epiic documentation completion

Question 1

What is the best sequence of obtaining and entering data during a physician encounter with a NEW patient with a complete EPIC chart?

Answer 1

Pre encounter open schedule then Chart(2nd row)
check Snapshot for quick review,
check chart, open media/notes click on “new patient intake” to find all info,
check history to be see if diseases need onset dates, new illnesses are added (hepatitis, narcotic use) consider add to history and problem list, then goto labs, use screen to gather autoab, hepatitis, hiv, copy if relevant and add to problem overview. then check imaging for ms studies
check problem list add ms diseases in history
After rooming goto chart, recheck media and referral type it out for easy reference, goto
Visit navigator and check outside information, chief complaint, Vitals check reviewed, meds. Goto Progress Notes, add appropriate initial note type. Check Problem list for diseases that are apt to affect management, add to diagnosis list.
Goto patient room, after a >2min discussion to identify major problems and ongoing illnesses,
open Visit Navigator,
goto history: update diseases-narcotic use disorders-add to problem list, social-living arrangements, disability-onset reason, birth control, goto progress notes refresh-add brief hpi with symptoms dates treatments and problem list additions,
Do physical and ros, type in ros and physical abnormals.
Leave room
goto history, add rheum disease to illness list, add to problem.
goto problem list and fill in plans; copy/paste plans into patient information
Goto Progess notes, refresh
Goto Meds Orders, add tests, referrals, check and add meds, SIGN, log off
Goto room
discuss plans add/sub tests, order meds
Goto los charge, make return visit
get scripts and sign
print discharge
sign off

Question 2

What is the best sequence of entering data during a physician encounter with a returning patient with a previous EPIC note?

Answer 2

Pre encounter open Chart, check Snapshot for quick review, open chart review, open notes for update other providers, outside information for other hospital info, media for outside labs. Goto labs, check all interval values, goto images and check. If new labs important, organize, copy, paste into problem overview. Goto history to be see if dates need addition, new illnesses are added (hepatitis, narcotic use) consider add to problem list. Goto Problem list, add probable dx’s.
If patient on narcotics check ISTOP and put reference no in record.
After rooming goto and check Chief complaint, Vitals, meds. Goto Progress Notes, add previous visit and check previous note. Order probable labs.
Goto room, after a brief >2min discussion to identify major problems and ongoing illnesses, open Visit Navigator, update meds and dc the discontinued. Update history with dates and problem list additions, goto Problem list, add to diagnosis list; goto Progress Notes, add new hx data.
Do physical and ros.
Goto Progress Notes adjust ros, physical.
Goto Problem iist, adjust plan, consider copy/paste into pt information
Goto Meds Orders, add tests, check and add meds, SIGN
Goto Progess notes, refresh adjust
goto Pat Inf give instructions
Goto los charge, return date
Goto visit, print
log off

Question 3

How many choices are available when looking at the initial schedule screen?

Answer 3

16+ the number of patients on your schedule plus the number of items in your in basket. there are 12 items on the initial top row toolbar, and 4 ways to adjust the date.

Question 4

How do I save and adjust items from a smart phrase list?

Answer 4

Put the phrase in your smart phrase editor, edit this smart phrase by adding a : (colon) then the preselected items in a list with each item surrounded by quotation marks and separated by a , (comma). Save the phrase with a unique name and enough description so you can find it using a variety of tags.

Question 5

How do I use someone else’s smart phrases?

Answer 5

Go to epic choose tools choose my phrases choose share, input email of friend, select phrase(s) of interest, double click, select merge to add or copy to replace.

Question 6

How many ways can a review of systems list be generated in progress note?

Answer 6

1) Type one in directly.
2) click ‘list phrases’ icon and type in row in search field: useful choices:
1) .probpain get brief note with short ros
2) .rosgen or similar for focused ros that requires marking same list twice; pos then neg
3) .pggenros get table with 15 system lists pos neg
4) .rosadult get statement of pos as free text then can choose from 15 systems to add negatives.
5) .rosag pulls in age specific problem list. Be careful, the SmartBlock cannot be deleted!
Make up your own and save
.larisrs lists various r(o)s to i(n)s(ert).

Question 7

what does the wrench icon indicate?

Answer 7

ability to modify associated task. In Visit Navigator in progress notes, upper right hand corner, it lets you open the progress note in a separate window.

Question 8

How can I get a more relevant encounter list in chart review?

Answer 8

Choose the filter option, select the types of encounters you want to review and apply. Save the search if you intend to use this selection frequently.

Question 9

How can I speed up imaging, referral ordering?

Answer 9

Save the order into personal preferences AFTER inputing usual choices such as location and reason for ordering. You will then not have to stop and input the same choices repeatedly.

Question 10

How do I obtain other people’s smart phrases?

Answer 10

Wen you are editing a smart phrase using the content tab on the upper left, switch the tab to “owners and users” and input the upstate email address of the person whose phrases you would like to Import. If you want to make changes, you need to copy the content then rename the smart phrase.

Question 11

How many ways can I enter text when documenting an encounter?

