.dot phrases
A .dot phrase (also called a SmartPhrase) in Epic is a shorthand that clinicians type into their notes (e.g., .otassessment) which then autofills a pre-written text template into the documentation field. It streamlines charting and improves consistency and efficiency in EMR workflows and saves clinicians time during documentation.
Generally, SmartPhrases can be used for:
- Evaluations
- Daily notes
- Discharge summaries
- Home Exercise Programs
- Common interventions (like neuromuscular re-ed, therapeutic activity, etc.)
How to create a .dotphrase
- Go to Epic > Click into any note
-
Type SmartPhrase Manager or go to Tools > SmartPhrase Manager
Click "New" - Name it (e.g., .OTDISCHARGE)
- Paste in your content
- Use {placeholders} for editable fields
Squegg Assessment (for initial evaluation)
.OTEVALSQUEGG – Initial Evaluation Using Squegg
Grip only
The Squegg smart grip device was utilized during the initial evaluation to assess the client's baseline grip strength. Client completed a standardized maximal grip strength assessment via Squegg, yielding the following results:
- Right hand: {lbs}
- Left hand: {lbs}
Client demonstrated {e.g., decreased grip strength bilaterally / impaired hand coordination / fatigue after sustained grip tasks}, limiting performance in tasks such as {e.g., grooming, utensil use, handwriting, etc.}.
Use of Squegg provides objective data to guide treatment planning and track progress over time. Skilled OT services are medically necessary to address upper extremity deficits that impede functional independence in daily occupations.
Grip and Pinch
The Squegg smart grip device was used during the evaluation to objectively assess the client’s grip and pinch strength. The client was assessed using Squegg’s integrated prehension patterns: lateral pinch, lumbrical pinch, and tripod pinch.
Results:
- Grip Strength: Right – {lbs}, Left – {lbs}
- Lateral Pinch: Right – {lbs}, Left – {lbs}
- Lumbrical Pinch: Right – {lbs}, Left – {lbs}
- Tripod Pinch: Right – {lbs}, Left – {lbs}
Client exhibited {e.g., decreased strength and/or motor control across grip/pinch etc.}, limiting performance in fine motor tasks such as {e.g., writing, manipulating fasteners, utensil use, buttoning}.
The use of Squegg enhances clinical precision by providing quantifiable measures across multiple functional grasp patterns. Skilled OT is medically necessary to address these upper extremity deficits and support functional task performance.
Squegg Reassessment (for re-evaluation)
.OTREVALSQUEGG – Re-Evaluation with Squegg
Grip only
Client was reassessed using the Squegg smart grip device to objectively measure progress in grip strength and UE function.
Updated Squegg Grip Strength Results:
- Right hand: {lbs}
- Left hand: {lbs}
Compared to initial assessment, the client demonstrated {e.g., a 20% improvement in grip strength / minimal change in endurance / improved hand coordination}, reflecting {e.g., positive response to intervention / need for continued skilled therapy}.
Continued use of Squegg supports data-driven adjustments to the plan of care and provides measurable outcomes to support functional improvement in ADLs and IADLs. Skilled OT services remain medically necessary to address remaining deficits and facilitate return to prior level of function.
Grip and Pinch
Reassessment was completed using the Squegg smart grip device to objectively evaluate grip strength and prehension patterns.
Progress Table:
| Measurement | Initial Eval | Re-Eval | Change |
|---|---|---|---|
| Grip Strength (R) | {## lbs} | {## lbs} | {e.g., +6 lbs} |
| Grip Strength (L) | {## lbs} | {## lbs} | {e.g., +4 lbs} |
| Lateral Pinch (R) | {## lbs} | {## lbs} | {e.g., +2 lbs} |
| Lateral Pinch (L) | {## lbs} | {## lbs} | {e.g., +1 lbs} |
| Lumbrical Pinch (R) | {## lbs} | {## lbs} | {e.g., no change} |
| Lumbrical Pinch (L) | {## lbs} | {## lbs} | {e.g., +1 lbs} |
| Tripod Pinch (R) | {## lbs} | {## lbs} | {e.g., +3 lbs} |
| Tripod Pinch (L) | {## lbs} | {## lbs} | {e.g., +2 lbs} |
Clinical Summary:
Client demonstrated {e.g., significant improvements in grip strength and tripod pinch}, supporting progress toward functional goals related to ADL independence. Lumbrical pinch remains limited, suggesting the need for continued skilled OT to address residual fine motor deficits.
