A PRACTICAL GUIDE TO

EPIC FOR RESIDENTS:

So You Do Not Spend 6 Months
Figuring this Out

By: Allison Levin

(with occasional contributions by
Ozzie, on the right, when he stepped
on my keyboard)

Your mood after

learning you can create
an order panel and just
type “Fever” to order
the entire fever
workup.
 TABLE OF CONTENTS

TECHNOLOGY 101 ...................................................................................................................................................... 4

Basics ......................................................................................................................................... Error! Bookmark not defined.
Epic Terminology ..................................................................................................................................................................... 4
Top Efficiency Hacks ................................................................................................................................................................ 4
Resident Tips ............................................................................................................................. Error! Bookmark not defined.
Practical Notes ........................................................................................................................................................................ 5
Assigning Roles/Teams ............................................................................................................................................................ 5
Patient Lists ................................................................................................................................................................ 6
Organizing/Creating Patient Lists............................................................................................................................................ 6
Useful Columns ....................................................................................................................................................................... 8
Sticky Note.............................................................................................................................................................................................. 9

Viewing Data ............................................................................................................................................................ 10

Summary ............................................................................................................................................................................... 11
Chart Review ......................................................................................................................................................................... 13
Results Review....................................................................................................................................................................... 14
Other Important Sidebar Sections ........................................................................................................................................ 14
Orders ....................................................................................................................................................................... 15
How to Place an Order .......................................................................................................................................................... 15
Lab orders .............................................................................................................................................................................. 16
Medication Orders ................................................................................................................................................................ 17
Viewing/Modifying Current Orders ...................................................................................................................................... 18
Editing Multiple Orders ......................................................................................................................................................... 19
Saving/Pending Your Orders ................................................................................................................................................. 20
Order History ......................................................................................................................................................................... 21
Signed & Held Orders ............................................................................................................................................................ 21
Ordering Home Meds............................................................................................................................................................ 22
Making an Order Panel ......................................................................................................................................................... 23
Using and Customizing Order Sets........................................................................................................................................ 24
Personalize an Order Set from Scratch ................................................................................................................................................ 25
Adapt Other Users’ Order Sets ............................................................................................................................................................ 27
Using and Customizing your Preference List ........................................................................................................................ 28
Preference List Basics ........................................................................................................................................................................... 28
Adding Orders to the Preference List .................................................................................................................................................. 29

Admission ................................................................................................................................................................. 32
 Steps in epic for every admission: ........................................................................................................................................ 32
Admission orders................................................................................................................................................................... 32
............................................................................................................................................................................................... 32
Med Rec & Ordering Home Meds ........................................................................................................................................ 33
Discharge .................................................................................................................................................................. 34
Steps for every discharge ...................................................................................................................................................... 34
Appointments ........................................................................................................................................................................ 34
Discharge Med Rec................................................................................................................................................................ 35
Discharge Instructions and Summary ................................................................................................................................... 37
“Clicking out” ......................................................................................................................................................................... 37
Haiku......................................................................................................................................................................... 38
Haiku Alerts for Labs ............................................................................................................................................................. 38
 EPIC 101

EPIC TERMINOLOGY

Take a few minutes to actually learn the terminology of key features of Epic. It’s worth it. Skip over this if you are
overwhelmed and come back later.

• Smart Phrase = Text that you type to pull up a block of text.

o That text can be anything. It can be a template for a progress note, a plan, common instructions for your
discharge summary, etc.
o It can contain smart links (see below).

• Smart Link = pulls in data from the patient’s chart

o Pulls in vitals, med lists, history, etc
** Dot phrases = used to call up either a smart phrase or smart link. If I make a smart phrase that has my plan for
an AKI, I use a “dot phrase” to summon it.” For instance, I would type .PLANAKI, and that phrase would
autopopulate. **

** Smartlink dotphrases are often preset by the institution. If you don’t want to have to remember the
long/complication smartlink, you can make a smartphrase of your own with that smartlink embedded. For
instance, instead of typing .labrcntipur[Cr:5] to get the last 5 creatinines, I can make a smartphrase with that and
call it cr5. So if I type .Cr5, it would populate with that smartlink, and I will actually remember that term.**

• Order sets = groups of orders specified by epic admin, all to facilitate certain tasks that require the same orders
each time
o e.g. admission orders). Make custom versions of these to save yourself tons of time

• Order panels = groups of orders YOU define, again saves tons of time
o E.g AKI workup, so you don’t have to order urine na, urine cr, RP ultrasound individually each time.
Instead, just type “AKI panel”)

