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Clinical Documentation Shortcuts

CE / CME

Improving Obesity Care Using Clinical Documentation Shortcuts

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Pharmacists: 0.50 contact hour (0.05 CEUs)

Released: November 09, 2023

Expiration: November 08, 2024

Jonathan Scott
Jonathan Scott, MD, MPP, AAHIVS
CME/CE Information

Activity

Progress
1
Course Completed

Background

Improving obesity care requires a commitment from healthcare professionals (HCPs) to develop a comprehensive obesity care plan and keep patients engaged. Clinical Care Options launched a national obesity QI program called “Obesity Change Makers,” and one of the participating practices aimed to improve obesity care by incorporating documentation shortcuts designed to systematically address obesity care at every visit.

Riverside University Health System

At Riverside University Health System (RUHS), 12 community health centers offer primary care services to patients living in Southern California. As Federally Qualified Health Centers, our clinics serve a diverse group of patients, including racial and ethnic minority patients and those with low socioeconomic status. Internal medicine residents rotate through the RUHS primary care clinics, and attending physicians serve as preceptors. First-year residents (interns) start every July, so they have the most to learn about providing comprehensive primary care, as they see patients who may have multiple chronic conditions. To enable staff to provide more consistent care for patients with obesity, our RUHS team worked to develop clinical documentation shortcuts called EPIC dotphrases.

EPIC Dotphrases

The EPIC electronic health record (EHR) allows HCPs to create clinical documentation shortcuts called dotphrases using the EPIC SmartPhrase tool. The suite of EPIC SmartTools includes SmartTexts (templated blocks of text), SmartPhrases (customized templated blocks of text), and SmartLinks (information pulled from another part of the chart), and clinicians can build their own shortcuts without involving IT resources. A dotphrase is a keyboard shortcut used to enter blocks of text quickly and leads to more consistent clinical documentation and care planning.1 For example, typing “.LBP” might generate a block of templated text related to lower back pain. After HCPs create a dotphrase, they have the option to share it with other users. A library of crowd-sourced EPIC dotphrases can be found at www.dotphrase.org. Other EHRs offer similar functionality (eg, Cerner has Auto Text), and terms such as “smartphrase” and “dotphrase” often are used as generic references (not specific to any EHR system) for keyboard documentation shortcuts.

Creating an Obesity Care Checklist

After performing a baseline assessment in early 2023, our team at RUHS saw that HCPs were not consistently addressing obesity care and offering interventions during clinic visits. We saw an opportunity to use dotphrases to make it easier for HCPs to address obesity care systematically at each office visit. The team developed an intervention with the aim to improve how HCPs addressed obesity care and discussed interventions with patients in the outpatient setting.

The internal medicine clinic built an “obesity care checklist” EPIC dotphrase and instructed residents and attendings to use this when seeing patients with obesity. This checklist was incorporated into the standard note template for all visit types. The dotphrase was designed to balance the clinical importance of delivering effective obesity care without adding unnecessary documentation burden on HCPs.2

This checklist was intended to remind HCPs to discuss obesity care with patients and offer appropriate interventions such as referrals (ie, nutrition, health coaching, or bariatric surgery evaluation) and pharmacotherapy. When the dotphrase was used, the checklist was required to be filled out before staff could close the clinic note. Many residents felt comfortable explaining and discussing interventions such as health coaching and a nutrition consult. However, some felt they needed additional education about topics such as bariatric surgery or medications, and this led some to learn more about these interventions.

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Clinical Impact

Using team huddles, clinical staff were reminded to use the obesity care checklist dotphrase and to spend time discussing obesity care and explaining the importance of each intervention. They found that interns (first-year residents) had the most to learn during their first year of training. When new interns started in July, the attendings and senior residents used the checklist as a tool to guide the interns on how to systematically provide obesity care. By using the checklist, all the clinicians working in the clinic are becoming more comfortable discussing obesity care interventions with patients.

In early 2024, RUHS will evaluate the impact of this intervention by reviewing patient charts and comparing that information with their baseline data collected in early 2023.

Barriers and Obstacles

While the obesity checklist was relatively simple to build and deploy in the EHR, the delivery of quality obesity care remains an ongoing challenge for certain patients. Because of differences in health insurance coverage policies, we found that some insurance plans do not provide coverage for nutrition referrals, bariatric surgery, or injectable weight loss medications. Some HCPs wanted to offer health coaching but found that their patients had limited English proficiency, and the coaching was not available in multiple languages. Although these barriers and obstacles have led some HCPs to feel discouraged about providing effective obesity care, they also have been reminded about the importance of social determinants of health and creative ways to navigate the healthcare system to address unmet needs.

Future Direction

We will continue to use tools such as the obesity care checklist to remind HCPs to offer interventions, but better health insurance coverage is needed to ensure that patients can access these services. Recognizing that the landscape of obesity care is evolving, we at RUHS hope to see better health insurance coverage in the future. Our supervising physicians also have been motivated to learn more about antiobesity medications, presenting these options to patients, and discussing potential treatment-related adverse events. Ongoing efforts are planned around empowering residents to feel more comfortable and motivated about discussing obesity care with patients.

RUHS remains committed to delivering high-quality care for patients and recognizes the value of clinical decision support tools such as checklists. The “obesity care checklist” dotphrase is quick and easy to use—and reminds HCPs to systematically address obesity care.


  

Image source: www.ruhealth.org/medical-center/medical-education/internal-medicine/internal-medicine-residency

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