The objective data from Squegg supports ongoing skilled intervention and provides measurable outcomes aligned with the established plan of care.
Squegg Discharge (for discharge summaries)
.OTDISCHARGESQUEGG – Discharge Summary referencing Squegg
Grip Only
Throughout the course of OT, the Squegg smart grip device was integrated as a tool to monitor and improve grip strength, fine motor coordination, and UE endurance.
Final Squegg Grip Strength Results:
- Right hand: {lbs}
- Left hand: {lbs}
Client demonstrated {e.g., full restoration / partial improvement / plateau} in grip strength and functional hand use, positively impacting {e.g., independent completion of grooming, writing, utensil use}. The use of Squegg provided objective progress markers and supported patient motivation during rehabilitation.
Discharge is appropriate at this time due to {e.g., goal achievement / maximal benefit reached / transition to HEP}. A Squegg-based home program has been provided to maintain gains.
Grip and Pinch
The Squegg smart grip device was used throughout therapy to track grip and pinch strength over time.
Final Progress Table:
| Measurement | Initial Eval | Re-Eval | Change |
|---|---|---|---|
| Grip Strength (R) | {## lbs} | {## lbs} | {e.g., +8 lbs} |
| Grip Strength (L) | {## lbs} | {## lbs} | {e.g., +6 lbs} |
| Lateral Pinch (R) | {## lbs} | {## lbs} | {e.g., +4 lbs} |
| Lateral Pinch (L) | {## lbs} | {## lbs} | {e.g., +2 lbs} |
| Lumbrical Pinch (R) | {## lbs} | {## lbs} | {e.g., +1 lbs} |
| Lumbrical Pinch (L) | {## lbs} | {## lbs} | {e.g., +2 lbs} |
| Tripod Pinch (R) | {## lbs} | {## lbs} | {e.g., +5 lbs} |
| Tripod Pinch (L) | {## lbs} | {## lbs} | {e.g., +3 lbs} |
Discharge Summary:
Client demonstrated meaningful gains in strength and control across all prehension patterns, particularly in gross grip and tripod pinch, which facilitated improved independence in tasks such as {e.g., handwriting, dressing, utensil use}.
Skilled OT services are no longer indicated at this time. Client has been discharged with a home program, including continued use of Squegg for strength maintenance and functional engagement.
Squegg Intervention (daily note)
.OTINTERVENTIONSQUEGG – Daily Note using Squegg
Grip only
Client participated in {duration} minutes of skilled OT including Squegg-based intervention to address grip/pinch strength, grip/pinch endurance, hand coordination, and UE activity tolerance.
Activities included:
- Repetitive grip/pinch training with visual feedback (Squegg app) to promote motor control
- Timed endurance squeezes with therapist cueing for sustained activation
- Fine motor control games to support functional grasp and release
Client required {e.g., verbal cues, visual modeling, hand-over-hand} to complete tasks. Demonstrated {e.g., improved engagement, mild fatigue, moderate improvement in control} during session.
Squegg provides quantifiable feedback and engagement, supporting continued skilled therapy for improved occupational performance in daily tasks requiring hand function.
Grip and Pinch
Client engaged in {duration} minutes of skilled OT with Squegg used as a therapeutic tool to target grip strength and isolated prehension patterns (lateral pinch, lumbrical pinch, and tripod pinch).
Interventions included:
- Lateral pinch task with sustained holds and graded resistance
- Lumbrical pinch activation with therapist cueing for MCP flexion/IP extension control
- Tripod pinch through precision grasp activities using Squegg’s dynamic resistance feedback
Client required {e.g., tactile and visual cues} to maintain proper hand positioning. Moderate fatigue noted with lumbrical tasks. Demonstrated {e.g., improved precision and control} during tripod-based activities.
Squegg’s functional feedback platform provides real-time data and engagement, supporting clinical decision-making and ongoing therapeutic need.
Squegg Home exercise programs (HEP)
Squegg bilateral hand strengthening and endurance exercises for improved container management during activities of daily living and grasp onto *** during functional transfers/ambulation using Squegg device and app. Exercises included making a fist (gross grasp), forming a ball requiring coordination of digits 1-5, repetitive lateral pinch, tripod pinch and lumbrical pinch. Patient completed bilaterally and agreeable to continue as home exercise program.