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 are cost and complexity implications. If the EHR that you select provides a library of pre-built templates, but requires your vendor to build 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 associated costs.
Consider the following 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 in place. 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 a consistent manner.
- 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. Pre-loading the standard symptoms, investigations, and treatment 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 everything documented in the encounter.
- Templates can also facilitate the process known as up-coding in order to maximize the E/M value for a specific encounter. Clinicians should be very careful to ensure that care being provided is warranted and can be justified in the event of an audit (read Dr. Michael Barr’s blog post “Cost, Quality, Coding & EHRs”).
In addition, read Will Underwood’s prior blog post: “Why Templates Are Essential When Using an EHR.”
How do you use templates with your EHR? Share your experiences and lessons learned.