Orthopaedic care is organized around a body part and a side. A patient comes in for the left knee, has the left knee imaged, gets an injection in the left knee and, a year later, may have the left knee replaced. A general purpose clinic note does not track that well, which is why Epic offers a separate orthopaedics application called Bones.
This guide explains Bones as Epic describes it publicly, how its location-based design shapes documentation and data, and how it supports patient-reported outcomes and registry reporting, which have become central to joint replacement programs. It is written for orthopaedic leaders, Epic analysts and vendors whose products serve orthopaedic practices.
What is the Epic Bones module?
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Epic Bones is Epic's orthopaedics application. Epic says it supports orthopaedists' clinical review, documentation, ordering and procedural workflows, and includes joint injection support, "one screen" orthopaedic documentation and location-based charting. It runs alongside EpicCare Ambulatory, so orthopaedic notes sit in the same record as every other specialty.
Epic also highlights Bones features for collecting patient-reported outcomes and reporting data to orthopaedic registries, which connect clinic documentation to the quality programs that now shape joint replacement care.
What is location-based charting in Bones?
Location-based charting means the body location, such as the right shoulder or left hip, is a structured part of the documentation rather than free text. Findings, problems, procedures and imaging can then be tied to a specific location and side across visits.
- Follow one joint over time: A provider can see every visit, image and injection for the left knee together.
- Separate problems cleanly: A patient with a right shoulder and a left knee problem keeps two clear histories.
- Better reporting: Questions such as how many injections a joint received before surgery can be answered from data.
- Fewer side errors: Structured laterality reduces the chance of documenting the wrong side.
This structure also matters for integrations. Systems that consume orthopaedic data, such as outcomes platforms or implant tracking tools, need the location and side as data, not inferred from note text. When a clinic moves to Bones from free text notes, the history before go-live will not have that structure, so reports that look back over several years need to account for the gap.
How does Bones support joint injections and procedures?
Bones supports joint injections with a dedicated documentation workflow, because injections are among the most frequent procedures in orthopaedic and sports medicine clinics. Each injection needs the same details recorded every time, which suits structured documentation.
- Location and side: Which joint, and which side.
- Medication: The drug, dose and lot number used.
- Technique: The approach and whether imaging guidance was used.
- Consent and timeout: The safety steps the organization requires.
- Orders and charges: The procedure and supplies, captured from the same documentation.
Teaching hospitals publish Bones provider training that covers express lane documentation, procedure documentation, SmartForms and summary views for musculoskeletal patients. The Medical College of Wisconsin's Froedtert course is one public example of how organizations train orthopaedic surgeons on these workflows. Training like this is worth planning for every new resident and fellow cohort, not only at go-live.
What does "one screen" documentation mean for providers?
One screen documentation means the provider can review history, examine, view imaging and write the plan from a single working view, instead of switching between activities. In a clinic that sees many short follow-up visits, fewer clicks per visit adds up quickly.
The design reflects how orthopaedic clinics run. A surgeon may see thirty or more patients in a session, many of them post-operative checks or injection follow-ups, with imaging reviewed during the visit. Documentation that keeps pace with that flow is the main reason clinics choose a specialty module.
Team roles matter here too. Athletic trainers, medical assistants and physician assistants often prepare much of the visit before the surgeon arrives, entering history, outcomes scores and orders for imaging. A single shared view lets each person add their part without overwriting another's, and lets the surgeon confirm everything in one place before signing.
How does Bones support patient-reported outcomes?
Bones supports collecting patient-reported outcome measures, often called PROMs, so orthopaedic teams can track how patients function before and after treatment. For hip and knee replacement, these measures now have direct regulatory weight in the United States.
CMS's hospital-level THA/TKA patient-reported outcome performance measure uses HOOS, JR for hip replacement and KOOS, JR for knee replacement. CMS materials specify collection 90 to 0 days before surgery and 300 to 425 days after surgery, and QualityNet states that during mandatory reporting hospitals must submit complete matched preoperative and postoperative data for 50 percent of eligible patients.
- Timing windows: Schedule questionnaires so they fall inside the preoperative and postoperative windows.
- Patient channels: Offer the portal, tablets in clinic and phone collection, since response rates depend on reach.
- Matching: Link each postoperative score to the right procedure and its preoperative score.
- Risk variables: Collect the additional data CMS uses for risk adjustment, such as BMI and mental health scores.
