Our MD Tech Tip article this week is how to make a faster chart in Epic. We will not bore you with multiple phrases or macros for our PE or ROS. Everyone knows that. I teach our residents to draw faster and be more efficient on the turn. Through hours of lectures I’ve given them, I’ve adjusted my instruction accordingly based on the feedback I’ve received with what works and what doesn’t. While the lecture and instructions I give are more detailed and nuanced, there are 5 key points I wanted to present that will make your next clinical day more efficient. In particular, I focus on the knowledge gaps I have seen in older residents when I learn to draw graphs. While some of the following may seem like subtle changes in workflow, they can lead to significant efficiency gains.
HPI illness form
Use the “Illness” template in Epic. Many do not know it. When making graphs in your emergency room or clinic settings, use the illness tab to pre-fill your HPI. I’ve found that using Epic custom HPI forms takes much longer. Too many clicks and variations. Therefore, for this patient with abdominal pain, consider using the HPI “Illness” form instead of “Abdominal Pain”. The disease form has a blank space for “location,” “quality,” “context,” and other key components. Gravity, start, and duration have easy-to-fill buttons in this template. This is great because it gives you the points you need to keep your service level high (1-5). I can’t emphasize this form enough. It’s a small thing, but it makes your HPI much faster over time. First fill out the “Illness” form, and then I’ll jump into the Narrative box and dictate a few lines accordingly. The total time this setting is used to complete your HPI is less than one minute.
Dictate, dictate, dictate (real time)
If you have the ability to dictate, dictate. Real-time dictation is the best. Transcription is not ideal. In my opinion, having to wait for a transcription service and then review it for accuracy hours later is not efficient. Dragon Real-time dictation has changed lives. I’m just frustrated that I didn’t use it before when it was available. If you are unfamiliar with real-time dictation, it is possible to use dictation software, such as Dragon dictation, along with EHR. For my setup, real-time dragon dictation is incorporated directly into the epic, and we have powerful microphones that allow us to dictate at the push of a button directly on the graphic. You can even place orders with the help of dictation.
I am one of those millennials who grew up with keyboards and was very proud of my words per minute. That’s why I assumed I could always keep writing faster than I could dictate. For a whole year our hospital activated dictation I refused to change, feeling I could write faster. Eventually, a faculty member convinced me to give it a try and it was a total life change. I’m not exaggerating at all. I found myself able to save about an hour per turn of graphics, and real-time dictation has saved me hundreds of hours of my life that I would otherwise have spent writing. I was able to certify resident charts and also make individual patient charts much faster. After switching to real-time dictation, I was able to finish the graphics much more easily during the turn and do almost all the graphics before the end of the turn. If you are one of those who has not passed the dictation in real time, do it. If you are on a system that does not have real-time dictation, press it. You will get support from your administration simply by saying that it will help you make the graphics faster so that the insurance can be billed sooner. If your hospital wants to do something about morale, this is an easy lever they can throw.
Minimize your dot sentences
Organize your medical decision making (MDM) with a general point sentence. The more general you are the better. I’ve seen vendors with over 20 dot phrases for custom MDMs. I’m not clear how this helps with efficiency. The more customization you do with your graphic, the more time and complexity you will add. Make it simple (not always possible with some patients, I understand).
My general point phrase for my MDM is:
Interpretation of the Image / Radiology ER provider:
ER provider ECG interpretation:
Labs ER Provider Interpretation:
@ MUTAR @
Key drugs administered in the ER: @EDMEDS @
Medical decision making:
Key download instructions:
Obviously, organize your general point sentence for your medical decision-making or evaluation, and plan accordingly. Whatever you decide, just make sure you keep it general. It is much easier to go and delete certain parts of your general sentence of points than to create multiple variations. Again, reduce clutter and complexity.
Use floating windows
Many vendors are unaware of Epic’s floating window option. When I teach this to my senior residents, many come back and tell me that this is the function that helps them the most. This feature only works well when you have two monitors set up. When enabled, floating windows are a great way to optimize charts, as they allow you to do multiple tasks and also display an incomplete note every time you are on a patient chart. To access the floating windows, go to your note editor. In the “Edit note” tab that appears, you’ll see a small down arrow, click on it, and you’ll see the “Move to floating window” option. This allows your note to be displayed on a separate monitor, allowing you to further review the chart as you fill out the note.
My favorite efficiency feature of this is that once enabled, every time you open the patient chart, your note appears if you haven’t pending it or haven’t completed it. It is a constant reminder to finish the note or update it.
Make sure all your “wrenches” are optimized!
Epic has small keys on most of the screens you are on. These keys are essential because they allow you to customize each screen and how the data is presented to you. Do not use the default settings! It’s worth spending 20 to 30 minutes on the main screens you use to customize the menus you want to appear in front of you. This will give you better access to historical test results, allow you to better see vital signs, and more. I can’t tell you how many times I’ve found that simply reconfiguring a resident’s keys allows them to save a few clicks on each patient chart.
Last two tips. Just draw what you do. Be careful how you use macros and make sure your graphics are accurate. Finally, make a real-time chart as much as you can. Even if it’s just about filling out the HPI, ROS and physical exam. You don’t want to end your clinical day or night with a blank graphics inbox!
Do you have any more tips that you would like me to add to this? Send me a twitter message (@complementMD) and I will add them to this list!