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Are EMR Templates Really That Bad?

Posted on December 16, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, I read an interesting blog item by healthcare veteran Bobby Gladd, kicking around the notion of whether structured EMR data is killing medical practice. In the item, Gladd makes as good of a case as I’ve seen that while open text has its place, the lack of same is NOT single-handedly killing medicine.

In the blog item, Gladd ribs critics of template-driven medicine such as Margalit Gur-Arie, who has called structured data “the one foundational problem plaguing current EHR designs.” Gur-Arie argues that templated data controls clinical interviews, a phenomenon she calls “Bingo Medicine”:

“When your note taking is template driven, most of your cognitive effort goes towards fishing for content that fits the template (like playing Bingo), instead of just listening to whatever the patient has to say.”

Gladd does concede that templates for Meaningful Use can be “simply stupid,” for example in the case of the MU Core 9 measure of smoking status. But do free-written EMR entries support the care process better?  Maybe we do actually need “open-ended analytical narrative in the progress note, replete with evocative, dx-illuminating metaphors and analogies and elegant turns of phrase in lieu of blunt instrument categorical and ordinal ‘structured data,'” Gladd notes wryly.

Ultimately, perhaps critics of templates have gone overboard, the blog contends. Gladd suggests that Gur-Arie’s “bingo medicine” argument is more sound than substance: “I have to be a bit skeptical that (it) is anything more than a motivated-reasoning assertion of opinion lacking evidentiary underpinning comprised of adequate psychometrically valid studies of physicians’ cognitive processes while at work, perhaps using docs on paper charts as the differential ‘control’ group.”

As Gladd sees things, the real issue with templates isn’t their existence, as such. For one thing, as readers are likely to know, EMRs almost always come with free-text narrative options from many different points in the workflow. So it’s not that there’s no opportunity for clinicians to write detailed prose about their patient encounters.

Also, the issue isn’t necessarily that doctors are having templates forced upon them, either. As Gladd rightfully points out, at least the Meaningful Use-related data gathering requirements have been extensively vetted by the public, with each stage generating thousands of recommendations from physicians. And both CMS and ONC incorporated as much as possible from that flood of commentary.

Ultimately, the problem isn’t that physicians are being asked to adhere to digital documentation styles at times, Gladd contends. The true problem is the “productivity treadmill” requirements that push doctors to see 25-30 patients a day. “If the typical physician only had to see an average of one patient per hour…adequate documentation would be way less onerous,” Gladd concludes.

And there you have it. Overwork is the bane of any profession requiring brain work, and turning back to all narrative-style documentation does little to remedy the problem. (In fact, it could make things worse — for if doctors don’t have time to use templates, how good are their long-form notes going to be?)

Maybe templates have some downsides. In fact, if someone tried to get me to practice blogging with word templates I’d probably object. But it’s worth bearing in mind that template medicine may be a symptom rather than a cause.

Why 2013 Will Be A Good Year For EMRs

Posted on December 14, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Recently, I wrote an article listing some unpleasant, stubborn EMR problems that are likely to cling to the industry like sticky burrs in 2013. Being a fair-minded gal, I also wanted to stop and reflect on what’s likely to work in favor of EMR adoption, maturation and success next year, so here goes:

*  Consolidation will lead to a more-stable vendor market:  With the (in my opinion) wave of new EMR vendors beginning to recede, the shakeout will begin. Vendors that remain may not be the best, sadly, but they’ll be better funded and hopefully better situated to take care of customers.

*  We’ll have a good amount of Meaningful Use experience under our belts:  Starting out with Meaningful Use has been nerve-wracking for all. But by 2013 the industry will have begun to acclimate itself not just to meeting MU standards, but making them work for their particular clinic or hospital.

*  Vendors are likely to offer more mobile options:  Right now, EMR vendors are offering minimal efforts around mobile EMR applications. My gut is that in the coming year, we’ll see some definitive progress on Android and iOS-natve EMR apps. There’s just too much demand to ignore.

*  Template medicine will get more sophisticated:  When templates merely inconvenienced doctors, nobody seemed that worried about their potential side effects. Now that it appears that templates encourage costly upcoding, however, it’s likely that vendors will be forced to make them smarter and less prone to encouraging cut-and-paste documentation. (How, I  haven’t a clue, but the pressure will force something to happen.)

Now, none of these are exactly raving endorsements of the EMR climate for next year. I’m not suggesting that adopting EMRs will suddenly become easy, training a breeze or ROI will magically appear.  But I do believe that we’re going to be seeing a nice uptick in EMR maturity.