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EPIC SmartPhrases for Chart Review & Problem List Updates (Smart Phrases)

EPIC SmartPhrases for Chart Review & Problem List Updates

You may use these to help CCS and SCs in reviewing their patient's charts and providing common advice on certain problems.

Prediabetes: Copy and paste the below smart phrase, name it what you want. Exists in Paloma Orozco Scott's phrases as "PREDIABETESPROBLEMLIST"

[ ] Discuss diet --> update problem list

[ ] Discuss exercise --> update problem list

[ ] Explain how exercise decreases blood glucose levels

[ ] Explain how the A1C lab works and what it measures

[ ] Offer nutrition consult --> document if offered and why rejected

[ ] Annual A1C - DUE *** (make appointment with Cms)

See last A1C here Delete after inputting next due A1C check @LASTLABX(hba1c:4)@

Obstructive Sleep Apnea: Copy and paste the below smart phrase, name it what you want. Exists in Paloma Orozco Scott's phrases as "OSAPROBLEMLIST"

[ ] Update BMI (input height + weight in rooming)

[ ] Nutrition consult - offer and document if following or if declined

[ ] Enhanced STOP-BANG (search UpToDate for questions)

[ ] ROS for obstructive sleep apnea (OSA) - daytime sleepiness(hypersomnolence), waking up gasping for air or choking, early morning headaches

[ ] Depending on sx, discuss with attending if patient should have polysomnography or home sleep apnea test ( HSAT) to test for OSA. ------According to UpToDate patient's with high pre-test probability may be suitable candidates for HSAT with the correct device.

Dyspepsia Alarm Symptoms: Copy and paste the below smart phrase, name it what you want. Exists in Paloma Orozco Scott's phrases as "DYSPEPSIAALARMSYMPTOMSPROBLEMLIST"

Patient has a hx of dyspepsia / epigastric pain, this has a broad differential. Be sure to comment upon the following alarm symptoms in the problem list.

[ ] unintentional weight loss

[ ] dysphagia (difficulty swallowing)

[ ] odynophagia (painful swallow)

[ ] unexplained iron deficiency anemia

[ ] persistent vomiting

[ ] palpable mass or lymphadenopathy

[ ] family hx of upper GI cancer

Obesity: Copy and paste the below smart phrase, name it what you want. Exists in Paloma Orozco Scott's phrases as "OBESITY"

BMI Hx: ? @BMI@

Diet Hx: ?

Exercise Hx: ?

Comorbidities: ?

Family Hx Obesity: ?

Prior to your visit consult the EHHAP page on obesity medicine "https://ehhapp.org/obesity"

[ ] Review pts chart for possible etiologies/medications that contribute to weight gain

[ ] Always record height, weight, and BP in rooming during visits

[ ] Ask the patient if they are comfortable discussing their weight with you

[ ] Take a full diet, exercise, weight hx and summarize above

- Screen for behavioral conditions / eating disorders

        - Night eating

    - Cravings 

    - Emotional eating "Do you feel a loss of control?"

    - Hx of anorexia, bulimia, or binge eating? 

- 24h food recall

    - What liquids does the patient drink?

    - When do they get hungry throughout the day? 

    - Do they have $ for access to fresh foods 

- What is their baseline weight?

- What is their heaviest weight? 

[ ] Set a goal weight and/or or goal waist circumference. Goal of female 35 inches (88.9 cm). If patient prefers a goal weight help them obtain a scale.

[ ] Screen for obesity comorbidities

- HTN

- T2D

- Dyslipidemia 

- Sleep apnea [STOP-BANG calculator

[ ] Family hx of obesity

[ ] Consider if patient needs T2D screening if BMI >=25, Age 35-70