Templates-Good-Bad

Clinicians Share Their Experiences Using Templates

Templates are an EHR functionality that can either enhance or inhibit clinical documentation. If templates work right, they are a terrific benefit to users of EHR systems; however, templates must be easy to create, modify, and customize. Some users are very happy and others very dissatisfied with their EHR’s ability to manage templates.

Over the last 18 months, AmericanEHR Partners — in conjunction with 8 professional societies (ACP; AAAAI; ACR; ACS; AOAMI; IDSA; RPA and AAPA) — has collected over 3,000 completed surveys from respective society members regarding their use of EHR systems and their satisfaction levels with a wide range of features and functionalities.

The following are selected comments submitted by clinicians regarding their experiences with templates:

  • To be practical, an EHR must have the ability to allow the user to individually create their own favorites and templates for documentation. This should be so easy to do that each user would be able to do it on their own without assistance.
  • After 6 years still learning, I need a lot of time to create templates to adapt to hundreds of different cases.
  • After initial implementation, the ability to change or design new templates to fit our practice was miserable. Our vendor did not work with us or help us in this endeavor, making the EHR virtually unusable for the first 6 months until we were able to get some additional templates designed.
  • Copying and pasting of information, and the use of templates makes many clinical notes worthless.
  • For me making a note that reflects the individuality of my patients is key to an EHR. My EHR allows this with keyboard, key strokes, dictation and templates — without the inefficient container methods and complicated edit modes of other systems. There are many customization options and training via remote access is very efficient. Unfortunately I do not have the time to optimize all relevant EHR functions and progress slowly with on-the fly customizations. Charting still take too long and Rheumatology dose not lend well to templates (heterogeneous, multi-system, and psychosocial overlays).
  • Histories have become very uninformative check-off lists or computer generated templates and do not really convey a sense of the actual patient condition.
  • I am one of the few physicians I know that is happy with their EHR choice. My practice has grown from a single surgeon to a multi-specialty group of 8, including neurosurgery, neurology, psychiatry, pain management and chiropractic. Our EHR is so flexible in creation of templates that everyone can have what they want without additional cost. Even our psychiatrist who doesn’t like computers and can’t type is using the system. She hand writes notes and scans them into the document management but uses E-prescribing, scheduling and past medical history features in the EHR. We have a minimum number of staff because the system is so efficient.
  • I wish a free text edition was possible in some of the pre-formatted templates. I believe this feature is available in some of the other EHR products.
  • In general EHR is very difficult for non-typists. I overcome this by using a hybrid system to point and click in a template, and then use Dragon speak voice recognition to produce a narrative office visit or consult note.
  • The functions of our EHR greatly exceed the level of training I received in using it. If I received more training I’d be faster/more efficient. For example, no one showed me how to make a template, how to draw a picture in the note, shortcuts, etc.

If you are satisfied with your EHR’s ability to manage templates, what makes it work? Conversely, what do you find challenging with templates? Share your comments below.

Comments:

One response to "Clinicians Share Their Experiences Using Templates"
  • January 25, 2012
    Nick van Terheyden, MD
    said:

    The collision between narrative and structured data is most acute in clinical notes and typified by the challenges in finding common ground for standard templates for clinical notes. While standardization is a good thing in general the unique nature of patent stories and the nuances that are contained in descriptive components of the note are essential to capturing the whole patient story.
    In many instances the journey of creating templates often finds some common ground but highlights the need for individual elements that may not be suitable for lists or check box selection.
    Speech recognition is the partner and the bridge to this divide offering a tool for easier navigation and the ability to capture essential details in the patient history and presenting complaint without the need to be an expert with a PC or an accomplished typist.
    As Apple’s recently launched product Siri has ably demonstrated this technology is now capable fo delivering a new easier man/machine interface offering a simple interaction to clinicians while loosing none of the detail.
    Speech enabled templates offer the best of both worlds facilitating capture of discreet data as well as the full patent story

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