Sweet Epic Tricks.

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Lex81 said:
Can anyone tell me how to access old vitals on a patient? Specifically in a comparative table as labs would typically be presented. I've worked a version of Epic in the past where this was possible, though now at a new facility and I can't figure out how to bring that up again.
Click to expand...
Yeah, my residency build had this right in the vitals tab. Not so in my current setup.
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Lex81 said:
Can anyone tell me how to access old vitals on a patient? Specifically in a comparative table as labs would typically be presented. I've worked a version of Epic in the past where this was possible, though now at a new facility and I can't figure out how to bring that up again.
Click to expand...

Keep in mind that each system may have their own unique smart phrases. Some may be disabled by your system.

If you want to type them in your note, then type "." followed by the name. If you are inserting into a customized smartphrase (your own smart phrase), then everything would be between "@" signs (like @EDTRIAGEVITALS@).

Vital sign smart phrases:

.edtriagevitals (for triage vitals, displayed in table format)
.vitalsigns (displays last 3 vital signs)
.vitalsmultiple (displays last 3 vital signs, but includes weight and height)
.vsranges (displays range of vital signs during the visit)
.vs (displays current vital signs)
.bmie (displays height/weight, BMI, etc.)

You can create custom templates that bring this all up and put it in the ED note writer section.

Example:

I have several history/physical templates based on STEMI, trauma activation, stroke, default, etc.

Each one brings up various things. Under the header for HPI, I have @CC@ (chief complaint) and our system's customized HPI template (you can find your system's default history template by right clicking the area where text is populated and noting the name of the template; if you put that name in between 2 @'s it will bring up the template).

Unfortunately, this is best described with the use of photos, but Epic's copyright prevents me from posting them. I may can show you online via GoToMeeting if you are interested.
 
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littlejuan said:
How do you make custom order sets?
Click to expand...

Two ways:

1. When you enter the order screen, our system has an "order sets" tab. If you click it and open an order set, you will see a drop down menu that allows you to create a new set, edit existing, switch to a different one, etc. Again, screen shots would be ideal.

2. You can go to a preference list composer to edit. I forgot how it's worded -- user order sets maybe?

Again, would be better to show you with images, but Epic doesn't allow that.

There are a lot of things you can do. I have many order sets (60+) for high risk PE (automatically orders CT), low risk PE (orders D-dimer), etc. The chest pain ones all order EKG, trop, cxr, etc. Have sepsis with cath UA, sepsis with regular UA; all have 30/kg bolus and necessary labs/cultures/lactate. Abd pain for appy, left flank pain, right flank pain, diverticulitis, etc. that automatically order PRN zofran, pain medications, CT's with symptoms already listed, fluids, labs, UA, etc. Seriously, it's one click and you're done (unless they have an allergy to something or you want to modify, but 90% are done with one click and then sign the orders).

I also have all my favorite labs, x-rays, CT's, splints, etc. in my preference list. Tons of medications in the preference list as well. One click selects them, then sign them. Need Colace to the right ear? Have a preference list entry for that. One for left ear as well. X-ray right ankle, left ankle, etc.

I spent probably 40 hours developing all of these and they have saved immeasurable hours while in the ED.

Keep in mind you can also create physical exam and review of system templates. I have ROS templates for chest pain, chest pain travel, chest pain leg swelling/pain, migraine, influenza, etc. You hit the template name, it applies everything, then you just modify what is different (or uncheck what you didn't ask). Same is true of physical exams. Have a default chest pain, asthma-mild, asthma-distress, CHF-mild, CHF-distress, trauma-negative, trauma-neck pain, trauma-head injury, etc. that automatically checks a bunch of stuff. You just modify what's needed.

I dictate my history portion. I can dictate into Dragon while applying ROS, phys exam templates, changing what is needed in those templates, document EKG, then MDM, and final disposition. I can do a chart in under 2 minutes usually.
 
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southerndoc said:
Unfortunately, this is best described with the use of photos, but Epic's copyright prevents me from posting them.
Click to expand...
That's sounds a little weird. What, are they worried that someone will use images to reverse engineer their highly modifiable project? I mean, I don't think anyone has an Epic client at home, using it for music or porn or gaming or anything except medical record keeping. And, from what so many people have said on SDN, I don't think any two locations have even a similar, if not identical, build.
 
Apollyon said:
That's sounds a little weird. What, are they worried that someone will use images to reverse engineer their highly modifiable project? I mean, I don't think anyone has an Epic client at home, using it for music or porn or gaming or anything except medical record keeping. And, from what so many people have said on SDN, I don't think any two locations have even a similar, if not identical, build.
Click to expand...

