Typing Ctl-Space anywhere in Epic will open a search text box in the top right corner. Type a search term into the search box and hit Enter. Epic will open a tab with a list of search results, containing all notes or image reports which contain the search term. Hover or single or double click a search term.
The top of the search results tab will be a series of filter buttons, which limits the search results to notes, labs, meds, imaging, and more.
The result (before you hit enter and open the result tabs) will allow you to either "Search" or "Jump To". Jump To is used to open a specific feature in Epic that is not available as a menu or button. For example, to open the "User dictionary", type ctl-space and search for "User Dictionary" and then click "Jump To".
These are some hints for customizing your Epic work environment. Note, however, that it seems that Epic is sooooo customizeable that no two hospitals that use Epic work exactly the same. Each may have different versions of Epic with different features turned on, but also each may have done different site-specific customizations. Below are some thoughts on how to tweak Epic on an Indiana University system in 2017 and University of Kentucky in 2021.
You load a SmartPhrase into a document by typing .phraseName where "phraseName" is the name you gave your phrase. The period "." before the name teels Epic this is a SmartPhrase to expand.
To create a new SmartPhrase
Your SmartPhrase text can include variables, that pull in data from the patient chart. This lets the SmartPhrase text to include data specific to each patient. As a result one SmartPhrase can include other nested SmartPhrases. You expand the top-level SmartPhrase by typing .xxx where xxx is the name of the SmartPhrase. The SmartPhrase body may include string like @yyy@ where yyy is the name of the nested SmartPhrase. So, the expanded text for SmartPhrase yyy appears somewhere in the body of the expanded text for SmartPhrase xxx.
Some of my favorite SmartPhrases are:
Patient identifiers:
Medical History:
Vitals:
Lab Values are a bit tricky. I cannot as yet find a way to pull in just a number, like "136" for a sodium. Epic seems to only support expanding the data into a formatted table with lots of other related information, like the date. All lab values use the same SmartPhrase
BRIEFLAB will take parameters, which specify which particular labs to use. For example, this SmartPhrase will include Sodium and Potassium:
Some useful lab names you can pass to BRIEFLAB are:
CMP Lab parameters to BRIEFLAB
CBC Lab parameters to BRIEFLAB
CBC Lab parameters to BRIEFLAB
Here is my template for the top of an clinic note.
=========================================================== NEPHROLOGY CLINIC NOTE: @M@ @LNAME@ is a @AGE@ @SEX@ with pmh Chronic Kidney Disease Stage xxx who returns to nephrology clinic for a regular followup. Since @HIS@ last clinic visit, @HE@ has been feeling well since his last clinic visit, with no hospitalizations or ER visits. @CAPHE@ denies use of NSAIDS and has been compliant with all medications. REVIEW of SYSTEMS: General: No fevers, no dizziness, no weakness, no fatigue Cardiovascular: no chest pain, no palpitations, no edema Pulmonary: no shortness of breath, no cough, no change in sputum production Gastrointestinal: no nausea, no vomiting, no diarrhea, no constipation, no abdominal pain Genitourinary: no nocturia, no dysuria, no urinary hesitancy, no hematuria, no partial voiding Dermatologic: no rashes All other review of systems are negative ACTIVE PROBLEMS: @PROB@ CURRENT MEDICATIONS: @MEDSCURRENT@ ALLERGIES: @ALLERGY@ PHYSICAL EXAMINATION: Vital Signs: @VS@ General: Alert and oriented, no acute distress HEENT: Pupils equal and round. No oral lesions. eyes are anicteric Cardiovascular: Regular rhythm, no murmurs or rubs. No JVD, no lower extremity edema Respiratory: Clear to auscultation bilaterally without wheezes or crackles. Good air movement, non-labored breathing Abdomen: Soft, non-distended, non-tender, normal bowel sounds Neurologic: No asterixis. Alert and oriented x3. Speech is clear and coherent. Face and limb movements are symmetric Dermatologic: No rashes LABORATORY DATA: Laboratory data and imaging was reviewed in the medical record. @BRIEFLAB(NA:1,K:1,CL:1,CO2:1,BUN:1,CREATININE:1,GFR:1,GLU:1,GLUFASTING:1,ALB:1,TBILI:1,PROT:1,ALT:1,AST:1,ALP:1)@ @BRIEFLAB(WBC:1,HGB:1,PLT:1,MCV:1)@ ASSESSMENT AND PLAN: #) Chronic kidney disease. Stage The original causes of the CKD are