Epic Smart Phrases and Dot Phrases: The Templates Worth Stealing

What smart phrases and dot phrases actually are Vocabulary

A dot phrase is a text expander. You type a period followed by a short name, the system replaces it with a block of text you built earlier. That is the whole trick. Type .hpshell and your entire admission note skeleton appears. Every electronic record system has some version of this. In Epic the pieces have specific names, and you should know them because your colleagues will use them.

The difference matters when you ask for help. "Can you share your SmartPhrase" is a specific, answerable question. "How do I make the computer write my note" gets you a shrug.

How to build one Workflow

Institutions customize the interface, so I will describe this generically. The workflow is the same everywhere I have worked.

1. Open a note and write the block once, well. Do not build a template from memory in some settings menu. Write the real note text in the editor, on a real patient encounter, and get it right.
2. Highlight the text and save it as a new phrase. There is a button or right-click option in the note editor to create a phrase from selected text. Give it a short, typeable name. Mine all start with my initials so they sort together and never collide with system phrases.
3. Replace every patient-specific fact with a wildcard. Go back through and delete the actual clinical content, leaving *** in its place. This is the step everyone skips and the step that matters most. A template that still contains the first patient's potassium will eventually put that potassium in a second patient's chart.
4. Swap in data tokens where your build supports them. If your institution has a token that pulls today's vitals, use it instead of typing vitals. Live data cannot be stale. Ask locally what the tokens are.
5. Test it on your next three notes and trim it. Any line you find yourself deleting more often than filling in should not be in the template.

Naming convention advice: keep names short, lowercase, and predictable. .xxhp, .xxsoap, .xxdc, where xx is your initials. Six months from now, at 3 a.m., you will not remember a clever name.

How to steal them from colleagues Encouraged

Nobody builds a good phrase library alone. The best templates in any hospital were written by one meticulous senior resident years ago and have been copied ever since. This is legitimate. Do it.

• Ask directly. When you read a note that is clean and complete, message the author and ask what phrase produced it. People are flattered, not annoyed.
• Use the built-in sharing. Epic lets a user share a SmartPhrase with specific colleagues or let others look up phrases they have made searchable. Once shared, copy it into your own phrase and rename it. Never keep using someone else's phrase directly, because when they edit theirs, yours changes without warning.
• Browse the phrase directory. Most builds have a searchable list of phrases users have opted to publish. Search a topic like "discharge" and read what the hospitalists built.
• Audit what you stole. A borrowed template carries the borrower's habits. If the original author's normal exam includes "cranial nerves II through XII intact" and you do not test cranial nerves, that line has to go before you sign anything with it. You own every word the moment it expands under your login.

The library: 14 templates worth having The product

These are patterns, not code. Adapt the placeholders to your build: *** means "stop and type the truth," and every @TOKEN@ means "your institution's data link goes here, ask locally what it is called." Each one is deliberately shorter than the versions you will find floating around your hospital. That is not laziness. Read the rules section for why.

1. Admission H&P shell

The skeleton for a full admission note. The structure and reasoning behind each section is covered in the admission H&P guide. The template only holds the frame.

2. Daily progress SOAP shell

Pairs with the SOAP note guide. Note that the subjective line is a wildcard, not "no acute events overnight." If you prefill that sentence, it will appear on the morning a patient coded.

3. Discharge summary shell

The full anatomy of a good one is in the discharge summary guide. The hospital course is a wildcard on purpose. It is the one section that can never be templated, because it is the story.

4. Normal exam by system

The most dangerous template on this page, so build it carefully. Every line describes only what you can actually verify on a routine exam, and anything you do not examine every single time gets deleted from your personal version.

5. ICU systems-based note shell

ICU notes run head to toe by system, not by problem list. Vent settings and drips change daily, so those are wildcards or live tokens, never typed numbers that survive copy-forward.

6. Procedure note

The universal skeleton. The complete version, with per-procedure specifics, is in the procedure note guide.

7. Death pronouncement

You will write this at 3 a.m. with a family in the room. Have the shell ready so you can think about the family instead of the format. Full walkthrough in the death note guide.

8. Code status conversation

Document the conversation you actually had, in the patient's words where possible. How to run the conversation itself is in goals of care and code status.

9. Night-call event note

Every cross-cover call that changes anything gets a note. The framework for the calls themselves is in common night calls.

10. Pain reassessment

Short on purpose. It exists because "pain addressed" is not documentation and because reassessment after intervention is the part everyone forgets to chart.

11. AMA discharge

An AMA note is not a form you wave at the patient. It documents capacity, the specific risks you named, and that the door stays open. Local policy governs the required elements, so check yours.

12. Sepsis time-zero documentation

When the sepsis clock starts, your note is the record of whether the bundle happened on time. The clinical content is in the sepsis bundle guide. This phrase just makes the times impossible to omit. Bundle elements and timing targets are set by your institution's current protocol, so match the phrase to it.

13. Family meeting / update note

Different from the code status phrase. This one records routine updates and formal meetings, which is how the next team learns what the family has already been told. Structure for the meeting itself is in running a family meeting.

14. Verbal order / clarification addendum

The humble one. Use it when you gave a verbal order overnight, clarified a med dose, or need to correct a prior note without deleting anything, which you should never do anyway.

Rules for not getting burned Read this part twice

Templates fail in predictable ways. Every one of these failures ends up in a chart audit, a billing denial, or a deposition. The full treatment is in medical legal charting, but the short version:

• Copy-forward is the template's evil twin. A dot phrase plus yesterday's copied note equals a chart where the vent settings are three days stale and the exam describes a patient who has since been extubated. Expand the phrase fresh, or use live data tokens, and read every line before you sign. "Reviewed" means read, not scrolled past.
• Never let a template say what you did not do. This is the cardinal rule and it bears repeating from the exam section. A phrase that expands to "all questions answered" when you never met the family, or "10 point review of systems negative" when you asked four questions, is fabrication with a keyboard shortcut. Build wildcards where the facts go, and let the hard stop force honesty.
• Keep templates shorter than you think. Every prefilled sentence is a sentence you might sign without reading. The best phrases are 80 percent wildcard. If your note looks impressive but says nothing a colleague can act on, the template made you slower at the only part that matters, which is the thinking. The same disease afflicts billing: a long templated note that does not reflect the actual visit does not support the code, a point covered in billing and coding for inpatient notes.
• Defaults are documentation. If a SmartList defaults to "normal" and you tab past it, you documented normal. Set your defaults to blank or to ***, never to the reassuring option.
• Retire phrases when practice changes. A sepsis phrase built on an old protocol, or an exam phrase from your ICU month lingering in your clinic notes, is a trap. Review your library every rotation and delete freely.

Local policy, your compliance office, and current clinical references govern anything on this page with clinical or regulatory implications. When your institution's rules and my opinions conflict, your institution wins.