What is a smartphrase?
A smartphrase is a way to tell the computer to replace a word with another word (or pages of words!).
Why use smartphrases?
Smartphrases are awesome because they save time, and make it easier to provide good documentation and care.
With smartphrases, we can create a library of phrases, paragraphs, or documents, and, then, with a couple of keystrokes, import it into the electronic medical record.
Here are some examples…
Prescribing and Informed Consent
Smartphrases are good for inserting (and remembering) the medication doses and schedules you’d like to prescribe.
We would type .rxTrazodoneInitial and get the following smartphrase:
Trazodone: Take 1/2 tablet (25 mg) to 1 tablet (50) at bedtime as neeed for sleep; okay to increase by 25 mg per night if ineffective and well-tolerated; do not exceed 200 mg dose; hold for excess sedation, cognitive impairment, orthostasis.
Then for documenting and guiding the informed consent process, we could type .icTrazodoneMale, and get...
.icTrazodoneMale
Informed consent disclosed for trazodone. Discussed excess sedation, orthostasis, cognitive impairment, priapism for trazodone. Discussed non-ahderence/abuse. Warned.
The text expander program, which you will learn how to use, has saved the information you want called up, and inserts it for you, when you type the smartphrase.
Making Note Writing Easier and Faster
Smartphrases are good for creating, borrowing, and storing parts of the note that you use frequently, such as intake notes, screening measures, mental status exams, and diagnostic criteria.
We could type the following smart phrase:
.dxADHD
And the following text would autoinsert in the note:
“The patient currently endorses or denies the following features of ADHD based DSM-5:
INATTENTIVE SYMPTOMS (Need 5 or more symptoms for Inattentive Type)
Fails to give close attention to details Y/N
Difficulty sustaining attention Y/N
Does not seem to listen Y/N
Does not follow through easily side tracked Y/N
Has difficulty organizing Y/N
Decreased mental effort? Y/N
Loses things Y/N
Easily Distracted Y/N
Forgetful Y/N
HYPERACTIVEAND IMPULSIVIVE SYMPTOMS (Need 5 or more symptoms for Hyperactive, Impulsive Type):
Often fidgets Y/N
Leaves seat Y/N
Maybe limited to feeling restless Y/N
Unable to engage in leisure activities quietly “Driven by a motor.” Y/N
Talks excessively Y/N
Blurts out Y/N
Difficulty waiting Y/N
Interrupts or intrudes on others Y/N
Developmental History of Symptoms (age onset? why seeking treatment now?)
What Is the Impact on Function?
Example 1:
Example 2:"
Providing Patients with Information and Educational Materials
After talking through some sleep hygiene principles with a patient, you could type the smartphrase:
.edInsomnia
And get the following text...
OP 10 SLEEP TIPS
#10 KEEP YOUR BEDROOM DARK
#9 GET LOTS OF NATURAL LIGHT IN THE MORNING. Go for a walk or buy a lightbox. Light and dark are the external signals controlling your circadian system, colloquially called the “circadian clock." Darkness tells your body to get ready for sleep and this is signaled in the brain through the release of melatonin (a neurohormone). Light does the opposite. It tells your body it’s time to be awake and alert.
#8 DON’T WORK ON YOUR COMPUTER LATE AT NIGHT OR IF YOU DO GET AN APPLICATION LIKE “FLUX" TO MINIMIZE THE AMOUNT OF BRIGHT LIGHT YOUR EXPOSED TO. “Flux" is a super cool application that controls your computer screen’s light output and tries to make it as natural as possible so that it mimics the actual time of day/night you are in; your computer screen will be brighter in the morning and dimmer at night.
#7 DON’T NAP DURING THE DAY. Sleep is linked to a homeostatic sleep drive. Basically, the longer you are awake, the more adenosine (a chemical metabolite) builds up in your body. The accumulation of adenosine correlates with the strength of your sleep drive, that’s why if you’ve been up for 24 hours straight you almost inevitably feel your eyelids becoming too heavy to lift up, and it’s hard or impossible to fight off sleep… Another cool fact is that caffeine works by antagonizing (acting against) adenosine, that’s why it’s a stimulant. So the point is… Let your sleep drive (and adenosine) build up. Don’t dissipate the strength of your natural sleep drive by taking a nap during the day!