xxxxxx. Today, serum Cr is xxxxx, which is within the range of approx xxxxx. @CAPHIS@ renal disease is stable with no signs of progression. Urine Prot/Cr ratio is xxxxx, suggesting approximately xxxx grams daily proteinuria. They are already on an ACE/ARB (Lisinopril). Serum CO2 is stable at xxxxx, so there is no indication for bicarbonate supplementation. We will continue to control @HIS@ renal disease by managing risk factors including diabetes and hypertension. @CAPHE@ was counselled to avoid NSAIDs and IV Contrast #) Hypertension BP = The current regimen is #) Mineral Bone Disease PTH Calcium and Phos are both stable and within normal limits. Meds: #) Anemia of Chronic Renal Disease Hgb = xxxxx, no indication for ESA. Meds: PLANS FOR NEXT CLINIC APPOINTMENT: SUMMARY OF CHANGES IN THIS CLINIC APPOINTMENT: - Return to clinic in Staff: Dr. Decker Dawson Dean (312-1226)
Here is my template for the top of an impatient note. I then use NoteBuilder to generate the plan
=========================================================== SUBJECTIVE: @M@ @LNAME@ is a @AGE@ @SEX@ who presented with REVIEW of SYSTEMS: General: No fevers, no dizziness, no weakness, no fatigue Cardiovascular: no chest pain, no palpitations, no edema Pulmonary: no shortness of breath, no cough, no change in sputum production Gastrointestinal: no nausea, no vomiting, no diarrhea, no constipation, no abdominal pain Genitourinary: no nocturia, no dysuria, no urinary hesitancy, no hematuria, no partial voiding Dermatologic: no rashes All other review of systems are negative CURRENT MEDICATIONS: @MEDS@ ALLERGIES: @ALLERGY@ PHYSICAL EXAMINATION: Vital Signs: @VS@ General: Alert and oriented, no acute distress HEENT: Pupils equal and round. No oral lesions. eyes are anicteric Cardiovascular: Regular rhythm, no murmurs or rubs. No JVD, no lower extremity edema Respiratory: Clear to auscultation bilaterally without wheezes or crackles. Good air movement, non-labored breathing Abdomen: Soft, non-distended, non-tender, normal bowel sounds Neurologic: No asterixis. Alert and oriented x3. Speech is clear and coherent. Face and limb movements are symmetric Dermatologic: No rashes LABORATORY DATA: Laboratory data and imaging was reviewed in the medical record. @BRIEFLAB(NA:1,K:1,CL:1,CO2:1,BUN:1,CREATININE:1,GFR:1,GLU:1,GLUFASTING:1,ALB:1,TBILI:1,PROT:1,ALT:1,AST:1,ALP:1)@ @BRIEFLAB(WBC:1,HGB:1,PLT:1,MCV:1)@ ASSESSMENT AND PLAN:
Here are my notes from watching the Epic training videos. I used Epic for a few years, a few years ago, but needed a refresher.
I only paid attention to the inpatient features, but Epic provides some different options for outpatient clinic doctors.
General Concepts
===========================
Phases of Care
This is the status of a patient, and it lets you enter an order to be executed when an event happens, like
after a surgery or transfer to another unit. This is mostly used for procedures or surgeries.
By default orders do NOT have an associated phase of care, which means they are active immediately when signed
and remain active until cancelled. However, you may optionally specify a phase of care for an order, which means it
will be held inactive until a patient enters the appropriate phase of care.
Some common phases of care
- Scheduling/ADT - require an admission or procedure room
- Pre-admission testing
- On Unit
- Pre-Procedure
- Intra-Procedure
- Recovery Only (PACU)
- Recovery and On Unit
- Phase II/On Unie
User Interface Components
=========================
Epic assumes it will control your whole desktop workspace.
There is a hierarchy of tabs, but each layer of tabs has a specific name
Top level Tabs are called workspaces. These are patient lists, patient charts and a few other things.
Within a patient chart, the subtabs are called "Activities". These are things like "Labs" and "Notes"
The screen is organized as follows:
Top row is a toolbar. This always includes the "Patient Lookup" tool.
Tools seem to be designed to work independant of a single patient. For example, "Patient lookup"
will open a modal dialog that lets you find a patient who is not admitted and opens their chart as a tab.
Below is a row of tabs for separate workspaces. Each of these top-level tabs is a different "workspace" and these include the following:
- Clinic Schedule Workspace
This is a list of patients for clinic today and is used by outpatient physicians. This is the tab with the calendar icon.
It is a list of names, and you double click to open an encounter.