• Preference list = orders that you nickname and set custom parameters for, so you don’t have to click 100 boxes
for each order
o E.g à K PO 40: when I type this into order box it will auto pull up potassium k-dur tablet 40 mg PO to be
given now, one time (rather than having to search for the med, find the correct order, specify # of
occurences, day, priority, etc)

TOP EFFICIENCY HACKS

If you are overwhelmed and just want the essentials:

• Time mark your labs and notes

• For daily progress notes, copy forward + refresh is your best friend
• Use Haiku lab notifications wisely
• Search across entire patient chart
• Day 1 à wrench in key summary reports to make prerounding a breeze
If you are ready for 201 level efficiency:

• After getting the hang of things, start building up your smart phrase library
• When pre-rounding/charting, move carelign to the left screen and keep your note on the right. Makes
it much easier to write in pertinent events/labs without having to constantly switch between carelign
and your note
• Set up your preference list
• Let order sets do your work for you by making custom order sets
• Use smartphrases wisely
• Search for inpatient via the search bar in the patient list

PRACTICAL NOTES

• Wrench = Option to personalize something. Click a wrench anywhere to see what you can customize on that page
• Copy forward notes, click “show my notes only.” It will remember this, and it will save you from having to find
your previous note among the many notes written the day before
• Collapse the notes screen to show only person and service, it makes reading it a lot easier (click on the wrench on
the top right of the notes section)

ASSIGNING ROLES/TEAMS

• Covering provider = Whoever should be called/messaged about the patient the call (NOTE: THIS IS CALLED
DIFFERENT THINGS AT DIFFERENT INSTITUTIONS)
o Right click on patients you want to sign in for, click “assign me” if assigning yourself. Then type in covering
provider
§ DO NOT assign yourself as the resident à This will pop up when a patient is in the ED. If you
don’t get this now, you will get it when it happens to you by mistake
§ When you sign in, it should auto-remove whoever was previously assigned under the same role
§ Note: If someone mistakenly signed in as the “resident” role (which happens for ED patients,
there will be two people assigned to the patient. Be a nice colleague and fix their mistake by
“ending others’ assignments” and removing them from the resident role
o If assigning someone else, right click and choose “assign others”
 PATIENT LISTS

ORGANIZING/CREATING PATIENT LISTS

When you first log in there will be a limited number of lists made for you. Customize the variables in these lists, and make
other useful lists that you can add different patients/provider lists to. This is how I chose to set my lists up, use it as an
example but find what works for you

• My provider list = the list for patients you are signed in for AND those you are PCP for who are hospitalized
o It can be really annoying to have patients who you are the PCP for show up, so I do not primarily use this
list. However, it is a useful way to see all of the patients you are signed in for at once
o Make sure you DO NOT sign in for the patients you are PCP for, unless they are actually on your provider
team

• Create a new list

o Edit List (on top left) à Create new list
o Add columns to your liking (see suggested columns on next page). At minimum, must have patient name,
location, MRN

• Adding patients to your list

o To add specific teams, follow these steps:
§ Available lists à HUP (or PPMC) system lists à
Provider Teams Medicine à drag and drop
desired list
• I suggest making the following lists:

o Current Team (I use this instead of my

provider list)
o Cross Cover
§ Put the teams you are frequently
covering here, so that they are easily
accessible
• e.g. you are on martin 1A à
1A will be your current team,
and 1B (sister team, 2B/2A
will be on your cross cover
team
o HUP Lists
§ At the beginning of the year I took
the time to add all of the services
medicine potentially rotates on to
this common team list. That way
whenever I want to find a list it is
very easy to just drag from
§ I haven’t made presby lists given we
are there far less frequently, but you
could!
o Interesting: Have a list of patients who were interesting/good teaching cases. It helps to use the “sticky
note” column to write a one liner to have a quick reminder of what made them interesting J
o Follow Up & Imaging: Same as above, lists you want to either see outcome or are good imaging examples
 USEFUL COLUMNS

• Customize your list columns: You can customize the columns to your own liking, the ones I use are below.
Everyone finds the ones they like best. KEY ones are the following:
**THESE ARE INSTITUTION SPECIFIC, MOST OF THE FOLLOWING SHOULD HAVE SIMILAR OPTIONS AT EVERY
HOSPITAL**

My current setup ( haiiii nick kuhl <3 )

