Epic Ambulatory Basics + MyChart

Sachin D. Shah, MD


  1. Visits
    1. Pre-visit
      1. Review old notes & labs
        1. Filter the notes you see in Chart Review
      2. Outline your note before going in the room (selective copy/paste)
    2. Visit Navigator
      1. Open Note in Notewriter
        1. Templates to choose from
        2. Blank template + dot phrases
        3. Notewriter + sidebar
          1. Review old notes alongside current note
        4. Vitals
          1. Review values (VS, BMI)
          2. Type in initial or second set of vitals (repeat BP, etc.)
  • Allergies (review)
  1. Medications (review)
    1. Medication reconciliation
    2. Reconcile outside filled meds
  2. Smoking cessation (review)
  3. History
    1. Past Medical
      1. Interfaces with problem list
    2. Past Surgical
    3. Family History
    4. Social History
      1. Narrative documentation
    5. Problem List (review)
      1. Problem list → Visit diagnosis
      2. Easily add to History (and clean up problem list)
      3. Overview notes (will populate comments section when moved to History)
    6. Meds & Orders (before patient checks out)
      1. Smartsets → streamline orders, associated dxs, medications, immunize
        1. Healthcare maintenance
        2. Diabetes
        3. Clinic Meds
      2. Individual orders – labs, tests
        1. Future orders
        2. Date & time shortcuts
  1. Prescriptions
    1. E-prescribe
      1. Set pharmacy if not already in
      2. Mail order pharmacies
      3. Checking insurance coverage
      4. Resolving e-prescribe errors
    2. Print scripts (controlled Rx)
  2. Patient instructions
    1. Care Notes (from References)
    2. Websites (e.g., MD Consult, UpToDate) from ‘Links’ drop down menu
  • Dot phrases
  1. Search instructions (e.g., colonoscopy)
  1. Return to work/school letters
    1. Communication management
      1. ‘Preview’ to print
    2. Follow up
      1. Follow up interval
      2. Notes to check out coordinators
    3. Copy Chart (in follow up section)
      1. Attending to co-sign
      2. Colleagues as FYI with message
    4. Notes
      1. Type HPI as you talk to patients (bullet points)
      2. Meds & Orders in the room before patient leaves
  1. Assessment/Plan → smart phrases when possible
    1. Healthcare maintenance (.genAPhmm, .genAPhmf)
    2. Diabetes (.genAPdia)
    3. CKD (.genAPckd)
    4. HTN, HLD, CAD
  2. Make your own smart phrase based templates if you’d like
  1. Health Maintenance Activity
    1. Influenza; pneumovax; AAA screening; HIV screening; colorectal cancer screening; cervical cancer screening; breast cancer screening; hep C screening; osteoporosis screening; childhood, adolescent and adult immunizations; diabetes screening; prediabetes surveillance
  2. Quick Actions
    1. Create QuickActions for routine letters, result notes, messages, QuickNotes, and MyChart messages to streamline the management of your in basket
  3. Closing Encounters
    1. Complete and copy your note to your preceptor w/in 48 hrs
      1. Ideally, before you leave clinic (write note as you go)
      2. Do not close encounters — attendings will close encounters
    2. Closing erroneous encounters
      1. No show or LWBS
    3. Outside of Visits
      1. Inbox
        1. Results
          1. Result Notes
            1. Annotate result
            2. File as quick note
          2. Forward to patients
            1. Forward result w/ note to pt
            2. Smart phrases
          3. Sending Staff Messages
            1. Sending yourself timed reminders via staff messages
  1. Delegating or sharing your inbox
  1. Refills
    1. Reordering strategies
    2. Review allergies
  2. Telephone Encounters
    1. Document advice
    2. Copy emails into Epic
  3. Labs/Tests
    1. Order as future labs with expect date
    2. Send email to PCG Orders
  4. Lab Add Ons
  5. Care Team
    1. Make yourself PCP on your patients
  6. Patient Lists
    1. Maintain patient lists of your patients (outpatient & inpatient)
  7. Demographics
    1. Add/update patient contact info
      1. Phone numbers
      2. (Email address)
    2. MyChart Intro | FAQs | http://mychart.uchospitals.edu
      1. Enrolling patients
        1. Send activation code via header in chart
      2. Types of MyChart inbox messages
        1. Pt advice request
        2. Pt prescription request
  • Results
  1. All advice and refill (and appt) request messages should go to a PCG pool first
    1. Pool is covered by PCG staff (nursing, administrators)
      1. Most requests can be taken care of without physician involvement
      2. Request that require physician input will be forwarded to them
    2. Policies on releasing results
      1. Lab results → automatically released 4 business days after resulted
        1. Normal and abnormal
      2. Pathology and imaging results → automatically released 7 business days after resulted
        1. Normal and abnormal
  • Inpatient results of all types → automatically released 36 hours after d/c
  1. “Sensitive” results → can only be manually released by provider
    1. HIV testing results
    2. Genetics test results
  2. Certain results are never released
    1. Autopsy results
    2. Transplant donor/recipient info
  3. How to release results in MyChart
    1. Patient comments – laymen terminology for patient
      1. Check associated box for comments to apply to that result
      2. ‘All results’ for comments to be applied to all results
    2. Result note – provider impression for the chart
      1. After patient comments entered, click ‘accept & open result note’
  • Comments and notes both appear in the Lab tabs of the Chart Review
    1. Comments are viewable to the patient in MyChart, result notes are not.
  1. Icon legend
    1. Auto release is scheduled
    2. Result was auto released as scheduled
  • Patient viewed result
  1. Provider manually released result
  1. How to look up past MyChart correspondence
    1. Chart review → Miscellaneous reports → MyChart Patient Message Review Report (with hyperlinks in ‘subject’ to message text)
  2. More Epic Tipsheets
  3. Q&A