Our MD Tech Tip article this week is how to chart faster in Epic. We are not going to bore you with multiple dot phrases or macros for our PE or ROS. Everyone knows that. I teach our residents on how to chart faster and be more efficient on shift. Through hours of lectures I’ve given them, I’ve tweaked my instruction accordingly based on feedback I’ve gotten with what works and what doesn’t. While the lecture and instructions I give are more detailed and nuance, there are 5 key takeaways I wanted to present that will make your next clinical day more efficient. In particular, I focus on knowledge gaps I’ve seen in senior residents when learning how to chart. While some of the following might appear to be subtle workflow changes, they can yield significant efficiency gains.
Illness HPI form
Use the “Illness” template in Epic. Many do not know about this. When doing charts in the Emergency room or clinic setting, use the illness tab to pre-populate your HPI. I have found that using Epic’s custom HPI forms actually take much longer. Way too many clicks and variations. So for that abdominal pain patient, consider using the “Illness” HPI form instead of “abdominal pain”. The Illness form has an empty blank for “location”, “quality”, “context”, and other key components. Severity, onset and duration have easy buttons to populate in this template. This is great because it gives you the points you need for your level of service to be high (1-5). I can’t emphasize this form enough. It’s a small thing, but makes your HPI so much faster over time. I first fill out the “Illness” form, and then will jump into the Narrative box and will dictate a few lines accordingly. Total time using this setup to complete your HPI is less than a 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 been a life changer. I am only frustrated that I didn’t use it sooner when it was available. If you are not familiar with real time dictation, it is the ability to use a dictation software, such as Dragon dictation, in conjunction with the EHR. For my setup, real time dragon dictation is built right into epic, and we have power mics that allow us to dictate at the press of a button right into the chart. You can even put in orders with the help of dictation.
I’m one of those millennials who grew up on keyboards and was very proud of my words per minute. Because of this, I assumed that I could always keep typing faster than I could dictate. For a full year that our hospital turned on dictation I refused to switch over, feeling that I could type faster. Finally, a fellow faculty member convinced me to at least just give it a try and it was a complete life changer. I am not exaggerating at all. I found myself being able to save about an hour per shift of charting, and real time dictation has saved me hundreds of hours of my life that I would have otherwise spent typing. I was able to attest residents charts and also do individual patient charts much faster. Post switching over to real time dictation, I was able to finish charts much more easily on shift and have almost every chart done prior to the end of a shift. If you’re one of those that hasn’t switched over to real time dictation, please do. If you’re at a system that doesn’t have real time dictation available, push for it. You will get support from your administration simply by saying it will help get charts done faster so that insurance can billed sooner. If your hospital wants to do something about morale, this is an easy lever they can pull.
Minimize your dot phrases
Organize your medical decision making(MDM) with a general dot phrase. The more general you can be the better. I’ve seen providers with more than 20 dot phrases for custom MDMs. I’m unclear how that helps with efficiency. The more customization you’re doing with your chart, the more time and complexity you’re adding. Keep it simple (not always possible with some patients, I get it).
My general dot phrase for my MDM is the following:
ER provider interpretation of Imaging / Radiology:
ER provider interpretation of EKG:
ER provider interpretation of Labs:
Key medications administered in the ER: @EDMEDS@
Medical Decision Making:
Key discharge instructions:
Obviously, organize your general dot phrase for your medical decision making or assessment and plan accordingly. Whatever you decide, just make sure you are keeping it general. It’s much easier to go and delete certain parts of your general dot phrase than creating multiple variations. Again, reduce clutter and complexity.
Use floating windows
Many providers don’t know about Epic’s floating windows option. When I teach this to my senior residents, many come back and tell me this is the feature that helps them the most. This feature only works well when you have a two monitor set up. When enabled, floating windows are a great way to optimize charting by allowing you to multitask and also bringing up an incomplete note every time you’re in a patient chart. To access floating windows, go to your note writer. On the “edit note” tab that shows up, you’ll see a tiny downward pointing arrow, click this and you’ll see the option for “move to floating window”. This allows your note to show up on a separate monitor, allowing you to do more chart review while you’re filling out your note.
My favorite efficiency feature from this is that once it’s enabled, every time you open the patients chart, your note pops up if you have not pended it or completed it. It’s a constant reminder to finish your note or update it.
Make sure all of your “wrenches” are optimized!
Epic has tiny wrenches throughout most of the screens you’re in. These wrenches are critical because they allow you to customize every screen and how data is presented to you. Do not use the default setup! It is worthwhile to spend 20 to 30 minutes on the main screens you use to customize the menus you want to appear in front of you. This will allow you to access historical test results better, allow you to see vital signs better, and much more. I can’t tell you how many times I’ve found simply reconfiguring a residents wrenches allows them to save a few clicks on every patient chart.
Two last pieces of advice. Only chart what you do. Please be wary of how you use macros and make sure your charts are accurate. Lastly, chart in real time as much as you can. Even if it’s just filling out the HPI, ROS, and the physical exam. You don’t want to end your clinical day or night with an inbox of charts that are blank!
Do you have any more tips you’d like me to add to this? Message me on twitter (@iltifatMD) and I’ll add them to this list!