Key Columns

• New Rslt Flag: Will have an icon that indicates a new lab has come back, double click on it to get taken directly to
that result.
o Make sure to time mark those labs when you get taken to the results screen to clear that flag
• Code Status: Obviously important, especially so for when you print out your list when you are cross covering with
an easy way to see who is DNR/DNI
• New Notes: When a new note is signed it will give you a notification. Can be annoying if its random/unimportant
buts it’s a good way to ensure you do not miss consult notes, etc

Very Useful:

• My Unsigned orders: If you mistakenly pend orders/get distracted/something else happens, there will be a flag
here that you still have orders there
• Publicly pended orders: Key for other services that can pend orders for you and you have to sign- like TPN/TEN
ordered by nutrition. Intern tip: TPN needs to be signed by 2pm the day before to get it on time for the next day.
If you are working with med students they can pend orders and you can cosign.
• Expiring Orders: Flags if there is an order expiring, easy way to see if you need to renew tele, etc
• Pended Note: There if you have a pended note, which I find helpful so I don’t miss actually signing a progress/HP
note. One annoying thing is that it counts discharge summaries here too, which you sometimes do in advance of
discharge
• MPP meds delivered: This turns green once patient’s meds have been delivered to bedside. I find this helpful for
discharge planning
 Stay on top of new orders/notes by time marking the labs/notes! You can time mark labs by either clicking on the lab flag
and pressing time mark on the results review OR from the bottom panel of the patient list screen

STICKY NOTE

There is a column called “Sticky Note” that you may use to keep track of key info on a patient. I find it highest yield to use
when I am on a rotation with patients with very confusion combos of antibiotics/steroids/diuretics. I will include those
meds and/or other key facts (like vented,CRRT, etc), in that sticky. If I have a lighter list I will typically not use this as this
information does change rapidly and you have to change it every day.

The column names are “My sticky note” and “my sticky note text.” There is one called “sticky note text,” do not add it,
its blank.

Poor alex was on night float for this list L

 VIEWING DATA

Once you click into a patient’s chart, you will use a variety of subsections to see pertinent data. This format may be
changing in summer 2020, but essentially down the left side there are the overall sections. There are many of these
sections, so customize the order/ size of these buttons to your heart’s content. The wrench to click is highlighted in the
picture. Key ones to have are:

• Summary
• Notes
• Chart review
• Orders
• I/O (I find this view the best)
• Admission
• Discharge
• Med view
• Care teams (nurse, SW, PT covering, etc)
• PDMP
 SUMMARY

This is the first screen that will come up when you click into a patient chart. You “wrench in” reports (see below, arrow
pointing to the right wrench), that summarize data that you access commonly. They show up across the top of the screen.
Pro tip: When you wrench the report in, also shorten the name so you can see many of your reports across the top
without having to choose the dropdown.

Wrench in the following reports, play around with them to see what you like. Anything requiring further explanation is
below.

• Active Orders: This is a great layout for seeing what orders are currently in. You can also go to the Orders section
of the chart, but it’s a bit clunkier there. If you actually want to put in an order, you will still have to go to the
orders section. Also use it to choose labs you want to go to Haiku (see below)
• MAR history: Summary of all meds administered, most recent to the right of the screen. Green = given, red =
held, black = due at that time. Control-Find is your best friend
• Pain management: The real utility of this is seeing how much total Ativan your patients on CIWA got over the past
24 hours. Also helpful for general pain management
• Antimicrobial monitoring: Great timeline that combines antibiotics, cultures, fever curve, labs, etc. Good if you
want to see timing of things, less helpful if you want to quickly scroll through summary report of micro results. If
you want to do that, use micro results
• Microbiology results: Quick way to see any/all cultures and sensies done on your patient during any admission
• Critical care rounding: Has vent/drip/hemodynamics and other ICU relevant data. Helpful but clunky
• Glucose monitoring: Key for insulin management. Make sure to change the time scale to help you get an idea of
total usage
• Diuretics: Summarizes all diuretic admins, Is/Os and electrolytes
• Anticoagulation Management: INR/PTTs, great for patients on Coumadin or warfarin
• Intake output: Self explanatory
• Radiology results: All of the text of impressions from radiology
• ED patient care timeline: Amazing tool that documents each event that happened in ED. Do you want to know if
your patient actually got fluids after that lactate came back @ 6? Go to this summary and use control-Find to
localize things within the timeline. ED notes are…less than stellar (understandably so, they are busy!)
• Blood transfusion: Only easy way to see how much product your patient has received
• Sedation: Great for ICU drips
• Labs since admission: Nice labs visualization (still not better than carelign)
Active Orders

