THE DIGITAL REVOLUTION
Figure 1 : A screenshot of the SmartSet for a complicated return obstetrics visit . then again using the SmartSet . I then performed the same task for a complicated prenatal visit . The uncomplicated visit was a 25-year-old G1 at 34 weeks with no comorbidities or pregnancy complications . The complicated patient was an Rh-negative 28-year-old G1 at 28 weeks with comorbidities of obesity and type 2 diabetes .
For the uncomplicated obstetric patient , utilizing the SmartSet shaved 20 seconds off the overall charting time . This was a result of a 33 % reduction in the number of mouse clicks ( 18 to 12 ) and a 24 % reduction in keystrokes ( 17 to 13 ) needed to complete the visit . Skeptics may argue that a SmartSet isn ’ t worth the hassle for uncomplicated prenatal return visits . However , if one sees 25 uncomplicated OB patients per day , that ’ s a reduction in charting time of over 8 minutes a day or 33 minutes per 4-day work week .
For the complicated obstetric patient , the SmartSet completed the task in a third of the time compared to the traditional charting manner , resulting in a time savings of almost 90 seconds . The reductions in mouse clicks ( 71 %) and keystrokes ( 80 %) were even more pronounced in the complicated patient scenario .
Figure 2 : A list of all secondary diagnosis codes included in the SmartSet build .
the board . This can be beneficial for each provider and the health care organization as a whole . If the EMR can auto-populate 95 % of the progress note , it makes little sense to type one out completely freeform . An added bonus is that the SmartSet can improve billing practices . Now an auditor doesn ’ t have to question the provider as to why a patient was billed a 99214 code ; the SmartSet will pull in the obesity and type 2 diabetes diagnosis codes automatically , making it quite obvious why the upcharge was applied . If the SmartSet presents the appropriate billing code choices based on the patient ’ s insurance provider , then confusion is reduced even further .
Lastly , the SmartSet can improve patient outcomes . Consider the scenario where a cesarean section was delayed , and the provider is running an hour late in the office . In the traditional manner of charting , a patient who met the criteria for low dose aspirin may have slipped through the cracks because the provider was rushed and failed to recall that gestational hypertension was diagnosed in a prior pregnancy . If the provider utilizes the SmartSet instead , the patient ’ s chart is combed through in a fraction of a second , suggesting the aspirin order before the visit is signed . This same argument can be made for progesterone supplementation and cervical length measurements for patients with a history of preterm labor , or a complete blood count that wasn ’ t done at the initial visit because the lab tech was unable to draw enough blood . The SmartSet catches things that the end user may have missed .
In order to highlight the time-saving potential of the SmartSet , I completed an uncomplicated prenatal visit in the traditional way and
I built the SmartSet to be as intelligent as possible in terms of suggesting lab orders , imaging studies , vaccines , etc . There are , of course , always exceptions . For this reason , I added four sections at the bottom of the SmartSet ’ s configuration . These sections essentially behave as preference lists for any type of order that would be placed during pregnancy . The purpose of this is to add flexibility to the build , allowing the provider to go off-script if needed .
As I stated at the outset , the AI revolution has begun . While I ’ m proud of the SmartSets I ’ ve built , there ’ s little doubt in my mind that AI will create an even more efficient solution to patient charting in the near future .
Dr . Ryan is an OB-GYN at Norton Healthcare with roughly 15 years of Epic experience .
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