Making Your Electronic Medical Records Work for You

Just like the real estate adage “location, location, location,” I believe something similar can be said about working with electronic medical records (EMR): “templates, templates, templates.”

It’s always astounding to me how many physicians say that their medical records take so long to finish. I agree that documenting the visits with your patients is tedious, and can be very time-consuming, but I find taking some time on the front end, can drastically reduce how much time it takes to complete medical records. There are a few ways many EMRs are designed to help you in this regard.

If you spend some time with your EMR, you will learn what features it has, and how to manipulate the data within it to create simple templates. If you learn to create all-encompassing templates for each medical record, your notes can take much less time to complete. In my experience, creating 3 templates for all my needs was a game changer. For example, you can create one template for your nail/callus care patients, one template for your new and established patients, and one template for your postoperative visits. I did this within one of the EMRs I’ve used and created drop-down menus within each of those templates.

One of the things with that particular EMR was that you could not carry forward your previous note into a new one. Many EMRs do let you carry notes forward, and that makes it infinitely easier. Depending on what data you are pulling into your note, carrying forward your previous note can cause some problems. Most people like having the patient’s age in their note. If you just do a carryover from your previous note, the way the EMR is coded, it won’t change over the patient’s current age on its own, in most cases.

So be wary, as when the patient has a birthday, your system won’t know it with a carried-over note. You either have to change the age manually within the note or create a brand new note from scratch for the new age to automatically show. This is something to be aware of.

One infuriating thing for me with respect to EMR is that the developers are generally not the end users, which can cause a rift between design and practice. Sometimes, there are just too many clicks, and since coders don’t use the systems, they aren’t always aware of how to design the system optimally. For example, for many EMRs, you have to tell the system whether you’re putting in a description of the ICD-10 or CPT code, or the code itself. It doesn’t understand that you can use both without telling it. This should be easy to code—ideally, users should be able to either put in a code or the description of the code, and the system should know what that data means. Another thing to understand is that there isn’t a single EMR that does it all. Some may not have features you desire, others may, but the user interface may be too crowded or difficult to personalize.

That being said, systems are much better with billing features throughout, which, in my observation, is incredibly important. The point is, you have to know to ask about these things before investing in an EMR. Some things I feel are missing from my current EMR is the ability to put in “his/her/them” or “he/she/they” within the template automatically. When your staff inputs that the patient identifies as male, the EMR should have a way to inject “he” into your note. I like to do this, as when I create a template for a note, I like it to read like a narrative. It does have a way to put in the patient’s name throughout, but not their gender.

Another thing my current EMR doesn’t do is something called a “list box.” Just about all the EMRs out there will let you create a drop-down–type menu, which you can then insert into your note, and select only one of the options within the menu list only. A “list box” is a drop-down menu, but it allows you to select more than one item on the list. This is most useful to me when creating a drop-down menu for the nails I’m debriding, for example. I am currently working with the creators of the EMR to resolve these issues and others I’ve encountered while using it. Some EMRs have 2 ways, or more, to create a note, but won’t let you use the complete functionality of the EMR in each note type. It has certain functions available if you create a template using one type of note versus another. For example, if I want to use drop-down, I have to create a certain style of note of the 2 available. It’s not a big deal, but I didn’t know that until I got into creating my own templates within that EMR.

Ultimately, over the last 20 years or so, I’ve used just about every EMR system out there, and none of them were perfect. Some were too bright and colorful for me. It distracted me with color templates and writing that was too bold and in different colors. Others made it difficult to do billing effectively from the EMR. I also found that some of the free, cloud-based EMRs were seriously lacking in functionality. Some wouldn’t even allow you to create templates at all, or the creation and utilization process was so confounding, it was just easier not to use their templates system at all. As always, you get what you pay for.

When all is said and done, each EMR does do its job. Some are easier to manipulate than others, and some have a much better user interface than others. With this little bit of knowledge, hopefully you’ll know what questions to ask, how to “play” with an EMR system when trying it out at a conference, and eventually will not be intimidated to dive into your EMR and make it work for you.

Dr. Raducanu is a Diplomate of the American Board of Foot and Ankle Surgery and Fellow of the American Society of Podiatric Surgeons. He practices in Galloway, NJ.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of Podiatry Today or HMP Global, their employees and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, anyone or anything.