One great feature of this summary tab is that if you scroll down to the labs section, you can click the alarm button that will
send the results of a lab to your Haiku app on your phone. Do this for night float when there is a lab that you need to follow
up on. Or, when there is a lab for your admission that will take a few days to come back on that you want to know when its
back. You will still see the lab pop up on epic, just a nice assurance. Make sure to not do this for recurring labs, its
annoying. Also, your outpatient box will see these labs unless you clear the labs from your computer, so be nice and do so
quickly.
 CHART REVIEW

Chart review is a more extensive history, but is formatted in a terrible way 99% of the time. Only come here for things you
need. There is the option to use chart review in the same way as the summary section (see the reports on the second row
below), but this part of the chart takes so much longer to load then chart review that its not worth using this as your
primary section. Some highlights of what you use chart review are:

• Encounters à Key! Each time the patient has a visit within the penn system, it will be a new encounter. All of the
notes, med records, etc, for that visit are filed under each encounter. When you go into a patient’s chart review
you are in the CURRENT encounter. If you want to go into old encounters (usually you do not have to do this so
much on inpatient side, more outpatient), then right click on any encounter and choose edit or addend
encounter.
• Imaging: Come here to pull up any imaging, you can also get to this from carelign studies section. For cards, echos
or other studies are in the cards tab.
• Procedures: See the procedure reports for most things, like colonoscopies, EGDs, etc. Cards procedures may be
found in the cards tab
• Cards: All things cards, from EKGs to echos
• Media: Pictures uploaded from HaIku, scanned documents sometimes
 RESULTS REVIEW

I have to be honest, PennChart does a terrible job with results review. It confuses me, and I don’t use it unless I need to. I
use carelign for most labs. If I want to find a result in the chart that is not easily available on carelign, I will search across
the entire chart (use the search button on the top right, next to your name, under the minimize button. If I need to find
an old ANCA study for example, I will “google” their chart by searching for it in that box. Someone else may be a guru at
results review and use it more. Someone should update this section for V2 J

The only pearl for this is that when you click on a new result flag from epic patient list, it will bring you to the results
review section and only show the actual new lab, as long as you pressed time mark after the last time you looked at it.
This is clutch!

OTHER IMPORTANT SIDEBAR SECTIONS

• Carelign- key part of your workflow, so its nice to have it embedded in epic. However, the best way to use it is in a
separate web browser, its just quicker that way to switch between patients. If I have time I’ll write a guide to
carelign, but I’m going to focus on epic for now because its less intuitive

• Medview- Use this to find your path results, EKGs (great way to see them because it lets you compare two EKGs
side by side)

• Care Everywhere – use this to look at outside records for places that use Epic. It wont show up as an option unless
your patient actually has outside records that can be accessed. It also may not show up while your patient is in
the ED, weird epic quirk

• Demographics- next of kin (can also be found under synopsis/overview), home address, etc
 ORDERS

HOW TO PLACE AN ORDER

You’ve finished 4 years of college, 4 years of medical school, step 1, step 2CS and CK (never mind the SATs, MCATs, etc),
and despite all of those amazing accomplishments I promise you that putting in your first few orders will seem like the
most confusing thing you have ever done. To save you from feeling this for more than the first day or so (which is
inevitable), I’m writing out a step by step guide to placing orders. Though this is here, the best way by far is to just ask your
senior. We’ve all been there are we are happy to help J

1) Click into the orders main tab (option bar

along the left hand of the screen) à orders
search will pop up on the right-hand side of
the screen

2) Type some version of the name of what you

want to order into the orders search

3) The following screen will pop up. Note that

it first looks for things in your “preference”
list. These are orders that you have
highlighted as common orders and pre-
formatted (see preference list section), or
orders that the epic gods have deemed
most common/useful

4) If the order you want does not show up on

this screen, sometimes you have to click on
the “facility list tab”, which will have all of
the orders that match your search term

5) Once you find the order you want, double

click on it. For now, lets pretend I have not
set up my order preferences, so I’d only see
the university set preference list (potassium chloride ER K-dur tablet is what I’m looking for, quite the mouthful…). Double
click on that.

6) Fill out all of the appropriate boxes.

