How quick templates today will save you time tomorrow (Templates Series 1/3)

Still spending after-hours finishing up notes for routine follow-ups? Manually documenting the same things over and over is wasting your time. Build simple templates for your most common visits or recheck visits to save time and stop taking your charting home.

Don’t you just love documentation? Really look forward to spending hours on your EMR (EHR)? Gazing lovingly at the list of still-to-finish notes? Yeah, me neither. 

I used to joke with patients that the paperwork takes as long as the procedure itself. And honestly, a lot of the time it did.

Unsurprisingly, data shows that half of physicians report spending “moderate”, “excessive” or “too much” time working on their EMR at home and up to 49% of the total time in a clinical day was spent on the EMR and doing paperwork.

When talking with colleagues, it feels like we’ve all accepted that evenings or a Saturday a month on our EMRs is normal and just part of the job. 

But does it need to be? Pro tip: No, it does not (or at least, not a regularly scheduled event).

So how can we take back these hours? In my humble opinion, and in one word: templates.

Why templates are going to save your time 

If you’re at the beginning of your template journey, starting can feel overwhelming and not worth the initial time investment. But oh, is it worth it. Investing only a few minutes to make a couple of templates today will start saving you minutes this week. And we all know how seconds and minutes add up. 

Templates are the closest equivalent to passive income that we get in the realm of medical documentation. 

Hear me out! 

You can create a template (with minor adjustments to make it even better going forward) for your most common visits. Those sentences you dictate or type every time for that given type of visit are already there. Or you click the selectable option based on how the patient is doing.

And don’t worry – the AMA and CMPA support the use of templates, As long as the notes are personalized to the patient, comprehensive and reviewed regularly.

Criticisms around using templates in your practice

Despite their consistency and time-saving value, criticisms around templates abound. Let’s address the two big ones: loss of personalization and inability to capture complexity and nuance.

To start, the beauty of templates in an EMR is that they are a foundation for the note. They can be formatted so that text can be added or changed with typing or dictation. This allows for personalization – as much as you feel is needed. 

Personally, I also don’t feel that I lose the ability to capture nuanced or complex situations by using templates. In fact, I think it is easier. I can spend more time documenting the complexity of a case because the foundational information I still always review for a given presentation is already included and clickable in the template. If a visit necessitates it, I always have the option to dictate a de novo note for an encounter. 

There are potential legitimate concerns around the accuracy of the documentation, particularly with pre-populated fields (i.e. ‘pre-selected’ default options within a note). One safeguard against this is building your templates with clickable or drop-down options rather than pre-populated selections. This forces you to run through the entire template, making the appropriate selections for each patient – here is your accuracy. 

Start with templates for one type of visit. 

To get started, instead of looking at your entire practice, start with a specific type of visit. 

Do your patients return often, and do you review the same questions and information with them? (Most of us do). This is ideal for a template. I started with follow-up visits.

For example, while every patient is an individual, I still ask the same questions to each post-op carpal tunnel release patient. Chances are, you do the same for the common rechecks in your practice. 

So, stop and think: What are the top 3 most common types of follow-up or phone/virtual visits in your schedule? Some common visits include: 

• Hypertension reassessment
• Diabetes glycemic control 
• Well-baby checks 
• Response to a new medication 
• Post-procedure rechecks 
• Pathology report review

How I created a follow-up template

In my case, I started with rechecks after skin cancer excision with pathology review, carpal tunnel release and trigger finger release. 

Here’s my skin cancer excision with pathology review follow-up template. Text in blue brackets is selectable. Anything highlighted in yellow is the default selection, but it can be changed. (Note: I do mostly facial skin cancers, which is why the selectable responses are targeted to those regions.)

Anywhere within this note, I can add more detail or nuance as needed. For most skin cancer follow-ups, completing this note takes seconds. 

Over time, I’ve added and adjusted the templates. If I notice that I regularly type a certain sentence into a given template, it gets added as a clickable option. This keeps saving even more seconds, which add up to minutes and even hours. 

Warning – this can be addictive. My obsession with templates has grown, so I now have one for essentially every clinical encounter on my schedule. 

How to create your own templates

Now it’s your turn. If you’ve never made a template, most EMRs have how-to videos that are easily searchable on Google. Epic, MedAccess, Oracle, Accuro – if they don’t have their own videos, someone else has (I checked!).

Ask yourself these questions: 

• What are the three types of follow-up visits you see most frequently? 
• What are the routine questions you ask and their most common responses? 
• What do you examine every time? 

There’s your template base. 

Alternatively, look at the last couple of notes you’ve done for this type of visit and use those as your base. Repeat for the other two most common visit types and start counting the minutes you save this week.

How do you use templates?

If you already use templates, have there been a couple you’ve been wanting to update? Or are there new templates you could make to reduce the amount of time you spend modifying an existing template? 

This doesn’t have to be limited to in-person rechecks. Don’t forget any phone or virtual appointments on your schedule. Do you have a template for those?

If you already use templates, how much time do you estimate these save in your week? Do you use them for most of your clinical notes or only a specific subset?

Stay tuned for our next article in this series where we’ll be tackling a huge time saver – consultation templates.