Common EHR Implementation Issue – Inadequate EHR Templates

Time for the latest entry in my series of Common EHR Implementation Issues. See also my previous posts on Unexpected EHR Expenses, EHR Performance Issues and a little follow up to avoiding the EHR performance issues altogether.

This weeks common EHR implementation issue is: Inadequate EHR Templates.

Before I begin with the major issues of inadequate EHR templates, it’s worth noting that there are a few EHR software out there that use a different EHR documentation paradigm than templates. For example, some use voice recognition to power their documentation. Others have a system that learns your documentation over time and based on that learning remembers how you want to document certain procedures. Others, use lots of independent documentation methods (one EHR vendor calls them controls – check box, radio button, freetext field, etc.) which can be grouped and used in interesting ways.

However, even with all of the above alternative documentation methods, there’s often an element of templating that’s occurring. They’re PR and marketing people will shudder at the term template, but concepts related to templates seem to pretty much always apply. For example, in voice recognition there’s something called a Macro. That’s basically a template. The EHR system that learns your documentation method is just using your initial documentation in the EHR to create personalized templates of how you like to document. The independent documentation methods often group those various “controls” into groups of common visits. That sounds like a template to me.

I’d be interested to hear of an EHR system that doesn’t use the principles of templates. It is worth noting that all EHR templates aren’t created equal. Some are much more flexible than others. Now to some details.

The inadequate EHR templates shows itself in a number of different ways.

No Specialty Specific EHR Templates – This has to be the complaint I hear the most. It usually goes something like this, “The EHR salesperson said they had templates, but they don’t have any templates I can use.” Did someone say EMR salesperson mis-communication? Yep, happens all the time. Let’s be honest for a second. How could the EHR salesperson know how good their cardiology or neurology templates really are? They just go by what they hear and what they’re told by the EHR company.

Incomplete or Unusable EHR Templates – You may have noticed a subtlety in the quote I put above. At the end the doctor says “templates I can use.” Maybe the EHR salesperson isn’t lying to you about them having those cardiology or neurology templates. Maybe they do have a bunch of templates for those specialties (or whatever specialty that interests you). However, just because they have templates for those specialties doesn’t mean that you’re going to want to use any of the templates that they’ve created.

My favorite complaint is when they say that the specialty templates seem to have been created be a general medicine doctor and not an actual specialist from that field. I’ve heard it far too much not to mention it.

The other major problem with this point is the unique documentation preferences of each doctor. Has there ever been any two doctors that document the same way? We could debate the good and bad merits of such documentation, but the point is that each doctor is very different. Some feel the need to over document the encounter. Other doctors want to just document the bare minimum. Plus, some (purposefully or not) do a terrible job documenting the visit. The templates in an EHR could reflect any of these various documentation patterns and depending on your perspective could mean that EHR has inadequate templates for your needs.

Hard to Modify, Add to, or Adjust – While not specifically an inadequate template, this is an important part of templates. Turns out that if a user can easily modify, add to or adjust a template that is inadequate, you’re going to be a lot better off. Some template systems are like pulling teeth to modify. Others are amazing at how you can on the fly modify the template.

One promise I can make you, You WILL want to modify their templates. I can’t say I’ve ever heard of someone using the templates perfectly out of the box. Well, maybe I’ve heard of one or two using them, but that was when they were complaining that they had no way to modify the things they wanted to change.

Avoiding EHR Template Inadequacies

The best way to avoid this issue is to test drive the EHR software and the specialty specific templates you hope to use. Run through the templates like you’re charting on some common patients. You’ll learn a lot about what templates are available doing this than anything else. You’ll see if the templates are overkill or below standard for your needs.

Another great test is to try using multiple templates for a complex patient. How easily is that done and how well does the documentation display?

Then, during your EHR demo with the EHR salesperson, ask them to modify part of the EHR template they’re using to document. Tell them you don’t like to ask one of those questions, so you’d like to see them remove it from the template. Many are likely to respond, “It can be done, but I’d have to switch systems to do it or I’d have to call in to tech support to make the change.” I think we all know the real message they’re sending.

For those not interested in EHR templates, you might take a second to read Dr. West’s Experience implementing EHR templates in his office.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

8 Comments

  • Templates don’t work very well because they are rigid and the way a doctor practices medicine is an art. It’s like trying to fit a square peg in a round hole.

    The only EMR out there I know of “that learns your documentation over time and based on that learning remembers how you want to document” is Praxis EMR.

    Instead of templates, Praxis uses an artificial intelligence engine called a “concept processor”. The system gets smarter and faster the more the doctor charts as it continuously learns the doctor’s charting tendencies “on the fly” and is therefor 100% customizable to each and every physician, no matter what the specialty.

    They have a very high user satisfaction level from physicians, especially small practices.

    Does anybody know of any other EMRs that function this way? I have researched this a lot, and Praxis seems to be the only one available with this unique approach to electronic charting.

  • Dr. Smith,
    There are others that function similar to Praxis. DoctorsPartner has some similarities to the way it learns over time for example. Although, the learning that Praxis does is just learning the templates a doctor wants to use. The interesting thing is that the templates it learns proves that a doctor’s documentation habits aren’t as much art as we like to think since the art can be repeated over and over after it’s learned.

    Although, the real key to it all is how well can the template be added to, changed, removed, etc. A number of template systems are making amazing strides in their flexibility to adapt to a doctor’s charting needs.

  • I’d like to point out that John has cited two different blog posts of mine at the end of his post above, just so people know. The hyperlink almost look like there’s only one link there, but it’s actually two.

  • Yet another question to ask vendors is: Do they share templates among users and if so how.

    Some vendors are big on building a sharable template library, while others guard them closely. Still others make it easy for users to give or sell their templates to other users.

  • I agree with all the comments above and I thank you John, for properly reporting the EMR template issue. I think the issue of templates and especially customization of templates is extremely when considering documentation efficiency. Moreover, if more than one individual contributes to the documentation process it helps to clearly delineate input components. In the end, there is nothing nicer than simply dictating a report and having expert assistance to convert and embed the final text into the patient’s EMR.

  • John, thank you for the info on DoctorsPartner. I checked out their website, although I couldn’t discern from it exactly how they are different from the other 300+ EMRs out there. In regards to Praxis, it’s the only EMR out there that literally has the ability to save EVERY SINGLE PATIENT ENCOUNTER the physician ever charts to be used again for future patient encounters. It is an art, as each encounter is saved with “keyword suffixes” that are created by the physician based off of the concept in the doctor’s mind for *why* he treated that particular patient/diagnosis the way he did. Of course over time he will repeat some basic cases, but the beauty is that the system gets faster and smarter the more he uses it, and the more unique encounters he saves.

    Template-based systems push doctors more towards technicians rather than unique physicians. The basic approach of templates is to take existing paper documentation and attempt to load it into a computer. Praxis takes a radically different approach, basically taking the “brain” of the doctor and cloning it into the software over time. Eventually the software becomes smarter than the physician as the software will remember things from the past that the physician may have forgotten.

  • Dr. Smith,
    I should have clarified that I’m quite familiar with the Praxis Concept Processor. Been watching it for 5-6 years now. I still mostly see it as good branding for an advanced template system.

    With that said, I’ve met a number of doctors like you that absolutely love the way the concept processor works. I’ve met others that haven’t liked it. If it’s working for you great, and I hope it will work for others. At the end of the day, I’m glad to see widespread adoption of EHR. That’s when HIT and EHR gets really interesting.

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