A common EHR decision question: "Do you have templates for my specialty?"
A common question that many practitioners have when looking for a suitable EHR for their practice is this: will it have features needed for my specialty? Is it a general-purpose EHR system, or is it specialty-specific? And what kinds of features in a specialty-specific product are missing in a general-purpose one? Is that important?
More specifically, where physicians often start to differentiate EHR options available to them is by looking at templates. Are there templates suitable for my specialty? This question, seemingly straightforward on the surface, is actually more complex than would appear. That is because “templates” mean different things in different EHR systems.
The simple answer
The simple answer for Practice Fusion is “yes.” Practice Fusion offers many universally-needed features, like medications, prescribing, summary information, document management and messaging. But at the same time, Practice Fusion includes a Template Library, which contains a collection of over 130 different templates, grouped into specialties, so that every specialty has tools apropos the common (as well as unique) workflows for that specialty. The Template Library grows continuously, as users in different specialties offer their own templates for distribution in the community. By grouping templates into Template Categories, and associating the categories with different specialties, Practice Fusion is able to auto-populate your own template collection, based on your declared specialty, on first-use of the system – you can always search for any template from the complete library if you so need.
More about templates
EHRs of all types have grappled with the balance of structured data on the one hand (which is searchable and lends itself better to interoperability) and descriptive, narrative text on the other hand (which is more readable by practitioners, and familiar to all). “Templates” are ways of trying to capture chart data for note creation – and their use and character depends on how the underlying EHR is created. Some EHRs are extremely “template driven,” meaning that a template is a form on a screen with lots of items to click, which create data in tables associated with each such template. This approach favors “structured data” as the most important thing – queries across each data element is possible, but the system often loses in “usability” and physicians complain that it takes them longer to chart using the EHR than it did before (thus impacting their productivity). Also, since the very-granular data created is so template-centric (it has even been referred to as “structured data over-kill”), it is difficult to import or export data between different installations of the EHR that use different collections of templates. Further, custom-creation of templates by users on-the-fly is nearly impossible.
Practice Fusion takes a different approach when it talks about “templates.” In Practice Fusion, usability and quickness of note-creation are centrally important, so that using the system will not result in the productivity slow-down experienced by users of other EHRs. “Templates,” as used by Practice Fusion, are collections of sentences and phrases commonly used in creating chart notes about certain types of visits. These kinds of templates are tools that allow for simple sentence-picking, and can be mixed-and-matched at will. The sentences chosen can be modified as desired, and supplemented with free text as well. These templates are stored in a Template Library, and can be individually modified as needed. New templates can be created and stored by the user without difficulty.
The result of the Practice Fusion approach to “templates” is a quick and easy way to build narrative chart notes, particularly the “S” section of a SOAP note – HPI, PMH, ROS, FH, SH, etc. The note is easily readable by other practitioners, and has the ability to capture truly descriptive narrative often highly important in describing a clinical situation, which might not be well captured in the stiffer click-driven templates of other EHRs. The challenge with this approach, of course, is the use of standard terminology and structured data for querying and interoperability. That is why the template usage approach implemented by Practice Fusion is mainly for parts of the note that should be narrative (e.g. HPI – history of present illness); other elements, like diagnoses, medications, prescriptions, immunizations, allergies, vital signs, etc., are structured and discrete, and lend themselves quite nicely to usable queries, reports, and interoperability.
“Templates” mean different things to different EHR systems. Physicians who ask the question “do you have templates for my specialty?” are asking a more complex question than meets the eye. There are EHRs in the marketplace – established, large, expensive ones included – which are very stiff and template-centric, and can negatively impact usability. Practice Fusion has tried to learn from these lessons, and offer a different approach to templates, which is more flexible, user-modifiable, and quicker, yet at the same time can create chart notes with sufficiently structured data elements where robust report-creation and interoperability are achieved.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion, Inc.