EHR Usability

Data Entry Strategies — Using Templates

The Oxford Dictionary defines “template” as “something that serves as a model for others to copy.” Templates are very frequently used in medical practice to reduce the work associated with having to collect the same information over and over again.

Clinicians have to collect and record clinical encounter information during each patient encounter. Whether one does this in a paper record or an EHR, it can be very time-consuming. Templates significantly speed up data collection. However, as useful as templates can be, in order to use them effectively, and avoid risky practices, there are some important elements to consider.

For the purposes of this article, I will define EHR templates as static or dynamic. A static template is one containing empty data fields where on simply fills in the blanks or selects items from a pick-list or drop-down menu. Each time the template is used, the data fields need to be completed from scratch. A dynamic template is one that works similarly, but automatically populates certain data fields from information that is collected and stored in the EHR. For example, when opened, the template may automatically populate certain fields such as the most recent laboratory results or vital signs collected by a nurse prior to being seated in the examination room. These dynamic or “smart templates” can be designed for a variety of complex conditions to ensure that all the required information is recorded in a standardized and repeatable format. They are ideal for managing patients with chronic diseases such as Diabetes Mellitus or Chronic Kidney Disease.

Depending on your style of practice, templates can be an important consideration when selecting an EHR. You should ask yourself the following questions:

  • Do you want to be able to design or customize your own templates?
  • Will you need to be able to share templates with other members of your practice?
  • How many templates do you think you will require? Generally, the more diverse your practice, the more templates you will potentially require. For example, if you limit your practice to pediatric attention deficit disorder, you may require just a handful of templates, whereas a broad-based general practice or internal medicine practice can require 100 templates or more.

The reason for asking this question is that there is a cost and complexity implication. If the product that you select provides a library of pre-built templates, but requires your vendor to build any new templates for you, it can become very costly. If you are not technically very savvy, you may elect to go this route, but realize that even small changes to a template can have an associated cost.

We have prepared the following for you to consider when using templates:

  • There are a number of different ways to create templates. A more traditional approach is to define which data you would like to collect through your EHR and then use a set of tools to lay out the data fields before saving as a template. Some EHRs allow users to create templates “on-the-fly.” This means that as the clinician uses the EHR during the clinical encounter, the SOAP notes, medical treatment, and default values can simply be saved at the end of the encounter as a template for a specific examination or condition.
  • If you develop a library of templates for your practice or to share with other clinicians, make sure that you have a standard naming convention for the templates that are created. This is particularly important if the EHR allows you to easily create your own templates. For example, if there are multiple templates for the same condition with different names, e.g. CKD, Renal Failure, Kidney Failure, you will not be able to query the EHR for consistent information if data is not recorded in the same way.
  • Templates can either be started blank or can be pre-populated with data. There are some advantages to pre-populating certain templates and then deleting the data that is not relevant before saving the encounter, as it can significantly speed up documentation. A good example is a simple urinary tract infection. Having the standard symptoms, investigations, and treatment pre-loaded can shave minutes off the encounter; however, be very careful how you pre-load data. It is not a good idea to have standard default values pre-loaded in a yearly complete physical. Unless you go through each symptom and question, you may be tempted to leave the default values checked. From a medical-legal perspective this is not a good practice, as all of your encounters will look exactly the same to the trained eye and you will have great difficulty proving that you actually completed all the items documented in the encounter.
  • Always use standardized data when creating templates. If your EHR allows you to define drug names or add practice specific codes for diagnoses, medications, and other clinical data, you could be creating an unmanageable data structure in your EHR. It can be extremely difficult to in the future to find data for reporting purposes, something that can be further amplified if you use templates created by another practice with a custom naming structure for their own data elements.
  • You can create templates with large narrative text boxes. These may be desirable for specialties, e.g. psychiatry. However, be aware that data that is recorded in narrative format, such as dictation, is not easily searchable in order to produce reports.

Comments:

4 responses to "Data Entry Strategies — Using Templates"
  • May 19, 2011
    Teri Lautman
    said:

    Good article about Templates; However in the paragraph that you talk about naming conventions, you note, “• you will not be able to query the EHR for consistent information if data is not recorded in the same way. ” That is not the reason to adopt meaningful naming conventions, that is a reason to minimize open-text fields on the template, and maximize consistent, existing discrete data fields that relate to coding, billing and reporting. If I am incorrect, please explain.

    Thank You.

  • May 19, 2011
    Alan Brookstone, MD (Cientis)
    said:

    Thanks Teri – correct. Appreciate your clarification.

  • May 19, 2011
    Bob Colocino
    said:

    Nice article. Everything said is totally dependent upon the programing and software being used. The proper use of Ad Hoc report creation eliminates the concerns mentioned above, as it should be able to pull report data based ON the values in the data base, vs the ‘naming convention’ (template name) used. Standard canned reports may not be able to do this. Look into Crystal Reports or Business Objects for a report writer with great capability and flexibility. Check to see if your data base is ODBC compliant, etc. The reports should NOT be based on the template name, they should be based on the value(s)in the data base fields.
    Regards, Bob

  • July 3, 2014
    Elliot Barry
    said:

    When it comes to creating and customizing EHR templates, there is a temptation to minimize the amount of unstructured data by increasing the number of checkboxes and other structured fields. While structured data is certainly valuable and a cornerstone of many of activities performed by primary care physicians, this approach to EHR templates could prove detrimental to other providers, particularly specialists, who have no need for many of the features comprising some of the more popular EHR systems.

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