Epic allows you to create Procedure Documentation (or "Proc Doc") SmartForms, which enable the automatic dropping of charge codes when procedures are documented. This will enable you to combine the ordering, documentation, and charging of in-office procedures into a single activity. In this article, we'll give you strategies on how to set up and validate Proc Doc.
Best Practices
When setting up Proc Doc, we recommend the following:
- Starting with the Epic-released forms, and customizing them from there, rather than creating forms from scratch
- Using the Epic-released rules where possible
- Setting the charge-related fields to be required
- Including CPT codes in parentheses in the button names, where possible
Determining Which Forms to Start With
We recommend starting with the forms that generate the most procedures, either in terms of volume, or in terms of revenue. Work with your billing and/or reporting teams to determine which procedures will get you the most bang for your buck by converting them to drop charges automatically.
Once you've determined what charges you want to prioritize, start looking for Epic-released rules and forms that will allow you to drop these charges. There are lots of Epic-released CER rules that were created for Proc Doc. To find these, run a Chronicles search for:
- all CER
- where item 9 (Logical Owner) = 1
- item 33 contains <CPT>, where <CPT> is the charge you're looking for
Once you (hopefully) find an Epic-released CER rule that contains your desired CPT code, look at the SmartData Elements that the rule evaluates. You can do this by looking at CER item 252, where that line evaluates a SmartData Element, for example EPIC#9999. Grab the .2 (record name) of this record.
You can then run a search on SmartForms (LQF) for some Epic-released SmartForms that use those SmartData Elements. Chronicles search for:
- all LQF
- item 9 = 1
- item 450 contains the .2 of your chosen SmartData Element
This should give you a SmartForm, with your chosen SmartData Element, and an Epic-released CER rule that corresponds to that SmartForm.
Setting Up the Procedures and Rules
Now that you've identified the SmartForm that you want to use for Proc Doc, we need to build and configure the procedure record. First, check to see if there is anything Epic-released or Foundation that you can use. Search the name and/or CPT code(s) for something either in your system, or in the Foundation system.
If nothing exists, create a new procedure. Do this by duplicating an existing procedure in Chronicles. It's easier that way. When you duplicate a procedure, make sure you check the following and change them if necessary:
- 100
- 107
- 110
- 420
- 2000
- 10950
- 10900
Next, you can link the CPT codes and rules to the procedure. Open the procedure in text, and set it to Orderable only. On the Linked Performables tab, set the values of item 6664 to the CPT codes that you want to set, item 6665 to "rule," and item 6670 to the CER rules you identified earlier.
Add to a Preference List
Next, you just need to complete the rest of the standard Proc Doc setup. Open up your Proc Doc Preference List (or create one, if you haven't already) and add your new Orderable procedure to the list.
Confirm that the preference list you're using is on the correct profile of the user you are testing with, and open a Procedure Note (more on strategies to set up a Procedure Note to launch Proc Doc here).
Within the Procedure Note, you should see a list of the procedures on your Proc Doc preference list. Click the procedure to order it, and confirm that your charges drop as you sign the note, per the configuration of the rules that you created.
What if the Epic-released SmartForms Aren't Good Enough?
Inevitably, you will find that the Epic-released SmartForms and rules just won't cut it. In these scenarios, we still recommend starting with Epic-released SmartForms, and duplicating them from there. It's much easier than starting from scratch. Find a SmartForm that is the closest to the procedure that you want to use, and duplicate it. You will then likely have to create new SmartData Elements for use in the new SmartForm.
Use scripting to show and hide different sections based on the answers to previous prompts (more on scripting here). When you are done creating the form, generate a new Text Generation Template by going to "Actions" in the SmartForm. Have clinical stakeholders validate the contents of the new SmartForms to confirm that the contents of the note capture everything they want to convey in their notes. You can also use rules to generate completely different text generation statements based on the rule returning true.
