General Template issues, 2007

Mostly stolen from the 2006 talkBy

Donald T. Stewart, MD FAAFPJuly, 2007

Overview

• Why use templates?– Speed of data entry– Structured data entry• You know where to find things• You don’t forget to document things• You can save things for later use

– The ability to “pull” data into your note

What is wrong with Templates?

• One size does not fit all• Needs for chronic disease management quite

different from needs for urgent care• Easy to be fraudulent• Excessive length of notes• “Cook-Book Medicine”• The patient’s story is the most important

diagnostic tool, and templates tend to depersonalize it.

Urgent Care Templates

• Goal is to get paid and document what you did.

• Speed of entry a priority• Chronic disease management NOT an issue.

Chronic Care Templates: Subjective

• These templates should provide a summary of the chronic issues you are addressing, including– Past history of the problem– Current status of symptoms, disease activity

markers, quality of care markers– Past and current lab values that matter– Patient Self-Management Goals– Other related and important issues

Chronic Care Templates:Objective

• Past pertinent physical findings should be visible when the patient is being examined

• Vital signs that are not to goal should be flagged

• The template should remind the provider to do and document the necessary elements of the exam

Chronic Care Templates:Assessment

• The template should prompt the provider to consider all appropriate parameters

• It should show the important data so the provider does not have to scroll back through the note.

• It should be easy to understand

Chronic Care Templates:Plan

• Should document treatment changes• Follow-up plans• Counseling activities – What was said– How much time was spent

• Labs, consultations, and procedures ordered

Acute Care Templates in the Primary Care Setting

• Should be – Quick to fill out– Uncomplicated

• Should document the visit adequately for reimbursement

• Should remind the provider of other chronic conditions or health maintenance issues that might need to be addressed

Primary Care Templates

• Both Acute or Urgent Care and Chronic Care have to be served by the same template

• You have to be able to address multiple issues in a given visit, both acute and chronic.

• Essentially, you need a Super Template, as developed by Greg Omura, MD, or you need a flexible templating system as developed by Rita Hanson, MD. Both of these systems are available for sale by their authors.

Let’s create a Primary Care Template

• We will start by modifying the SOAP: Single or Multi-Problem Template that ships with 8.2.1

• Please refer to the Handout for details on this.

Project 1—Improving the Drop-Down Subjective Menu—

What to do when the patient has another problem?

The Solution• Recursive Quick Text – expands to

include itself, so it can be clicked again

Recursive Subjective List

What it Looks Like

If you click “ *S Chronic ” you get this menu

If you click “ *Subjectives “ you get this menu

“ S- “ expands to:

The other choice expands to Cascading Quick Text ordered by Organ System

The Canned “Abdominal Pain” choice under the “S-” menu:

Project 2 – Cleaning up Patient Data

• The patient histories (PMH, SH, FH) and Medications and Allergies quick texts make the template seem cluttered

• We will create a drop-down menu for these, and add some functionality

This is what you get if you chose “BMP” off the Lab Results Menu

Conditional Logic for the Exam

The Handout for this Talk

• We are now up to page 3 of the 12 page Power Point handout for this talk.

• The rest of the handout discusses such issues as– Making quick text “Subjective Templates” for chronic

disease management– Making your templates “Disease Aware”– Saving physical findings as lab values

• In the interest of saving time for questions, I will now present some additional concepts

Messaging Templates

• Messaging templates are a new feature in Practice Partner 8.x which offer the opportunity to greatly improve workflow

• By pulling patient information into the message itself, you are spared the time wasted by opening the chart and looking for things like the patient’s Date of Birth, Phone Number, Recent Lab Values, Medication List, Allergies, etc

Messaging Templates (2)

• In a given messaging document, you and your co-workers may need to use several different templates.

• This is because unexpanded Quick Text in the template will disappear each time the message is sent to someone.

Messaging Templates (3)

• For example, the receptionist or medical assistant may start with a template that pulls in the basic information and request

• The provider might bring in a template with responses, questions, and orders

• The MA or Nurse might bring in another template to document how the orders were accomplished

Rx Refill Template

• For Rx refills, a typical workflow would have the receptionist taking the call and starting a template, which is sent to the MA.

• The MA would check the request against protocol, and either handle it, or forward it to the Provider.

• The Provider would review the request, and either ask for more information or make a decision, forwarding it back to the MA

Rx Refill Template (2)

• The MA would then either get the additional information requested, or would call or fax in the provider’s response to the pharmacy and to the patient

• The MA would then save the message as documentation of the transaction

You get to the Template Menu from “Template” in Message Editor

The person who starts the note sees this

When this goes to the Provider, a new template is added

After the Provider has given orders, the MA adds a new template