Episode 110:
From Templates to Time-Savers: EHR Tips for Coders and Clinicians

Episode Transcript

Welcome everybody to another episode of compliance conversations. I am CJ Wolf with Healthicity. 

And today's topic is such a great topic, and I'm so grateful to our guest, Elizabeth Herbert. Welcome, Elizabeth. 

Hi. Thank you for having me today. 

Absolutely. And I'm so grateful for the the thought that you've put into some of the things we're gonna talk about today. We're gonna be talking about EHRs and templates and all sorts of good things. But before we jump into that topic, we just wanna give you an opportunity to tell us a little bit about yourself. What do you do? What's your background? Anything that you feel comfortable sharing. 

Alright. Well, currently, I am an Epic application analyst with Baptist Health System in the Kentucky, Indiana region. Okay. I have a background in the medical field for, oh, I don't know, twenty five years or so just in a variety of different, roles, anywhere from medical assisting, pharmacy to billing, and then into coding, coding education, and CDI. So then I jumped into this application analyst role, and so I help to support providers with their EHR use and customization. 

You're a saint because that that can't be easy. 

You know, and I have been doing this for over twenty five years. So I remember when we were still using paper records, and and electronic records were just starting a little bit more frequently. 

And and I would try to help, doctors develop a template or something, and I'm not a technical person, but I did my best. 

So I'm glad there are folks like you who who know how to do this well. 

Well, you know, there's so many new, you know, new technologies out there, and you really have to stay on top of it, to, you know, use it appropriately. And I feel like I have a little bit of an advantage for the providers and that I have that coding and auditing background Yes. That I can kinda give them that point of view, but also give them their options in their EHR customization, so that we kinda, you know, support support it from all all all views. 

Exactly. 

Well, let's kind of maybe start with a foundational question. One that we probably all hear quite a bit is, you know, EHRs and EHR templates specifically. So, you know, most of our audience compliance, coding folks. So, you know, a lot of coders, oh, I hate templates, and there's all sound so rote and blah blah blah. So EHR templates often get this bad rap. Right? So why do you think that is, and and how can they actually be a valuable tool for providers? 

Well, you know, when we talk about templates, I think the word itself is kind of improperly used sometimes. So sometimes when we use the word template, some people are using it for a really broad range of kind of documentation tools. So they might be picturing in their mind, you know, something like a prebuilt and pre prefilled content, maybe a full physical exam with all the findings already put into it. And then and then sometimes if someone says template, you might be thinking of just that generalized kind of layout. 

You know? Right? So, like, your typical SOAP note where you've got a subjective section objective and then assessment and plan, and that's it for the template. So, really, I think the the misuse of the term is, you know, leads into that. 

Yeah. 

But, you know, templates can be a very valuable tool. They can help with efficiency of documenting the visit. Right? So, you know, during that whole medical decision making process in their mind, they're looking at those different differential diagnosis trying to narrow down those possibilities of whatever that complaint may represent. 

So a template that provides prompts related to a certain complaint and the details that a provider would wanna collect and document, in order to rule out and narrow down that final impression, you know, could be very helpful and less less than that cognitive burden of remembering, you know, what else did I wanna cover? Did I do that already? Did it you know? And Yes. 

Just have that prompt. In that way, it's there. They don't have to think about it, and, you know, they can document it. 

Yes. And then the other thing is that it can help with capturing the needed details for accurate coding. So, you know, those those, templates can be a prompt to document certain elements that are needed on specific procedures in order to get that correct code. So think about all the details that are needed for skin lesions. So, you know, different types of biopsies. Is it shaving or is it excision? 

What's the location? What was the technique? You know, the the size, all of that. So a really well built template will prompt for those so that those details are added when it's done, and that'll lessen the time that's spent by the providers and your coding department messaging back and forth. Right? Yes. And communicating and trying to get that detail when, you know, it was documented, appropriately, you know, the first time. 

That's right. You know? And I like what you said kind of about reducing cognitive load. I mean, your brains only can do so much at one time. 

And, yes, doctors are smart. But if you could reduce the cognitive load of what questions do I have to ask all the time, it's like you said, especially with a given complaint. Right? That might lead you down these twenty seven questions or these sixteen questions depending on what the chief complaint is. Or, if if you can reduce that burden, then they can use their full cognitive powers, if you will, to you know, for deciding what a differential diagnosis it might be and what test to order. And then that, I think, as patients, that's what we all want our doctors to be able to do, is to be more focused on thinking of our problem and how to find it, diagnose it, and solve it as opposed to, you know, did I leave out question twelve of my, you know, predetermined list. 

