An Epic Guide to an Epic Setup

for Using Epic Epically

I'm sorry; I couldn't resist
by Daniel Hwang
Updated 5/12/17
 Table of Contents
Customizing toolbars 2
Creating patient lists 3
Time marking 4
Printing lists with writing space 5
Signouts 6
Order preferences 7
Orders timing 15
Order sets 17
How to do admission orders 19
Releasing orders 20
Cancelling hidden orders 21
Summary and activities 22
Flowsheets 24
Rounding page, procedure notes 25
Macros 26
Smart/DotPhrases/Dictionaries 28
Pre-admit order 30
Phone app, adding pics to Epic 31
 Epic Main Screen 2

We'll be using
Patient Lists most
often, but there
are few others that
are useful:
Click here to pin to top of menu
Unit manager to
track patient
movement

ED tracking board
to look at ED pts: 2
ways to see this

You can customize the tool bar with this wrench.

You can even
change your Epic
theme!
 MAKING YOUR LIST MORE EFFICIENT 3

To create a list, go to Properties and Create My List (lists are

alphabetically sorted, so I number the lists to get the important ones on
top). Otherwise, highlight your list then click Properties

Search for the columns you want and click Add

You can copy others' lists, too

These are the good

ones; pick the ones
you want!

Additional potentially useful columns:

Name Age/Sex Cr LDA Name (lines and date placed)
MRN CrCl Ucath Days (days Foley has been in)
Patient/Location/Age/Gender/DOB Hb Therapy recommendations
Admission Date K+
 MAKING YOUR LIST MORE EFFICIENT - WHY? 4

You'll see two new columns on your list

A time under new result means there's a lab value you haven't marked
A note icon means there are new notes to view
You can click these to see just the updates and use the icons to monitor
for new information about all of your patients all at once (easier to view
using a short list without all the signout information)

No time or icon? These are not the data you're looking for; move along

How do you get the time and note icon to go away?

Use the Time Mark button in the NOTES activity

This note has NOT been marked

This one has

And Time Mark button above the table of results in the RESULTS REVIEW
activity

Unmarked labs are in bold, and reviewed labs are not

 PRINTING A LIST WITH SPACE IN WHICH TO WRITE 5

Either go to properties for an existing list or create a new one

Add just these columns - the fewer the better because it leaves more
room to write

Drag and drop your team list into your new list

Click any patient on your list and hit print in the top right corner

You end up with something like this...

Unit/Bed Name/Age/Sex/DOB/MRN
A Mr. X (82 y.o. M)
1 DOB: 1/2/34 writey space
MRN: 123456
A Ms. Y (38 y.o. F)
2 DOB: 5/6/78 more writey space
MRN: 234567

Find what works for you! The method here allows you to sort by room
location or by name (default is geographic sorting)
 A note on handoffs (signout) 6

Select your patient and click Write Handoff to open the signout

Your senior resident will delve more into what constitutes a good signout,
but to assist in writing it... click on that white arrow to open up the chart,
so you can have the chart and your handoff side-by-side!

You can also open the signout from within each patient's
chart by clicking Write Handoff from the Patient Summary
tab.

Also, when you click Print Handoff, it prints the signout for each patient
on the list - if you want to print only a few of the patients on the list,
you'll need to put them in a separate list.

The signouts that print are rather long, so if you want a list with just the
signout information, create a list using these columns:
Unit/Bed
Name/Age/Sex/DOB/MRN
Handoff Summary
Handoff Situational Awareness/Contingencies
Handoff Action List
While we're in the Patient
Summary tab, you can see
lines/drains/airways/wounds
HOW TO STEAL COPY SOMEONE'S ORDER 7

PREFERENCES/FAVORITES
STEP 1
Click the Epic button at the
top left of the screen and
go to Tools then
Preference List Composer.
 STEP 2 8

Now you should see this screen.

We can use this to see/manage/add order preferences (later), but first
let's steal some preferences.
You'll want to click Copy User at the bottom.
 STEP 3 9

1) Type in the name of your victim benefactor - feel free to use mine
since I've already saved a bunch
2) Scroll down to Orders (Inpatient) and check the box
3) To keep the ones you've already saved, make sure Merge is checked
4) Hit Copy

1) 3)

2)

4)
 STEP 4 10

To see what you've done, hit Close to go back to this screen:

These are your preference lists
Now double click ORDERS PREFERENCE IP
 STEP 5 11

You can now see the orders you've copied here:

You can change the order you see them in Epic using the arrow buttons
at the bottom of the screen
 STEP 6 12

Go to Manage Orders and click NEW on the right of the screen

Make sure you have ONLY MY FAVORITES checked. You'll also want to
click the LEFT MOST VIEW BUTTON, so you can see the parameters for
each order.

To find things outside of your favorites, hit F6

Enjoy your new set of orders!

