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Archive for the ‘Epic’ Category

Finding Charts

Do you ever want to look up a patient that you saw a week or two ago, but you already attested to their chart, marked it as complete, and cleared it from your inbasket?

In those situations, I usually run a “My Patients Last 7 Days” report in Reporting Workbench, and play with the date range until I find my patient. But that’s time-consuming (even for Epic).

Recently I learned the Search function in the Chart Completion area is not as bad as I imagined and actually lets you search “done” (completed) charts pretty fast:

image1

When you select just the “Done” charts and the date range you want, click the Search button.

It may seem that zero results are returned because of the unhelpful results screen. At that point, just click “Chart Completion” or “My Incomplete Charts” (somehow I always get those mixed up) and you should see all your done charts, in a grayed-out (but still clickable) format.

Screen Shot 2013-01-20 at 6.48.16 PM

Happy searching,
Nick

Written by phil

January 20th, 2013 at 11:50 pm

Posted in Epic

Healthix

Written by phil

October 31st, 2012 at 11:56 am

Inpatient Physician Documentation is coming June 10

This affects what you do in Epic, in two ways:

1. You can finally see what the residents and attendings upstairs are charting on that patient you admitted (currently, all you can see are nursing notes – and it’s hard to read between the lines of fall risk assessments).

2. You can see what your consult wrote, without looking for a scanned piece of paper in the “media” tab. Easy-to-read typed out consult notes will appear under Chart Review in the Notes tab

So… has anything changed about ordering a consult? Well, yes:

You now need to order the consult, to make the patient appear on the consultant’s worklist. Sure, you still have to talk to the consultant, and can call AMAC (x43611) to page a consult, AMAC will go ahead and do that, and they will make a note of the time you called. But AMAC can’t place orders – only you can do that. This may seem like a hassle but it’s a good thing, because it will mean the consultant notification time is unambiguous and easily reportable and there will be less tedium about reading MRNs and spelling names over the phone.

You order the consult by going into the patient’s chart, clicking orders, and typing “consult neuro” or whatever service you want. You’ll be presented with a window asking you to choose Neurology, or Neurosurgery, or Neuropsychology, or others… In the order box you can state the reason for the consult (good exercise) and while a callback number is not required to place the order, it’s a good idea.

— in the ED, the consultant may ask you (or a BA) to be marked as “arrived” — this is important for their metrics (we are watching them!). You do this like you always do — go into Communications, click Shared Consult, and then find the specialty of the consultant and click “Consult Arrived” … only now, there’s no sheet of paper to print and hand to the consultant.

— how will you know the Consult note has been entered? In many trackboards, there’s an icon under the “Consults” column — this will change from the blue telephone to something new when the consult note is signed. I’m not even sure what the new “done” icon will look like, but can’t wait to find out. Here’s the “consult order placed” icon:

There’s also a whole “Consults” trackboard, if you want to get a sense of how many Ortho consultations your patient will have to wait through, before getting to yours.

So, that’s it for big changes. I really do look forward to better consult note legibility and better followup on admitted patients, now that we’ll be able to read their notes in Epic — hope you find it useful, too.

Nick

Written by reuben

June 9th, 2012 at 9:20 pm

Posted in Epic

ED Policy / Protocol online reorganization

We’ve been reorganizing how the ED’s policies and protocols are
presented online, for your use on shift.

This reorganization was an outgrowth of the big ED policies review, in
anticipation of the Joint Commission visit. ED policies were
cross-referenced with hospital policies, and in many cases revised.
This effort was led by Suzanne Young-Mercer, Keri Gardner, and Kevin
Baumlin, with contributions from many of you in the department. I
thought it was a good opportunity to categorize the policies online.

The old way — an alphabetical list — was not easy to use or browse.
The policy about who gets sent to L&D was under “I” for Initial Care
of Pregnant Patients. The protocol for managing Animal Bites was under
“A”, but the protocol for Monkey Bites was under “M” (and yes, we have
a monkey bite protocol).

Policies and protocols are now organized by category. All medical
protocols are together, and we have some sub-sections for protocols
for at-risk populations as well as diversion, EMS and disaster
policies. The policies surrounding admissions and dispositions are
together, as are policies involving consults and interactions of other
departments.