Answer 11

1) type it in indirectly.
2) adjust icons at top of screen by clicking on these star at the far left. Include “list phrases, list my phrases”
click on the button “list phrases”, adjust screen for favorites, etc., search and select.
click on the button “this my phrases” which preselect my phrases from the screen noted A number 2 above.
3) click on the “select smart text” button, and search in the next screen and select. the text will appear where you let the cursor.
4) Type a . (period) after a blank space then a letter that begins a smart phrase. Depending on the sequence, various choices appear, hopefully you will find what you want. Backspacing will permit starting all over.

Question 12

How do I order a walker, or cane, or wheelchair ?

Answer 12

Goto “Meds and orders”, select medications tab, enter “durable”
Include indications in progress note so that nurses can use this information for further ordering if necessary.

Question 13

How can you view/edit your smart phrase before using it?

Answer 13

Instead of simply using the .phrase approach, use the “my smart phrase” icon at the top of the working window, input the beginning of the phrase, choose the phrase, and choose edit, edit then finish using the “add and close” button.

Question 14

What choices do I have in working with the smart link/phrase Butler?

Answer 14

Your first choice is to adjust the size of the window as a small window will make identification of the full phrase difficult.
After entering text that you want to search for, you can check the box indicating “full text”which expands your search to include the phrase description as well as the phrase itself.
You can then click on the area “clear filters” if available. When the “no filters applied” box is in place, it cannot be clicked. When you click “clear filters” the filter box on the far right selects the top three filters and deselects the “my filters only” choice. This maximizes the choices available.
When looking for new phrases, deselect “my filters only” choice. Mark your usual phrases as favorites and leave the “my filters only” choice intact when closing in order to speed up choice selection when working within a document.
Use the lower row of choices to “preview” the content of the smart phrase/link. Table format is not shown. The links contain data from the chart on which you are working.
The edit choice only works after selecting a “My SmartPhrases” choice.
The “Show all matches” choice appears above the close icon, when the list is long and only a limited number are shown at once. clicking the “show all matches” choice increases the speed at which you can scroll through a long list.

Question 15

While many choices are there to choose from when looking at the initial schedule screen?

Answer 15

16+ the number of patients on your schedule plus the number of items in your in basket. there are 12 items on the initial top row toolbar, and 4 ways to adjust the date.

Question 16

How does one view an x-ray described in the results section of the in basket?

Answer 16

if you are viewing the results using the standard results format, at the bottom right corner of the x-ray report there are six links. Choose “order details” and now a link appears at the top “result images” which when clicked, eventually will display the results. these choices do not appear when viewing the x-ray report using the “results” format.

Question 17

How many choices are there when viewing the screen that appears after clicking “results” from the in basket?

Answer 17

12 choices on the upper toolbar, 13 choices on the top in basket toolbar, and once a patient is selected an extra 13 choices are available to deal with the results, 38 choices at all.

Question 18

How do I review the trend of laboratory results in a patient with months to years of data?

Answer 18

Go to chart review, select labs, click on filters. A long list of tests in alphabetical order appear in a window on the left, that include all tests done on that patient. If you check the box next to the type of test, that test will appear in a spreadsheet with each result in a separate column. The more tests you add the bigger the spreadsheet, each row with a separate test, with some date columns being excessively wide. The final spreadsheet quickly becomes difficult to view. Try naming selection, saving it so that it appears in a row above the spreadsheet. Depending on the patient, you can then select various combinations of saved filters to generate a series of views that summarize your interests.

Question 19

How do I file charges on a discharged patient?

Answer 19

Go to the patient’s chart, and just above care team on patient station. The selection criteria, called on all, to look at all encounters. Double-click on the encounter that contains your note. Be sure to adjust diagnoses to reflect the one’s affecting your consult.

Question 20

What panels are available using rhu as the search request in meds and orders?

Answer 20

Hepatitis panel in RHU contains hepatitis C antibody, hepatitis C RNA Qual, hepatitis B surface antibody, hepatitis B surface antigen and hepatitis B core antibody, total. The ordinary hepatitis screen panel uses hepatitis C antibody without RNA Qual.
Other hepatitis tests not included include hepatitis B DNA ultraquantitative, PCR: hepatitis C RNA, quantitative, PCR: hepatitis C genotype, and hepatitis panel acute

The lupus panel contains anti-DNA antibody, double-stranded as well as ANA specificity.

The arthritis panel contains the sedimentation rate, C-reactive protein, rheumatoid factor, ANA, uric acid, and anti-CCP.

The vasculitis panel contains the ANA, rheumatoid factor, sedimentation rate, urinalysis with microscopic, neutrophile cytoplasmic antibody, cryoglobulin, C3, C4.

The metabolic bone panel contains vitamin D 25 hydroxy, total, calcium, phosphorus level, magnesium level, and pth, intact.

The lupus anticoagulant panel contains DRVVT, hexagonal phospho neut, cardiolipin IgG IgM, beta-2 glycoprotein IgG IgA IgM, partial thromboplastin time PTT.

