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<p class="MsoNormal"><b><span style="font-size:24.0pt;font-family:"Britannic Bold",sans-serif;color:black">Epigram: Spring Cleaning</span></b><span style="color:black"><o:p></o:p></span></p>
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<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0)"><span style="font-size:14.0pt;color:black">With the weather warming, it is a great time to do some spring cleaning! Over the next few weeks, focus on streamlining notes and reducing “note bloat”.
Improved notes are faster to create, more efficient to read and can save you from risk by reducing information that you have not fully addressed.</span><span class="apple-converted-space"><span style="font-size:14.0pt;color:black"> </span></span><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px">
<span style="font-size:14.0pt;color:black"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px">
<b><span style="font-size:14.0pt;color:black">What is note bloat</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px">
<span style="font-size:14.0pt;color:black">Note bloat is the addition of extraneous information into notes that is addressed elsewhere in the chart and does not directly relate to the current (today) visit or inpatient day. Extraneous material makes it harder
to read notes- notes are longer and the reader needs to evaluate each data point to wonder if it is relevant and why it is mentioned. Materials like labs that are not related to the patient’s condition and are normal, repeating material from old notes, copying
multiple scan results and other material are simply not needed. <o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in"><span style="font-size:14.0pt;color:black"><o:p> </o:p></span></p>
<p class="xmsonormal" style="margin:0in"><span style="font-size:14.0pt;color:black">The EMR is the medical record.</span><span class="apple-converted-space"><span style="font-size:14.0pt;color:black"> It does not need to be recreated in your notes.
</span></span><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px">
<span style="font-size:14.0pt;color:black"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px">
<b><span style="font-size:14.0pt;color:black">What should be in a note</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px">
<span style="font-size:14.0pt;color:black">The material that should be in a note is that material that references why you saw the patient
</span><span style="font-size:14.0pt">today</span><span class="apple-converted-space"><span style="font-size:14.0pt"> </span></span><span style="font-size:14.0pt">including a medically appropriate history and exam, what you found and evaluations of material
data points with a plan in support of your medical decision making. <o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
<p class="xmsonormal" style="margin:0in"><span style="font-size:14.0pt;color:black">You can reduce note bloat with the aid of many personalization tools in Epic. Reach out to me or the training team (4-epic) to learn how.</span><span style="color:black"><o:p></o:p></span></p>
<p class="xmsonormal" style="margin:0in"><span style="font-size:14.0pt"><o:p> </o:p></span></p>
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<p class="xmsonormal" style="margin:0in"><b><span style="font-size:14.0pt;color:black">Examples</span></b><span style="color:black"><o:p></o:p></span></p>
<ul style="margin-top:0in;caret-color: rgb(0, 0, 0);font-variant-caps: normal;orphans: auto;text-align:start;widows: auto;-webkit-text-size-adjust: auto;-webkit-text-stroke-width: 0px;word-spacing:0px" type="disc">
<li class="xmsolistparagraph" style="color:black;margin-top:0in;margin-bottom:0in;mso-list:l2 level1 lfo3">
<b><span style="font-size:12.0pt">Lab studies:</span></b><span style="font-size:12.0pt"> abnormal results (or studies you are trending for a patient problem) should be addressed. Other normal labs from the visit can be left to the results review section of
the EMR. Example: a patient with renal disease may be important to mention the levels of K, Ca, BUN and Cr, but it may not be relevant to automatically add liver enzymes. Just because a lab was part of a panel, does not mean it needs to be added.</span><span class="apple-converted-space"><span style="font-size:12.0pt"> </span></span><span style="font-size:12.0pt"><o:p></o:p></span></li><li class="xmsolistparagraph" style="color:black;mso-list:l2 level1 lfo3"><b><span style="font-size:12.0pt">History:</span></b><span style="font-size:12.0pt"> Try to stick to interim history only. Past medical history, family history and social history along
with a review of systems should be documented in the EMR but no longer need to be included in the provider note for outpatient E&M (inpatient coming in the future). You can eliminate the use of smartphrases and templates that bring this information into your
outpatient note. <o:p></o:p></span></li><li class="xmsolistparagraph" style="color:black;mso-list:l2 level1 lfo3"><b><span style="font-size:12.0pt">Exam:</span></b><span style="font-size:12.0pt"> E&M documentation guidelines for outpatient services now only require a medically appropriate exam. Now
is a great time to update your exam templates to eliminate items previously included just to support billing. Similar changes are anticipated for inpatient E&M in the future. <o:p></o:p></span></li><li class="xmsolistparagraph" style="color:black;margin-top:0in;margin-bottom:0in;mso-list:l2 level1 lfo3">
<b><span style="font-size:12.0pt">Problems and diagnoses</span></b><span style="font-size:12.0pt">: You do need to specify problems addressed and cofounding issues for utilization review and coding. Issues not relevant to the current visit, however, can be
left to the chart’s problem list.<o:p></o:p></span></li><li class="xmsolistparagraph" style="color:black;margin-top:0in;margin-bottom:0in;mso-list:l2 level1 lfo3">
<b><span style="font-size:12.0pt">Radiology results</span></b><span style="font-size:12.0pt">: have a new result? Summarize it in your note to discuss. Do not copy the entire result into the note. Especially do not copy forward notes adding studies each time
to substitute for results review. No one wants to read through 6-7 old scan results while reviewing a note. Instead create an entry in the problem list with the important findings.</span><span class="apple-converted-space"><span style="font-size:12.0pt"> </span></span><span style="font-size:12.0pt"><o:p></o:p></span></li><li class="xmsolistparagraph" style="color:black;margin-top:0in;margin-bottom:0in;mso-list:l2 level1 lfo3">
<b><span style="font-size:12.0pt">Copy forward:</span></b><span style="font-size:12.0pt"> this enticing tool has</span><span class="apple-converted-space"><span style="font-size:12.0pt"> </span></span>led<span class="apple-converted-space"><span style="font-size:12.0pt"> </span></span><span style="font-size:12.0pt">to
many cases of practitioners copying the last note and then adding new material for the day. This leads to each note being an ever-growing long interim summary where it is hard to filter out what is new and important. Clean out copied notes to just contain
the accurate information for the visit/day- the rest of the material is already in the chart and should not be repeated.<o:p></o:p></span></li></ul>
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<span style="font-size:10.0pt;font-family:"Calibri Light",sans-serif;color:#A6A6A6">From the Desk of the CMIO</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" align="right" style="text-align:right;caret-color: rgb(0, 0, 0)">
<span style="font-size:10.0pt;font-family:"Calibri Light",sans-serif;color:#A6A6A6">Neal Seidberg, MD</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" align="right" style="text-align:right;caret-color: rgb(0, 0, 0)">
<span style="font-size:10.0pt;font-family:"Calibri Light",sans-serif;color:#A6A6A6"><a href="mailto:seidbern@upstate.edu" title="mailto:seidbern@upstate.edu"><span style="color:#954F72">seidbern@upstate.edu</span></a></span><span style="color:black"><o:p></o:p></span></p>
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<span style="font-size:10.0pt;font-family:"Calibri Light",sans-serif;color:#A6A6A6">315-464-7507</span><span style="color:black"><o:p></o:p></span></p>
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<span style="font-size:10.0pt;font-family:"Britannic Bold",sans-serif;color:#A6A6A6"> </span><span style="color:black"><o:p></o:p></span></p>
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