THE SITUATION
Fisher-Titus Medical Center engaged Hit that Noggin to bring their Dynamic Documentation catalog current with Oracle Health’s standard content across both inpatient and ambulatory settings.
While Fisher-Titus had completed individual projects for their Oncology and Women’s Health modules, the DynDoc catalog as a whole had not been updated since go-live, aside from minor customizations to individual note templates. The result was a catalog with minimal standardization and outdated content that did not reflect nearly four years of new code releases. Design decisions around customizations had accumulated over the years, leading to a documentation experience that varied noticeably across specialties.
The larger problem was that the notes weren’t doing much work for the providers. Templates required significant manual entry in places where auto-qualifying data could have populated information directly into the note, leaving providers to locate and re-enter information that already existed elsewhere in the chart.
Compounding this, Dynamic Documentation was not a core competency of the in-house IT team. Analysts were capable of making small edits to note templates, but they lacked the depth of expertise needed to fully manage the module, limiting both what they could build and what they could confidently maintain.
“It was eye opening to us to see how much customization we actually had; this project allowed us to create a better standard.”
“Inconsistent format of hospital progress notes, discharge summaries, confusion about medication reconciliation; patient complaints about confusing visit summaries; medication lists on ambulatory notes that didn't reflect changes or was truncated and confusing; labs had to be tagged, didn't flow automatically to note; messy social history. The impact was the development of work arounds, non-standardized notes, difficulty reading notes and extracting important information, certainly frustration amongst primary care providers, extended care providers.”
the solution
project timeline: 4 months
Hit That Noggin delivered a two-pronged engagement. The first prong brought all existing content up to Model baselines, updating templates and reorganizing them to align with Oracle Health’s Model standards for EMR content pieces and general template layout. The second prong focused on ensuring that the in-house IT team could independently own and maintain the Dynamic Documentation module long after the engagement ended.
To build that long-term capability, HTN’s lead consultant conducted weekly training sessions with the internal IT team. The curriculum spanned three formats:
- Conventional classroom sessions covering the fundamentals of HTML and how Dynamic Documentation functions
- Hands-on scenarios in which analysts were required to create and respond to simulated build situations
- Build-alongs where the consultant walked through customizations and explained design decisions while making them in real time
The Fisher-Titus IT team came away with greater proficiency in the DynDoc module. By the end of the engagement, they were already planning out their own DynDoc builds for projects slated for the months following the uplift.
The classroom sessions deliberately began with the foundations of HTML and progressed to more advanced DynDoc configuration. The sessions were also recorded, creating a learning resource that spanned the breadth of the module and could be used to support future additions to the IT team.
"I was invited to participate in work group meetings and shown the options that existed to get our documentation back to Model standards. [The lead consultant] also scheduled extra meetings with me to help me understand how some of the documentation changes would work. [The consultant] was very easy to work with, explained things in a way that a non-IT savvy physician could understand, and helped me to present the changes to our provider group. I learned a lot from those meetings!"
our approach
We divided the hospital’s entire catalog into three phases, meeting with providers from the specialties included in each phase. These sessions served multiple purposes. We began by walking providers through what their updated documentation content would look like, while also giving them an opportunity to identify existing pain points in their note templates and additional workflow improvements that could be addressed as part of the project.
For example, providers identified opportunities to pull nursing documentation, such as ventilator settings and/or important clinical scales, directly into their notes. This eliminated a recurring manual workflow in which providers had to locate the data elsewhere in the EMR and manually enter it into their own documentation. These conversations allowed us to deliver meaningful workflow improvements beyond the broader catalog updates while also increasing physician engagement in the project. Rather than experiencing the work as a broad IT initiative being implemented around them, providers could see tangible improvements that resulted directly from their feedback.
We also developed a repeatable model for communicating changes across the organization. Rather than highlighting updates to each individual template, we focused communication on how functionality was changing across the catalog as a whole. For each phase, we identified the common headers and elements being modified and demonstrated how they would look and function following the updates.
For example, demonstrating the new look and functionality of vitals once was far more effective than presenting before-and-after comparisons for more than 80 individual templates. This created a clear, scalable communication approach that could be reused across all three phases of the project.
"This was more than setting out to complete a project, [the lead consultant] guided the team, assisted with build, feedback, and provided the education to our teams how to be able to truly support this functionality going forward."
OUTCOMES
Updated content was deployed across three successful go-lives, each following the same structured approach. We met with the specialties in scope, identified gaps and improvement opportunities, built and tested the updated templates, and deployed the new content.
Beyond the active template updates, the HTN consulting team configured all of Oracle Health’s standard DynDoc components, including those Fisher-Titus did not plan to use immediately. This gave the internal IT team a stronger foundation to support future functionality as the organization’s documentation needs evolve.
The result was a more cohesive Dynamic Documentation catalog with a concise, standardized set of provider note templates. By the end of the engagement, the Fisher-Titus IT team had not only a modernized catalog, but also the knowledge and framework needed to maintain the module and support future DynDoc needs independently.
Hit that Noggin:
- Delivered a fully updated Dynamic Documentation catalog aligned to Oracle Health’s 2026 standards across inpatient and ambulatory settings, bringing Fisher-Titus current after more than four years of updates
- Updated more than 80 note templates
- Developed new baselines for demographics, vitals, labs, and radiology reports to qualify into inpatient and ambulatory notes
- Delivered a comprehensive Dynamic Documentation training curriculum to the internal IT team, spanning HTML fundamentals, simulated build scenarios, and live build-alongs
- Improved documentation efficiency by automatically qualifying more relevant chart data into provider note templates
"Providers are happy with the notes and really appreciate the medication reconciliation section which does incidentally meet some new quality metrics by our Managed Medicare plans (meaning we didn't have to create an extra workflow or quick text to meet it) — one less step for us!"
"Working with the Hit that Noggin team was an exceptional experience. Their professionalism, expertise, and collaborative approach consistently exceeded expectations. They were not simply an external vendor; They became a trusted extension of our IT organization and a valued partner in achieving our goals."
