stage roadmap

Stage 1 is entirely in your hands today. Stages 2 and 3 need a builder ticket — this page gives you copy-ready request text for both.

Quick start — for physician partners

The strict structured phrase preserves every required v3.5 section and uses eleven visible F2 stops. Date of Service and Objective stay clinician-controlled until Avera validates compact, context-correct SmartLinks. The exact-note fast path pastes the complete canonical note as one normalized document without relocating sections.

One-time setup in Epic (~10 minutes)

1. In Epic: Epic button → Tools → SmartPhrase Manager (or type "SmartPhrase Manager" in the toolbar search).
2. Click New. Name it DISPO5 — exactly that, no leading dot (Epic adds the dot). Build this one first: the master phrase references it by name, so it has to exist before the master phrase can nest it.
3. On this page, scroll to Nested phrase, hit Copy, paste the block into Epic's compose box, save. Leave every *** exactly as triple-asterisk — Epic natively treats it as a fillable stop.
4. Create SOMAPROBLEM35 from the repeatable problem block. Keep it standalone; invoke it as many times as the patient needs.
5. Create SOMAPROGRESS35 from the structured master.
6. Optional: create HOSPPROGRESSPASTE35 from the exact-note fast path. It contains one wildcard and never relocates Date, Vitals, Chronic Stable, or Code status.
7. Open a note on a test/training patient and type .somaprogress35. Confirm every canonical header appears in order and .DISPO5 unfolds at the bottom.
8. Confirm @CODESTATUS@ resolves in this note type. If it renders literally or as bare @@, delete it and reinsert the matching SmartLink through Insert SmartLink.
9. Practice the keys: F2 jumps to the next *** stop, Shift+F2 goes back.
10. Resolve or delete every wildcard, verify the five disposition lines, and confirm no content follows Follow-ups before signing.

Daily use

1. Generate the note in somaNotes; copy it; paste it into the paste chain on this page.
2. Fast path: click Copy full canonical note, then paste into a blank Epic progress note or the single stop in .hospprogresspaste35. Copy full is enabled only when the canonical v3.5 structure is present.

For section-level control with visible Epic sign-blocking stops:

1. In Epic, type .somaprogress35.
2. F2 to the first stop → click Copy next here → Ctrl+V in Epic → F2 → repeat. The button names each chunk as you go and stops at "All chunks copied".
3. A missing Chronic Stable value is not optional: enter None. Generated Disposition may contain only the supported fields, so an omitted Disposition value is not a rail placeholder; the static .DISPO5 phrase still leaves its physician-fillable *** stops for you to complete or clear before signing.
4. Cross-check the note's Code status reference against the value rendered by @CODESTATUS@.
5. Sign.

Upgrade a wildcard only after the candidate output passes the Avera training-patient checks below. Index presence alone is not enough.

Paste chain — split a generated note now

Paste the full somaNotes progress note here. Canonical v3.5 notes split into the exact eleven wildcard stops used by .SOMAPROGRESS35. Legacy headings are recognized only to help migrate old text; Copy full stays disabled until the canonical structure is present.

The deterministic copy gate checks exact headers and spacing, CC shape, one-paragraph Course Summary, three-paragraph Subjective, ordered Objective subsections, numbered A&P problem blocks with 1–4 supported actions (up to 6 for Worsening), one-line Chronic Stable, ASCII-safe text, and a final Disposition containing any supported subset of its five fields in canonical order. The bare final DISPOSITION heading may be empty; present fields may not be empty, duplicated, invented, or reordered. It is a paste-safety check, not a substitute for clinical review.

Runs entirely in this tab — nothing you paste is uploaded, stored, or logged. Reload the page and it's gone.

