3/3/2024 0 Comments Smartphrase epic definitionFor example, if a provider would normally chart “aa” in the record, it could mean “African American” or “antacid” however, if the provider has predefined an “aa” dotphrase then when she types “.aa” it automatically populates the term “antacid”. They can also alleviate the need for word sense disambiguation because of their ability to perform abbreviation expansion. They can also enable more consistency, fewer misspelling, and fewer grammar mistakes in the clinical notes. Dotphrases, if used appropriately, can reduce the number of abbreviations in the clinical record, making the text more readable. They are a powerful tool – they aim to enable high quality, structured documentation while reducing documentation burden and maintaining natural language in clinical text. SmartPhrases are defined by Epic as “shortcuts for entering text quickly.” They are small pieces of text that start with a period and upon typing them in the note, they expand into a larger body of text. ![]() Both have been referred to as “dotphrases” as the method for calling upon these shortcuts is by typing in a “.” Here, we focus on the Epic SmartPhrase tool. The Epic version of this functionality is called SmartPhrase and the Cerner version is called AutoText. The two main vendors that account for over 50% of the US healthcare market (Cerner and Epic) 5 both have this type of tool. Most EHR vendors have the ability to allow for these shortcuts. Many clinical departments have employed medical scribes, utilized dictation software, or experimented with personalized EHR documentation shortcuts. There have been some innovations and strategies employed in an effort to combat this pervasive issue. 2–4 Proper documentation can be onerous and time-consuming. However, the burden to create high quality clinical documentation is sizeable. ![]() Accurate and useful clinical notes are especially important in the Emergency Department (ED) setting as the ED is the gateway to the hospital for the large majority of patients. In an ideal world, clinical notes are able to provide an up-to-date, accurate, thorough, useful, organized, comprehensive, and succinct narrative describing the patient care trajectory 1. ![]() Clinical notes account for a crucial part of all clinical documentation and have important implications for clinical, medico-legal, and reimbursement. Documentation is a key part of healthcare.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |