Epic EMR inefficiencies

[deleted993114]

Has anyone used Epic EMR for a long period of time? If so, what methods have you used to reduce the inefficiencies associated with that system? I have used a couple versions of Allscripts for 10-12 years and found them to be much, much faster.

Particularly it seems it takes nurses forever to check in patients. Ordering meds is very slow and ordering any imaging. Just writing the note and entering CPT codes is fine.

Any thoughts appreciated. It appears this system was built for hospitals and not for clinics.

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[deleted131481]

Epic has been my primary system through training and now. Correct it was really designed for inpatient and then sort of forced outpatient workflow. There ar different versions of epic so may vary on what's available.

In terms of efficiency:
- must spend time making smartphrases. These are used for note templates, procedure notes, patient instructions, medication templates, opioid counseling, etc
- 'favorite' or starred medications. When you order gabapentin 300 TID #90 this can be saved to be a single click for future patients
- other orders including imaging can be favorites
- customized your tab order and use note filters to make review easier

Many of these features are unfortunately not very obvious, see if you can get a power user to sit with you for a half hour.

 

[deleted993114]

Epic has been my primary system through training and now. Correct it was really designed for inpatient and then sort of forced outpatient workflow. There ar different versions of epic so may vary on what's available.

In terms of efficiency:
- must spend time making smartphrases. These are used for note templates, procedure notes, patient instructions, medication templates, opioid counseling, etc
- 'favorite' or starred medications. When you order gabapentin 300 TID #90 this can be saved to be a single click for future patients
- other orders including imaging can be favorites
- customized your tab order and use note filters to make review easier

Many of these features are unfortunately not very obvious, see if you can get a power user to sit with you for a half hour.

Thanks for the pointers. That is a very good start. Thanks very much!

 

[Ducttape]

yes, use smartphrases as much as possible. the advantage is that you can specify exactly what you want to say... and you can go in and change them in under a minute. I change something in these smartphrases roughly once a month.

add favorites for as much as you can. when you click on Add order, you can pull up the menu and if already done, will prepopulate the med/test etc.

as far as your ACO goes, you can even put in your smartphrase to put in your prior auth info.

 

[DOctorJay]

I prefer making templates in M*modal or dragon. you can save that file and bring it with you if you leave. I don't think you can save/bring along epic templates.

 

[Ducttape]

sure, why not? just copy the content to a .doc file.

 

[deleted993114]

yes, use smartphrases as much as possible. the advantage is that you can specify exactly what you want to say... and you can go in and change them in under a minute. I change something in these smartphrases roughly once a month.

add favorites for as much as you can. when you click on Add order, you can pull up the menu and if already done, will prepopulate the med/test etc.

as far as your ACO goes, you can even put in your smartphrase to put in your prior auth info.

Again- thanks for the helpful pointers. I am a complete computer idiot, so those suggestions were not intuitive to me.

Thanks!

 

[hyperalgesia]

The epic I am forced to use at a hospital has a bunch of check boxes at the end of entering orders. You have to specify with each order, is it pre op, intraop, pacu, postop, post dc, etc, etc. Then you have to click unnecessarily multiple times. I want to put a bullet in my brain when I use it.

 

[painfree23]

The epic I am forced to use at a hospital has a bunch of check boxes at the end of entering orders. You have to specify with each order, is it pre op, intraop, pacu, postop, post dc, etc, etc. Then you have to click unnecessarily multiple times. I want to put a bullet in my brain when I use it.

check your setting when you log in and make sure you are in the ''outpatient environment'' --> after logging in, the first prompt that pops up,make sure its an outpatient clinic and not defaulting to an inpatient setting.

 

[clubdeac]

Feel your pain... epic totally sucks. It may be good relative to other EMRs and once your get used to it not too bad, but overall I waste way too much time charting every day

 

[Ducttape]

After the next time you do this order, make sure you save it and put in an easy to find tab of Orders. Name is something remarkable - ie TF dexamethasone.
Next time you order, click on Orders and find it and all that info should be prepopulated....

 

[deleted993114]

After the next time you do this order, make sure you save it and put in an easy to find tab of Orders. Name is something remarkable - ie TF dexamethasone.
Next time you order, click on Orders and find it and all that info should be prepopulated....

Thanks for all the suggestions! I am a complete computer idiot, so the help is greatly appreciated.

Thanks!

 

[deleted131481]

One I will add is 'common diagnosis button'. I forget the exact name, but in the area where you put in ICD diagnosis to save common ones as 'buttons' - I think up to 20. You can also rename them. And for follow up patients you can previous diagnosis. Would be nice if just auto populated but should save some repetitive searching.

 

[DOctorJay]

Tell me more about the previous diagnosis button. I haven’t figured that out yet.


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[Ducttape]

if yours is like mine....

under Plan, there should be a Visit Diagnosis tab that we have to put in our diagnosis and generates the ICD 10 code.

in this tab, after Common, there is Previous.

in addition, you can add diagnoses in to the Common tab that you use a lot.

stevelobel would probably have to add failed back, degenerative spinal stenosis, trigeminal neuralgia. mine currently is populated with myofascial pain dysfunction, pain of multiple sites, reactive depression..........

 

[DOctorJay]

thanks for the screen shot. mine doesn't look like that. I can't find a way to add the "previous" button.

 

[dhcofc]

On mine I can see previous diagnoses that were used previously. Also if I am prescribing a medication that was associated with different diagnoses in the past and re-order that medication the diagnoses associated with the end previously automatically are populated for the visit diagnoses.

My common diagnosis section are very commonly used by me and it saves time.

Example: if you have a patient on gabapentin for 3 different pain problems and you reorder gabapentin those three diagnoses previously used for gabapentin will automatically populate. This really makes it easy to see patients and follow up and choose the correct diagnoses if you are managing chronic pain with medication.

 

[dhcofc]

This is what it looks like when you favorite medications. It is worth your time upfront to set up all the medications you would commonly prescribe and all you have to do is press that little button in the very bottom left corner to bring up your favorites list for orders. Then you can click on as many medications, Imaging, PT referrals, neurosurgery referrals, etc. that you need to and adds it to active orders. If you typically prescribe a certain medication For 30 days with three refills for example that can all be pre-populated so you don’t have to change anything. Ordering medications and other things for me is as easy as checking a box. There is an easier and faster way to add all of these to favorites, message me if interested.

 

[Ducttape]

now, to save even more time, when you start typing in Orders, you may a pop up as you are typing the order. your saved orders should pop up in this little bubble.

unfortunately, I cant use the snip tool to show you, but the orders you save should show up.

Previous Diagnosis will not pop up until you enter some diagnosis on your initial evaluation.