Cloverleaf site design for Epic

We are a fairly large organization with 3 hospitals + hundreds of clinics.  Our sites are organized by Epic functions:

asap
beacon
beaker
charges
cardiology
diet
endo
him
lab
materials
miscellaneous
miscellaneous adt (peers who don’t fall into the other categories but receive ADT only)
pharm
radiology
stork

We also have grand parent sites that feed parent sites that then feed down to the sites listed above if they need ADT.

Hope that helps!

Hi Gina,

We have a similar setup to Grace.  We have eight hospitals and multiple clinics.

We have three ADT interfaces out of Epic.
– One is strictly for clinical use so doesn’t have the hospital admissions, transfers, and discharges – just the registration and patient level updates.  The messages come in on one site and then route to 4 other sites to downstream systems.
– The second one has everything the clinical one has, plus all the hospital admissions, transfer and discharges.  The messages come in on one site and then are routed to three “hub” sites, which then distribute the messages out over 13 other sites.  We did it this way because Epic LOVES its ADT messages – about an average of 310K a day.
– The third one is a scaled down version of the second ADT interface by using different profile variables to eliminate some of the messages

For Cupid interfaces (Cardiology) we have the Orders/Results out of Epic come into one site and then Orders are routed to a Cupid orders site and results are routed to a Cupid results site and from there are routed to the downstream systems.  Incoming results to Epic are in the same initial site.

For Radiant interfaces (Radiology), it is similar to Cupid: Orders/Results out of Epic into one site and then split into separate Radiant orders and Radiant results to then be routed to downstream systems.  Incoming results to Epic are in the same initial site.

Lab orders (we are currently NOT on Beaker) come in on one site and most are routed within that site.  The exception is the lab orders which are routed to a site that strictly handles both orders to the lab system and results from the lab system.  A lot of the smaller Epic interfaces are connected in this same site (Optime, Diet orders, Education orders, Provider updates, Supplies, etc).  We really need to split this up more because that site currently has 30+ processes.  We are also in the starting stages of switching to Beaker (2-year plan) so this will be changing for us.

Outgoing Cadence messages (SIU) are sent into one site and then routed into six other sites which then route to downstream systems.  Incoming appointments are also sent from this site.

Device interfaces (four of them) into Epic are split between four different sites because of the sheer volume of messages.  We also configured Epic to NOT send acknowledgements for these interfaces.

For the bigger downstream systems that have multiple interfaces, we created separate sites and routed the messages to the appropriate interface.  This was mainly done to make it easier for maintenance on those systems and for when those systems have downtimes.

You probably already know this, but build an HL7 variant specifically for each Epic interface and store them in a master site.  An order/result message out of Epic for Cupid can be defined vastly different from one for Radiant.  This also allows you to create the custom Z-segments as you need for each interface.

We currently run on a AIX Power-10 server.

Hope this helps.  If you want to talk in more detail, let me know and we can connect.

• This reply was modified 20 hours, 38 minutes ago by Paul Bishop.