What Should a Doctor be Looking for When he Examines EMR Templates?

Flexibility and Adaptability are Key.

By Sheldon Needle

Most EMR and EHR vendors advertise their wide variety of templates. But do the templates make the EMRs easier to use, or do they complicate your patient histories and billing issues?

The question is not whether an EMR or EHR will use templates, but what kind of templates an EMR will provide. Some vendors discuss the savings in storage space, but the data storage issues are really the smallest issue involved.

The greater issues are flexibility, or the lack of flexibility, that a template creates for a doctor at the point of care in his clinical documentation; and the savings in time and precision that a good template will afford.

Another issue that a poor template can create is inaccuracy in billing codes which result in “downcoding” – that is trivializing the complaint and coding it as a minor appointment for the doctor, which will result in his receiving very minor payment from the insurance company. Of course “upcoding”, or making more of a visit and procedure than it should be, is dishonest and exploitive as well.

What this tells you as a doctor is that a template needs to be “customized” but not to the point where it trumps the diagnoses that the doctor makes for his patient, or does not allow the doctor to fully describe the point of care encounter..

There are two distinct categories of template type:

Documentation by Exception (DBE)
These are the more fully filled out forms, that prompt the doctor for less. They are “pre-answered” and thus describe a fairly healthy patient.

Documentation by Findings (DBF)
These templates inquire after individual complaints, and are not pre-answered. They prompt for individual findings and conditions, and thus take longer to fill out. Because they are more specific and exacting, they can support specific billing codes for insurance purposes. They can also be much more useful for a doctor in reviewing a patient’s conditions over time.

Since DBFs are more specific and more exact, EMRs that have DBF templates tend to have more templates than EMRs that have DBE templates.

Some physicians feel that this is unrealistic, and the time required to fill out DBF templates is just too great. But even if a doctor prefers an EMR with DBE templates, and wants the quick broad brush record that they offer, he has got to look for flexibility and adaptability in the template.

So, as in all things, the long run gains and the short run costs have to be taken into account when considering efficiencies in EMRs. Though the more fully filled out templates requires less time from the doctor, they do not allow for full and exact documentation, and in the long and short run they can create problems for both doctor and patient.

When a doctor considers the purchase of an EMR/EHR she must look into the flexibility of the templates available. Make sure it is easy to import notes and customize the template. Request to fill out a few templates when you are shown a demo, ask how to customize and adapt it. If the salesman tells you that tech support can do it for you, forget that EMR and move on to the next option.

There is no free lunch, and there is no work-free template worth its bytes, either.

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