The one year follow-up is the hard part. Patients often stop coming to clinic after recovery, so postoperative collection depends on outreach that the clinic does not normally do. Plan reminders and staff time for it from the start.
The scoring also shapes what the program reports. CMS's technical report for the clinician-level version of the measure defines improvement as meeting a substantial clinical benefit threshold of 22 points on HOOS, JR for hip patients and 20 points on KOOS, JR for knee patients. Storing raw item responses, not just totals, lets the program recalculate if definitions change.
How does Bones help with registry reporting?
Epic says organizations can use reports compiled from Epic data to submit information to the American Joint Replacement Registry. Run by the American Academy of Orthopaedic Surgeons, AJRR describes itself as the world's largest national registry of hip and knee replacement data by annual procedure count, with data on more than five million procedures.
- Submission: AJRR participating sites submit data through the AAOS RegistryInsights upload process over SFTP or HTTPS.
- Reports back: AJRR offers on-demand reports, including a CMS THA/TKA PRO-PM report and a Joint Commission advanced certification report.
- Benchmarking: Sites compare their performance against national data and similar institutions.
- Program requirements: AJRR participation supports some certification and quality programs.
Registry data depends on what was documented. Implant details, procedure type, laterality and outcomes must all be captured discretely in Epic for the registry extract to be complete, so registry requirements should shape the build, not be added afterwards. Review a sample of submitted cases against the chart each quarter to catch gaps before they become a pattern.
How do outside systems connect to orthopaedic data in Epic?
Outside systems connect to orthopaedic data in Epic through the same interfaces as any other specialty: HL7 v2 feeds for patients, orders and results, FHIR APIs for apps, and scheduled extracts for registries and analytics. What changes in orthopaedics is the data those systems need, which is heavy on location, side, implants and outcomes.
Outcomes platforms are the most common example. Many joint replacement programs use a dedicated tool to send questionnaires, chase non-responders and score results, then show those scores inside Epic. The integration needs the surgical schedule to know who to survey and when, the procedure and side to label the scores, and a way to return results to the chart where surgeons will see them.
Implant data is the second example. Epic describes OpTime as documenting the surgical workflow in one perioperative record, and implant details captured there feed registries and recall searches. Systems that track implants or surgical plans need to read those details and match them to the joint and side recorded in clinic.
Imaging is the third. Orthopaedic clinics review radiographs at almost every visit, so the link from Epic to the image viewer has to open the right study quickly. Integration teams should test that path with real clinic volumes, not a handful of test patients.
How do standalone orthopaedic centers use Bones?
Standalone orthopaedic centers use Bones alongside EpicCare to connect with the wider care team while documenting by body location. Epic describes orthopaedic centers using Bones features for documenting common procedures such as joint injections, collecting patient-reported outcomes and reporting data to orthopaedic registries.
For an orthopaedic group, the appeal is that referring physicians, hospitals and the group can share one record or exchange data easily, while the group keeps tools built for its specialty. The trade-off is the size of an Epic implementation, which smaller groups often reach through a health system's instance rather than their own.
What should orthopaedic programs plan for with Bones?
Plan for structured documentation, outcomes collection, implant data and imaging. Bones provides the tools, but each program decides how much of its care is captured as data rather than narrative.
- Templates by subspecialty: Sports, joints, hand, spine and trauma clinics document differently.
- Implant data: Decide how implant identifiers from the operating room reach the record and the registry.
- PROM workflow: Assign who sends questionnaires, who follows up and who checks completion rates.
- Imaging: Make clinic imaging easy to open during the visit, with the right side and study.
- Reporting: Build the registry extract and PRO-PM reports early and test them with real cases.
How Agnotic can help
Agnotic Technologies builds Epic integrations for specialty programs. For orthopaedics, we work on outcomes collection tools that connect to Epic, data feeds for registry and quality reporting, and integrations with imaging and implant tracking systems.
For vendors of orthopaedic software, such as outcomes platforms and surgical planning tools, we help design integrations that respect Epic's location-based data and fit the clinic's workflow. That includes reading the surgical schedule, returning scores to the chart and producing the matched data sets quality teams submit each year.
Plan your orthopaedic integration
Find out how we connect specialty software to Epic, or browse the EHR integration hub.
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Read about Epic's modules, clinical documentation in Epic, Epic Radiant and EHR customization.
