EPIC...

[la gringa]

my hospital just made the switch. am having a tough time adjusting to the massive amount of clicking and typing. have had overuse thumb issues in the past and that's only part of it.... takes forever!

scribes are still in training, hospital is not getting Dragon to the ED docs for at least 3 more months.

any tips? i know, macro this, dot phrase that.... but HPI and MDM is not so easy to "macro"

i have colleagues who bring a laptop or computer on wheels in the room, but i cannot practice medicine with a computer in my face. terrible, terrible for the dr-patient interactions. i DO still like taking care of people!!!

and FWIW i used Cerner w/ Dragon previously and it was so much easier - i think the key factor was the "precompleted notes".

any advice is welcome, thanks!!! (40 charts in the hole)

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[Doctor Bob]

I spent 8-10 hours in the computer lab before our hospital went live with Epic. I made so many dot phrases for HPIs of all varieties. And then it was a matter of replacing all the "***" that I scattered throughout the HPIs. I had a ton of templated physical exams, etc, etc. I basically made a bunch of EpicTSheets equivalents with all little variations.

That 8-10 hours paid for itself many times over throughout the next year as it saved me a lot of time per chart. But it's not something you can easily do while at work. Kind of takes a dedicated day.

 

[Psai]

I spent 8-10 hours in the computer lab before our hospital went live with Epic. I made so many dot phrases for HPIs of all varieties. And then it was a matter of replacing all the "***" that I scattered throughout the HPIs. I had a ton of templated physical exams, etc, etc. I basically made a bunch of EpicTSheets equivalents with all little variations.

That 8-10 hours paid for itself many times over throughout the next year as it saved me a lot of time per chart. But it's not something you can easily do while at work. Kind of takes a dedicated day.

You should sell it

 

[Crayola227]

Check out some of my intern related posts previously I talk about ideas for getting more out of Epic

I posted here and I'll try to come back with those tips

 

[LaBusqueda]

I had a dot phrase chart that was a standard. Had labs, past hx, meds all imported automatically with dot phrases imbedded into the note...my thought is that with scribes this would be awesome.
You can dot phrase in the smart block HPi if you want instead of text too.

 

[southerndoc]

Be leary of macros and dot phrases. CMS is tinkering with the idea of data mining charts for similarities. Cut-and-paste type charting (dot phrases, smart phrases) are a landmine for RAC's. So be sure to change a few things in your charts to keep everything somewhat unique.

 

[cbrons]

You can get dragon to the point where you say, "insert chest pain template" and itll bring right up a specially designed note for the situation.

Why are u hiring scribes when you got the dragon?

 

[LaBusqueda]

I think dot phrases will be safe.

I am also a Dragon fan and with "advanced scripting", which is really nothing advanced at all, you can tell dragon to put in orders for you as well such as "dragon, insert chest pain order set 1", Etc.

 

[TooMuchResearch]

I think dot phrases will be safe.

I am also a Dragon fan and with "advanced scripting", which is really nothing advanced at all, you can tell dragon to put in orders for you as well such as "dragon, insert chest pain order set 1", Etc.

I should probably figure out how to build my own order sets and how to get dragon to order them.

...Or you could hand hold me through it real quick here.

 

[styphon]

I love EPIC.

I use Macros and "smart sets". I individualize these so they do not look like carbon copies, but a UTI/sprain/URI note will take me around 1 minute to finish.

 

[WilcoWorld]

Be leary of macros and dot phrases. CMS is tinkering with the idea of data mining charts for similarities. Cut-and-paste type charting (dot phrases, smart phrases) are a landmine for RAC's. So be sure to change a few things in your charts to keep everything somewhat unique.

You are correct that we must be careful. However, my understanding is that, as long as you actually asked the questions/did the exam you say you did, and you review the auto-populated data, dot phrases are totally legit and would stand up to a review.

That being said, making sure you actually did your standard chest pain (or whatever) H&P and reviewed the auto populated data are no small tasks.

I am in the habit of doing certain standard things on every patient, so that my dot phrase exams are honest. As such, I'm sure some of my patients wonder why I'm checking them for CVA tenderness when they're complaining of a headache...