If these aren't enough, and you want to add more... keep reading
 STEP 7 13

To add order preferences, go back to this screen (repeat steps 1 and 4):

Click New Item, type in your order, and pick it from the list

Set your parameters and click Accept (Accept & New Item to add more)
 STEP 8 14

Alternative way to add orders to your preferences

1) Click the star next to the order
2a) To add it to a specific list you already have, type it in the box next to
SECTION (default is Existing)
2b) To add it to a NEW LIST you're about to create, click NEW SECTION
and enter a name
3) Click Accept

You'll see this next. Replace order turns the star yellow (helps to know
which ones you've already favorited); keep order doesn't (but still saves
the order). It doesn't make a difference which one you pick.
 Orders timing 15

"every 6 hours" is VERY DIFFERENT from "4 times daily."

Q6h labs start at the time they are placed; 4 times daily occur at weird
times that likely correspond to phlebotomy draw times and are NOT q6h
The "Q6h - timed w/ am labs" defaults to 0400, 1000, 1600, and 2200
draw times to correspond with AM lab draws at 0400. If you order this at
1100, the next time it will be drawn at is 1600. This is to keep the ICU
nurses happy
Q8h - timed w/ am labs are done at 0400, 1200, and 2000
Q12h - time w/ am labs are done at 0400 and 1600

When you order interval labs, ALWAYS NOTE THE DRAW TIMES, see
below
 Changing the times of lab draws (and also meds) 16

When ordering labs at specific time intervals, always look at the schedule

Q8h doesn't actually exist anymore - it defaults to "3 times daily"

The above schedule is the default for this... we can clearly see it is NOT
actually q8h...
Click Adjust Schedule to set your own times for when you want the labs
drawn
This can also be done to change medication administration times

Be wary of this - the lab/med will only be done at the next indicated time,
which can be several hours from when you placed the order

You can also search for specific

orders! Just press CTRL+F
Or... you can do a global search at the
top right:
 Order Sets 17

These make your lives easier, and if you can't find an order the normal
way, try an order set (think sliding scale insulin)!

Go to Manage Orders on the left and click Order Sets on the right

You get this:

You can right click and hit Add to Favorites to save them for future use!

For admission order sets, I recommend NOT ordering them within ADT.
We'll go over how I do admissions later
Shown above are some of the ones I have saved and are rather useful
- Chest pain one has the various stress tests within
- Body fluids for LPs, paras, thoras
- Diabetes for SSI
 Order Sets cont'd 18

In addition to saving the order sets I've already saved, you can
CUSTOMIZE them.

You'll notice that the gen/tele admission has two options underneath.

This is because I saved a version of this order set with orders that I nearly
always check/uncheck (the User one)
Here's how to do it:
Open the order set - most useful for admissions ones
Before checking/unchecking orders, click Manage My Version then click
Create New Version.

You get this:

Name your version and scroll through to check/uncheck your default

orders for this version - you shouldn't have to do too much more, and
some things you can't change the defaults for.
 How I like to do admission orders 19

I use the ADT activity for just one thing: verifying home
meds then doing the med rec. SUPER IMPORTANT TO DO!
Ord Rec - Sign Now gives you this menu at the top:

Verify Order home meds DON'T TOUCH*

The next 2 things are basic admission orders and AM labs

Use MANAGE ORDERS (not ADT) for both - you can start
these before seeing the patient and then SAVE your orders.
You can't save them if done via ADT.

Do order sets from here

- you'll have the option
to save them if you're
not ready to sign

Now for your AM labs - use the order preferences we created earlier

*You can use New Admission Orders if you wish, but I would recommend
NOT doing the admission order set here. I also would recommend NOT
using the labs section of the admission order sets - do these elsewhere.
 Releasing orders 20

This is particularly important for medications put on MAR hold when the
patient goes to the PACU. We need to release them so they can be
accessed. Patients kinda sorta need their meds usually...

Go to ADT then click the Transfer tab

Click Release Orders

Check the orders you want to continue/discontinue/modify

Then click release!

I know people who have manually re-ordered all the meds... don't be like
them =P
 Releasing orders - cont'd 21

HELP!!! I there is NOTHING under release orders...

Never fear - there's a work around (it means the transferring service didn't
do a transfer med rec)

Click Order Reconciliation

Review orders, discontinue unwanted ones, then click Continue Unselected

Then click Review and Sign, scroll to the bottom and click Sign and Hold-
Initiated by Receiving Unit

Go back to Release Orders - you should now have all the orders to release!

I JUST PLACED AN ORDER I CAN'T CANCEL...

Admission/transfer orders don't show up where other orders do... to
cancel go here under Manage Orders (follow 1-4):
1) 4)

2)
3)
 Viewing meds, vitals, and other useful things 22

You'll want to use the Patient Summary activity.

