Managing my EMR Results InBox

My practice has been using the EPIC electronic medical record for 5 years now, and it’s taken about that long for me to figure out how to tweak the system to make myself more efficient, and for the system to evolve to a place where I could tweak it myself.

Case in point – Quick Actions.

EPIC’s most recent upgrade includes little self-made macros called “quick actions” that turn repetitive tasks into a mouse click. I’m using quick actions to manage my results in basket in much the same way you may be using Rules in Outlook to manage your email.

Some of my macros are actually little work-arounds for a system that is not yet entirely integrated and a patient population that has not yet embraced online results communication. About half of my patients sign up for online results – I’m working hard on the rest…

Like many of you, I like a clean inbox, but need a place to park messages that are awaiting some future task for completion. I’ve decided to use the “results notes” inbasket for this purpose, so you’ll see some of my macros moving messages there.

I now have the following Quick Action options whenever I view a lab report –

  • Normal Pap – creates a standardized normal pap letter, sends it to my secretary to print out and mail and inserts a little addendum note to the encounter that results were sent.
  • Left message – After I’ve called and failed to reach a patient about a lab result, adds “left message ”  addendum to the patient’s visit note and moves lab result to my results note in-basket, where it will sit till she calls me back (or I call her again, don’t get me started on the phone tag game…).
  • My Chart – Inserts a little note into the patients EMR that her results were released to her via My Chart – an online patient communication system that sort of lives outside my EMR with incomplete integration, so I put that little note in so I know I communicated results to her. It’s faster than searching through the My Chart inbasket later.
  • Hold for HPV – Moves mildly abnormal pap results into my results notes inbox where it will wait for the HPV result, which comes a few days later.
  • Failed mammo – creates a reminder letter to patients who have failed to get their mammogram, the order for which is sitting in my “overdue results” basket, and sends the letter to my secretary to mail it. I then delete the overdue message from my inbasket.

Any other EPIC users out there have Quick Action macros that are working well for them? If so, feel free share them with us in the comments section .

10 Responses to Managing my EMR Results InBox

  1. Not meaning to be hyper-critical, but it’s interesting to use “fail” for the mammo choice. I guess the physician I’ve seen thinks I “fail” to get a yearly mammo, but the big recommendation organization (the name of which I can’t remember right now, making my argument a whole lot weaker, alas) recommends every other year, rather than every year for women my age. I think of myself making a choice to get one every other year rather than “failing” to get one. (I’m guessing you don’t use the “fail” language in the reminder letter to your patients, but are way more politic.)

    (The language of “fail” in medicine has caught my attention since a friend “failed” chemo. What a nasty way to put the failure of the treatment.)

  2. Bardiac –

    These are patients who have chosen to get a mammogram and accepted a referral for and/or made a mammo appointment then did not show for it. If women choose not to get a mammogram for the myriad of reasons they may not want one, I don’t give them a referral, and the result never goes overdue.

    One of the definitions of “fail” is “To leave undone”, so my use of the term is technically correct. However, if you’d like, I’d be happy to rename my macro in your honor.

    What should I call it?

  3. oh, i was just about to comment on a “failed” mammo — to me it suggests a bad result. and yes, i thought of chemo failure, too.

    from the doc’s perspective, it just didn’t work; but cancer patients often feel like they are being blamed for the disease. (which is not entirely untrue. we have all heard those kinds of comments when news of someone’s cancer goes around — “oh, she never took good care of herself.” sometimes it’s more along the lines of a busybody’s advice that “you can definiely beat this if just think positive and take this supplement, blah blah.”)

    what about no-show, or request to reschedule? there may be various reasons a patient doesn’t make an appointment.

  4. Kathy A has good suggestions 🙂 Missed Mammo has a nice bit of alliteration!

    I didn’t realize they’d agreed to get one and then didn’t. (At the local clinic, they send you a reminder thingy. Maybe that counts as a referral?)

  5. thanks, peggy. these macros are for your own use, and i’m sure you are an understanding doc, so maybe bardiac’s comments and mine are beside the point, but i like that you changed the macro.

    i’m a bit sensitive about disconnects between doctors and patients; and they happen even with great doctors and informed patients. in my own very different work, i find it helps me work better with clients to be framing things internally in a less (potentially) judgmental way.

  6. Can you email me more info about Quick Actions in Epic. I tried to replicate what you have done and seem to have very few options. One just opens a letter and the other just makes a quick note. Am I missing something or is my software. Great Blog. Thanks.

    • Lost –

      You have to create the quick actions yourself, to match your individual workflows. Just go ahead and start the action (writing a result note, forwarding results, open a letter, etc) and just before finishing it, there should be an option on the page to save it as a quick action.

      I don’t have any documentation on this, maybe your IT support team can Log in and show you how to do it.

      Thanks for reading!

      Peggy

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