Setting Up Epic

Time to talk about everyone's favorite software, Epic Hyperspace (very epic, I know). Most of what makes a fast intern fast in Epic is boring: a fixed pre-rounding order, a handful of dot phrases, and a patient list set up the way you like it. Here is what I'd set up in your first week.

Pre-rounding

Pick an order and do it the same way on every patient. You miss less when you aren't bouncing between tabs.

An order that works

1. Start in your patient list. Sort by room or team and glance at the flag column for overnight alerts, new consult notes, and nursing flags.
2. Open Flowsheets or the nursing summary. Look at vitals trends, ins and outs, and what was given overnight.
3. Go to Results Review. Focus on overnight and early morning labs, and look at trends, not single values.
4. Read the overnight notes. Filter the Notes tab to the last 12 to 24 hours for cross-cover, nursing, consultant, and ED notes.
5. Check the MAR. It shows what was actually given, not just what was ordered. Look for held or refused scheduled meds and PRNs that got used a lot.
6. Scan active orders for anything to renew, stop, or change. Expiring antibiotics, diets that should be advanced, and telemetry or restraint orders that need renewing every day are the usual ones.
7. Check imaging and micro. Pending reads and preliminary cultures are easy to miss if you only live in the lab tab.

Saving time

The Synopsis or Patient Summary tab puts vitals, labs, active meds, and problems on one screen. In most builds it replaces several of the steps above, so you toggle between fewer tabs.

Customize your patient list columns. Add the latest vitals, recent BMP and CBC, diet, code status, and attending, and you can see your whole list without opening a chart. You can also set the list to flag new labs and new notes. That one is super helpful.

Set your default tab. You can choose which tab opens when you open a chart. Set it to Synopsis or Results Review and you save a click on every patient, every day.

Reading notes

Filter by date. Set the Notes tab to the last 24 hours to see only what's new. Widen it to 48 or 72 hours when you pick up a patient or come back from a day off.

Read the assessment and plan first. It tells you what the author thinks and what they want done. Then go back to the HPI for detail. This matters most for long consult notes (I'm looking at you, infectious disease).

If your hospital has a "Notes I Haven't Read" filter, turn it on. It shows what was filed since you last opened the chart.

Check notes after the attending cosigns them. Attendings sometimes add an addendum or edit when they cosign, and you don't get a separate notification when they do.

Note History shows which parts of a note were typed and which came from a template or copy-forward. Right-click in the note or look for "View Audit Trail" or "Note History" (the name varies). It tells you what the author actually wrote versus what a SmartPhrase pulled in. Some builds color-code the templated text.

Use Chart Search, the magnifying glass at the top of the chart. It searches the whole record, including notes, results, orders, and documents. Ctrl + F only searches what's on your screen. Chart Search is the fastest way to find one consultant's recommendation or an old workup result.

Writing notes

Dot phrases

Dot phrases (SmartPhrases) save more time than anything else in Epic. Type a short code that starts with a period, and it expands into a block of text with fields filled in from the chart.

Type .yourdotphrase in any text field and press Enter or Tab. Fields marked *** are blanks. Press F2 to jump to the next *** without touching the mouse. You can also open the SmartPhrase Manager and borrow dot phrases from attendings and other residents.

Build one for everything you write more than twice:

• .admit for the admission note
• .progress for the daily progress note
• .dc or .discharge for the discharge summary
• .event for cross-cover event notes

Use SmartLinks so the chart fills in the details. @NAME@ gives the patient's name, @AGE@ the age, @MRN@ the MRN, and @TD@ today's date. They come straight from the chart, so there's nothing to mistype.

Make a .lab dot phrase that pulls in today's labs with SmartLinks like .LASTCBC or .LASTCHEM. It saves a lot of time on progress notes. Ask a senior to share theirs.

Give yours a prefix, like your initials: .mknote, .mkadmit, .mkdischarge. They're easier to find and won't clash with the hospital's own.

The = sign

In the attending field of a note, type = and Epic fills in the last attending you used. Handy when you're writing a stack of notes on the same service, especially in clinic.

SmartLinks worth knowing

• @VITALS@: most recent vitals
• @MEDS@: current medication list
• @PROBLEMS@: active problem list
• @ALLERGIES@: allergies
• @LABS@: recent labs (may need setup)
• @BMI@: BMI
• @DIET@: current diet order
• @HE@: the patient's pronoun

Put these in your templates and you type less and mistype less.

Copy forward

Copy forward drops yesterday's note into today's as a starting point. It's fine for stable patients, but update the subjective, the objective data, and the plan every time, and delete whatever no longer applies. Stale information in a copied note is a patient safety problem.

Orders

Search instead of browsing the menus. Type the first few letters. Epic usually guesses right after three or four characters.

Use order sets. Most hospitals have them for common admissions like CHF, COPD exacerbation, DKA, sepsis, and post-op. They're faster than ordering one at a time, and they remind you of DVT prophylaxis and diet.

Star the orders you place all the time so they land in your favorites. Do it in week one for the common PRNs (Tylenol, ondansetron, melatonin), labs (BMP, CBC, coags), and a portable CXR.

Queue orders and sign them together with "Sign Orders" instead of one at a time.

Keyboard shortcuts

These vary by hospital, but these are common:

• Ctrl + Space: Epic search bar
• Ctrl + O: orders
• Ctrl + 2: patient list
• Ctrl + 3: Patient Station
• Alt + S: sign or submit
• Alt + A: accept
• F2: next *** in a note
• Ctrl + Alt + S: secure the workstation
• Ctrl + Alt + L: log out

If a button has an underlined letter, Alt plus that letter will press it.

Discharge

Start the discharge summary early in the stay, not the night before. It's more accurate, and you won't dump the work on whoever takes the service after you.

Build a dot phrase for the After Visit Summary, the patient's discharge instructions. Cover your common scenarios, with med changes in plain language, follow-up appointments, and return precautions.

Reconcile meds as you go. When you stop an inpatient-only med or switch IV to PO, fix the discharge med list right then. The final reconciliation goes much faster.

Set up follow-up a day or two before discharge. Place referrals and schedule appointments early. Waiting until discharge day is where discharges get stuck.

Odds and ends

You can hyperlink results, imaging, and notes inside your own notes. It helps in handoffs and complicated assessments, where the reader wants to click through to the source.

The Synopsis or patient report usually prints as a one-page summary. Plenty of teams use it as the rounding sheet instead of writing one by hand.

If your hospital uses Epic Secure Chat, use it for non-urgent (yes, NON-URGENT) messages to nurses, pharmacists, and consultants.

Your first week

Set all of this up during orientation or the first week. It takes 30 to 60 minutes:

1. Build or import your core dot phrases (admission, progress, discharge, event, procedure).
2. Set up your patient list columns.
3. Pick your default tab.
4. Favorite your common orders.
5. Learn three to five shortcuts until your hands know them.
6. Find a senior who charts fast and watch them for 15 minutes.

Nobody knows Epic on day one. Every minute you don't spend fighting the chart is a minute at the bedside, reading, or sleeping.

Best of luck

Mike

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Disclaimer: Epic is a registered trademark of © 2026 Epic Systems Corporation. This article is not affiliated with, endorsed by, or sponsored by Epic Systems Corporation. StrudelMed / Strudel Academy LLC is an independent medical education resource. The content above is not medical or clinical advice and is intended for educational purposes and general guidance only. Epic builds vary by institution; some features, shortcuts, or menu names may differ at your hospital.