The only required ones have a red
exclamation point. Avoid filling out
non-required ones unless truly
necessary, it will only mess you up
 LAB ORDERS

Options
• Once = one time. Defaults to time of order but
you can specify a date/time
è There are tons of frequency options. Click
on the magnifying glass to see many
options.
è For labs you want every few hours, the
best option is to choose “Now and then
every X hours” (great for TLS labs, etc)
è You unfortunately cannot schedule for a
certain repeated time every day. Let’s say
you want an additional BMP at 2 pm every
day in someone you are diuresing
aggressively. The easiest way to do this is
to either just order it separately, or you
can do some fancy ordering maneuvers.
For instance, you can schedule every 48
hour labs starting @ 2PM today, and
another order q48 hours starting
tomorrow @ 2pm, to essentially get daily
2 PM labs. There are few situations that it
is worth doing this over just ordering 2PM
labs for that day separately

• Scheduled lab = lab at a certain time with

phlebotomy. Honestly no different than once
at a scheduled time. Sometimes its safer to
order it under scheduled phlebotomy so it
prints out on their work list correctly

• AM draw = defaults to every morning @ 5 AM

• Provider draw = if you are going to draw it, lets
the nurses choose to print the labels for you at
that time.
**Make sure to double check today/include now vs. as scheduled, to
make sure it’s the correct date/time
**Choose “stat” to get labs done within an hour by phlebotomy. If they
don’t draw it you can cureate phleb for that building.

** If you want the labels to print out for a lab YOU are drawing, choose
provider + stat, OR provider + ask the nurse to “release them”
 MEDICATION ORDERS

• Not as complicated as lab orders

• In general, epic will give you the most
common dosing regimens as options
to just click

à BID is NOT equivalent to q12h!! BID

would schedule 9AM and 5 PM, vs. q12 is
a true every 12 hours. For antibiotics you
will want to chose q8 hours rather than
TID, for example. BID/TID defailts to
making it during the awake hours

• If you want to quickly see dosing

guidelines, click on the lexicomp
formulary link at the top. I also really
like the epocrates app

• Pay attention to the starting date and

time!! You can also click on the
scheduled times blue text to change
the schedule/admin times

• Ensure you choose routine vs. stat

(especially for antibiotics!)
 VIEWING/MODIFYING CURRENT ORDERS

When you click into the order pane, the first tab that will load is the “active” orders. You can modify or discontinue orders
from here. Though it’s a good way to see active orders, if you are just trying to look at all active orders the easiest way to
do so is through the summary à order report.

• To modify an order, click modify, then just adjust as you need

 EDITING MULTIPLE ORDERS

Save yourself a ton of time by changing any of the order parameters for multiple orders at the same time. To do so:
1. Place multiple orders, either by choosing
multiple in your preference screen or typing
multiple into the order search

2. Choose options à edit multiple à click all labs

you want to make the same edit to and specify
your changes
 SAVING/PENDING YOUR ORDERS

If you pre-populated a ton of orders but

aren’t quite ready to sign them, you can
“save work” and re-load it later. This is
particularly useful when you are writing
admission orders but haven’t officially
taken over the patient’s care. You will
usually pend admission orders, labs, etc.
n When ready to order, go back to
your order screen and click the
blue link under saved work
 ORDER HISTORY

Use this pane under the orders tab to look at prior orders. To be honest, it’s a very difficult view to use. Its most useful to
reorder old versions of orders, especially diets that were held for patients when they were made NPO. Protip: you can
“control-F” to find a certain order.

SIGNED & HELD ORDERS

For patients in the ED (or any other unit before getting admitted), you can “sign and hold” order to be released. For
patients in the ED who are boarding there, the ED nurses will usually go in and “release” the sign and held orders.
However, this does not always happen to make sure to go take a look and make sure sign and held orders are released
after patients are officially admitted. This will be under the orders pane à signed and held orders
ORDERING HOME MEDS
 MAKING AN ORDER PANEL

You will order the same things over and over again. Many times, you are going to order certain groups of things together.
It is a huge time saver to make order panels, which combine these various orders into one panel that you can just pull up
together. For instance, on liquid nights you will order a fever workup a TON. Instead of writing all of the components
individually, make an order set. Here is how:

1) Order all of the things you’d want in this panel. Make sure to specify routine vs. stat, source if prompted
(sputum, blood, etc).
2) Choose options à create panel
3) Name your panel whatever you want to type into your order box to pull up that panel (e.g. Fever workup +
Tylenol”
4) Click on all of the blue text under each order, and make sure all pertinent options are chosen, or you will be
prompted to enter them each time you order the panel (such as portable option for CXR)
5) If you want it to show up in a specific section of your preference list, you can change that on the top right boxes
(pref list+section). See the preference list section for more details on that

6) Type “Fever workup + tylenol” or any

portion of this, and it will bring up the
order panel/set at the top of your order
pop up. Choose that panel