Use this to look at the MAR (displays per 24hrs)

MAR = medication administration report

Let's permanently add some summaries:

To the right of the above buttons, click the wrench

The following are the most useful:

1) Medicine rounds displays vitals, lines, weights

2) ICU vitals in graph form – HAS OXYGEN FLOW RATES!
3) MAR – grouped by active, completed, and discontinued per 24hrs
4) Fever shows fever curve, abx start/stop dates, culture dates
5) Transfusion in tabular format (WARNING: NOT ACCURATE)
6) Good for diuresis (see below for prior admission weights)
7) Where you find Swan numbers for cardiology
 Activities everyone should add 23

Click Customize at the bottom to drag and

drop the activities you want in your
toolbar - you can even change the size of
some of the buttons

Here we have more useful Activities

1) Review flowsheets
2) Medications
3) Intake/Output
4) History
5) Flowsheets
Review Flowsheets: prior admission
weight

Medications: prior to admission meds

You can also filter for specific medications

to see when prescribed (such as
pentamadine for PCP ppx)

Intake/output: full chart, can view by time

History: Add PMH/PSH/SHx - pulled in by smartphrases
Update these for new admissions!

Flowsheets on next page

 Flowsheets 24

Flowsheets has a lot of very useful tabs:

To add these, click the wrench then check this box:

1) Ventilator settings and when they were changed!

2) Blood product administration – harder to view than the other one.
IMPORTANT NOTE: when blood is done, it disappears from here then
goes to the I/O page unless you click Hide Comp'd. Unfortunately, this is
still not a very accurate way of looking at transfusions
3) Lines and when they were placed/removed (includes PIVs)
4) Same as 3) but for drains, tubes
5) HD flowsheet (flowrate, volume removed, vitals, etc)
6) Same as 5) but for CRRT
7) You can see how patients are getting scored on AWS

#2-4 aren't all that useful, but I'm stuck with them on my list...
#3 and 4 can be seen under Active Lines in Patient Summary
 Being efficient on rounds 25

It’s nice to have this view pulled up during rounds, so you’ll have all the
information you need readily available.

Open Results Review, and on the right under Index, click Meds Current
You can now see labs and all active medications very easily

I would also recommend sorting

your orders by Order Type

Procedure Notes

Use NoteWriter and type Procedures to get the screen on the right.
Select the relevant procedure – click “More” if not listed.
Now you can just click the buttons below – no typing!
 Macros 26

When writing notes, our templates use Smart Blocks (text in orange) for
physical exam and review of systems

Yay, we get to click (and not type) everything, but that's a lot of clicking...

Earlier the buttons were all clear.

I just clicked my normal macro...

BAM all checked (just edit for abnormal ones now)

You want in on this sorcery? Keep reading
 Macros - cont'd 27

Click Manage Macros - if you've already checked a bunch of things,

Create macro from current data - otherwise, Create new macro

Check all the things

you want
Click Save As
Click Accept

You can make

multiple macros

You can do the same

for the review of
systems
 Smart/Dot phrases 28

DotPhrases are built into the system, and anyone can access.
SmartPhrases are only for you, but you can share them.

Go here to create SmartPhrases

New to create new; Edit to edit current one

Open allows you to see other people's SmartPhrases (and steal them)
 Smart/Dot phrases - cont'd 29

Choose a name then write

your SmartPhrase
On the right, you can create a
list with selectable options

You can also highlight text in a note,

right click, and create smartphrase

Useful DotPhrases:
.LDA (shows lines, drains, airways)
.cmeds (current meds in table with dose, route, frequency)
.radimgrestult48h (radiology results from last 48h)

Service-specific smartphrases for notes

Use the service-specific smartphrases!
.gim*, .cvm*, .pulm* for medicine, PCS, MICU

Dictionaries: right-click a note, click here

Go to
auto
correct

Enter abbreviation then Uncheck

unabbreviated form this box
 Pre-admit Order 30

Let’s say a patient is being transferred or direct admitted, and they need
an admission order. You open their chart, but you can’t put in orders…
Guess you don't have to do the admission!
Just kidding. Here's what to do:

Click Encounter at the top

Type in the patient’s name or MRN and search
Click “New” at the bottom left of the next dialogue box
Then you get this:

Type in Orders Only, and you’ll open a new encounter that allows you to
put in orders

Use THIS
NOT THIS

Click Manage Orders as usual, and search for Admit

Make sure you use the one that says "Admission:"
 Haiku and Adding Pics to Epic 31

Setting up Haiku:
What is Haiku? It's an app you can use to access Epic notes, labs, etc.!
Download the Epic Haiku app on your phone. Under settings, set Server
to haikucanto.umm.edu and Path to haikucanto.

Adding pics to Epic

"A picture is worth a thousand words." In other words... Dr. Attending -
instead of trying to describe the wound, why don't I just show you a
HIPAA-compliant picture of it?

Get on Haiku, open a patient's chart, then click the camera button

Android - easily found iPhone - hidden cuz reasons

After taking a picture, select document type (the note type into which
you're inserting the pic). Note: saving a picture uploads it to the chart. If
you're just testing the feature, DON'T SAVE THE PIC

Now go to the real Epic and start a note. Click where you want the
picture to appear.

Click on this button at the top then select your picture(s)