Right? Right. 

So I I appreciate that kind of background. 

So with that said, so what would you say are some key principles for building and using EHR templates correctly so that you improve efficiency without compromising any, documentation quality? Let's say. 

So I think some of those key principles or things to think about, when you're building and using templates is to build the template to the format that you prefer and tailor it to prompt the information that you need documented. 

Also keep open to feedback and communication from compliance or coding and regularly review and update your template as your documentation needs or preferences change. So so many times, I see providers that will, you know, they'll they'll build out their templates and they'll be using them for years. Right? And they will consistently and constantly make the same change to the note template they're using throughout their clinic day, which it may only add, you know, five to ten seconds to their documentation time of that note. But when they do it multiple times a day, five days a week, you know, fifty weeks a year or whatever, and, you know, and they could have just taken two minutes to update that template Yes. 

To their new preference, it would save them so much time in the long run with their editing and and time documenting. 

That's such a great point too. Like, I was just reading some guidelines from the Society of Critical Care Medicine, I think is what it's called. And I was reading some of their recommendations. I I was looking into critical care coding and documentation. 

And I was reading some of their more current recommendations, and they're going away from using one screening tool set of questions to another. Like, they've their formal recommendation is to no longer use this one and to use these others. And so you just talked about updating your templates and your maybe your flow, workflow. Right? 

That might be an example. You might have others too, but that might be an example of a time when a clinician might be, yeah. You know, for the last twenty years, the standard of care has been to ask those questions. But new studies have been released to show that these are better questions or these are better indicators of disease. 

And so that might be a good time to update a template. Do do you agree, or or do you have other examples? 

Oh, absolutely. That is a perfect example. 

You know? 

And providers have to remember and keep up to date on so many things. You know? Right. You'd want them to spend their time on, you know, standards of care and medical treatment, you know, advances. 

Right? And not have to worry so much about coding and documentation. So to rely on those departments within your organization and the feedback that they give and, you know, let them educate you on those things and Yep. Give you that give you those new requirements, have your training and support team help you in those updates. 

You know? You've got you you've gotta take care of your patients. So let them the the ones that are trained the best at the system, let them help you do those updates so that it takes less time, it gets done, and, and now you've got that template that really, hits on those points that need need to be hit on. 

Perfect. Perfect. So let me now ask you because it's because you have experience in here. So in your work with providers, what would you say are some common mistakes that you often see when it comes to EHR template use? And so, one, what are some of the comments common mistakes? And number two, how can you avoid some of those? 

Well, one would be, overutilizing tools or reset information without that proper review and editing or a proper understanding of how they work. So an example of that is, in the past, you know, an audit was done on a provider who utilized templates and also include which also included a prepopulated, text block of his normal physical exam findings. 

So he would and he also he also utilized a copy forward of these exams. So he would copy forward his previous exam from that patient from a previous encounter, and he did know. He he knew that he needed to edit it in some way to show that he had reviewed it and updated it. Right? 

So so he was on top of that. But the thing about the thing about it was that system attribution was showing, you know, the information was copied from a previous date, but it didn't show any changes and updates made for the encounter. So during the audit education meeting, he was kind of perplexed. He was, like, insisting that he always makes changes. 

Right. And he finally shared the details and demonstrated that the change that he sometimes made was a deletion of some type of information. 

So that was the key in, you know, of course, understanding how the system works is is is the part that that was missing from that, is that the system attribution will show when something is added and where where it came from, but it doesn't indicate when there's a deletion of data. So, really, the only way to see that is to pull that that old note where it was pulled from, pull the new note side by side, and kinda look at it. You know? So that that typical hovering and seeing that system attribution isn't giving that detail. 

Gotcha. 

So now that he knew that, you know, he could, shift his workflow to ensure that he's updating the exam correctly and changing and add or adding information so that there wasn't a misunderstanding of the documentation and kind of that risk that he was not doing, you know, a proper physical exam. 

That makes complete sense. What a great example. 

This is really great. You know, Elizabeth, we're gonna take a quick break because we want to to give ourselves a quick break, send some additional messages to our listeners, and then we're gonna be right back to keep on this conversation of, EHR and templates. So, be right back, everybody, after this short break. 

