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EPIC EMR: tricks and tips for hospitalists

What are the best tips for hospitalist physicians for using EPIC EMR?

Lot of hospitals are changing their EMR to EPIC with time. We had been using EPIC for a few years now. Here are some tips that help to quickly set up tabs for high efficiency.

Of course, with time you will develop your own workflow that helps you become very efficient and fast using the EMR.

Each hospital has their own version of the EPIC EMR. So, it might be very different from hospital to hospital.

Some good things about EPIC EMR are:

You can make your own templates for H&P, Progress notes, Discharge summaries, etc. With just a couple of clicks your notes is almost ready as it pulls all the updated labs, imaging studies, vitals, etc.

You can set up “ Notify Me ” when any test is ordered so you can get notification on your mobile EPIC haiku app . Bell symbol below. This way if you order some urgent lab, you don’t have to keep checking if the result is ready or not.

You can make Dot phrases [=SmartPhrases] for almost anything you want to recollect later when needed. You can include several SmartTexts e.g. @PMH@ in your SmartPhrases.

You can put *** anywhere in your template to alert you before signing your note to make sure the preformatted template still is good for this patient.

Pre-Prepared order sets are very useful for some like CVA, CHF, etc so you don’t miss core measures.

The screen looks very clean and spacious.

You can set up your notes to show different colors if you want to make your notes look beautiful. You just set colors once in your templates and it shows colors every time you use template.

By changing what columns you want on your home page and in what order, you can design it to look good and help with your workflow.

If you want to know what smart phrase others used in their note, you can find out and incorporate in your notes easily. Just click on “ copy ” button on top of their note so a new copied forward note appears—>right click on the smart phrase part of the note—>go to “ SmartPhrases ” which opens up a drop-down menu —>click on “ Create SmartPhrase from Selected Text ” drop down menu.

All the columns or horizontal row of buttons have wrench symbol on their right that you can click to arrange those columns or tabs as you like.

Make most commonly used ‘orders’ and ‘order sets’ your ‘favorites’ by clicking on star symbol just before signing your orders so it becomes easy to open them and order next time. Look below how they pop up after making them your favorites.

You can pretty much make anything and everything your favorites to get to it easily next time.

You can make dot phrases for any diagnosis that you treat commonly. For example: COVID 19 diagnosis as below.

Columns for your own Patient list

I placed the columns in the following order. This order helps me reach the needed parameter very quickly.

Current Location, MRN, Age, Patient Class, Adm Date, New Notes, Patient Name, New Results, My sticky Note, My Sticky Note Text, To Do -Care Mgmt, Expected Discharge Date/Time, Adm Dx, Need Admit Med Rec, Need D/C Med Rec, Attending, Treatment Team -Nurse, Treatment Team – CM Staff, Foley (IUBC). Below 2 pictures are actually in one single line but since they don’t fit as a single line, I made 2 pics.

—–

H&P template.

Progress Notes Template

Top horizontal row buttons after opening an individual chart

I arranged in the following order.

Chart Review, Discharge, Flowsheets, MAR, Manage Orders, Notes, Results, Summary, Letters, Care Teams.

Top Horizontal row buttons on top left of the screen

In Basket, Hospital Chart, My Smart Phrases, Web Links, UpToDate, ED Track Board.

You can look up SmartPhrases made by others by searching for them.

Click on MySmartPhrases –> SmartPhrase Lookup –> Type the word in search. It will display smartphrases made by others and you can select one of them, copy and make your own.

Discharge Button

We use the following buttons under discharge tab.

Unresulted Labs , Disch. Instructions and Disch. Summary .

If you want to find out anything and you can’t find it, use Search button . It is very helpful.

You can change the colors of your EPIC screen by changing the theme by clicking on EPIC button on left upper corner and going to My Settings–> themes .

You can Create Panel by clicking on Options on right side of Manage Orders and Order Sets area. In my version of EPIC, you can see it’s disabled.

You can use My Sticky Note for writing reminders etc.

Sorting out notes section:

When you click on the wrench to the far right in Notes section, you can see different options. If you click on Note list layout settings and click on Service instead of Author Name , the notes section will display notes with Specialty name prominently instead of the person’s name . This helps to quickly look for different specialty notes as sometimes we may not recognize the specialty from a person’s name. Below 3 pictures.

We can make a graph of vitals to easily see the trend. Go to Flowsheets and then click on drop down menu for Graph as shown below. Choose what graph you want in the drop-down list.

