Capturing the Clinical Story: Notes and Flowsheets

Purpose: To learn how Epic captures the complete patient story by combining unstructured clinical narratives (notes) with structured, discrete data (flowsheets).

Two Forms of Documentation

Clinical documentation is a tale of two data types. On one side, you have unstructured notes, which capture the nuanced story, context, and thinking of a clinician. On the other, you have structured flowsheets, which record discrete, consistent measurements like vital signs and assessments. Both are essential for a complete picture of patient care.

The Clinical Narrative: Notes and Documents

Clinical notes are the heart of the patient’s story. Epic’s system stores a wide variety of note types from different authors.

View the different types of clinical notes available

View SQL Query

SELECT DISTINCT
    ni.IP_NOTE_TYPE_C_NAME as Note_Type,
    COUNT(*) as Note_Count
FROM HNO_PLAIN_TEXT nt
JOIN HNO_INFO ni ON nt.NOTE_ID = ni.NOTE_ID
GROUP BY ni.IP_NOTE_TYPE_C_NAME
ORDER BY Note_Count DESC;

Note_Type	Note_Count
	115
Letter	5

Each note has metadata (author, time, status) and the narrative content itself, which are stored in separate tables.

Read the content of a recent clinical note

View SQL Query

SELECT 
    ni.IP_NOTE_TYPE_C_NAME as Note_Type,
    pe.CONTACT_DATE as Date,
    ni.CURRENT_AUTHOR_ID_NAME as Author,
    nt.NOTE_TEXT as Note_Text
FROM HNO_INFO ni
JOIN HNO_PLAIN_TEXT nt ON ni.NOTE_ID = nt.NOTE_ID
JOIN PAT_ENC pe ON ni.PAT_ENC_CSN_ID = pe.PAT_ENC_CSN_ID
WHERE pe.PAT_ID = 'Z7004242'
  AND LENGTH(nt.NOTE_TEXT) > 100
ORDER BY pe.PAT_ENC_DATE_REAL DESC
LIMIT 1;

Note_Type	Date	Author	Note_Text
Letter	8/9/2018 12:00:00 AM		itional Information If you have technical questions, e-mail our support team at MyUnityPointSupport@unitypoint.org or call (877) 224-4430 Monday through Friday 8am-5pm CST. Remember, MyUnityPoint is NOT to be used for urgent needs. For medical emergencies, dial 911. Sincerely, Puneet S Dhillon, MD

Epic also stores external documents, such as scanned records from other facilities.

Find external (scanned) documents

View SQL Query

SELECT 
    d.DOC_INFO_ID,
    d.DOC_INFO_TYPE_C_NAME as Document_Type,
    SUBSTR(d.DOC_RECV_TIME, 1, 10) as Received_Date,
    d.DOC_STAT_C_NAME as Status
FROM DOC_INFORMATION d
JOIN DOC_LINKED_PATS dp ON d.DOC_INFO_ID = dp.DOCUMENT_ID
WHERE dp.LINKED_PAT_ID = 'Z7004242'
ORDER BY d.DOC_RECV_TIME DESC
LIMIT 10;

DOC_INFO_ID	Document_Type	Received_Date	Status
286469708	Therapy Scan	4/25/2022	Received
279197497	Health Screening	3/16/2022	Received
271960348	Physician Order	2/9/2022 4	Received
394976848	HIM ROI Authorization	2/7/2024 1
396629681	HIM ROI Authorization	2/16/2024
392613498	HIM ROI Authorization	1/24/2024
391765922	HIM ROI Authorization	1/19/2024
251026646	MyChart COVID-19 Vaccination Record Document
251148583	MyChart COVID-19 Vaccination Record Document
251272186	MyChart COVID-19 Vaccination Record Document

Structured Data Capture: Flowsheets

Flowsheets are used to capture discrete clinical data in a structured, template-based format. This is where you’ll find vital signs, pain scores, and other recurring assessments.

> Note: This EHI export appears to be missing vital signs data. The flowsheet structure is present, but the actual measurement values are not populated. This is a limitation of this particular data extract.

TODO: This query returns no results due to missing vital signs data in this EHI export

View a patient's recent vital signs from flowsheets

View SQL Query

SELECT 
    fr.FLO_MEAS_ID_DISP_NAME as Measurement,
    ip.FLO_CATEGORY_VALUE as Value,
    SUBSTR(ip.RECORDED_TIME, 1, 16) as Recorded_Time,
    ip.ENTRY_USER_ID_NAME as Entered_By
FROM IP_FLWSHT_MEAS ip
JOIN IP_FLOWSHEET_ROWS fr ON ip.FSD_ID = fr.INPATIENT_DATA_ID AND ip.LINE = fr.LINE
WHERE ip.FLO_CATEGORY_VALUE IS NOT NULL
ORDER BY ip.RECORDED_TIME DESC
LIMIT 20;

No results returned

Flowsheets use a template system (FLOWSHEET_MEAS) to define what can be measured, while the actual values are stored in IP_FLWSHT_MEAS.

TODO: This query returns no results due to missing flowsheet data in this EHI export

List all flowsheet measurements recorded for a patient

View SQL Query

SELECT DISTINCT
    fr.FLO_MEAS_ID_DISP_NAME as Measurement,
    COUNT(DISTINCT ip.LINE) as Times_Recorded
FROM IP_FLWSHT_MEAS ip
JOIN IP_FLOWSHEET_ROWS fr ON ip.FSD_ID = fr.INPATIENT_DATA_ID
GROUP BY fr.FLO_MEAS_ID_DISP_NAME
HAVING Times_Recorded > 0
ORDER BY Times_Recorded DESC;

No results returned

Connecting Documentation to Encounters

Both notes and flowsheet data are linked to the encounter where they were recorded, providing essential context.

TODO: This query returns no results due to missing flowsheet data in this EHI export

View measurement context, including who recorded it and where

View SQL Query

SELECT 
    fr.FLO_MEAS_ID_DISP_NAME as Measurement,
    ip.FLO_CATEGORY_VALUE as Value,
    SUBSTR(ip.RECORDED_TIME, 1, 16) as When_Recorded,
    ip.ENTRY_USER_ID_NAME as Who_Recorded,
    fr.FLOWSHT_ROW_NAME as Row_Name
FROM IP_FLWSHT_MEAS ip
JOIN IP_FLOWSHEET_ROWS fr ON ip.FSD_ID = fr.INPATIENT_DATA_ID AND ip.LINE = fr.LINE
WHERE ip.FLO_CATEGORY_VALUE IS NOT NULL
ORDER BY ip.RECORDED_TIME DESC
LIMIT 10;

No results returned

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Key Takeaways

• Two Documentation Types: Epic uses unstructured notes (HNO_INFO, HNO_NOTE_TEXT) for narrative and structured flowsheets (IP_FLWSHT_MEAS) for discrete data.
• Note Structure: Note metadata (author, type, status) is stored in HNO_INFO, while the actual text is in HNO_PLAIN_TEXT.
• Flowsheet Structure: Flowsheet rows (IP_FLOWSHEET_ROWS) define the measurements, and the patient-specific values are stored in IP_FLWSHT_MEAS.
• External Documents: Scanned and external files are managed in DOC_INFORMATION.
• Context is Critical: Both notes and flowsheet entries are linked to a specific encounter (PAT_ENC_CSN_ID), providing vital context for the documentation.
• Data Quality: Flowsheet values (FLO_CATEGORY_VALUE) are stored as text and may require conversion for analysis.

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