#6 NO CAFFEINE 3 HOURS OR MORE AFTER WAKE UP TIME. See detailed explanation above for how caffeine works. Caffeine has a long half-life, so it’s hanging around in your system, making it harder for you to sleep if you drink it later in the day.
#5 ONLY USE YOUR BED FOR SLEEPING OR ROMANTIC ACTIVITIES. Your brain is smarter than you are. If you play video games, or do work on your laptop in bed, and then try to go to sleep, your brain will associate back to those activities, even if you don’t want it to. It’s like the classic example - “Don’t think about a white elephant.” You will probably find yourself thinking of the white elephant automatically or going back to the work in bed example thinking about your work.
#4 FIGURE OUT IF YOU'RE A NIGHT PERSON OR A DAY PERSON, and try to make your sleep schedule as natural as possible (while still showing up for work on time:).
#3 GET A RELAXATION ROUTINE BEFORE BED. This will be different for everyone. For some people, watching ESPN could be the most relaxing thing in the world. For others, listening to football players colliding could induce a state of wakefulness and irritation. So pick something that mellows you out - reading, a bath, vegetating to TV or the radio or a podcast, meditating - and start a routine of doing this 1 to 2 hours before your intended bedtime.
#2 IF YOU CAN'T GET TO SLEEP AFTER 15 TO 30 MINUTES GET OUT OF BED AND DO SOMETHING RELAXING. Probably the biggest driver of insomnia is anxiety about insomnia. Don’t lie there thinking about how tired you’re gonna be the next day. Get up, do something on your list from 5. above. When you start to feel sleepiness naturally coming to you, try to sleep again.
#1 DON’T DRINK ALCOHOL IN THE EVENING or limit alcohol to 1 drink. Alcohol makes most people sleepy but has a very short half-life (you metabolize about 1 beer an hour). Since alcohol stimulates the GABA system, and since GABA is a neurotransmitter system, which helps modulate relaxation, alcohol causes the opposite effect - anxious AROUSAL - when it is metabolized. Alcohol can be great for getting you to sleep but is terrible for keeping you asleep and disrupts the integrity of your sleep density (translation: reduces the quality of your sleep). People with anxiety-sensitivity can have this experience after even a single beer or glass of wine.
Documenting Difficult Decisions
Smartphrases are good for common but difficult decisions.
For example, to explain why a patient does not present an imminent danger of harm to self or others, we could type the following smart phrase:
.ratSafetyChronic
And the following text would autoinsert in the document:
“Safety risk is increased overall given multiple dynamic (we could type out any changeable, current risk factors here, such as 'active methamphetamine abuse, psychotic symptoms') and static ('we could type out any fixed or historical risk factors here, such as 'axis I - III, history of 2 previous suicide attempts') risk factors mitigated by protective factors, as documented above and/or in initial assessment. There was no indication of currently increased or imminent danger to self or others based on today's exam; outpatient care with close monitoring is appropriate.”
Or for medication management, if we decided to change multiple medications on the same visit, we could type the following phrase...
.ratMultipleMedicationChanges
And get the following text...
"Discussed r/b ratio for a more conservative, single-medication sequential change approach to pharmacotherapy versus more aggressive approach with multiple concurrent medication changes; potential risks include increased side effects and greater difficulty establishing cause and effect relationships; potential benefits include more rapid and/or robust therapeutic effects."
Automating Other Repetitive Tasks
Smartphrases can help to make simple but laborious things much faster. For example, if we need to insert our address at the top of a letter, we could type...
.address
And get the following...
University of Rochester Medical Center
Department of Psychiatry
300 Crittenden Blvd., Box Psych
Rochester, NY 14642
How do you actually use a text expander program?
The most popular text expanders are TextExpander for mac and or Breevy for windows.
