Keeping an Eye on the Watch List – Epic Tips & Tricks

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

How to Determine if Your Current EHR Platform Can Solve Your Revenue Cycle Challenges

Don’t Buy More Software! – Four questions to help determine if your current EHR platform can solve your revenue cycle challenges


How to determine if your current EHR platform can solve your revenue cycle challenges

When hospitals determine that they have a challenge to be solved within their revenue cycle, it is extremely common for them to buy “bolt-on” software to fill perceived gaps in their electronic health record (EHR) capabilities.  But what we have found is that this is often unnecessary and can add cost and complexity to a problem that can often be solved by leveraging existing EHR functionality.

There are many vendors on the market with excellent bolt-on technologies, and we are not discounting the value or importance of these tools, as they are sometimes much more robust that EHR capabilities.  But we believe that hospitals don’t always need the “gold standard” and can frequently leverage existing technologies.  The old adage “progressive improvement is better than postponed perfection” is applicable here, and we believe that in-house solutions can drive similar results if implemented correctly.


Here’s a simple list of questions for Hospital CFOs to ask to potentially avoid making unnecessary technology expenditures:

Question #1 | Does your staff have the right experience and training to optimize your EHR Platform?

Ideally your information technology (IT) analysts have clinical and/or operational experience so that they truly understand how to apply existing EHR capabilities to solve problems and achieve goals.  Training classes and certifications for both IT and end-user staff are critical to ensure you are getting the most from your investment.


Question #2 | Have you established an interdisciplinary “Technology Team”?

In order for hospitals to maximize the utility of existing EHR platforms, the entire organization has to be aligned and moving towards a common goal – getting the most value from the EHR investment.  When IT, clinical, operational, revenue cycle and other relevant staff come together regularly to evaluate progress and options, solutions using existing tools and capabilities are more readily uncovered.


Question #3 | Are you fully engaged with your EHR vendor?

Unfortunately, it is not uncommon to hear EHR vendors respond to questions about capabilities with answers such as “it can’t be done” or “no other hospitals are using that functionality.”  However, we have found that with the right approach, often those answers are simply wrong.

In some cases, it’s a matter of finding the right person in the vendor organization.  If you are getting different answers from different people, be persistent – ask more than once and more than one person.  Often the best resource is a product manager or modular specialist who will have more expertise and knowledge than sales people or management. And always review the latest user manuals before engaging in discussions vendor resources.


Question #4 | Can you activate your peer network?

Some of the best information about EHR capabilities can come from “those who have been there before us.”  Aside from contacting your peers, hospital alliances, user groups, conferences, and social media communities are filled with people who have paved the roads to  optimization using the same EHR platform you are running today.  In many cases they have already solved the specific problem you are trying to address – so reach out to them, and you may find the hidden gems of functionality that you already own.

Clearly software vendors aren’t knocking on your door to tell you that you already have an internal solution.  They are highly skilled at creating a scenario where you simply can’t live without their technology!  In the end, though, evaluating what you have in place already – before you buy another piece of software – can save you time, money and the headaches that can come from introducing new technology into your environment.  Most people automatically make the assumption that their current EHR platform can’t do this or that.  The checklist above will help you ensure that you exercise all options before making another investment that you might not need.

For more information about what Pinnacle Healthcare Advisors can do for your EHR platform, contact us.