Our MD Tech Tip article this week is how one can chart quicker in Epic. We aren’t going to bore you with a number of dot phrases or macros for our PE or ROS. Everybody is aware of that. I train our residents on how one can chart quicker and be extra environment friendly on shift. By hours of lectures I’ve given them, I’ve tweaked my instruction accordingly based mostly on suggestions I’ve gotten with what works and what doesn’t. Whereas the lecture and directions I give are extra detailed and nuance, there are 5 key takeaways I wished to current that may make your subsequent scientific day extra environment friendly. Particularly, I deal with data gaps I’ve seen in senior residents when studying how one can chart. Whereas a number of the following would possibly look like delicate workflow modifications, they’ll yield vital effectivity features.
Sickness HPI kind
Use the “Sickness” template in Epic. Many have no idea about this. When doing charts within the Emergency room or clinic setting, use the sickness tab to pre-populate your HPI. I’ve discovered that utilizing Epic’s customized HPI varieties truly take for much longer. Approach too many clicks and variations. So for that stomach ache affected person, think about using the “Sickness” HPI kind as an alternative of “stomach ache”. The Sickness kind has an empty clean for “location”, “high quality”, “context”, and different key parts. Severity, onset and period have straightforward buttons to populate on this template. That is nice as a result of it offers you the factors you want in your degree of service to be excessive (1-5). I can’t emphasize this kind sufficient. It’s a small factor, however makes your HPI a lot quicker over time. I first fill out the “Sickness” kind, after which will soar into the Narrative field and can dictate a couple of strains accordingly. Whole time utilizing this setup to finish your HPI is lower than a minute.
Dictate, dictate, dictate (actual time)
When you have the power to dictate, dictate. Actual time dictation is the perfect. Transcription shouldn’t be best. For my part, having to attend for a transcription service after which assessment it for accuracy hours later shouldn’t be environment friendly. Dragon actual time dictation has been a life changer. I’m solely annoyed that I didn’t use it sooner when it was out there. If you’re not aware of actual time dictation, it’s the means to make use of a dictation software program, equivalent to Dragon dictation, along side the EHR. For my setup, actual time dragon dictation is constructed proper into epic, and we have now energy mics that enable us to dictate on the press of a button proper into the chart. You’ll be able to even put in orders with the assistance of dictation.
I’m a type of millennials who grew up on keyboards and was very happy with my phrases per minute. Due to this, I assumed that I might at all times preserve typing quicker than I might dictate. For a full 12 months that our hospital turned on dictation I refused to change over, feeling that I might kind quicker. Lastly, a fellow school member satisfied me to at the very least simply give it a try to it was a whole life changer. I’m not exaggerating in any respect. I discovered myself with the ability to save about an hour per shift of charting, and actual time dictation has saved me a whole bunch of hours of my life that I’d have in any other case spent typing. I used to be capable of attest residents charts and likewise do particular person affected person charts a lot quicker. Submit switching over to actual time dictation, I used to be capable of end charts far more simply on shift and have virtually each chart carried out previous to the top of a shift. For those who’re a type of that hasn’t converted to actual time dictation, please do. For those who’re at a system that doesn’t have actual time dictation out there, push for it. You’re going to get help out of your administration just by saying it would assist get charts carried out quicker in order that insurance coverage can billed sooner. In case your hospital desires to do one thing about morale, that is a simple lever they’ll pull.
Decrease your dot phrases
Arrange your medical resolution making(MDM) with a common dot phrase. The extra common you might be the higher. I’ve seen suppliers with greater than 20 dot phrases for customized MDMs. I’m unclear how that helps with effectivity. The extra customization you’re doing together with your chart, the extra time and complexity you’re including. Hold it easy (not at all times attainable with some sufferers, I get it).
My common dot phrase for my MDM is the next:
ER supplier interpretation of Imaging / Radiology:
ER supplier interpretation of EKG:ER supplier interpretation of Labs:
@EDLABS@
@WETREAD@Differentials thought-about:
Key drugs administered within the ER: @EDMEDS@
Medical Choice Making:
Key discharge directions:
Clearly, manage your common dot phrase in your medical resolution making or evaluation and plan accordingly. No matter you determine, simply be sure you are preserving it common. It’s a lot simpler to go and delete sure components of your common dot phrase than creating a number of variations. Once more, scale back litter and complexity.
Use floating home windows
Many suppliers don’t find out about Epic’s floating home windows choice. Once I train this to my senior residents, many come again and inform me that is the characteristic that helps them probably the most. This characteristic solely works nicely when you’ve gotten a two monitor arrange. When enabled, floating home windows are an effective way to optimize charting by permitting you to multitask and likewise mentioning an incomplete observe each time you’re in a affected person chart. To entry floating home windows, go to your observe author. On the “edit observe” tab that exhibits up, you’ll see a tiny downward pointing arrow, click on this and also you’ll see the choice for “transfer to floating window”. This enables your observe to indicate up on a separate monitor, permitting you to do extra chart assessment whilst you’re filling out your observe.
My favourite effectivity characteristic from that is that when it’s enabled, each time you open the sufferers chart, your observe pops up when you have not pended it or accomplished it. It’s a relentless reminder to complete your observe or replace it.
Be sure your entire “wrenches” are optimized!
Epic has tiny wrenches all through many of the screens you’re in. These wrenches are important as a result of they let you customise each display screen and the way information is offered to you. Don’t use the default setup! It’s worthwhile to spend 20 to half-hour on the primary screens you utilize to customise the menus you wish to seem in entrance of you. This may let you entry historic take a look at outcomes higher, let you see important indicators higher, and far more. I can’t inform you what number of instances I’ve discovered merely reconfiguring a residents wrenches permits them to save lots of a couple of clicks on each affected person chart.
Two final items of recommendation. Solely chart what you do. Please be cautious of how you utilize macros and ensure your charts are correct. Lastly, chart in actual time as a lot as you possibly can. Even when it’s simply filling out the HPI, ROS, and the bodily examination. You don’t wish to finish your scientific day or evening with an inbox of charts which are clean!
Do you’ve gotten any extra ideas you’d like me so as to add to this? Message me on twitter (@iltifatMD) and I’ll add them to this checklist!
