Customization in Epic is a blessing and a curse.  If you can get it right, it can drive reporting and workflows that far exceed functionality of other EMR platforms.  When it goes wrong, it can result in information overload and cumbersome workflows that kill productivity and put accounts at risk.  One underutilized reporting feature that is highly customizable within Epic is the Watch List. In this month’s blog, we’ll discuss the flexibility of the Watch List, how it can best be used, and common pitfalls of Watch List development.  

Watch List – Overview and flexibility

The Watch List is a component that can be plugged into Radar Dashboards within Epic that highlights key metrics within Patient Financial Services (PFS).  While the Watch List has improved over time, it remains one of the most powerful, yet underutilized tools within Epic. The Watch List is comprised of custom rules that can be catered to various owning areas (billing, follow-up, denials, variance, self-pay, department specific etc.) within the revenue cycle.  Strategic metric design can help identify high opportunity/risk account populations to drive back end collections efforts while reducing bad debt.

Watch List – Use cases

There are three different types of metrics that should be monitored within the Watch List.

  • High Risk – Populations of accounts that if not addressed, may result in the provider being exposed to heightened financial risk.  Examples include accounts not qualifying for workqueues, accounts on delinquent workqueues, and timely filing/appeal.
  • High Opportunity – Account populations that represent significant financial opportunity once resolved.  Examples include high dollar visits with a single billing edit, aged uncoded visits, high dollar underpayments or revenue guardian edits.
  • System Clean-up – Populations of accounts that are cluttering worklists, but do not require immediate action.  Examples may include aged low dollar open denials, open denials with a $0 balance, populations that should qualify for the next responsible payer, accounts on numerous workqueues, and vendor populations that have not been returned to the provider.

Watch List – Common pitfalls

The Watch List is a powerful tool when utilized and managed correctly.  However, despite the best of intentions, many providers fail to adequately build out functionality and manage populations.  The following are common pitfalls that are encountered when developing the Watch List.

  • Lack of clear ownership – The best metric build is worthless if we don’t have clear ownership and accountability. Many providers fail to delegate a single person to manage Watch List metrics or assign various owners to specific metrics.
  • Limited testing/validation – Building out rules within Epic always requires extensive testing and validation.  IT and operations need to partner to validate metrics prior to roll-out.
  • Overbuild – Too many metrics can be burdensome and take away from the key areas of focus.  Metric build should be focused on those highest priority populations that can be effectively managed.
  • Failure to monitor over time – Workflows and functionality evolve over time.  Watch List metrics need to be maintained over time to ensure they continue to provide value.

Parting Thoughts

  1. The Watch List is a highly powerful, yet under utilized tool within the Epic reporting platform
  2. Strategic metric design can drive a powerful daily management tool that can expose issues surrounding system build, as well as high opportunity/risk account populations
  3. Strategic build/testing/validation is critical to a successful Watch List implementation
  4. Clear ownership and accountability must be in place to drive long term performance
  5. Overdevelopment of the Watch List can take away from the ability to quickly identify areas of opportunity

For more information related to Epic optimization or revenue cycle management, please contact Kevin Blanchard at