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Epic Systems meeting addresses doctor notes, opioids, smoking cessation

August 29, 2018

UW Health and UnityPoint Health-Meriter soon will do what some other Epic medical record customers have done: let patients see doctor notes summarizing their visits.

As a national movement called OpenNotes continues to catch on, health systems are using Epic software to make doctor notes available to patients online, even though some doctors are skeptical of the idea, a doctor said Tuesday at Epic Systems Corp.’s annual users group meeting in Verona.

“I was not a believer in OpenNotes at the beginning,” said Dr. Jason Row, chief medical officer of Parkview Physicians Group in Fort Wayne, Indiana, which is implementing the program.

“But all this note is, really, is a reflection of what happens in the exam,” Row said. “I’ve become a believer.”

The Epic meeting also addressed opioid prescribing and smoking cessation, including a new program at Group Health Cooperative of South Central Wisconsin.

Seeing doctor’s notes

UW Health plans to start OpenNotes on Sept. 25, letting adult patients see doctor notes from primary and specialty care clinic visits — except for substance abuse visits — through Epic’s MyChart portal, spokeswoman Lisa Brunette said.

At UnityPoint Health-Meriter, patients will be able to see doctor notes from clinic and inpatient visits, except for sensitive topics like behavioral health, starting Oct. 16, spokeswoman Leah Huibregtse said.

SSM Health’s Dean Medical Group allows doctors to let patients see the notes if the doctors want to. A plan to make the sharing automatic has been delayed, spokeswoman Kim Sveum said.

Row said that in Fort Wayne, the vast majority of patients think their doctor’s notes accurately describe their visit, and only 1 percent felt worse about their doctors after reading the notes.

However, he said it’s important for doctors to avoid using acronyms patients might misunderstand. For example, they shouldn’t use “SOB” for “shortness of breath,” he said.

“You may not want use ‘FU’ for ‘follow-up,’” Row said. “You may want to write that one out.”

Programs for opioids, smoking

With the country’s opioid abuse epidemic continuing to escalate, doctors are being required to limit opioids for new patients, take extra precautions in prescribing opioids to high-risk patients and check prescription databases to prevent “doctor shopping” for drugs, said Dr. Kit Chan of Partners Healthcare System in Boston.

Epic medical records can be a “one-stop shop,” allowing the steps to become routine, Chan said.

At two Group Health clinics, Epic software is prompting doctors to ask patients who smoke if they want to quit. The pilot program, designed through the UW Center for Tobacco Research and Intervention, encourages patients who say yes to pick a specific date to quit.

So far, among nearly 600 smokers, about 25 percent have set quit dates, up from a typical rate of less than 2 percent, said Dr. Michael Fiore, director of the UW center.

One of the patients is Elaine Edgren, 57, of Madison, who smoked for more than 30 years.

This June, her Group Health doctor, prompted by the Epic program, asked her to quit. Edgren decided to stop July 4 and got a prescription for Chantix, a smoking cessation drug.

Nearly two months later, she hasn’t had a cigarette. “It hasn’t been super easy, but it hasn’t been hard,” she said. “I’m getting older, and I needed to quit.”

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