These policies can be really helpful to you, on shift:

— When the MICU is full, who is “responsible” for calling other ICUs
about admission? It’s the MICU fellow – clearly stated in policy 34.5,
ICU Consults and Admissions.

— When Vascular Surgery is giving you trouble about seeing a diabetic
foot ulcer, refer to policy 34.8, Admission of Patients with DM and
Foot Ulceration or Infection. They are supposed to be consulted on ALL
ED DM patients with infections/ulcers of foot or leg, and all
admissions should go to them unless comorbidities supersede.

— If you want to know your responsibilities and resources for
domestic violence patients, check policy 26.3, Domestic Violence.

— Plenty of guidance on transfers, what constitutes crowding or
diversion status, what you can say to patients over the telephone,
what should be reported to the police, to the CDC, etc.

— if you ever need inspiration, we also have a vision statement and
mission statement, under Administration (at the very bottom of the
page).

You can keyword search, as always, by pressing Control-F, though it
will take some familiarity with the policies to search well (“OR”
works but “Surgery” doesn’t…)

Accessing the policies from inside Epic: Click on “My Dashboards” then
click on ED Policy Manual in the middle column.

From the web: http://www.mssm.edu/departments-and-institutes/emergency-medicine/about-us/manual
(there are links to this from mssmEM.com and SinaiEM.org)

If you have suggestions for moving, renaming or clarifying some of
these policies and protocols, please let me know!

Thanks,
Nick

Written by reuben

May 20th, 2012 at 5:20 am

Posted in Epic,Policy

Epic Charts

did you know that there is a difference between an ED chart & a regular chart?

if the pt has been seen in the ED post go live, you can use the “ED chart” button along the top pane of the window to search for that pt’s name or mrn & navigate to their chart. (you will also notice that the “use sounds-like” is now auto unchecked! yay!)

if the pt has not been to the ED in the past few months or you are searching for a pt that was seen in the clinic or for whatever reason, you can use the “chart” search function. this is found under “Epic” à “Patient Care” à “Chart” & this will allow you to search for any Sinai Epic encounter.

happy searching!

vaishali

Written by phil

September 11th, 2011 at 12:29 am

Posted in Epic

Epic Dispositions

a few changes in the disposition section …

– you will notice there is no option for “observation” anymore – to do it, you must enter an order to “admit to observation” – the department is “emergency medicine” and then enter the diagnosis. accept the order & then you can then make this a favorite by clicking the star to the right of the order. once you sign the order, it will automatically change the disposition to “observation”. this will also help in our obs billing as we will now always have the order in place.

– you will also notice that you can dispo to “cath lab”, “to clinic”, & to “L&D” … so less confusion as to where to find it. you can still find other dispositions, if needed, if you click the magnifying glass.

we will continue to work to improve the functionality of epic & keep everyone up to date.
vaishali

Written by reuben

August 18th, 2011 at 9:16 pm

Posted in Epic

HIV anonymous test procedure & results in EPIC

with one comment

Dear Carolyn & Winston,

We now have special forms: Stat Laboratory-ANONYMOUS TESTING NEEDLESTICK SOURCE PATIENT REQUISITION

to use in Occupational exposure situations where the source patient is unable to give HIV consent.
Each pre-printed form is used for one source patient. It has 3 special pre-printed code labels. The labels are used by the needlestick coordinator(NSC)/nursing administrator:

1. For the BBFE worksheet p.1
2. For the BBFE worksheet p.2
3. Affix to the green top blood specimen tube-for the rapid HIV test.

The NSC puts this code label on top of the specimen tube labeled with the source person’s name. The NSC knows which code is linked to the specific source patient.

The green top tube goes to the lab with the pre-printed green form with the date & time written in by NSC.

All the source patients have the same name: Stick, Needle
All the source patients have the same MRN 3592458
All the source patients have the same DOB 11/11/1900
All the source patients have the same location 444

Different anonymous code: NS ____ anony

This enables the provider of the exposed person ability to look up in EPIC one patient name: Stick, Needle. The provider does not need to know the source patient name or memorize the MRN. They only need to know source patient name: Stick, Needle.
Results also in SCC.