A smartphrase is a way to tell the computer to replace a word with another word (or pages of words!).
Why use smartphrases?
Smartphrases are awesome because they save time, and make it easier to provide good documentation and care.
With smartphrases, we can create a library of phrases, paragraphs, or documents, and, then, with a couple of keystrokes, import it into the electronic medical record.
Here are some examples…
Prescribing and Informed Consent
Smartphrases are good for inserting (and remembering) the medication doses and schedules you’d like to prescribe.
We would type .rxTrazodoneInitial and get the following smartphrase:
Trazodone: Take 1/2 tablet (25 mg) to 1 tablet (50) at bedtime as neeed for sleep; okay to increase by 25 mg per night if ineffective and well-tolerated; do not exceed 200 mg dose; hold for excess sedation, cognitive impairment, orthostasis.
Then for documenting and guiding the informed consent process, we could type .icTrazodoneMale, and get...
.icTrazodoneMale
Informed consent disclosed for trazodone. Discussed excess sedation, orthostasis, cognitive impairment, priapism for trazodone. Discussed non-ahderence/abuse. Warned.
The text expander program, which you will learn how to use, has saved the information you want called up, and inserts it for you, when you type the smartphrase.
Making Note Writing Easier and Faster
Smartphrases are good for creating, borrowing, and storing parts of the note that you use frequently, such as intake notes, screening measures, mental status exams, and diagnostic criteria.
We could type the following smart phrase:
.dxADHD
And the following text would autoinsert in the note:
“The patient currently endorses or denies the following features of ADHD based DSM-5:
INATTENTIVE SYMPTOMS (Need 5 or more symptoms for Inattentive Type)
Fails to give close attention to details Y/N
Difficulty sustaining attention Y/N
Does not seem to listen Y/N
Does not follow through easily side tracked Y/N
Has difficulty organizing Y/N
Decreased mental effort? Y/N
Loses things Y/N
Easily Distracted Y/N
Forgetful Y/N
HYPERACTIVEAND IMPULSIVIVE SYMPTOMS (Need 5 or more symptoms for Hyperactive, Impulsive Type):
Often fidgets Y/N
Leaves seat Y/N
Maybe limited to feeling restless Y/N
Unable to engage in leisure activities quietly “Driven by a motor.” Y/N
Talks excessively Y/N
Blurts out Y/N
Difficulty waiting Y/N
Interrupts or intrudes on others Y/N
Developmental History of Symptoms (age onset? why seeking treatment now?)
What Is the Impact on Function?
Example 1:
Example 2:"
Providing Patients with Information and Educational Materials
After talking through some sleep hygiene principles with a patient, you could type the smartphrase:
.edInsomnia
And get the following text...
OP 10 SLEEP TIPS
#10 KEEP YOUR BEDROOM DARK
#9 GET LOTS OF NATURAL LIGHT IN THE MORNING. Go for a walk or buy a lightbox. Light and dark are the external signals controlling your circadian system, colloquially called the “circadian clock." Darkness tells your body to get ready for sleep and this is signaled in the brain through the release of melatonin (a neurohormone). Light does the opposite. It tells your body it’s time to be awake and alert.
#8 DON’T WORK ON YOUR COMPUTER LATE AT NIGHT OR IF YOU DO GET AN APPLICATION LIKE “FLUX" TO MINIMIZE THE AMOUNT OF BRIGHT LIGHT YOUR EXPOSED TO. “Flux" is a super cool application that controls your computer screen’s light output and tries to make it as natural as possible so that it mimics the actual time of day/night you are in; your computer screen will be brighter in the morning and dimmer at night.
#7 DON’T NAP DURING THE DAY. Sleep is linked to a homeostatic sleep drive. Basically, the longer you are awake, the more adenosine (a chemical metabolite) builds up in your body. The accumulation of adenosine correlates with the strength of your sleep drive, that’s why if you’ve been up for 24 hours straight you almost inevitably feel your eyelids becoming too heavy to lift up, and it’s hard or impossible to fight off sleep… Another cool fact is that caffeine works by antagonizing (acting against) adenosine, that’s why it’s a stimulant. So the point is… Let your sleep drive (and adenosine) build up. Don’t dissipate the strength of your natural sleep drive by taking a nap during the day!