Discharge summary Template:

Patient ID: @NAME@@MRN@@TD@@NOW@ Date of Admission: @ADMITDT@ Date of Discharge:@TD@

Discharge Physician:  @MEMD@ Primary Care Physician:  @PCP@

Discharge Diagnoses:   @HOSPROBL@

Admission Condition:  {condition:18240} Discharged Condition:  {condition:18240} Procedures:  *** Consultants:  {consultation:18241} LABS AND DIAGNOSTIC STUDIES @LASTECHO2DCOMPLETE@ @LASTUA@ @LABRCNTIP(CK:3,TNI:3,CKMB2:3,CKMB:3,GLUWB:6,WBC:3,HGB:3,HCT:3,MCV:3,PLT:3,CREA:3,BUN:3,NA:3,K:3,CL:3,CO2:3,MG:3,PHOS:3,INR:3)@ @LASTLFT@@LASTA1C@@LASTLAB(tsh)@ @LASTCOAGS@ @LASTMICRO@ {trk diagnostic studies:35768} DISCHARGE MEDICATIONS:  @DISCHARGEMEDSLIST@ DISPOSITION:  @MRDDSPOCOMMENT@ FOLLOW UP: Follow up with PCP in {NUMBERS 0-10:22140} {TIME FRAME:20514}Follow up with {consultation:18241} {NUMBERS 0-10:22140} {TIME FRAME:20514} PENDING TEST RESULTS/FOLLOW UP TESTS *** HOSPITAL COURSE:  *** VITAL SIGNS : @VITALS@ PHYSICAL EXAM: AAOX3 RS: CTAB,no added sounds RRR abd soft NT Discharge Instructions: Take all medications as prescribed. Keep all follow up appointments. Contact your primary care physician with any questions or concerns that arise. Come to the emergency department with worsening of your symptoms, severe chest pain, shortness of breath, or any other medical emergency

@DISCHARGEDIET@  @DISCHARGEACTIVITY@ @DISCHARGEPROCEDURES@ @DISCHARGEAPPOINTMENTS@ TIME SPENT ON DISCHARGE:  {NUMBERS 1-140 BY 10 (NORMAL):140020} minutes spent on this discharge, face to face time, answering questions, and arranging care.

There are a lot more customizations that will be useful. We can explore and add more features as needed.

Hope some of these are useful to you.

2 thoughts on “EPIC EMR: tricks and tips for hospitalists”

This is Epic! Thank you for sharing this, do you by any chance has more templates such as procedures or discharge summary template?

Thank you for this helpful thread.

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UI Health Care Epic Education

Check in/check out, cadence (scheduling/check in/check out).

Cadence Check In and Check Out workflows include a number of tasks such as updating patient and appointment registration, collecting copays, printing after-visit summaries and parking vouchers, and updating appointment statistics. Check In and Check Out are primarily completed using the Department Appointments Report (DAR).

The following documents that provide information on Check In/Check Out functionality in Cadence.

Accident Related

• Accident-Related Encounters (Claim Information Record)  - (Handout) When scheduling or checking in an accident-related appointment, additional information needs to be collected regarding the accident. Claim Information Records keep track of information related to an encounter that is accident-related. A Claim Information Record must be created for the accident and attached to each encounter related to that accident.

Cash Drawer

Cash Drawer (Cadence) webpage

Check In Workflows

• Canceling Check In  - (Handout) Once the Check In workflow is completed for an appointment, the Check In can be canceled if needed from the Appointment Desk or Department Appointments Report (DAR). This most typically occurs when a patient is Checked In and cannot stay to complete the appointment. Check In cannot be canceled after end of day processing has run on the appointment.
• Checking In a “No Show” Appointment  - (Handout) “No Show” appointments that have already gone through End of Day processing need to be Checked In using the normal Check-In workflow while the appointment is still in a “No Show” status. Completion of the Check-In workflow will place the appointment in a “Completed” status. Current-day "No Show" appointments must have EOD status changed to "Arrived" before completing the Check-In workflow. Check Out must also be completed for current-day appointments.
• Checking in an Appointment  - (Handout) An appointment can be checked in from the Department Appointments Report (DAR) or from the patient’s Appointment Desk.
• Checking In a Patient with an Identity Theft FYI Flag  - (Handout) When a patient with the Identity Theft FYI Flag presents for Check In for a clinic visit (not Emergency Department or Urgent Care), staff will first verify the patient’s identity, and then document the patient’s identity was verified within the Check In workflow.
• Clinical Workflow for Patient Check In  - (Handout) Clinical staff may need to check in patient appointments in areas where patients are transported directly for patient care or when there is not a front desk staff available.
• Completing the MyChart Signup Prompt during Check-In  - (Handout) During the Check-In workflow, if a patient does not have an active MyChart account, the MyChart Signup prompt will display. Check-In staff will use the prompt to indicate the patient’s response.