The ED/EHS provider will be informed of the date, time & code of the source in order to look up the rapid HIV test result.

We need to educate the ED staff regarding this process.
Carolyn, as the ED education link, how do we start this?

I am meeting today with Winston Charles ( at 3:30pm Friday) He is the education link with the Nursing Administrators.

Thank you,

Sandy

Alexandra (Sandy) Derevnuk, MEd, FNP-C
Department of Infection Control
Needlestick/BBFE Coordinator
212-659-9469/Beeper 4475 or 4118
FAX 212-849-2582

Written by reuben

May 13th, 2011 at 6:45 pm

Posted in Epic,Needlestick

EPIC OnSite CDR Instructions

Written by phil

February 11th, 2011 at 9:43 pm

Posted in Epic

CDR Training

You had a little taste of Epic this morning with Amish, Romona and
Rocko’s demo of the ASAP ED module.

You can also learn more abotu Epic when you head over to our
intranet’s tutorial on CDR. CDR is Epic’s clinical data repository
that will exist alongside the familiar EDR and be accessible for
clinical care starting in a few weeks (10/26).

Like EDR, CDR will give you read-only access to old visits, labs and
reports. You’ll also see clinic notes, d/c summaries, etc. EDR is not
going away anytime soon but we think it’ll be helpful to start
accessing CDR — because clinic notes are organized better in CDR, and
because it’s a good idea to start getting familiar with Epic’s
navigation.

The tutorial is available at http://intranet1.mountsinai.org/epic/ (if
you access this from campus, you can hear the computer narrator voice
over slides — otherwise, there’s captions)

To the left of the nice picture of Bruce Darrow and Romona Tulloch,
you’ll see a link for “E-learning”. Click that.

Then you’ll be prompted to enter your login and password — this is
the same login you use to tunnel into MS Onsite Health and Citrix from
home.

Then you’ll see a screen with three columns. At the top of the middle
column is the CDR training module. Click that. Learning CDR through
this tutorial is a good idea because it’ll show  you some of the Epic
interface, some of their terms and quirks, etc. This tutorial is
specifically geared toward a medicine intern and focuses on features
to make rounds easier (lists of patients, lab printout for rounds,
etc). But you might find a lot of it useful, as well.

You may notice in the third column on the E-learning page, there are
tutorials for Epic’s ED software, called ASAP. The really curious
among you are of course welcome to start looking at these modules but
please understand we’ve working to customize ASAP so that the
templates, tracking boards and workflows that we’ll have for go-live
will be more familiar and suitable. Those ED training modules don’t
reflect these changes.

That’s all for now. If you’ve got questions or access issues, please
let me or Geoff Lapp (cc’d on this email) know.

Thanks,
Nick

Written by phil

October 13th, 2010 at 6:38 pm

Posted in Epic

Epic eLearning Modules

Please check out the new Epic web page
http://intranet1.mountsinai.org/epic/
<http://intranet1.mountsinai.org/epic/> . Our team has spent a great
deal of effort making it both useful and easy to use. Among the things
you can find are: downtime procedures, training information
e-learning(online learning of how to do things in Epic), quick reference
quides, epic request forms(enhancements, reports, etc) and updates on
the inpatient, pharmacy, and ed implementations.
Joseph Kannry MD
Lead Technical Informaticist
Epic EMR Clinical Transformation Group
Mount Sinai Medical Center

Use your novell log in to enter the e learning modules on the intranet (i.e. at Sinai or via onsitehealth).

http://intranet1.mountsinai.org/epic/

Our team has spent a great deal of effort making it both useful and easy to use. Among the things you can find are: downtime procedures, training information, e-learning(online learning of how to do things in Epic), quick reference guides, epic request forms(enhancements, reports, etc) and updates on the inpatient, pharmacy, and ed implementations.

Joseph Kannry MD

Lead Technical Informaticist

Epic EMR Clinical Transformation Group

Mount Sinai Medical Center

Written by reuben

July 13th, 2010 at 12:51 am

Posted in Epic