1. General Template issues, 2007 Mostly stolen from the 2006 talk By Donald T. Stewart, MD FAAFP July, 2007

2. 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

3. 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.

4. Urgent Care Templates Goal is to get paid and document what you did. Speed of entry a priority Chronic disease management NOT an issue.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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.

16. Project 1—Improving the Drop-Down Subjective Menu— What to do when the patient has another problem?

17. The Solution Recursive Quick Text – expands to include itself, so it can be clicked again

18. Recursive Subjective List

19. What it Looks Like

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

21. If you click “ *Subjectives “ you get this menu

22. “ S- “ expands to:

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

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

26. 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

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

35. Conditional Logic for the Exam

36. 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

37. 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

38. 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.

39. 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

40. 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

41. 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

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

44. The person who starts the note sees this

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

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