Structured master — canonical v3.5

The Subjective stop receives all three required paragraphs. The Objective stop carries Vitals, timestamped Labs, optional Imaging/Microbiology/Pathology, and Exam in v3.5 order. The A&P stop preserves the opening synthesis plus any number of #n Problem [Status] blocks. Chronic Stable stays separate and must contain a pipe-delimited line or None. Date and Objective remain visible stops until Avera proves replacement SmartLinks in this note context.

Repeatable problem helper

First stop: number. Second: concise problem name. Third: exactly Worsening, Active, Improving, Stable, or Resolved. Fourth: a 2–4 sentence assessment. The static helper seeds two physician-fillable action rows for convenience, but generated problems need only one supported action; delete an unsupported extra row rather than padding it. Keep this helper standalone and invoke it repeatedly when authoring the A&P manually.

Nested phrase

Built standalone so the canonical master can nest it. This static physician-fillable phrase intentionally keeps all five lines and every *** hard stop; generated rail output separately emits only supported Disposition fields. Under therapeutic anticoagulation, document that supported state as the DVT value rather than suppressing it.

Exact-note fast path — .HOSPPROGRESSPASTE35

Paste the complete canonical v3.5 note into one wildcard. This phrase intentionally adds no wrapper: moving Date, Vitals, Chronic Stable, or Code status outside the generated document would violate the immutable section order.

Copy full canonical note returns the normalized complete note. It never reconstructs the document from chunks and remains disabled for noncanonical legacy input.

Captured in our build — existence is not output proof

The captured Avera index proves that a name exists, not that it renders the right semantics, time window, shape, or label in this progress-note context. The strict master therefore hardwires only @CODESTATUS@, which also has signed-note round-trip evidence.

This is a small fraction of what the build actually has. Treat it as a discovery list. Every candidate still needs a training-patient expansion test before it replaces a visible wildcard.

Baseline and candidates

Labs — the .LL family (this build's version of the Foundation lab links)

The .LL family is an optional discovery aid, not part of the canonical baseline. Use a specific lab link only after its Avera expansion stays compact and preserves the Objective ordering; prune anything over the <5-lines rule below.

Also captured in the index — validate output before use

Stage 1 — candidate discrete-data SmartLinks

The baseline wildcards are deliberate. Of the outbound fields, only @CODESTATUS@ has signed-note output proof. Treat every other captured name and catalog entry as a discovery lead until it expands correctly on a training patient in this exact progress-note context.

Promote a candidate into a *** stop only after checking its meaning, time window, timestamp, compactness, oxygen-device handling where relevant, and whether it prints its own label. Mnemonics, parameter order, identifiers, and context availability can vary by Epic build; use the in-note help text and insert/search tools rather than typing an identifier from this page into production.

Labs — trended & most-recent values

Flowsheet rows — the workhorse for Objective data

Imaging — impressions only

Micro / culture & sensitivity

Meds, allergies, problems, diagnoses

Stage 2 — make the dispo schema discrete (builder ticket)

A plain SmartList only inserts text. It becomes a discrete-data capture tool when its record has "use discrete data" enabled and its options are mapped to a SmartData Element (SDE — HLX master file; values stored in HLV). This is the mechanism that turns a VTE-ppx or code-status pick into reportable, auditable data instead of dead text in a note — and it's the clearest safety/quality payoff of anything on this page, since code-status confirmation and VTE prophylaxis are Joint Commission core-measure territory.

Mechanical constraint: an SDE cannot link directly to a SmartPhrase — the phrase must contain an SDE-linked SmartList (or a SmartForm/NoteWriter block) to actually file discrete data.

