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Last saved on May 24, 2021

Epic EMR for outpatient medicine

Epic is a commonly used electronic medical record system. It has spread due to deployment to hospitals. It is very useful to hospitals because a large amount of energy has been spent on complying with government mandates. By making health care providers "click" on an immense amount of required buttons, it manages to satisfy government requirements.

Our private practice moved over to Epic on Oct 30, 2019. We did this comply with government mandates. Our previous EMR, Amazing Charts, was faster, cheaper, and (amazingly) more reliable than Epic, but it just couldn't keep up with the ever changing government requirements.

Epic does NOT make the physicians life easier or more efficient. Epic adds immensely to overhead. Epic makes you (as a physician) sit and type, rather than examine the patient or talk to them face-face, because Epic requires a gigantic amount of input to "get through" the day. The overhead scales with patients. In other words, if you see a lot of patients/day, your time overhead will increase amazingly.

Epic does not provide much documentation -- it is far easier to figure out how to do something with a programming platform, such as PHP (which is well documented online), than it is to do something very simple in Epic. This is a little puzzling. Training in Epic seems to be piecemeal, provided by people assigned to support.

Epic is not private. Epic shares patient health care information with other Epic users - -which may be a LOT. If you message your doctor that, lets say you have ear wax, every single health care provider with Epic access in that hospital system (perhaps a very large # of people) can look at your ear wax message. While usually people who access celebrity information inappopriately are fired (after they access the information), most of the access is "under the radar" as most of us are not celebrities. So think about this, and if you are interested in privacy, this could be a big problem.

Our suggestions for those moving to Epic, working in an outpatient setting.

  1. Try to be as "light" on Epic as you can. If there is an "Epic way", and some other way to do something, it is usually best to avoid Epic. For example, many physicians do not update the diagnosis list in Epic. This is avoids the arduous process of changing diagnoses, which can of course be just changed right back again by someone else. It works reasonably well to just keep a list of your diagnoses in your note. Then you can just copy the diagnosis list from the last note into the following note --bypassing the time consuming effort of checking other physician's diagnoses.
  2. Have a backup to Epic. It crashes for several hours every month. Paper is a good backup system. Be sure you can write prescriptions, write orders, and do progress notes, with or without Epic. Practically the progress note part is a little tough -- it might help to prepare the day before and have a printout of the planned follow-up encounter in hand (i.e. before the possible crash).
  3. Although Epic asks you to deal with long lists of medications, diagnoses, etc. notice that many physicians just ignore this. All you really need in Epic is your note. You are not obligated to update everyone else's lists of diagnoses, medications, or allergies.
  4. Use Smartphrases if you can. These smartphrases can be very useful for things like vital signs. They also make your notes longer by including stuff found in Epic by the smartphrase. This is sometimes fine, and sometimes a bit disturbing (for example, when the smartphrase puts in data from 10 years ago). There is almost no documentation about Smartphrases so this is a trial/error thing.

Notes about how to do simple nut very important things in Epic

Create a new patient in Epic.

  1. Open a chart (i.e. click on the Chart icon, typically at the top left). The "New" box at the bottom of the Patient lookup will be greyed out
  2. Enter in their name and date of birth as well as sex.
  3. Click on find patient -- you will get a box that says "A matching patient was not found".
  4. Now the "New" box will not be grayed out anymore, and you can proceed.
  5. Unless you are sure this is right, do not continue as otherwise it will create a false record in Epic.

Delete an erroneus encounter in Epic.

  1. Use the erroneus encounter SmartSet
  2. Goto the SmartSet section of the Plan tab.
  3. Search for "error".
  4. Select the check box for Erroneus Encounter.
  5. Proceed and sign.

Citrix to respond after clicking on multiple times.

  1. Click on it 20 times in a row sometimes works.
  2. Go to task manager, and end every process that has "citrix" in its name. Then try again.

 

© Copyright January 14, 2020 , Timothy C. Hain, M.D. All rights reserved.
© Copyright May 3, 2021 , Timothy C. Hain, M.D. All rights reserved.
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