Question 21

What should be included in a review of systems in someone with a lupus like disorder?

Answer 21

constitutional: fever, malaise, anorexia, weight loss,
oral ulcers,
pleuritic chest pain (history pleuritic pain or rub heard by physician or pleural effusion or pericarditis by ekg, rub or pericardial effusion)
abdominal pain, nausea,
facial rash (if+ malar(fixed erythema, flat or raised malar area, spare NL folds), discoid (adherent scales, follicular plugging), photosensitivity(due to sunlight by patient history or physician exam)),
Renal disorder: (proteinuria > 0.5 gm/day or >3+, or cellular casts red hemoglobin granular tubular or mixed)
arthritis (nonerosive 2 or more peripheral joints, tenderness, swelling or effusion)
Neurologic disorder: Seizures or psychosis in absence of drugs or metabolic cause, memory difficulty.

Question 22

With symptoms cover a 15 point review systems?

Answer 22

15 point review of systems
fever , chills
redeye, pain fly
oral ulcers , sinus pain
hives asthma
excessive bleeding , poor healing
excessive thirst unexplained weight loss
breast nodules , enlargement
chest pain was deep breaths, hemoptysis
chest pain on exertion, orthopnea
passing blood, jaundice
kidney stones, ankle edema
skin psoriasis, ulceration, 
joint pain, swelling, 
seizures, paralysis,
hallucinations, depression

Question 23

How many ways can you review lab results?

Answer 23

1 Go to chart review, click on results review (#4 on right vertical choice list), click on view (#3 on horizontal list), click extended view, address sidebars to view or use mousepad-on a Mac vertical scrolling works but not horizontal. Unable to get normal range.

2. Goto chart review, click on chart review (#2 on vertical choices), click on labs (#5 on 2nd row of horizontal choices), click on filters (#2 on the 1st row of horizontal choices), click the boxes in the vertical table that contain tests of interest adjusted for number available and last date obtained. Highlight all tests of interest in rows within the second vertical table that appears, click on lab flowsheet (9th choice on 1st horizontal row. You should see the results of interest by date and value along with normal values, ready to be copied and pasted into your note.
3. Follow steps as in 2 but save the selection by name for future use, if you can get it to work. 2 alone permits a more selective view, better adjusted to a patient’s unique problem list.

Question 24

How can I work with a Problem in a separate window?

Answer 24

Click the icon (+ within a magnifying glass).

Question 27

How do I find a word in the current document

Answer 27

Control f, command f on mac,
works in report viewer
not work in problem list overview, plan

Question 27

How do I edit protected uneditable text?

Answer 27

right click on highlighted text and choose edit from pop up list.

Question 27

How do I organize my preferred meds and orders.

Answer 27

Go to meds and orders in any patient, select favorites, then goto list of unclassified orders, Right click on the favorite order you wish to subclassify. Choose from menu into which subgroup to place the order (laboratory,med,referral,imaging etc), adjust name and order e.g. have test done at UHCC, etc. The order appears under the new heading but is not removed from original heading. To get rid of it in the old position, right click, then chose delete.
You cannot organize the sub-classified list!

Question 27

How do I organize my smart phrases?

Answer 27

Anyway you like by adjusting the name. This takes work and luck and constant adjustment. Use the search function in smart phrase editor as this finds a word in any part of the phrase.

Question 29

How do you add maritial information to the record?

Answer 29

Go to snapshot, choose demographics, and fill in marital status info (upper right of form).

Question 30

How many ways can a problem list be entered into a progress note?

Answer 30

1) .prob-> simple problem list
2) .probapnotes-> list + plan entered at that visit per problem
3) .probovr-> list + overview with date the overview was first developed

Question 31

How do I complete an EPIC encounter for outside referral patient without prior EPIC note?

Answer 31

Pre encounter open Chart, check Snapshot for quick review, check chart, open media/notes click on Document type to see “new patient intake”, check labs, use screen to gather autoab, hepatitis, hiv, copy if relevant and add to problem overview.check imaging for ms studies
check history, add diseases from referral note, add rheumatic disease to problem list as well,
After rooming goto chart, recheck media and referral, PRINT notes and labs.
goto navigator and check outside information, chief complaint, Vitals check read, meds check read. Goto Progress Notes, add appropriate initial note type. Check Problem list for diseases that are apt to affect management, add to diagnosis list.
Goto patient room, after a >2min discussion to identify major problems and ongoing illnesses,
open Visit Navigator,
goto history: update diseases add dates-add narcotic use disorders-add to problem list, social-living arrangements, disability-onset reason, birth control, goto progress notes refresh-add brief hpi with symptoms dates treatments and problem list additions,
Do physical and ros, add ros and physical abnormals.
Leave room
goto history, add rheum disease to illness list, add to problem list.
goto problem list and fill in plans; copy/paste plans into patient information
Goto Progess notes, refresh
Goto Meds Orders, add tests, referrals, check and add meds, SIGN, log off
Goto room
discuss plans add tests, meds check pharmacy sign,
Goto los charge, make return visit
get scripts and sign
print discharge
sign off