I'll email my contact at Epic and ask. One of the websites I visited a while back when I was learning all this had a post that images were removed because Epic had contacted him stating it was a copyright violation.

Supposedly health systems sign non-disclosure agreements about not posting screen shots.

It's time to remove EHR gag orders. For patient safety's sake.
 
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southerndoc said:
Two ways:

1. When you enter the order screen, our system has an "order sets" tab. If you click it and open an order set, you will see a drop down menu that allows you to create a new set, edit existing, switch to a different one, etc. Again, screen shots would be ideal.

2. You can go to a preference list composer to edit. I forgot how it's worded -- user order sets maybe?

Again, would be better to show you with images, but Epic doesn't allow that.

There are a lot of things you can do. I have many order sets (60+) for high risk PE (automatically orders CT), low risk PE (orders D-dimer), etc. The chest pain ones all order EKG, trop, cxr, etc. Have sepsis with cath UA, sepsis with regular UA; all have 30/kg bolus and necessary labs/cultures/lactate. Abd pain for appy, left flank pain, right flank pain, diverticulitis, etc. that automatically order PRN zofran, pain medications, CT's with symptoms already listed, fluids, labs, UA, etc. Seriously, it's one click and you're done (unless they have an allergy to something or you want to modify, but 90% are done with one click and then sign the orders).

I also have all my favorite labs, x-rays, CT's, splints, etc. in my preference list. Tons of medications in the preference list as well. One click selects them, then sign them. Need Colace to the right ear? Have a preference list entry for that. One for left ear as well. X-ray right ankle, left ankle, etc.

I spent probably 40 hours developing all of these and they have saved immeasurable hours while in the ED.

Keep in mind you can also create physical exam and review of system templates. I have ROS templates for chest pain, chest pain travel, chest pain leg swelling/pain, migraine, influenza, etc. You hit the template name, it applies everything, then you just modify what is different (or uncheck what you didn't ask). Same is true of physical exams. Have a default chest pain, asthma-mild, asthma-distress, CHF-mild, CHF-distress, trauma-negative, trauma-neck pain, trauma-head injury, etc. that automatically checks a bunch of stuff. You just modify what's needed.

I dictate my history portion. I can dictate into Dragon while applying ROS, phys exam templates, changing what is needed in those templates, document EKG, then MDM, and final disposition. I can do a chart in under 2 minutes usually.
Click to expand...

you've convinced me to do this. how'd you come up with all of hte possibilities you would need? do you use dragon?
 
Anyone know where I can find a list of all keyboard shortcuts for Epic? For example, using F2 to cycle through to next ***

Also, does anyone have any experience with bringing on a consulting group to improve overall doc experience with Epic?

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The coolest thing about EPIC for me is the SlicerDicer. Instant research ideas.
 
LaBusqueda said:
Been a few years since I changed jobs and currently not on EPIC. However the hospital let us know EPIC will happen soon.

I was curious, has EPIC added .phrases that are globally available for the various ED clinical rules like HEART etc. ones that would auto pop relevant pasht Hx/documented RFs etc and have *’s for the subjective stuff?
As of a few years ago we had to make our own, at least our hospital didn’t have them/purchase them.


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Click to expand...
Lately I've been using copy and past from mdcalc.com. You have to sign up for a free account. After that it's super convenient to copy and past whatever clinical scores you want. Fairly painless

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southerndoc said:
Is anyone aware how to click a button to accept defaults with {}?

For example: {No} - GCS <15 etc?

I would like to set up templates with these prepopulated with the ability to simply remove the {} and accept defaults.
Click to expand...

I do it with Dragon functionality built into EPIC at my institution. "Accept Defaults" is the voice command (i have unfortunately not found a button to do that either) from Dragon to make that happen.
 
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evilbooyaa said:
I do it with Dragon functionality built into EPIC at my institution. "Accept Defaults" is the voice command (i have unfortunately not found a button to do that either) from Dragon to make that happen.
Click to expand...

I can do this within the dictation box of Dragon Medical Practice Edition. Unfortunately, my health system doesn't provide Dragon for us. I would need Dragon Medical Network Edition or Dragon Medical One installed to do what you describe from within an Epic window, but the health system will not allow us to install it.

Raryn said:
I just hit F2 and then enter for each individual prompt.
Click to expand...

