Transcript General Template issues, 2007

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