Teaching To The EMR Template?

Are teachers of family medicine being forced to teach to EMR templates?  According to one blogger, the answer is a decided “yes” — and it’s probably not a good thing.

In a posting on the blog for the Society of Teachers of Family Medicine, Bill Cayley, Jr., MD. argues: “With the increasing use of electronic medical records (EMRs) and their ever-so-helpful templates, smart sets, and forms for capturing information needed to support billing and guide protocols, I fear we are losing the narrative forest for the well-documented trees.”

Cayley writes  that teachers of family medicine  have a particularly strong tradition of teaching students to write nuanced narratives. “The flow of meaning and story that comes from a patient’s history and give far more insight into what may be going on than one gets from simple documentation,” he notes.

These days, however, EMR documentation pushes  physicians and learners to document positives and negatives rather than the patient’s story, he says. For example:

* Emergency department documentation is growing in length, but conveying less meaningful information. “Documentation of an ER visit that in the past was captured by a one or two page dictated note now comes in an eight or nine page template document that gives no real clue as to what really brought the patient in,” he says.

* Doctors are increasingly responding to the template in office visits, sometimes ordering something because it’s there in the template, rather than listening to the patient’s narrative, he says.

* Far too often, doctors are being forced to re-gather the entire history with the patient themselves, because prior documentation fails to provide the nuance needed to understand what happened during the last visit, Cayley reports.

Even if everything Cayley says is true, it’s worth nothing that templates offer some relief over paper charting duties.  As John Lynn notes, doctors have historically had to go through stacks and stacks of paper to do traditional charting, often bringing home piles of charts just to stay caught up. That sort of backlog has consequences of its own.

But if using an EMR is squeezing meaning out of doctors’ — and future doctors’ — record-making process, that’s a warning sign that shouldn’t be ignored.  Let’s hope vendors find more of a happy medium going forward.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Yes, this is a warning message that shouldn’t be ignored. It is a problem in search of an innovative, flexible and fully integrated application. Many of the medical transcription (now calling themselves clinical documentation) companies have been struggling to deliver some type of hybrid documentation capability within EMRs/EHRs. A combination of dictation/templates/speech that enables the “complete” patient story to be told–and then heard.

    Because the opposite side of this problem is that template EHR documentation is also very hard to read.

  • When I sat in on my first EHR sales demo, the vendor was touting how much time would be saved with the templated medical notes.

    I remember thinking this didn’t seem like a good idea.

    It is my understanding that this method has at the very least been frowned upon if not “outlawed”.

  • Of course this is happening. And, physicians in practice see it happening. But, we are powerless to change the system as many of us are held captive by our employer’s choice of EHR. EHR’s are less about health care and more about monitoring of healthcare. So, whether or not the ‘note’ is helpful to others is not important.

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