I'm looking for something that would have a review of systems with multiple {} that could be removed with an easy click. Hitting F2 and individually accepting each one would defeat the purpose of trying to further streamline charting.
 
doctalaughs said:
What do you mean? Basically any smartphrase or smartlink (even one you made) can be put inside @...@ and nest within another defined smartphrase. Epic has an excel spreadsheet of all system smartlinks you can find it on their website.


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Click to expand...
Hi,
Does anyone know how to "map" something from the Flowchart. I am tying to pull data over to make a progress note that's in one of the Flowcharts. I know it has to be @#####@.
 
Lex81 said:
Can anyone tell me how to access old vitals on a patient? Specifically in a comparative table as labs would typically be presented. I've worked a version of Epic in the past where this was possible, though now at a new facility and I can't figure out how to bring that up again.
Click to expand...

"Flowsheets" are the key here, though where you find it (and your ability to find it) will vary by Epic flavor. Try: chart review > encounters > flowsheets (it'll ask "Use only selected encounter(s) for gathering data for flowsheet? "; answer is NO) > search for the "vitals" flow sheet; institutions usually have several, so see which one you like best.
 
southerndoc said:
I can do this within the dictation box of Dragon Medical Practice Edition. Unfortunately, my health system doesn't provide Dragon for us. I would need Dragon Medical Network Edition or Dragon Medical One installed to do what you describe from within an Epic window, but the health system will not allow us to install it.

I'm looking for something that would have a review of systems with multiple {} that could be removed with an easy click. Hitting F2 and individually accepting each one would defeat the purpose of trying to further streamline charting.
Click to expand...

Have you tried Ctrl+F12? This is the shortcut for the "set defaults in SmartLists" button in the notewriter (three lines and a little yellow arrow) - see below.

This will only work if the SmartList (the bracketed items) has defaults chosen...if the SmartLists in your ROS etc don't have defaults, have their 'owners' edit them so they have defaults, or create your own SmartLists.

smartlistDefault.jpg
 
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southerndoc said:
I've seen that button, but I think it's been disabled in my health system.
Click to expand...

I guess try the keyboard shortcut. If not, best option is to just have your own smartphrase template with the defaults built in.
 
Lazarus'ing this thread. Ok, it's been several years since I used EPIC, like 7 or 8. I'm soon to be switching from Cerner to Epic with my new job and am trying to acclimate myself again. I have some dumb questions:

1) In Cerner, it's easy to see all the pt's that have been dispositioned over the last 12 hours in the checkout tab. You can easily see your own pt's discharged/admitted or other doc's discharged/admitted pt's. It's sometimes interesting to surf through here to see any interesting critical cases over the last day that were interesting. Yours or someone else's. Is there some way to easily do this in EPIC?

2) How do you guys follow the pt's you admit to the hospital? In Cerner, I have a custom list that shows all pt's I admit over the past 2 weeks and I can click on them individually and read progress notes or discharge summaries, etc.. How would you do something similar in EPIC?

3) How do I run a report to show bounce backs to the ED? For instance, I have a report I run in Cerner where it shows me a custom date range and all pt's that show back up in the ED within 3-5 days after discharge. Any way to do the same in Epic?

4) What's your general flow like? Are you guys sitting on the ED Manager screen and picking up patients as they arrive or do you monitor ED Track Board (Waiting for Provider)? I'm just curious as to what specific screens you are clicking on to monitor the ED for new pt's and how you start managing them while multitasking new patients who are arriving?

I'm sure it will start making sense soon enough but damn...it's been a long time and I can't remember enough of it to say what has changed and what hasn't. One thing is damn sure, there are way too many colors to keep track of on that tracking board! I'm annoyed that I can't see vital signs on the tracking board like in Cerner.
 
Groove said:
2) How do you guys follow the pt's you admit to the hospital? In Cerner, I have a custom list that shows all pt's I admit over the past 2 weeks and I can click on them individually and read progress notes or discharge summaries, etc.. How would you do something similar in EPIC?
Click to expand...

Not sure about the rest of your questions and it's been a few years since I've sued EPIC, but you can make custom lists in EPIC without issue - I used to keep track of every patient I saw in residency.
 
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Raryn said:
Not sure about the rest of your questions and it's been a few years since I've sued EPIC, but you can make custom lists in EPIC without issue - I used to keep track of every patient I saw in residency.
Click to expand...
Agree. There might be a more automated way to do this, but I just have a list that I add everybody I see/hear about in the ER or other unit (as a consultant). It's not that many though so it's relatively easy for me to manage manually. Might be a PITA if you're trying to track 20-30+ patients a day.
 
