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Automating Health Screening Surveys

Question:
  1. Is there a way to generate health screening surveys automatically in EPIC?
Name: Marina Basina , MD,
Clinic: Stanford Adult
Adult or Pediatric Population: Both
Date: 10/11/2022
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T1DX-QI

This Post Has 3 Comments

  1. At UF we had our EPIC team build in the PHQ8 and our patients complete this at the check-in kiosk (not always ideal as sometimes may lack privacy) or if they check in at the desk then they are given a tablet. We have also trialed giving them the tablet once in the room or having them log into the room computer which worked okay but was more work for our diabetes-specific staff and slowed down clinic. They only get the measure if they are “due” for the measure. We have firing rules set up in EPIC to give the PHQ8 once a year for appropriate ages.

    The PRO can also be sent via EPIC MyChart ahead of telemed visits which we got better at doing during the peak of the pandemic but it only works for those who are signed up for MyChart instead of those just using zoom links.

    Then the raw data (question and score as well as the total) are pulled into our note (all diabetes providers use the same note template) and we review it. We also set up a soft stop in EPIC if the PHQ score is above a certain cutoff that we are alerted when we close the encounter and have to acknowledge it.

    -Laura Jacobsen, MD University of Florida

  2. For in-person visits we use the Welcome tablet for all of our PROs. There is logic for firing frequency and # of questionnaires that will be offered at a given visit. For depression screening, we use an adaptive frequency of every 3 months if score is high or +SI, every 6 months for moderate score, and annually for low score. We have a SW called for any moderate, high, or +SI scores for same day evaluation or telephone call within 24 hours if family does not wish to stay to SW in clinic. The welcome tablet integrates into Epic encounter so responses are visible under the Rooming tab of navigator. Items, response, and score are reported and also brought into progress note. Results are also searchable in a flowsheet if you want to see past responses from a different encounter.

    There is also a separate flowsheet we built that captures if depression screening done, if yes, prompts score and offers some decision support for interpretation, asks if SI endorsed, and referral action taken if any.

    Similar to UF, there is a best practice alert if +SI endorsed.

    We can send PROs through My Chart, but opted not to do so for PHQ-9. Instead, either nurse or SW will verbally ask PHQ-9 items if screening is due for a telemedicine appointment.

    – Sarah Corathers, MD Cincinnati Children’s

  3. Our current workflow is to have the patient complete the PHQ-9 on a paper survey and then it is scored and entered into a flowsheet in Epic by an MA or social worker depending on the TCH location (7 clinics total).

    Our At-Risk Care Process Team, led by Dr. Selorm Dei-Tutu who is currently out on maternity leave, is exploring the option of using the Welcome app for direct Epic integration. It’s a bit more challenging in pediatrics since parents have access to the Welcome app, but the pediatric patient (age 12+) receives the PHQ-9 screen. In the adult world, the Epic Welcome should be much smoother.

    – Dan DeSalvo, Texas Children’s Hospital

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