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.

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H&P template.

Progress Notes Template

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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.

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Top Horizontal row buttons on top left of the screen

I arranged in the following order.

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.

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Discharge Button

We use the following buttons under discharge tab.

Unresulted Labs, Disch. Instructions and Disch. Summary.

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

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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.

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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.

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You can use My Sticky Note for writing reminders etc.

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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.

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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.

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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:AAOX3RS: CTAB,no added soundsRRRabd 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.

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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.