 

[gutonc]

I should probably figure out how to build my own order sets and how to get dragon to order them.

...Or you could hand hold me through it real quick here.

This may not be possible for you. Every hospital system I have worked at that used Epic (4 so far) restricted creating order sets to Super Users. You could do so if you were willing to do a 3 day course in Wisconsin (on your own time and at your own expense of course), or if you knew who to bribe/sleep with at your hospital.

The best option most of us have is to add common orders and order sets to a preference list. Although I honestly find it easier (after nearly 10 years of using Epic) to just type the orders in directly.

 

[LaBusqueda]

This may not be possible for you. Every hospital system I have worked at that used Epic (4 so far) restricted creating order sets to Super Users. You could do so if you were willing to do a 3 day course in Wisconsin (on your own time and at your own expense of course), or if you knew who to bribe/sleep with at your hospital.

The best option most of us have is to add common orders and order sets to a preference list. Although I honestly find it easier (after nearly 10 years of using Epic) to just type the orders in directly.

Yes the "sets" will be system specific and usually too order heavy to be useful, although you can customize what is "pre checked"

You will be able to build your "preference list" in the preference list composer and just choose order preference IP (OP for DC meds/orders)
These are essentially your own sets! These can also be shared and borrowed from other docs in the system!
You have to put in work on these though as you have to be sure your hospital has it, what dose, route, concentration, and all that crap. I have a separate order pre don for just about every possible med and route of admin.
You can also sort these in any way you think is logical or works for you.

It's from here that I have dragon do the work as well. The dragon super user showed me how to do it and it was easy (but time intensive) from there...I got pretty silly with it to be honest. But I had dragon sign charts, cosign, put in orders all by voice command.

 

[DrYoda]

my hospital just made the switch. am having a tough time adjusting to the massive amount of clicking and typing. have had overuse thumb issues in the past and that's only part of it.... takes forever!

scribes are still in training, hospital is not getting Dragon to the ED docs for at least 3 more months.

any tips? i know, macro this, dot phrase that.... but HPI and MDM is not so easy to "macro"

I've just made generic template notes for most of the common complaints just click through and replace *** spots with what tooth number hurts, or how long the pain has been present. It's takes a few minutes to do but totally worth it in the end.

Sucks you don't have dragon or scribes yet. should be better once you do.

 

[Old_Mil]

Have you tried using a touch screen device?. A surface pro 3 or samsung galaxy tab pro might help if your goal is to eliminate mouse clicks.. If your IT department has a BYOD policy you can get a device like this and even add dragon to your personal device before the hospital makes the move.

Sent from my awesome Ubuntu device using the Forum Browser app

 

[la gringa]

part of the problem, i think, is that they want us to use the "notewriter" function. not sure if this is enforced though....

Mil - problem w/ own device is that they can't be on the network. the physician wireless doesn't let one maintain an ongoing connection. argh.

they did move the dragon date up, so that's a plus.... though scribe + dragon is imho the best. i've done it elsewhere w/ a different emr.

 

[CopToEM]

I've successfully installed Dragon on a thumb drive in the past and used it on a computer that didn't have it installed. I haven't tried this in many years but it's something to look into to make your life easier if possible. The Dragon Pro version does just as good a job as the medical version in my limited experience.

 

[Angry Birds]

I had epic in residency.

I type really fast but clicking slows me down. So what I did was skip to the final note and use dot phrases for everything instead of templates. Even my physical exam was a dot phrase, which I would then edit for positives. This minimized the clicking and waiting for screens to load.

But I guess this would only work if you are a fast typer.

 

[WilcoWorld]

part of the problem, i think, is that they want us to use the "notewriter" function. not sure if this is enforced though....

Mil - problem w/ own device is that they can't be on the network. the physician wireless doesn't let one maintain an ongoing connection. argh.

they did move the dragon date up, so that's a plus.... though scribe + dragon is imho the best. i've done it elsewhere w/ a different emr.

I've ignored the notewriter function in favor of my preferred templates for 4 years and nobody's said a word, yet...