EMR Templates - Are they a blessing or Curse?

EMR Templates - A topic of heated discussion keeps on popping up in meetings and blogs, and rightly so. Studies have been published and we have also heard of CMS audits revealing how templates are sometimes used mindlessly. There are various issues pushing and pulling in opposite directions.

Here's an interesting post from the Society of Teachers of Family Medicine - "Are we teaching Template-based Medicine?"

  • You want speed of charting but you don't want each to look similar as the previous one.
  • You want to code 'just right' but you don't want to over-code.
  • You want to automate charting as much as you can, but you don't want to order tests and procedure where not required.
  • You want to give enough attention to the patient and you want to document their 'story' and 'narrative'.

Where is the balance?

You need to understand what a template really is. Every vendor has their own definition of 'template'. It could mean anything from a single button template for a condition, to sub-templates of every part of a SOAP note. You can have sub-templates for HPI, ROS, Physical Exam, Assessment, Plan, Orders and Procedures, Medications. There cannot be one-size-fits-all templates.

The first step is to understand your own office workflow. What happens when a patient comes in? Who does the initial triage? Who does what part of the patient encounter? For example, your MA could be collecting initial data such as:

  • Chief complaint
  • Asking related questions and getting answers that could go into the HPI section
  • Review of Systems and Medical history
  • Current medications
  • Vitals

When you see the patient, you must have quick access to previous notes as well as what the MA collected so far. This was easy in a paper based system because you just flipped the pages in the patients' folder - assuming everything was there. Then you engage the patient and elaborate on the 'narrative'. Then you do the physical exam. At that time, you are ready to chart assessment, plan, order, procedures and medication.

If you examine closely, the single element that is most difficult to 'templatize' is the HPI Narrative.

Trying to build a template that can capture every patients' unique narrative, is extremely difficult if not impossible. Technologists will tell you it is possible and perhaps it is, but as a provider, you also want to say it in your (and patient's) words. My personal opinion is that this is best done by typing or dictation.

Use various forms of templates your vendor offers for everything else.

This guideline will make things easy, keep the workflow smooth, speed up your process, and most importantly, avoid audits because your templates look exactly the same. Ask you vendor how you can do all this and do it fast.