Dictating vs. templating chart notes: a real no-brainer

Tonight I read an inspiring post from my friend and amazing health IT guru, John Lynn.  He reviewed an EMR service called Chart Talk, which allows a doctor to dictate directly into the EMR using Dragon Naturally Speaking.  I have to admit, I really liked the video — very cool technology indeed.  Back several months ago, when I was still dictating my History of Present Illness (HPI) section of the chart notes, I was using a similar approach, and this was quite an efficient process.  By that point in my EMR user mental development, I was already templating all other sections of the notes, and I thought I had reached a certain cruising altitude.  Life was good.

However, nowadays I put a fraction of the effort into developing and using templates that I can use over and over again with a few clicks of the mouse.  Allow me to illustrate the change in efficiency with a basic example.

About 30-40% of my patients see me for thyroid disorders.  For the sake of simplicity, let’s say about a third of these patients have hypothyroidism — or an underactive thyroid gland–, a third have thyroid nodules, and a final third have an overactive thyroid.  I have templates for both hypothyroidism and thyroid nodules.  For hyperthyroidism, I simply modify the paragraph used for hypothyroidism since a lot of the questions remain the same.  I strike a few mouse clicks at the beginning of my patient encounter and in flies a conveniently detailed little paragraph scattered with a smattering of underscores serving as fill-in-the-blanks (like this _ ).  If I had continued to dictate an HPI for hypothyroidism over and over again — like I used to do all the time –, well then I would be wasting an aweful lot of time.  So while I love dictation technology that can convert my words into typeface, I love even more letting a computer save me all that extra time that I can spend on other pursuits, like reviewing incoming faxes, e-prescribing refills, and calling back patients who called earlier in the day with questions or concerns.

Today, I saw 18 patients, didn’t dictate a thing, and left my office at 5 PM without a single note to finish, document to look at, or phone message left to answer.  That’s how I spell R-E-L-I-E-F.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

8 Comments

  • That sounds good for you, but doesn’t apply so well in primary care where variability is the rule. On a day where I see 20 patients, I would probably need 16 different templates (adult male physical, adult female physical, 4 month well child, 6 year well child, colposcopy, acute low back pain, anxiety, diabetes, hypertension, knee pain, poison ivy, sore throat, migraine, birth control, etc). And at least half the patients I see every day would require more than one template.

  • Hi Peter. Yes, primary care has a lot of variability, but I still see the potential to generate simple templates that could save a lot of time. Back pain, sore throat, hypertension, diabetes, health maintenance visits. When I was dictating, I used to think to myself, “Well everyone’s story is so unique that I couldn’t possibly template this stuff.” Then I tried a few and the rest was history. I saw your site and it looks great! Going to take a look around it some more now.

  • Dr. West,
    When you were dictating you obviously weren’t using a voice recognition software like DNS that had things like Macros. Plus, Chart Talk has their own version of Macros which makes it even more interesting. Certainly, voice recognition isn’t for everyone, but it can achieve some of the same template benefits you describe as well. If implemented correctly.

  • John, you are correct in that I didn’t know how to macro/template, but I was using DNS. That would have even been more efficient, indeed. But, nevertheless, glad I am rarely dictating anymore.

  • Hi Mike. Thanks for writing. Completely agree that any template, no matter what subject you are exploring or EMR system you are using is going to carry potential risks. Thus, the design of the template must allow for free text of patient particulars. My templates in particular are covered with lots of blanks where patient-specific information is required to be hand entered by the doctor as he or she inquires about the detailed history of the patient in order to make a complete and thorough assessment.

  • […] are also a lot of downsides to their use. I remember when Dr. West wrote a blog post about why he loves his EMR templates. As I thought about his views I realized what the difference was in his templates and the templates […]

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