7) This will bring up all the orders of your

panel into your ordering box. You can
delete either the entire panel or just
specific components, if you’d like (e.g.
you don’t want a resp culture if they are
not producing any sputum, unless you’re
inducing…)
 USING AND CUSTOMIZING ORDER SETS

Order sets are pre-defined groups of orders that are made on a system level for epic (i.e. we cannot make one, and to ask
for one to be made is actually a huge ordeal). Order sets are a huge time saver. They combine many things you need for a
certain task into one pane, and/or collects certain information for procedures. While we cannot decide on the exact
components of the order sets, we can customize the order sets by “pre-selecting” its components so you do not have to fill
it out many, many times over.

Key Order Sets

• Medical Admission Order Set

• ICU Admission
• Adult Blood Product Administration (used for any type of product)
• Subcutaneous insulin order set
• Restraints (not used super often but super, super annoying to fill out each time)

You can make several versions of the same order set, so that you can use each when most appropriate. This is super
helpful for efficiency. For example, for the subQ insulin order set I made an order set with only a low SSI, and another with
basal + prandial + SSI. Take a look at the order sets I customized, you’ll figure out how customized or generic you prefer!

My Order Sets
 PERSONALIZE AN ORDER SET FROM SCRATCH

1) In the orders screen, choose the

“order sets” option rather than
“manage orders.” My customized
order sets show up on the left, but
if you don’t have any custom order
sets nothing much will show up
there

2) Pull up the order set that you want to

customize
n Start by typing in any
component of the order set you
want to use (admission), then
choosing medical admission
order set.
n The following screen will pop up
after you double click medical
admission order set
n If you wanted to choose which
options to do every time you
admitted someone, you could simply scroll through the entire order set and pick things one by one. Don’t
do that. Instead, stick the blue “personalize,” then “Create new from original”

3) This will bring up the template for that specific

order set. Make a name for it. Go through the order
set and customize each setting. For instance,
choose q4 vital signs, weight on admission, up as
tolerated, SQH for VTE ppx, etc

4) For each selection, click the checkbox AND order

details text in blue, which will prompt you to fill out
the nitty-gritty details so you don’t have to do so for
every single patient
 You do not need to fill out every box for the order set! Just pick the ones you want. You can leave certain boxes
empty even if you want to use them in the future. For instance, maybe you will leave VTE ppx empty, because
you want to choose SQH vs. enoxaparin vs. SCDs based on the patient’s cr and bleeding risk. Instead, you can
choose to empirically say SQH for example, then change that selection in the future for patients whose CrCl is >
30. The world is your oyster. Do what speaks to you (and your level of anal-ness. For me, I’m too nervous I’d
miss the Cr being <30 so I may just leave it blank and have the system make me fill it in per patient)

5) To use your new order set,

return to the main order
screen
n press order sets again
n Then choose the version
of the order set that you
just customized
n Press open order set

6) The order set with your

prepopulated options will pop up
n Scroll through the order set
rapidly to ensure you don’t
want to make changes and/or
need to fill in options that are
patient specific
n If you scroll down the order
summary on the right, the
things you need to fill in will
have an exclamation point.
n Note: if you did not check off
a box for a certain section in
your original personalization, it will not pop up on the right order summary box (i.e. if you didn’t check the
box to choose a diet, it will not require you to choose a diet prior to placing orders)
 ADAPT OTHER USERS’ ORDER SETS

1) Open orders à choose order sets à press the

green +New button

2) In the screen that pops up

• choose the preferences tab
on the top right
• Type in the name of the
person who you want to
copy an order set from

3) Double click the order set you want

to use, press accept

4) The order set will open. Press the

personalize link again, then copy this
version

5) The same screen as prior will pop up

(what you use to personalize the default
order set). If you like as is, just rename
and accept. If you want to make any
edits, you can do so now

6) This will pop up in your order set list

now, which you get to by again clicking
on the “order set” tab in the order
search bar (see above)
 USING AND CUSTOMIZING YOUR PREFERENCE LIST

PREFERENCE LIST BASICS

Your preference list has two functions

1) Make a pre-defined set of common orders that you can pull up quickly, without having to modify the order much
a. if I type K PO 40, an order pops up that is for potassium chloride 40 mEq tab, to be given now
2) These preferred orders can be grouped by type (you specify this), into a preference list that is pulled up when you
press the green plus button next to the ordering text box. This allows you to check multiple preferred orders off
at once.
a. You can set up your preference list however you like. I am pasting my current preference list example
here. See below for preference list setup if you’d like to take a deep dive into this

** IF YOU WANT TO SEE ONLY YOUR PREFERENCE LIST, NOT THE ENTIRE PREFERENCE LIST OF THE HOSPITAL, MAKE SURE
TO CHECK OFF THE “ONLY FAVORITES” OPTION ON THE TOP LEFT OF THE PREFERENCE LIST SCREEN**
 ADDING ORDERS TO THE PREFERENCE LIST

There are a few options to get an order into your preference list. Here are the options ranging from basic à more
advanced

Option 1: “Starring it” from the order search screen

1) Place a new order, put in all of the parameters you want.

