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Why Templates Are So Important — Allergy Highlight

When our five-physician Allergy/Immunology practice decided to take the plunge into the world of electronic medical records about three years ago, templates were one of the key features we were looking at. Most clinical allergists, as other specialists, see the same type of medical issues and ask the same basic set of questions. Who else but an allergist would ask multiple questions about your bedding, type of heating you have in your home, your flooring, your pets, etc. It was very important for us to be able to capture all of the history elements in our new electronic record that we had captured previously on paper. Our group was already using a “New Patient Questionnaire” and this became the basis for our first customized template. It was very useful to have an EMR that provided some basic templates, but it was even more important to be able to customize those templates to meet the specific needs of our specialty and our clinic. Creating a “New Patient” template that looked and flowed like our prior patient questionnaire made our transition easier.

Templates are one of the most important aspects of your EMR and have been discussed in recent blogs (Optimizing the EHR — Templates | Why Templates Are Essential When Using an EHR ). I am a believer in the 80/20 rule. If templates can fit the majority of my patients, that is good. We started with one main template for new patients and one for follow up patients. We have created additional templates over time but I still find myself using these main two templates most of the time. For those more complicated patients that don’t fit one of my existing templates I use free text. A system that allows you to diverge from your templates is critical. Finding templates that fit 100% of your patient encounters is futile and will only frustrate you.

I can’t stress enough how important it was for us to be able to customize and update our templates on our own. Not a week goes by that I don’t log on and tweak something in our templates. We would find it very frustrating to have to submit a request to tech support every time we wanted to change something.

While there are some specialty specific EMRs, the choices are limited, especially for smaller specialties. Many allergists may find their EMR choices limited by their multi-specialty clinic, hospital, or even payor. While multiple EMR vendors offer “allergy specific” templates, many of these don’t appear to have been written by clinicians, let alone allergists. Even specialty specific EMRs should allow you to customize the templates. Your practice needs a clinician willing to spend the time it takes to make your template work for your group. I believe the EMR champion in the office needs to be one of the physicians.

Although I have been very happy with the ability to customize my templates, I remain frustrated at the inability to share those templates with other allergy practices. With all the hard work and hours it took to create them, I want to be able to share them with my colleagues. In addition, I would love to be able to import their templates. I am not only unable to share my template with allergists on other EMRs, but can’t even share with allergists who use the same EMR.

It boils down to the much larger problem of systems unable to talk to each other. What we need are specialty-specific templates written by the clinicians that use them. EMR systems should allow individual clinicians to customize them to meet their needs, then be able to export these templates to share with other clinicians. This is but one step towards better communication among clinicians enabled by interoperability between systems and allowing better care and outcomes for our patients — the ultimate goal of a true electronic healthcare system.

In summary:

  • Look for a system that offers templates geared towards your specialty.
  • Ensure that you will have the ability to customize and update these templates on your own.
  • Remember the 80/20 rule. Build your templates to fit the majority of your patient visits but don’t get bogged down trying to create ones that fit 100% of your patients.
  • And one last cliché — “less is more.” Stick to a few templates and really make them work for you.

Melinda M. Rathkopf, MD, FAAAAI, FACAAI, FAAP
Allergy, Asthma and Immunology Center of Alaska
Assistant Clinical Professor, University of Washington

Comments:

9 responses to "Why Templates Are So Important — Allergy Highlight"
  • November 6, 2012
    Stuart Rusnak
    said:

    This is an excellent article, and I could not agree more. There are very few EMR’s written for allergists.

    We have been paperless since 1994. You must be able to change templates by yourself and not be locked into a system where you have to ask a programmer change them for you.

    I just came from KY where I rewrote the system for an allergist. I also did the same system in pediciatrics and intnernal medicine.

    It is very important to choose the system very carefully. Ask the dealers if they have a shot system for allergys. If not, go on to the next system.

  • November 6, 2012
    ganapathy bala
    said:

    I agree completely . I have used my EMR for 2 years now. I find it easy to create and edit templates- I do follow the 80/20 rule . Unfortunately , I cannot create forms in it the way I like and I have to create them in WORD and import them . But then, every EMR has some limitation. I tend to scan my allergy injection records

  • November 7, 2012
    Jonathan G. Black, MD
    said:

    Dr Rathkopf,

    Thanks for your article on templates and their importance in EHR’s. My allergy practice is contemplating getting an EHR; can you tell me the name of the EHR you purchased? It is essential for us to get an EHR that works for our specialty, as you can understand.

    Thanks,

    Jonathan G. Black, MD

  • November 12, 2012
    Sherri Aaron, Computer Operations & Data Mgr
    said:

    I completely agree with your information on the importance of templates and the proper EMR for your specific specialty. Our allergy practice has been on an EMR for 5 years. Our physicians have the ability to create their own individualized templates. They can even edit them on the fly if they choose. They can share them with each other as a whole, or I have figured out a way to share only portions. We did interface with another software for our injection module which allows our patients to electronically sign in via an office KIOSK or office iPad, which has worked out great.

    Thanks for sharing the article,

  • November 13, 2012
    Melinda Rathkopf
    said:

    Thank you for your comments. Customization has been challenging but I think it is the most important aspect for success with your EMR.

  • November 16, 2012
    Jeff Nugent MD
    said:

    Well spoken to keep templates few, (ie “new” and “followup”), lean, and to learn right up front how to modify them yourself as the provider. Our allergy practice has been on one of the “largest EMRs” for just under 1 year- just as we were getting optimized with this, the EMR company is doing a “mandatory upgrade” to a new platform… and the templates do not port-over. So they need to be re-invented on the new platform. Expect this as EMR companies merge, converge, go bankrupt, and upgrade over the next few years!

  • November 20, 2012
    Thomas Zimmerman, DO, FACOFP, CPHIMS
    said:

    While templates can be invaluable in saving time and avoiding repetitious typing, it’s important not to over-utilize them. Physician offices are being audited by Medicare and other entities more frequently, and progress notes that are overwhelmingly similar to one another can invite lots of problems. In fact, many hospitals and hospital-owned practices are disabling or severely limiting the use of templates to avoid this problem.

  • November 27, 2012
    Diane Cymerman, MD
    said:

    Ms. Aaron and Dr. Rathkopf
    I would appreciate knowing which EMR and allergy modules you chose and which you considered and rejected.
    I have not been sold on the functionality of the EMRs i have looked at so far.

  • February 3, 2013
    AA
    said:

    Has anyone used E-Clinical ??

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