Epic and efficiency

[da8s0859q]

I like Epic. Not as fast as T-sheets, way better than some other EMRs. My opinion.

My institution uses the latest Epic 2015 build. I'm posting to start up some talk on how efficiency can be best fine-tuned with this latest build. Much of which would apply to any build.

This is my current workflow:
- Free-text HPI via Dragon
- Ten-system attestation or appropriate for ROS -- no macro, which I find more time-consuming than including in HPI with a billing-appropriate statement.
- Templated physical exam (not Epic macro) which generic, common findings -- PERRL, normal conjunctivae, no rebound, no gallop/rub, etc -- onto which I dictate brief things as appropriate or change whatever I need to change.
- MDM consisting of Dragon dictation with occasional SmartPhrases to speed along the process somewhat, connected to Dragon MyCommands as many of us do.

Several saved MyCommands for commonly-used discharge information, followup referral lines, common prescriptions saved as custom favorites in Epic, and so forth.

Extensive order preference list for in-ED orders commonly used by me. Now have these Quick Sets which mean I have two extra clicks to get to the order preference list I use.

All that said: what can I be doing to make things faster, either my workflow or Epic's own load times? I'm paring down what I look at and what loads to see if it makes a difference as far as menus. Trying to make it better.

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[Old_Mil]

These recommendations actually work for a lot of EMRs. I would caution you about doing the HPI on dragon. When my old shop switched from Tsheets to dragon collections dropped substantially because providers were losing details of the HPI necessary to level the chart - things that a template prompts for and scores for in real time. It has improved but their collections are still worse than when we were using tsheets.

What are the specs on the computers you are using? Do you have a robust secure WiFi connection in the hospital?

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[Xerxes1729]

These recommendations actually work for a lot of EMRs. I would caution you about doing the HPI on dragon. When my old shop switched from Tsheets to dragon collections dropped substantially because providers were losing details of the HPI necessary to level the chart - things that a template prompts for and scores for in real time. It has improved but their collections are still worse than when we were using tsheets.

That's odd. I've had the opposite experience. I sometimes hear from the coding/billing company that I don't chart enough ROS or exam (although I think I do, but whatever), which I do as check boxes. I've never been told I don't chart enough HPI, which I always free text.

 

[da8s0859q]

What are the specs on the computers you are using? Do you have a robust secure WiFi connection in the hospital?

Don't know the raw hardware specs offhand -- other than to say that they seem at least acceptable for our uses. Yes, robust secure Wi-Fi exists. All rooms also have mounted workstations in them. Been thinking about using them to chart in patient rooms real-time and be able to walk out of a room with the HPI and ROS complete, needing only me to sit down and fill in a PE and place orders. Problem is, I'm often in the room with the RN who's also charting their assessment info on said computer. And there's the argument about not doing that in rooms.

I try to make myself throw in bits in the freetext HPI that hit needed elements for billing so as to not have my HPI get a chart downcoded but do sometimes catch myself forgetting as you said. Torn between templated entry for that versus freetext which I feel tells a better story and is more defendable/purposeful.

Should clarify that my transition from resident to attending this summer has me staying on the same exact platform -- Epic, Dragon for dictation, and with intermittent scribe use. Hence my interest in fine-tuning for efficiency and appropriate billing.

 

[Old_Mil]

If you can get your institution to approve bring your own device, consider getting a fast surface pro 4 with good specs. A nice Bluetooth headset should allow you to dictate to the chart on the tablet. That way you aren't fighting nurses for computer access. I also think in the room charting and cpoe works very well because ancillary staff doesn't get hit with boluses of orders. Where I was before I tried to leave the patient room with everything done.

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[Angry Birds]

Epic is not great... just might be the least worst. I think all the EMR's, including EPIC, suck.

On a related note, Epic founder is a billionaire now.

 

[BAM!]

anyone have a link for a list of EPIC smart phrase commands? Ex, @sex@, @Name@, etc.