2) Then hover over it and click the star that pops up and/or
right click the actual order
3) Choose create preference list entry
Option 2: Go into your preference list composer/editor- allows for batch editing of the preference list

1) Epic button à Tools à Patient care tools à Preference list composer

2) This will bring up a very long, intimidating

looking list.
Don’t get overwhelmed. From here, you can
choose to either copy another user’s
preference list OR edit your own

3) Just choose “Order Preference IP

n You can create a preference list for each
“type” of order. The only ones that actually
matter what you assign are for the
haiku/canto mobile options. For everything
else, you can put all orders under the same
heading and it wont matter. Instead of
making a preference list for imaging, labs,
etc, just put all of them in the “Orders” list.
n Once you get the hang of this, if you like to
separate your preference list panels into
separate groups go for it. I don’t use that,
but you do you!!

4) Create Subsections
n Click “New Section” to create a subheading. I
like starting with common orders/frequent,
so all of the orders I place all the time are
easily available. See my preference list above
to look at the subsections I use (labs,
imaging, etC)
5) Add orders to each subsection
n Click “New Item”
n I added Tylenol here. I chose the typical dose
I order (650 mg) to be given once. I would
also make a recurring Tylenol order
separately. You can add any order, order
away to your heart’s desire!!
n Rearrange/reorder as much as you’d like. The
key here is just playing around with it to get
the hang of it.
6) How to copy another user: You can choose to
copy another user’s preference list, or to edit
your own. You can’t select only certain parts
of the other users’ preference list to add, you
can add all of them or just merge yours and
theirs. Its annoying.
n Click copy another user, then it will bring up
the search option. Search for them, then
choose if you want to merge (will keep your
orders and just add theirs) or replace (will get
rid of all of your previous orders)
 ADMISSION

STEPS IN EPIC FOR EVERY ADMISSION:

1) Place admission orders (after getting doc2doc)

2) Home medication reconciliation and order home meds (+/- pharmacy med rec)
3) Order AM labs
4) Write your H&P note
5) Verify allergies and family contact number

ADMISSION ORDERS

1) From order screen or in the admission tab à admission orders section, type “medical admission” in the order set
box.
2) You simply go through each of the sections and type in the appropriate info – I’d suggest just making a basic
admissions order set template that has everything filled in, and you just edit as needed (see the above section on
customizing order sets, I used the admission orders as a template)
a. Level of care = “Med-surg” on all non ICUs, “Critical-Care” for all ICUs
b. I would not suggest using the lab ordering in the admission set. Its clunky and hard to use. I just order
them separately
3) If your patient is in the ED, when you sign admission orders it will actually be “signed and held.” A nurse needs to
release them, either in the ED or when the arrive to the floor. If they are in the ED forever make sure the nurse
releases them. See the above section on how to release signed and held orders
4) Order any AM labs you think you need, I’d suggest making an order panel J
a. If you are in an ICU, you will also order “conditional” labs. Just type “conditional” into the frequency
section. I made a conditional order panel. This allows the nurses to just draw labs as needed
5) Write your H&P note- your note type is just “H&P.” You can use the provided template, but most people have a
smart phrase they use for H&Ps
6) If you click on allergies it lets you edit/add, or from allergies section of admission tab
7) Go to the demographics section to add/update any contacts
 MED REC & ORDERING HOME MEDS

1) In the admission tab, go to “Review

PTA Meds” Go through the patient’s
meds
2) Add any that are missing/adjust doses
3) Delete Meds that are outdated by
clicking the red X to the right

4) Order home meds by going to Orders

section à Home meds tab across the
top. When you click “reorder home
meds”, it will allow you to batch re-order or choose alternates for their home meds.
 DISCHARGE

STEPS FOR EVERY DISCHARGE

The main sections you will use in the discharge tab are highlighted in the picture to
the left