Check Out Workflows

• Checking out an Appointment  - (Handout) During Check Out, registration information can be updated, copays collected, and follow-up appointments scheduled.

Chart Review

• Opening Chart Review for Front Desk Users  - (Handout) Front Desk users can most easily open Chart Review from Patient Station.

Customer Relationship Management (CRM)

• CRM for Schedule Variance Tracking  - (Handout) When a scheduling variance is identified or perceived to be outside of “ideal” scheduling or check-in times, a CRM is created to document the variance and outcome.

Department Appointments Report (DAR)

• Customizing the DAR  - (Handout)) The DAR can be customized to better fit day-to-day tasks by creating a private report, specifying the criteria for the report, and adjusting the columns to display.
• Patient Updates from the DAR  - (Handout) In case of a clinic delay or similar clinic disruption in which a patient notification is necessary or of benefit, supervisors can send a message for affected appointments from the Department Appointments Report (DAR).
• Reviewing the DAR  - (Handout) The Department Appointments Report (DAR) is the central report for Cadence patient check-in and check-out workflows. The DAR provides information about the day’s appointments, may be used to check patients in or out, and provides access to other workflows such as printing parking validation or updating End of Day status.

eCheck-In/Welcome Tablet

MyChart webpage

Welcome webpage

• Assigning and Un-Assigning Welcome Tablets  - (Handout) For departments using Welcome Tablets for Check-In, the Tablets can be assigned and un-assigned to patients using the Department Appointments Report (DAR). The user must be logged into a department that uses the Tablet.
• Charging a Credit Card during Check-In for Patients Who Pre-authorized Copayment during eCheck-In (MyChart)  - (Handout) Patients can complete Check-In from within MyChart using “eCheck-In” up to five days prior to their appointment, including paying their copay by credit card. The credit card is ‘authorized’, but not charged until the date of service when the UIHC staff must complete the Check-In in Epic.
• Identifying Patients’ Check In Status: eCheck-In  - (Handout) Patients can check in early for an appointment using MyChart prior to arriving for their visit (called eCheck-In). The Department Appointments Report (DAR) displays unique columns to track eCheck-In (MyChart) by patients for these appointments. Users must be logged into a participating department to see the columns. The Interactive Face Sheet in Registration will also display coverage changes indicated by the patient during eCheck-In (MyChart) if any were indicated.

End of Day Status (EOD)

• Changing the 'End of Day' (EOD) Status  - (Handout) The End of Day (EOD) status for outpatient appointments can be updated from the Department Appointments Report (DAR) or the Appointment Desk. Common status changes include “Left without seen”, “No Show”, and “Scheduled”. Statuses can be changed multiple times for the same appointment as needed, up to three days from the date of service (check with a supervisor for clinic specific EOD processing timelines).
• Adding Guarantor Notes at Check In  - (Handout) At Check In, if a patient identifies a change to their insurance, front desk staff can add a guarantor note using Note type "Check In Insurance Information [340]" with the updated insurance information. This note type populates a PFS Registration workqueue. Front Desk staff should also scan the new insurance card.
• Updating a Guarantor Address During Check In  - (Handout) During Check In, the guarantor address should be updated if it is missing or incorrectly formatted.

Medicare Secondary Payor Questionnaire (MSPQ)

• Medicare Secondary Payor Questionnaire  - (Handout) The MSPQ is the questionnaire associated with Medicare coverage for senior citizens and disabled persons and will be initiated at Check In and during insurance creation.

Patient Care Teams and Sensitive Visit

Patient Care Teams webpage

• Adding a Provider on the Fly  - (Handout) The Provider on the Fly activity allows users to create a provider record when it does not currently exist in the system.
• Marking a Visit as Sensitive  - (Handout) Marking a visit as “Sensitive” will prevent the visit-level documentation from being shared with outside entities. The documentation will not be available through the Iowa Health Information Network (IHIN), Care Everywhere, UI CareLink, or Comm Management, but will be viewable to the patient in MyChart. This functionality is only available for outpatient visits.
• Patient Care Team/EMR Information Sharing Matrix  - (Handout) This matrix provides details on the Epic activities used to share patient information from the Epic system.
• Updating the Patient Care Team During Scheduling, Check In, and Registration  - (Handout) The Patient Care Team activity provides a single access point for managing the relationships a patient may have with a variety of providers involved in their healthcare. The Patient Care Team is reviewed and updated during Scheduling, Check In and Registration. (Other roles have access to edit the Care Team, as well.) In addition, the PCP is verified on the Checklist during Scheduling and Check In workflows when it displays as unverified.

Patient Not Present

• Patient Not Present Appointments  - (Handout) The “Patient Not Present” (PNP) scheduling workflow is used when a Hospital Account Record (HAR) needs to be created for a patient that is not present but for whom billable services are being provided. Examples of when a Patient Not Present encounter would be used include: • Various lab specimens received • Outside tests are performed and sent to the UIHC to be read by our providers, including radiology exams • Optical Shop & contact lens • Pathology specimens for diagnosis/consultation • Other reasons Staff may schedule same-day appointments using the standard scheduling workflow or they may use One Click. One Click must be set up for a department. To schedule appointments for past dates, the standard scheduling workflow must be used.

Patient Status & Rooming

• Delete Dashboard Status Using the Event Log  - (Handout) If a patient’s appointment status is manually updated in error, the erroneous status should be deleted using the Event Log. This button can be found on the Schedule activity toolbar, within certain provider and nurse navigators, and on the toolbar for the Department Appointment Report (DAR).
• Manually Updating a Patient's Dashboard Status  - (Handout) Dashboard statuses allow users to track the movement of a patient throughout the clinic. A status may be updated manually from the Schedule activity, from within nursing and provider navigators, and from the Department Appointments Report (DAR).
• Rooming a Patient on the Schedule  - (Handout) Rooming a patient on the Patient Multi-Provider Schedule activity allows clinic staff to keep track of patients as they move throughout their clinic visit. The rooming tool also helps clinic staff easily see which rooms are available and ready for patients. The Room Patient button may be accessed in the Schedule toolbar, the Visit Navigator, and the Department Appointments Report (DAR).

Patient Transport

• Requesting Transport for a Patient  - (Handout) The Patient Transport activity is used to alert transport staff that assistance is needed to move a patient.

Pharmacy Benefits Plan

• Verifying the Primary Pharmacy Benefit Plan during Check In  - (Handout) How to verify pharmacy benefits when presents as warning during Check In.
• Verify Pharmacy Benefits – Medical & Rx Benefit Crosswalk  - (Handout) A patient’s pharmacy benefit plan (prescription coverage) is not necessarily the same as their medical insurance coverage. When more than one pharmacy benefit plan exists, a primary must be verified with the patient and selected.

Quick Care and Urgent Care

• Checking In an "On My Way" Appointment for QuickCare and Urgent Care  - (Handout) Patients may self-schedule appointments at Quick Care and Urgent Care locations using “On My Way" from both MyChart and the UIHC webpage. These visits will display on the DAR, and the patient will need to be checked in upon their arrival at the clinic.

Workqueues webpage

• Filtering Workqueues  - (Handout) Workqueues can be filtered and saved as favorites to provide quick and easy access to the most commonly used workqueues.
• Reviewing Workqueue List Basics  - (Handout) To find patients that have referrals and need to be scheduled, the Referrals Workqueue List is used to quickly find these patients.
• Working Front Line Patient Workqueues  - (Handout) Front line Patient workqueues are worked by staff on a daily basis to correct errors on appointments that must be fixed.

Return to  Cadence (Scheduling/Check In/Check Out)

Return to Epic Resources

Improving Patient Scheduling Outcomes with Epic

Co-authored by Brennan Turner, President and Co-Founder of The Joiner Firm .

Scheduling patients can be a deceptively complex process. While the idea of a patient selecting a time slot seems simple enough, there are several questions to consider:

• Does the patient have general questions or specific symptoms that may require an appointment with a specialist?
• Does the patient have an existing relationship with a provider?
• Is the patient new to the healthcare system?

As you can see, a clinic’s scheduling process is important in ensuring that appointments are scheduled accurately.

Appointments scheduled incorrectly are not always identified right away. In many instances the patient has already arrived, or the appointment is canceled at the last minute. This makes it difficult to ensure schedules are full and the provider’s time is maximized. When appointments are scheduled correctly the first time, there will be fewer last-minute cancellations and visit volume will increase.

Improving patient scheduling is key. The implementation of decision tree functionality can ensure that the patient is seen by the right provider at the right time. An effective decision tree can remove barriers to patient access, increase patient satisfaction, decrease revenue loss, and ensure effective time management. Decision trees are an Epic functionality that utilize rules and logic to aid a scheduler in navigating complex scheduling scenarios. Much of the decision tree logic runs in the background, unbeknownst to the scheduler, and references specific patient data within Epic to guide the scheduler through the scheduling process.

Epic is a leading Electronic Medical Record (EMR) software that stores all patient data, ranging from patient demographics to medical history. Since it is an electronic database, healthcare organizations can leverage this patient data against their specific clinic workflows through the implementation of decision trees.

An effective decision tree can remove barriers to patient access, increase patient satisfaction, decrease revenue loss, and ensure effective time management.

Sendero sat down with Brennan Turner , a senior Epic Cadence consultant with The Joiner Firm , who we recently partnered with at a large healthcare provider to improve their clinic-specific scheduling workflows. We discussed the functionalities and benefits of scheduling with Epic decision trees:

What are Epic decision trees, and how can they help improve the patient scheduling process?

Brennan Turner : Decision trees are scheduling tools in Epic that utilize a set of predetermined questions and logic to guide a scheduler to correctly make an appointment with a clinic, without having to know the specific scheduling rules of each department. This tool can improve scheduling accuracy by making sure the right visit type, provider, and location are selected the first time, with an overall benefit of lowering no-show and cancellation rates.

How does this improve patient satisfaction?

What impact does this have on training of new staff?

Brennan Turner : Scheduling rules are often either stored in a repository, written on a sticky note, or live within the knowledge of seasoned schedulers. This can make it difficult for new staff to schedule appointments accurately, causing frustration for the patient, the clinics, and the providers. With the decision-making process being built within Epic and automated through decision trees, there is less clinic-specific information a scheduler needs to learn.

Decision tree design considerations for healthcare organizations

An effective decision tree is not a one-size-fits-all solution. Each organization needs to consider their unique requirements and operational needs:

Considerations for Clinics

Decision trees can provide a high degree of automated control to ensure that patients are being scheduled for the right visit at the right time with the right provider:

• Clinic level payor restrictions can be built to filter out certain insurance types. The decision tree uses logic in the background to determine if a patient’s primary insurance is accepted at a clinic.
• Age restrictions can also be built at the clinic level if there is a certain age group that the clinic does not see. As noted above, a pediatric clinic can set an age restriction to only accept new patients over 2 years of age.
• Clinics with subspecialists or unique programs can also utilize decision trees to aid in scheduling accuracy. For example, a clinic with a weight-management program can ensure qualifying patients are scheduled in the right time slots with the right subset of providers.

Considerations for Physicians

Every physician, regardless of their practice, serves a unique panel of patients. Decision trees can help maintain unique workflows through monitoring patients’ reasons for office visits.

To ensure that patients’ concerns are not only identified prior to the visit, but also scheduled properly, a decision tree can be built to “flip” an appointment type to the proper visit type. A series of questions can be asked by the scheduler to determine if the original visit type is correct. For example, a patient with multiple concerns may need a little extra time, so the decision tree can suggest offering an extended office visit vs. a standard office visit. Additionally, a patient could call in with a specific concern that warrants its own specific type of visit, such as ADD/ADHD care.

Considerations for Implementation

Implementing decision tree functionality is no light undertaking; it involves detailed conversations across the clinic to verify that no details are overlooked in the process. To ensure that decision trees are inclusive of the entire clinics’ workflows, meetings need to be held with clinic management, subject matter experts, front desk personnel, and anyone else that may be involved in the scheduling process. It is very important at this step to get everyone past a theoretical understanding of what Epic can do and get them to critically think about how this application will affect their scheduling if they were to solely rely on it to accurately reflect their clinic processes.

Epic decision tree design is a complex process involving detailed scrutiny prior to the build and implementation phase. Sendero’s partnership with Epic allows for technical analysts to obtain the necessary clinical considerations and focus on building an effective program. We can liaise with a clinic and focus on communication, process alignment, and project execution.

Interested in learning more about Sendero’s expertise in this area? Use the form below to reach out to one of our consultants.

By Christina Speros and Harris Neuens

Decision trees can improve scheduling accuracy by making sure the right visit type, provider, and location are selected the first time, with an overall benefit of lowering no-show and cancellation rates. Brennan Turner, President and Co-Founder of The Joiner Firm

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A large non-profit healthcare provider experienced significant growth through mergers and acquisitions, now providing services to more than five million patients. As a result, the organization faced a multitude of overlapping strategic and departmental initiatives.

After the merger of two large Texas-based healthcare systems, a need existed to change to one electronic medical record (EMR) system across the enterprise.

After a healthcare system went through a merger, they launched a project to consolidate Find a Doctor websites to improve the patient experience.

A large healthcare system was notified that it is now required to report compliance as one entity, rather than separate small business units. Through existing relationships, the client learned of Sendero's experience with PCI Compliance and requested assistance.

About the Author

Harris is a Consultant in our Dallas office with industry experience in healthcare and financial services.

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