The hospitalist note template inside New Orleans-based Ochsner Health’s Epic system had gone unchanged for nearly a decade. This June, the 46-hospital system, which spans Louisiana and Mississippi, rebuilt it from the ground up and rolled it out everywhere at once.
Jason Hill, MD, system vice chair of hospital medicine and innovation at Ochsner Health, helped design the original template about 10 years ago. Revisiting it meant reworking his own creation.
“The hospitalist note structure, the artifact of the structure, was actually architected by me and several other people 10 years ago, so I’m somewhat killing my own creation that I built a long time ago, but a lot of that was based off legacy infrastructure that we had at that time,” Dr. Hill told Becker’s.
Ochsner had since upgraded to newer Epic features, he said, but moving the note forward required years of infrastructure catch-up and a more fundamental rethink of what belongs in a note, and how the system itself could help generate documentation rather than leaving hospitalists to type it from scratch.
Rather than have hospitalists start from a blank page, the new note arrives prepopulated with an editable baseline that hospitalists then review and update.
“AI is not writing our notes. AI is helping to provide us with the baseline template, so that we don’t have to operate from zero,” Dr. Hill said.
The redesign also targets a habit Dr. Hill calls the “tyranny of copy paste.”
“Copy and pasting notes is terrible in the sense that it provides bad medical care and documentation. It provides things that are inaccurate, but it also is highly efficient, so it’s very difficult to clip that behavior amongst the team,” he said. “There’s no less clicks than one click copy paste. You can’t go to zero clicks.”
To make accuracy easier than the copy-paste shortcut, Ochsner replaced blanket copy-forward text with problem-based, pregenerated language tied to a patient’s active labs and conditions, a template Dr. Hill has described as “diagnosis-aware” in a LinkedIn post announcing the rollout. The redesign is also meant to work with upcoming Epic functionality that would nudge hospitalists toward evidence-based documentation, for example flagging when a patient’s labs suggest anemia that hasn’t been added to the problem list, then surfacing likely anemia subtypes and treatment options for the hospitalist to confirm.
“Patients get more complex. Last time I was on service, half of my patients were on three or more drips in the ICU,” Dr. Hill said.
Reducing that cognitive burden, not just saving time, is central to how Ochsner approached the rollout, and to its plans to eventually layer ambient listening onto the same note template for inpatient hospitalists, a project Dr. Hill called “a largely uncharted sea.”
The work behind the new template took roughly two years, according to Dr. Hill, who credited Ochsner’s own IS team.
Unlike smaller technology pilots, the note rebuild could not be phased in campus by campus. It had to flip across the entire system at once, so Ochsner spent months on change management before the switch, including running the new template with a small innovation group of 10 to 15 doctors for several months ahead of the systemwide launch in June.
“This is a burn the bridges moment, we’re not going to go back, this is preparing us for the next 10 years,” Dr. Hill said.
Because the change is barely a month old, Dr. Hill said Ochsner deliberately withheld surveys to avoid capturing off-the-cuff, reactionary responses. The health system plans to track documentation metrics such as note length and time spent in notes, along with adoption of the nudging features and future ambient tools, and to survey hospitalists on burnout and EHR-related cognitive load.
“If you ask a doctor if they would want to practice medicine without it, and they say no, you have your ROI,” Dr. Hill said.
The note redesign and an accompanying AI-generated hospital course summary launched simultaneously this year as part of a cadence Dr. Hill described as roughly one new AI product per quarter, building on earlier work on chart summarization. Dr. Hill said Ochsner hopes to pilot inpatient ambient listening in the third quarter, though he described that timeline as an aspiration rather than a firm commitment, followed by a goal-directed medical therapy tool built with outside partners to help pharmacists and clinicians confirm heart failure patients are on appropriate therapies before discharge.
“Look at it [AI] as a partner, look at it as a way to help complement, supplement, and add to your clinical care teams, and not a way to reduce, remove, or replace those individuals,” Dr. Hill said.
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