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Groove said:
Lazarus'ing this thread. Ok, it's been several years since I used EPIC, like 7 or 8. I'm soon to be switching from Cerner to Epic with my new job and am trying to acclimate myself again. I have some dumb questions:

1) In Cerner, it's easy to see all the pt's that have been dispositioned over the last 12 hours in the checkout tab. You can easily see your own pt's discharged/admitted or other doc's discharged/admitted pt's. It's sometimes interesting to surf through here to see any interesting critical cases over the last day that were interesting. Yours or someone else's. Is there some way to easily do this in EPIC?

2) How do you guys follow the pt's you admit to the hospital? In Cerner, I have a custom list that shows all pt's I admit over the past 2 weeks and I can click on them individually and read progress notes or discharge summaries, etc.. How would you do something similar in EPIC?

3) How do I run a report to show bounce backs to the ED? For instance, I have a report I run in Cerner where it shows me a custom date range and all pt's that show back up in the ED within 3-5 days after discharge. Any way to do the same in Epic?

4) What's your general flow like? Are you guys sitting on the ED Manager screen and picking up patients as they arrive or do you monitor ED Track Board (Waiting for Provider)? I'm just curious as to what specific screens you are clicking on to monitor the ED for new pt's and how you start managing them while multitasking new patients who are arriving?

I'm sure it will start making sense soon enough but damn...it's been a long time and I can't remember enough of it to say what has changed and what hasn't. One thing is damn sure, there are way too many colors to keep track of on that tracking board! I'm annoyed that I can't see vital signs on the tracking board like in Cerner.
Click to expand...

Do you have Reporting Workbench access?

You can create custom reports that search for all your patients within a certain time frame (such as last 30 days or 24 hours) or all your 72 hour bouncebacks, or more recently a report of all your covid patietnts, and I can provide the instructions, but you will need access to reporting workbench in Epic.

Reporting Workbench is found in different places in different builds of different versions. It can be found in Epic->Reports->My Reports, or there is a My Dashboard tab at the top left. As long as you have security access to create Reporting Workbench, you can build the reports.
 
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We have so many pods (12 + peds) that we have a screen for each pod. Hardly ever look at the ED manager (it's just too much info). We also have pods with a tab for all patients in a pod, all my patients + unassigned (for shift change), and some tabs for combined pods when covering multiple pods during certain shifts.

We have an ED Return Visit tab in the Epic Inbox (where you sign your charts for patients not currently active or where you cosign charts from residents/APP's). It automatically shows return visits within 72 hours. I think this is Epic standard now.

You can track patients by using the "remind me" tab, which will place the patient in your inbox under Reminders. You can also run a report of patients seen in the last 24 hours, last 72 hours, and customized reports (provided your health system hasn't turned it off).
 
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Groove said:
Lazarus'ing this thread. Ok, it's been several years since I used EPIC, like 7 or 8. I'm soon to be switching from Cerner to Epic with my new job and am trying to acclimate myself again. I have some dumb questions:

1) In Cerner, it's easy to see all the pt's that have been dispositioned over the last 12 hours in the checkout tab. You can easily see your own pt's discharged/admitted or other doc's discharged/admitted pt's. It's sometimes interesting to surf through here to see any interesting critical cases over the last day that were interesting. Yours or someone else's. Is there some way to easily do this in EPIC?

2) How do you guys follow the pt's you admit to the hospital? In Cerner, I have a custom list that shows all pt's I admit over the past 2 weeks and I can click on them individually and read progress notes or discharge summaries, etc.. How would you do something similar in EPIC?

3) How do I run a report to show bounce backs to the ED? For instance, I have a report I run in Cerner where it shows me a custom date range and all pt's that show back up in the ED within 3-5 days after discharge. Any way to do the same in Epic?

4) What's your general flow like? Are you guys sitting on the ED Manager screen and picking up patients as they arrive or do you monitor ED Track Board (Waiting for Provider)? I'm just curious as to what specific screens you are clicking on to monitor the ED for new pt's and how you start managing them while multitasking new patients who are arriving?

I'm sure it will start making sense soon enough but damn...it's been a long time and I can't remember enough of it to say what has changed and what hasn't. One thing is damn sure, there are way too many colors to keep track of on that tracking board! I'm annoyed that I can't see vital signs on the tracking board like in Cerner.
Click to expand...

I use both Cerner and Epic.

You can easily make a custom list in Epic, called .... shiit.....I can't remember now. It's one of the ~200 selections on the left. I think it's patient List? Sorry not all that helpful
 
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