- Patient List Workspace
This is a list of patients admitted to the hospital, and is used by inpatient physicians.
There is a left-side sidebar with the names of patient lists. Click one one of these and the main pane will fill with a list of those patients.
Selecting a patient in the patient list will display a group of subpanes
- Vitals
- Labs
- Medications
Note, you are only browsing the patient info for quick results. You have not yet opeend the patient
chart in a new workspace tab. You can, however, see a lot of information in this preview pane.
You can click one of the buttons under the patient's entry in the patient list, and that will eopen
the patient's chart in a new workspace tab.
- Dashboard workspace
This generates reports in Epic, and uses the Cogito product called "reporting workbench"
Reports essentially run a Database query against Epic and show the results as a table.
Click "My Report Metrics" to open up the left sidebar.
In the sidebar, click "Show Catalog".
This has a bunch of pre-made reports. You click on the icon for a particular report to run that report.
Once you run a report, it displays the results as a table
You can sort the table by any of the columns.
You can also filter the results.
- Inbox workspace
This is more of a Request Queue and To-Do list than an email system. They use this analogy that a pending order is like
a letter in an envelope sent to a destination, so action requests or alerts are analogous to messages sent to an inbox.
There is a list of sections called "Folders" on the left, selecting a section will open it in the right-hand side pane
Each pane has its own context-specific toolbar that lets you process and respond to messages or requests.
Some important folders:
"Results" shows new unread lab results
"Requested Prescriptions" - refill requests
"Chart Completion" lets you sign verbal orders, cosign notes, answer queries, and more.
The center pane is a list of items that need to be signed.
Select one item in this list will open it in the right subpane.
In the right subpane you can cosign an order or note.
- Secure chat workspace. Chat. Does not seem to integrate with other systems like Volte.
- Each patient chart is a separate workspace tab.
Inpatient and Outpatient charts are similar but have important differences
Both have a summary column on the left. They call this the "Patient Storyboard" and it is high level basic info about the patient (name, PCP, admission status, etc)
Both have a sidebar which is on the right and has commonly referenced info
Both have subtabs for "Activities", and each subtab is called an activity.
Inpatient charts have "Activity" subtabs for
Chart Review - This is several different lists, each is a subsubtab
List of admissions/visits - Click one visit and a sidebar opens on the right
List of past notes - click one and it pops open
List of all labs - tests are listed by date or lab name
List of Imaging
List of all current meds or all current and previous meds
Summary - This has several subtabs called "Reports"
There are subtabs ("Reports") for vitals, in/out, labs, micro, med history, weights, and more
There is also a subtab called "Summary" wjhich is a compilation of key things from the different tabs, all within a single page.
There is a "Fever" report which shows a graph of WBC, Temp and antibiotics.
Care Everywhere
This is a list of visits to outside clinics and hospitals.
Double clicking a hospital or clinic visit will replace the tabs content with a "report" of that visit.
The report has sub tabs for Documents, Lab Results, Summary, Other Results, and an X to close the report.
Notes
The text editor is on the right sidebar (which is really awkward to use because it is so narrow).
You can use templates and macros that expand.
SmartText
These are templates that can be inserted into the note and can pull in data from the patient chart like labs.
In the toolbar above the text editor is a text box with a "+" command. Enter the name of the smarttext macro
and it will open a dialog with a list of possible smart text templates. You can preview a template, and then either
double click it in the list or select it and hit the "Accept" button.
A smart text macro has a series of choice statements (called smart links and smart lists) that can be customized for the final note.
Smart links are in blue, smart lists are in yellow
Smart links seem to be automatically populated from data for the patient. They are hot-links specified in the template.
Smart lists are options that can be configured when authoring the note.
Use F2 to step through the smart lists, and as you visit each, it will open a context menu that lets you select one or several
text expansions.
NoteWriter
This is a series of dialogs that selects expansion text strings for the template being edited in the word processor.
In a sense, this uses a dialog box and buttons to control the text expansion, while Smart Text uses a context menu to
control the pattern expansion.
In all cases, you can just edit the text directly in the text editor in the sidecar.
This is why the text editor is a small narrow side bar - they assume you will never edit it directly.
The NoteWriter can also pull in a list of problems selected for this visit
(this is specific to notewriter and is pulled from the Problem List)
You select which problems to be included in the note, and modify the "Overview" and "Assessment and Plan" text associated
with each problem.
NOTE: The associated "Overview" and "Assessment and Plan" text seems to be shared by all providers.