#6 NO CAFFEINE 3 HOURS OR MORE AFTER WAKE UP TIME. See detailed explanation above for how caffeine works. Caffeine has a long half-life, so it’s hanging around in your system, making it harder for you to sleep if you drink it later in the day.
#5 ONLY USE YOUR BED FOR SLEEPING OR ROMANTIC ACTIVITIES. Your brain is smarter than you are. If you play video games, or do work on your laptop in bed, and then try to go to sleep, your brain will associate back to those activities, even if you don’t want it to. It’s like the classic example - “Don’t think about a white elephant.” You will probably find yourself thinking of the white elephant automatically or going back to the work in bed example thinking about your work.
#4 FIGURE OUT IF YOU'RE A NIGHT PERSON OR A DAY PERSON, and try to make your sleep schedule as natural as possible (while still showing up for work on time:).
#3 GET A RELAXATION ROUTINE BEFORE BED. This will be different for everyone. For some people, watching ESPN could be the most relaxing thing in the world. For others, listening to football players colliding could induce a state of wakefulness and irritation. So pick something that mellows you out - reading, a bath, vegetating to TV or the radio or a podcast, meditating - and start a routine of doing this 1 to 2 hours before your intended bedtime.
#2 IF YOU CAN'T GET TO SLEEP AFTER 15 TO 30 MINUTES GET OUT OF BED AND DO SOMETHING RELAXING. Probably the biggest driver of insomnia is anxiety about insomnia. Don’t lie there thinking about how tired you’re gonna be the next day. Get up, do something on your list from 5. above. When you start to feel sleepiness naturally coming to you, try to sleep again.
#1 DON’T DRINK ALCOHOL IN THE EVENING or limit alcohol to 1 drink. Alcohol makes most people sleepy but has a very short half-life (you metabolize about 1 beer an hour). Since alcohol stimulates the GABA system, and since GABA is a neurotransmitter system, which helps modulate relaxation, alcohol causes the opposite effect - anxious AROUSAL - when it is metabolized. Alcohol can be great for getting you to sleep but is terrible for keeping you asleep and disrupts the integrity of your sleep density (translation: reduces the quality of your sleep). People with anxiety-sensitivity can have this experience after even a single beer or glass of wine.
Documenting Difficult Decisions
Smartphrases are good for common but difficult decisions.
For example, to explain why a patient does not present an imminent danger of harm to self or others, we could type the following smart phrase:
.ratSafetyChronic
And the following text would autoinsert in the document:
“Safety risk is increased overall given multiple dynamic (we could type out any changeable, current risk factors here, such as 'active methamphetamine abuse, psychotic symptoms') and static ('we could type out any fixed or historical risk factors here, such as 'axis I - III, history of 2 previous suicide attempts') risk factors mitigated by protective factors, as documented above and/or in initial assessment. There was no indication of currently increased or imminent danger to self or others based on today's exam; outpatient care with close monitoring is appropriate.”
Or for medication management, if we decided to change multiple medications on the same visit, we could type the following phrase...
.ratMultipleMedicationChanges
And get the following text...
"Discussed r/b ratio for a more conservative, single-medication sequential change approach to pharmacotherapy versus more aggressive approach with multiple concurrent medication changes; potential risks include increased side effects and greater difficulty establishing cause and effect relationships; potential benefits include more rapid and/or robust therapeutic effects."
Automating Other Repetitive Tasks
Smartphrases can help to make simple but laborious things much faster. For example, if we need to insert our address at the top of a letter, we could type...
.address
And get the following...
University of Rochester Medical Center
Department of Psychiatry
300 Crittenden Blvd., Box Psych
Rochester, NY 14642
How do you actually use a text expander program?
The most popular text expanders are TextExpander for mac and or Breevy for windows.
