When I was at Northgate seeing some diabetic patients the other day Marty Levine showed me a dot-phrase he had developed that includes patient friendly language explaining the most common things that he and his colleagues often put into After Visit Summaries. Those topics include:
What is diabetes?
How do I know if my diabetes is under control?
Do I need to check my blood sugar at home?
How often do I need to come in for tests and check ups?
How to use metformin
How to use insulin
The idea Marty had was to put all of these in one dot-phrase and then just delete from the AVS the parts that are not relevant to that patient. I like it a lot. Each short paragraph is written as the answer to a commonly asked question which is the same approach that I have taken in my book The Diabetes Answer Book and the blog that accompanies it:
I had our Patient Health Education Resource (PHER) team look over Marty’s dot-phrase to make sure it is at the appropriate reading level and written in plain language. It is now in production in EPIC so feel free to check it out and see if you like it. It is called:
.pidiabetesexplained
If other folk have developed dot phrases that they really like feel free to share them on the blog.
Where will the smart phrase be posted for sharing? Bev
I will look forward to that smartphrase.
And from the beginning of Epic I’ve longed for some place where people can post smartphrases that they’ve created – that would be available to all – and SEARCHABLE. e.g., I’ve created smartphrases to document Wells criteria for DVT and Ottawa rules for ankle and knee in my notes – I would think these would be quite useful to others – yet had no place to
1. see if someone had done this already (so spent my time doing so)
2. place to post for others to use as they wish.
Yes, we have ability to share our smartphrases with others – and we can search others personal smartphrases – but on the fly I don’t know of any way to go to a kind of smartphrase ‘wiki’ of others’ smartphrases and search for what I need.
Any hope of something like that occuring?
Wayne
Hi Wayne,
Great suggestion. I am not techy enough to know the answer about how we can have searchable dot phrases. I will ask Gwen O’Keefe, Chris Thayer and others who might know better how to do it. Bev, I believe that if you are in EPIC and in any space where you can write text (like progress notes, secured message, patient instructions etc) you can just type in .pidiabetesexplained and it will appear.
I made a dot phrase to help patients choose their own massage therapist (or acupuncturist, chirporactor, etc). I have mostly used it via secure message but there are times during an office visit where patients don’t want to commit to referral until they have done their own research.
The downfall to this dot phrase is it seems every 6 months I have to update it because they change the ghc website.
“To search for a massage therapist that accepts Group Health insurance, go to ghc.org.
Near the bottom of the screen, click on Site Map, then click Provider and Facility Directory, then Doctors and Other Providers. In the pull down window choose the insurance you have (usually Group Health), enter the zip code you prefer, and under the specialty pull down menu choose massage therapy. Then click search. You will get a list of Group Health affiliated massage therapists in and around that zip code. Let me know when you have made a choice and I can place a referral for you.”
One more I use at least once or twice daily for patients who have borderline hypertension. I explain I’d rather get a broader picture of their blood pressure at varying times of day, give them a blood pressure diary/wallet card and put this dot phrase in the AVS or secure message, asking them to report back to us in a month.
“It is very helpful for us to look at what your blood pressure readings are outside of our clinic. If you can help by monitoring your blood pressure, keeping good records, and mailing or bringing them into us it would help when making decisions about medications.
Some important things to keep in mind:
1. Proper technique: When checking your blood pressure make sure your arm is SUPPORTED and at heart level. Your blood pressure can increase by up to 10% if these are not done. Sit with your back supported, with your feet flat on the ground (not crossed or dangling).
2. Timing: You should rest at least 5 minutes before taking a blood pressure reading. Or wait 30 minutes if you have just exercised. Some experts advise taking 3 blood pressure readings 1 minute apart and then averaging them. Nicotine and caffeine can increase your blood pressure, so try to get a blood pressure reading before using these or wait 30 minutes after nicotine use, or a couple hours after caffeine use to check your readings.
3. Choosing a monitor: we prefer the cuffs that go around the upper arm instead of the wrist monitors. Make sure the cuff fits, if it is too small or too large the readings can be inaccurate. Lifesource and Omron are reputable monitors, but there are many others that may work fine. If you have doubts about your machine, bring it in with you to your next visit.”