For a value already captured elsewhere in the chart that you just want to display inline (not re-capture), the retrieval tools are CUIPAT (patient-level), CUIENC (encounter-level), and CUIEPI (episode-level), with option flags N (label only if a value exists), L (always show label), M (message if no value), and B (break to a new line only if data exists — lets you stack several SDE links without blank-line gaps). DBLINK retrieves arbitrary master-file items. These are builder-level tools, illustrated (not literal for your build) below:

Copy-ready request for your informatics/Bridges team:

Stage 3 — conditional logic: the reality

Epic has no inline .if/.el/.end or @if@...@else@...@endif@ token inside SmartPhrases or SmartText. Branching output is delivered only through CER-rule-driven SmartLinks:

• RULESMARTLINK / RULESMARTLINKREFRESH (HHS 60402 / 60404) — displays information based on a rule record. Documented parameters, verbatim: "Parameter 1 - Enter the ID number of the rule to evaluate. Parameter 2 - Enter the mnemonic of the SmartLink to display if the rule is true. Parameter 3 - Enter the mnemonic of the SmartLink to display if the rule is false," plus formatting flags in parameters 4–7.
• CERMSG / CERMSGREFRESH (HHS 64343 / 14042) — evaluates one or more CER rules and returns either the rule's error message or specified SmartTexts.

A CER rule is a configurable rule-logic record evaluated as TRUE/FALSE. Building rules (CER) and new SmartLinks (HHS) is typically restricted to project-team members — you'll need physician-builder access or your informatics/Bridges team, and every rule should be validated with the Rule Tester before it goes live.

Lower-effort partial conditionality that doesn't need a CER rule: SDE display flags can self-suppress optional content inside an existing section. They must never suppress one of the five required Disposition lines.

Copy-ready request for your informatics/Bridges team:

If you want to own this logic directly instead of ticketing it every time, Epic Physician Builder certification (e.g. CLN150-level coursework) is the fastest route — it's the credential that grants CER-rule and HHS SmartLink build access.

What NOT to add

The same anti-boilerplate discipline that governs somaNotes' own generated text (nothing ungrounded, nothing the doctor didn't ask for) applies to the Epic side of this template too:

• Reflexive line-day counts, generic goals-of-care language, and "defensive" normal-template prose add volume without discrete value — leave them out.
• Let empty fields self-suppress (the SDE M/B flags from Stage 2) instead of printing "none" or "n/a" on every field, every note.
• Benchmark to change course: if a given SmartLink dumps more than ~5 lines of noise, or frequently returns stale/blank data, drop it or narrow its lookback window — don't keep it "just in case." A published intervention that cut routine lab-SmartLink use from over 90% of notes to under 18% shortened notes in the process (see Evidence, below) — pruning auto-imported data is the empirical win, not a compromise.

Field crosswalk

Discovery & verification workflow (do this before building anything)

1. In-note help text: type the dot-command (e.g. .LASTLAB, .FLOW) and read the *** HELP TEXT *** it returns — it lists your build's exact parameters.
2. SmartLink/SmartList search: in SmartPhrase Manager or the SmartTool editor, type . plus a few letters to search available SmartLinks. Check the link's available contexts — a link that renders as bare @@ isn't evaluating in that context; make it available to all contexts if you need it everywhere.
3. FLO IDs: the .FLOW+Tab picker (newer Epic versions), the Report & Print Group Assistant's "Debug Print Group," or right-click a flowsheet cell → Properties.
4. SDEs: SmartData Manager (searchable; supports category: / sws: search syntax).
5. CER rules & new HHS SmartLinks: require physician-builder privileges or your informatics/Bridges team — validate with the Rule Tester before deploying.
6. Cross-org portability: SmartPhrase Manager can upload/download personal SmartPhrases and SmartLists between organizations, but IDs won't translate across sites — re-verify everything if you move builds.

Stage 1 upgrade path (after the baseline works)

1. Swap any wildcard for a SmartLink from the catalog above once you've verified its mnemonic/ID for our build via the discovery workflow.
2. In .DISPO5, click into the DVT ppx wildcard, use the toolbar's Insert SmartList, search "VTE prophylaxis" or "DVT," pick our build's list. Epic resolves the real ID — you never type one.
3. Stage 2/3 aren't self-service — file the copy-ready request text above with the informatics/Bridges team and reference this page.

Evidence for the discrete-data-first approach