5 responses

  1. Jay
    February 4, 2013

    If the EMR locks you into a templated response its a bad EMR. (I wonder how CMS would feel about forced templated responses! )

    Maybe docs just don’t know that they have options?

    Here’s the long version of my response in case you are intersted.


  2. Kathy Nieder MD
    February 5, 2013

    This reminds me a little of a similar problem, though less devastating in terms of patient care, in terms of coding. Often the code “isn’t quite right” but we are forced to pick one. Like having a code for a chin laceration–well there’s a code for open wound, but not laceration. Or benign hypertension vs malignant hypertension, neither of which quite fit but my auditing people tell me how I MUST code with jaw dropping ignorance of the medical facts. Hopefully ICD 10 will help. The complexity of the EHR and the possibility of fitting square patients into round holes complicated by the very real likelihood that the MD will finally just pick something in frustration so he can move on to the next patient–shuddering to think about.

  3. John
    February 5, 2013

    Dr. Nieder,
    Good comparison. That is similar in many ways. I know I deal with counseling diagnosing a lot. They’d often do what they called a rule out diagnosis. Unfortunately, EMR doesn’t handle that very well. There’s no nuance to how firm you feel about the diagnosis either. Most EMR don’t capture those subtleties.

  4. Cornell Hardman, Aprima Product Manager
    February 5, 2013

    While it is true the template driven systems are definitely a challenge because they are the results of programmers trying to capture the complexity of a medical visit, template-driven EHR isn’t the only option. Aprima is a non-template, Chief Complaint driven system. It isn’t a serial approach to documentation, but rather it mimics the workflow of a provider and the way they are taught to think and document in medical school. By intuitively understanding the type of problem or problems presented, and how a provider typically handles it/them, clinically relevant information is presented to the provider instead of the provider having to go find it via pointing and clicking. Preferences and habits are saved and the more often a given problem is treated in the same manner the faster and more efficient the provider is able to document, including any exceptions which are just as important. Free text doesn’t have to be the evil of structured documentation when you shed the handcuffs of traditional templates.

  5. Joe Ketcherside MD
    February 13, 2013

    I’ve worked with a few different EHRs that have some template-driven documentation tools but all of them allow free text additions, comments, or even completely free-text sections. There is absolutely nothing about them that prevents the physician from easily adding the nuances they need to add, nor anything that forces them into inaccurate documentation. Maybe there are some poorly-designed EHRs out there, but if so this problem would be a feature of the product itself and has nothing to do with the concept of an EHR.

    I think the original concept is incorrect, and trying to make an issue where there isn’t one.

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