A provider can write their own, which then becomes the latest version of the "Overview" or "Assessment and Plan"
But, you don't have to change any text to use the latest text (which was written by somebody else).
Epic describes this as "good" and a "feature", but it seems to mean that the system is *designed* to copy and paste
text generated by one doctor into another doctor's note.
Orders - This is where you enter, view, and modify orders
There are several subtabs. Each is a different subset of orders, including "Active", "Signed and Held", "Home Meds" and more
Opening the activity defaults to the "Active" group.
Each group of orders is a list, and can be sorted in several ways.
You can select an order in the list and there will be a "Modify" and "Discontinue" button for each order.
The "Modify" button will open a dialog with the standard order options, like frequency, time, etc. For meds it is
also dose and route. But, IV and PO meds are considered different meds. So, to change the route of a drug, (like IV --> PO)
you must discontinue the old med and add a new med with the desired route.
Inside the Orders activity, there is a right-hand sidebar with the "+ New" item. You type the text into the
"+ New" text box, and hit enter. This will open a dialog box with a list of possible orders matching the text you typed.
In this dialog box, you can also ignore the list of possible matches and search through all orders.
Once you find the order you want, select it in the list and click Accept button or just double-click it.
All new orders or changes to modify or discontinue an existing order are batched up in the right sidebar.
You can click an "X" by each pending order to remove it from the list of pending changes.
You click the "Sign" button in the right handed sidebar to commit these changes. You can commit many changes all at once.
In the "Home Meds" group, you can click a "Reorder Home Meds" and this will display a list of all home meds which
you can carry over to the hospital. You click "Edit" next to the med you want to carry over, and then click the
"Order" button.
Admission
This contains a list of sections to complete when admitting a patient from the ER, and is called the "Admission Navigator"
These include "Problem List", "allergies", "History", and "Admission Orders". Clicking an entry in this list will
open a window pane for that section.
The "Problem List" shows a copy of the problem list for this patient.
You select which of these problems are PoA, and which is the chief complaint (called "principal problem")
You can also add new problems to the problem list from here.
The "Admission Orders" includes the admit med reconcilliation and more
This is a pane with tabs; go through each in section in sequence
There is a list of pending orders on the right, and as you continue each order, it will be added to the pending list on the right.
At each step, you can click "Mark Unreconciled Continue" or "Mark Unreconciled Discontinue"
At each step, you can click "Next" to go to the next step.
1. "Review Current Orders"
This is a list of meds ordered in the ER, and you can continue/Discontinue/Modify each order.
2. "Review Home Medications Orders"
This is a list of outpatient meds and you can Order/Dont Order/Replace/Remove/OrderAndHold each order.
3. "Order Sets"
This is a list of standard order sets that is probably customer/hospital specific
At the top of the pending orders list is a text box with a "+ New" button.
This lets you add anything that is not part of a standard order set.
Transfer
This is used when transferring a patient between floor and icu or other service.
It is similar to the "Admission" tab.
This contains a list of sections to complete when transferring a patient. Clicking an entry in this list will
open a window pane for that section.
The "Transfer Orders" includes the transfer med reconcilliation and is like the "Admission Orders"
Discharge
This is used when discharging a patient and is similar to the "Admission" tab.
This contains a list of sections to complete when discharging a patient. Clicking an entry in this list will
open a window pane for that section.
The "Discharge Orders" includes the discharge med reconcilliation and is like the "Admission Orders"
Problem List - list of past medical histories, surgical history, etc
The problem list is structured data and is interpreted by Epic to generate
recommendations and billing.
You enter new problems when you make a new diagnosis.
You start by searching problem names by entering some text, like "angina", in the "Add" text box on the problem list.
Then, Epic opens a dialog with buttons to select qualifiers for the general problem.
Epic includes *lots* of ICD information, so it prompts you to add the specific qualifiers for each different problem.
Additionally, each item in the problem list has associated data you can enter
Click on a problem and you see optional details
You can add a text "Overview" which will be saved with a problem and pulled into notes.
You can add a text "Assessment and Plan" which will be saved with a problem and pulled into notes.
The editor is not just text, it also has combo boxes and smart text and
You can also view past (resolved) problems
After adding or changing problems, click the "Mark Reviewed" button to save changes
to the problem list.
You can change a problem, with the delta icon. This brings up the dialog of ICD10 modifiers
specific to that problem and you can add more modifiers.
You can click on "x" icon to mark a problem as resolved. It will no longer appear in the
daily not eproblem list but will appear in the discharge summary.
Links are blue text, which open a modal dialog over the chart
Use the back arrow to move back to the previous page