December 8, 2023

Our MD Tech Tip article this week is the best way to chart quicker in Epic. We’re not going to bore you with a number of dot phrases or macros for our PE or ROS. Everybody is aware of that. I educate our residents on the best way to chart quicker and be extra environment friendly on shift. By hours of lectures I’ve given them, I’ve tweaked my instruction accordingly primarily based 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 can make your subsequent medical day extra environment friendly. Specifically, I deal with information gaps I’ve seen in senior residents when studying the best way to chart. Whereas among the following would possibly look like delicate workflow adjustments, they’ll yield vital effectivity good points.

Sickness HPI type

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. Method too many clicks and variations. So for that stomach ache affected person, think about using the “Sickness” HPI type as an alternative of “stomach ache”. The Sickness type has an empty clean for “location”, “high quality”, “context”, and different key parts. Severity, onset and length have straightforward buttons to populate on this template. That is nice as a result of it offers you the factors you want to your degree of service to be excessive (1-5). I can’t emphasize this way sufficient. It’s a small factor, however makes your HPI a lot quicker over time. I first fill out the “Sickness” type, after which will soar into the Narrative field and can dictate a number of strains accordingly. Complete 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 most effective. Transcription will not be excellent. For my part, having to attend for a transcription service after which assessment it for accuracy hours later will not 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 skill to make use of a dictation software program, akin to Dragon dictation, along with the EHR. For my setup, actual time dragon dictation is constructed proper into epic, and we have now energy mics that permit us to dictate on the press of a button proper into the chart. You may even put in orders with the assistance of dictation.

I’m a kind of millennials who grew up on keyboards and was very happy with my phrases per minute. Due to this, I assumed that I may at all times preserve typing quicker than I may dictate. For a full 12 months that our hospital turned on dictation I refused to change over, feeling that I may kind quicker. Lastly, a fellow college member satisfied me to not less than simply give it a try to it was an entire 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 lot of hours of my life that I might 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. Publish switching over to actual time dictation, I used to be capable of end charts far more simply on shift and have virtually each chart completed previous to the tip of a shift. In the event you’re a kind of that hasn’t converted to actual time dictation, please do. In the event you’re at a system that doesn’t have actual time dictation out there, push for it. You’ll get assist out of your administration just by saying it’ll assist get charts completed quicker in order that insurance coverage can billed sooner. In case your hospital needs to do one thing about morale, that is a simple lever they’ll pull.

Reduce your dot phrases

Arrange your medical resolution making(MDM) with a common dot phrase. The extra common you may 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 along with your chart, the extra time and complexity you’re including. Maintain it easy (not at all times potential 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:

Differentials thought-about:

Key medicines administered within the ER: @EDMEDS@

Medical Resolution Making:

Key discharge directions:

Clearly, arrange your common dot phrase to your medical resolution making or evaluation and plan accordingly. No matter you resolve, simply be sure to are conserving it common. It’s a lot simpler to go and delete sure elements of your common dot phrase than creating a number of variations. Once more, cut back litter and complexity.

Use floating home windows

Many suppliers don’t learn about Epic’s floating home windows choice. Once I educate this to my senior residents, many come again and inform me that is the function that helps them probably the most. This function solely works nicely when you could have a two monitor arrange. When enabled, floating home windows are a good 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 reveals 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 function from that is that when it’s enabled, each time you open the sufferers chart, your observe pops up you probably have not pended it or accomplished it. It’s a continuing reminder to complete your observe or replace it.

Ensure that your whole “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 help you customise each display screen and the way knowledge is offered to you. Don’t use the default setup! It’s worthwhile to spend 20 to half-hour on the primary screens you employ to customise the menus you wish to seem in entrance of you. This may help you entry historic check outcomes higher, help you see very important indicators higher, and far more. I can’t let you know what number of occasions I’ve discovered merely reconfiguring a residents wrenches permits them to avoid wasting a number of clicks on each affected person chart.

Two final items of recommendation. Solely chart what you do. Please be cautious of how you employ macros and ensure your charts are correct. Lastly, chart in actual time as a lot as you may. Even when it’s simply filling out the HPI, ROS, and the bodily examination. You don’t wish to finish your medical day or night time with an inbox of charts which might be clean!

Do you could have any extra suggestions you’d like me so as to add to this? Message me on twitter (@iltifatMD) and I’ll add them to this checklist!