1) Request discharge appointments

2) Discharge med rec +/- pharm discharge med rec
3) Send any meds to be delivered to bedside to my penn pharmacy (MPP) with
enough time to deliver (ideally the night before, OK if early morning of
discharge). Also cureate the MPP tech for whatever building the patient is in
4) Discharge instructions
5) Discharge summary

**whenever you go into the discharge summary an order will pop up in the order
column that says “discharge order.” Make sure to cancel that order prior to signing anything. You cant order this by
mistake, because after signing it it will prompt you to enter a discharge date and time, so youll just go back and delete it.
But avoid having to do this extra step if you can

APPOINTMENTS

Click into the appointments subsection to see if they have previously scheduled appointments with anyone. If you want
new appointments scheduled within the penn system OR any appt rescheduled, Penn has an amazing discharge
scheduling team to help you. To place an order to schedule an appointment (at HUP!), perform the following steps:

1) Go to discharge order/rec
2) Choose the third option across the top “3. Review Orders for Discharge”. This takes you to the discharge med rec
3) Ensure the order box says “Discharge order set” à search for IP-PENN
4) Fill out the appt request
5) You will get a cureatr from one of the outpatient scheduling coordinator with a confirmation and/or any issues
that come up
DISCHARGE MED REC
You need to go through each of the patient’s home meds and inpatient meds, and say which to continue/stop. Always
start with the home meds, because if you choose someone’s “home Lasix,” it will override the “IV Lasix inpatient,” so you
don’t have to click twice.

1) Discharge order/rec section à “3. Review orders for discharge”

2) Start by clicking the arrow at the top of the home medications, which will then make all of the home meds
“green”
3) Go through the home meds one by one- if you want them to continue keep as is. If you want to edit it, click the
pencil at the top right of that med. If you want to discontinue it, click the X
4) Go through the inpatient meds- d/c anything that shouldn’t be continued at home. In general you can just click
the X button at the top of the inpatient meds section, then just click the green arrow on each individual med you
want them to continue at home.
5) If you want a HOME med sent to MPP:
a. Click the modify button on that medication
b. Choose e-prescribe
c. In the note to pharmacy section, you can add text that says “Please deliver this to patient’s bedside, thank
you. Contact covering provider with any issues.” (pro tip, make this a smart phrase). Instead, you can also
just cureate the MPP pharmacist in that building with the names of the medications you need refilled and
delivered. I often just do the second option, as it also ensures I have a dialogue going about when the
meds will be delivered. I often add the nurse to that thread.
d. Press accept, and make sure the pharmacy that you are sending the meds to is “HUP O/P pharmacy.” If
not, click on the pharmacy (above the sign button) and search for HUP O/P pharmacy
e. Sign these orders. You do not have to have the rest of the med rec done to send those down.
 DISCHARGE INSTRUCTIONS AND SUMMARY

Go to the discharge tab à instructions and summary are separate sections. The instructions are for the patient. Use the
smartphrase .dcinstructions and follow that template to fill it out. This should have clear steps for the patients. Its not
sent to clinicians. The discharge summary is for clinicians. You can use the template that pops up or another one of your
own. This is what you can send to any of their doctors. Of note, the nurses sometimes DO provide this to patients. Be
mindful of this when thinking about the language you will use (as you should always be!). But, you don’t have to write this
in layman’s terms. Make sure to avoid any acronyms that are truly not universal.

Note- technically the patient only needs the discharge med rec & instructions written before they can leave. If you are
truly strapped for time you can write the discharge summary later that day (this should be a rare occurrence).

“CLICKING OUT”

When everything is set to go, you can go back into the discharge order rec. This will have the discharge order pop up.
Choose the facility they are discharged to and expected time and date and sign that order. That is what allows the nurse
to actually discharge them and print all the documents.
 HAIKU

HAIKU ALERTS FOR LABS

To have a lab get sent to your Haiku on your phone, you can do one of a few things:

1) As you are ordering it, you can click the alarm bell thing that comes up when you hover over it
2) Go into the orders section, modify whatever order you want to see in haiku. Click accept without making any
changes. Before signing, hover over it and click the alarm (essentially just like option 1, but for orders already
ordered)
3) Most convenient way is to go to the “active orders” report in the summary tab. From there, go to the lab section,
and you can click the bell on the right side of each order (“notify me”)

**make sure to clear the flag from your haiku inbox on your computer asap, or those labs will be seen by the
outpatient residents covering your box. Also, be cautious with making alerts for recurring labs. Make sure to go back
and un-click it**

From the Ordering Screen:

From the Orders Report in the Summary Tab: