It’s Not About The Box Improving Care at Group Health with People, Process and Technology

September 30, 2005

Multiple Vitals: Coming with December Upgrade

Filed under: Electronic Chart — admin @ 5:58 am

Multiple Vitals

Over the next few months, your CIS team will be preparing for a major upgrade to the EpicCare system. I will be posting coming features. In some cases, we will be making decisions on your behalf about whether to turn new features “on” or not.

One of these is “Multiple Vitals.” From the attached screen shots, you can get a glimpse of what it offers – the opportunity to tell, at a glance, when repeat measurements are taken for things like temperature, blood pressure, and peak flow, without having to go into the current extended vitals section. This new feature is “borrowed” from the inpatient module of EpicCare.

This new functionality comes at a slight price. You will notice that even when there is just one set of vital signs, more screen real estate is taken up by this new feature. The tradeoff in seeing less data when there is one data, is seeing all of the information when there is more than one measurement taken. At the current time, the decision is to “go” with this.

Comments welcome.

September 29, 2005

New Preoperative Smartphrase beta-test: “.BETAPREOP”

Filed under: Documentation,Electronic Chart — admin @ 4:38 am

In this post Stephen Lee, Mike Wanderer, and myself introduced a new preoperative smartphrase/smarttext designed to guide primary care physicians in the right components of the preoperative physical exam.

This smartphrase is hard to interpret on paper, so we’ve put it into EpicCare for you to use, now. Simply use the smartphrase


In the practice or production regions of EpicCare and try it out. Post your comments here – we will use this blog as the place to conduct testing and improvement so that this meets the needs of our patients.

Note: This is a beta test – feel free to use in documentation for your actual patients, but keep in mind that you are accountable for what appears in your progress notes.

Click below to see the actual smartphrase:

.NAME is a .AGE .SEX seen today for a pre-operative history and physical examination.


1.1. Planned operative procedure: ***

1.2. Side of operative procedure: {SIDEOPPROC:15685}


September 28, 2005

Medication refill diagnoses : fixed

Filed under: Medications — admin @ 4:19 am

Happy to report that code to add medication refill diagnoses has been successfully deployed.

There will be a period of time where refills placed on medications ordered prior to the code being installed will not have diagnoses appended.

In this case, the Group Health pharmacy staff will check for the last refill diagnosis and associate it to the refill for physicians. This is new work for pharmacy staff to assist with provider and patient efficiency and was made in agreement with GHP.

September 27, 2005

2006 – Year of the After Visit Summary

Filed under: After Visit Summary,Quality / Affordability — admin @ 6:59 am

After Visit 2006

There was Recent discussion about the after visit summary (AVS). This post is a follow-up to that.

It is felt that the AVS is the most important clinical deliverable that we provide to patients, in many cases more important than other “deliverables” like prescriptions. Kaiser Permanente has found this to be the case (see the attached document).

We are working to build support for the idea that the CIS team would spend significant effort on the AVS in 2006.

Comments welcome.

September 22, 2005

A new preoperative progress note – comments needed

Filed under: Documentation — admin @ 6:48 am


Primary care (Mike Wanderer and myself) and our Anesthesia consultants (Stephen Lee, MD) have been working on an updated progress note for pre-op. I am posting it here for your comment.

When you look at, note that for the vast majority of patients, the default of “no” will be the appropriate selection.

The goal is to guide the primary care practitioner to the right questions and care in doing these evaluations. Going through these elements will more likely ensure a complete evaluation that will allow Anesthesia to screen the patient and assist you in deciding which comorbid conditions to refer for before surgery.

We will put this in as a smartphrase for you to test out as well. Feel free to post your comments here.

A note about the way this reads: This is a standard Epic format, which shows the skeleton of the note followed by the smartlists contained in the note. The numbering scheme is intended to match the required elements of a preoperative evaluation per Group Health and JCAHO policy.

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