No More EPIC Notes

I am not going to discuss the pros and cons of the EPIC medical record, but I am going to state that EPIC notes do not have to be “epic” notes. Some notes in EPIC are so long and include so much data that they take tons of time to read. That usually means they won’t be read. Some EPIC notes contain detail far beyond what is required to take care of the patient. For example, some clinicians copy entire procedure reports including such things as the patient’s positioning during the procedure, intravenous contrast doses and x-ray angles. These may be important sometimes, but in progress notes??? Many problem lists contain everything except what’s important. And all this drivel gets copied and carried forward daily.

This is not medical documentation. This is pollution of the medical record.

There is a story about a wealthy industrialist who got lost hiking. He came across a forester cutting wood who asked him, “Who are you and where do you want to go?”. The industrialist was so impressed by the importance of these questions that he hired the forester to wake him daily and ask him the same questions.

Every EPIC progress note should use the forester’s approach: a brief summary of the patient and what the plan is.

These should be at the very beginning of the note so they get found and read. I usually state, something like, “I made the following recommendations for the following reasons.” The recommendations are detailed and include what the clinician needs to know to carry out the plan including such specifics as doses, telephone contact numbers, appointment dates, etc. If you know these details, putting them into the note saves time for other clinicians. Providing the reasons for the plan not only educates other clinicians, but empowers them to make the plans in the future, and explaining your reasoning is your best defense if something goes wrong.

So, just say “NO” to epic EPIC notes.

This was also published on my blogs on Substack under pauldthompsonmd.