Welcome back from the break. We're talking to Elizabeth Herbert who has so many great ideas and a lot of experience working in an electronic health record, the functionality that's available, common mistakes that people might make with templates and those sorts of things. So I I wanna maybe switch a little bit and go beyond templates and just talk about what other EHR tools or maybe their workflows that you find that might be underutilized, but could, you know, really reduce, the burden on on a provider. Any other EHR tools or workflows you you could recommend? 

Absolutely. Yes. So, you know, personalization options and settings that can be, you know, changed within the EHR system themselves. 

It really helps with, you know, that efficiency of other tasks and activities that the provider is, you know, burdened with and, you know, will allow more time to be spent on maybe the proper documentation. Right? So, over just over the past couple years, it's just gotten better and better. There's been so many advances that, you know, so many tools that I've been excited about and sharing with my provider. So, of course, it's gonna vary depending on, you know, your health system, what EHR you have, what version or changes they decide to implement. 

But, you know, tools that you know, standard tools that make, you know, chart review and recall of information quicker like filtering within the chart, bookmarks with comments so that you can see why this certain, you know, diagnostic study, for example, is, significant. 

Synopsis that pulls all that information together in different reports that kind of, generate and pull past documentation up for quick review. You know, those can all be helpful for chart review. 

Orders, orders that are placed. You can save orders with certain personalization of how you want those orders to be done, you know, what time frame. You can even, associate diagnoses with some saved orders, now within our system, which I love it. It that is reducing steps in having to add that diagnosis to the chart and then associate the diagnosis later when you're placing that order. 

So that's a couple steps right there just with that one order that can, you know, reduce, you know, the steps and reduce the clicks. So of course any of that kind of thing kinda comes with some training and education on how that works, making sure that your saved order is clearly displaying what is set within it, so that, you know, it's helpful when you you end up using it. And then, of course, I'm definitely a fan of, like, Dragon Mike dictation over manual entry with a keyboard because your brain can always move faster than your fingers no matter how fast you are with typing. And, again, there's always typos. 

Right? That's right. 

I I am also a fan of the AI assisted note generation that's all the rage now. 

I've Nice. 

Had great feedback from providers that have started using it and seen the ability of it to capture details of a visit and maybe that history of present illness that the provider might not have been able to recall and document later when they got around to, you know, documenting the visit, you know, once they had time to complete it. 

So, you know, just that help in order to capture those details just for the the history portion alone Yep. I feel is, you know, beneficial. 

Wow. Those are all wonderful examples. You know? And and I appreciate someone like you that kinda understands all of those, possibilities because when I you know, if I'm not working in an EHR day in and day out, I I don't kinda recall all those. So just hearing all of those, it makes me think, wow. 

If you really got, you know, proficient with with with maximizing your use of an EHR, you could really, really improve your efficiencies and and then spend more time with the patient, which is what a lot of doctors wanna do and what a lot of patients want. 

Oh, yeah. Yeah. 

You can finish your note, you know, within the visit or shortly thereafter and, you know, not spend your weekends documenting Exactly. 

On on notes you didn't get finished throughout your day, and, you know, you can make sure that your your patients are getting the proper care. 

Exactly. 

So, let me ask you a kind of a compliance question. You know, I have a compliance background. A lot of our listeners do. So how could, a well designed EHR template support compliance with documentation and coding requirements, and what should providers watch for to avoid compliance pitfalls? 

Well, I think a well designed template can help to capture the that needed documentation details that we talked about kinda earlier, like like with procedures or like you said with the critical care changes. 

You know, that can really help to capture all that needed documentation. 

If there's something that's a requirement for a code selection, you know, it's got those prompts. If you build those prompts in, you know, it'll prompt the provider to, you know, add those details. Now if it's a requirement for that code selection, I would make it a requirement for that field to be completed as well. Because there's sometimes, you know, you've got these templates that they may use, but if they're not filling out all the spots, then you might still end up with, you know, not great documentation. 

So, you know, build it so that it it's a requirement if that's what's needed. On the other hand, you know, using a a prepopulate populated procedure note or kind of that cloned note that has details already built in, that can kinda be, you know, that compliance pitfall. 

So providers may build it, you know, with all good intentions. Right? And they started out with that documented information the way that they would definitely do it, and they fully review it when they first start using it, and they're great with it. Right? 

But Right. 

As as their the stress of all the requirements and all the administrative burden of everything else they have to do comes on, it might get to the point where they don't take that proper time to review and edit and ensure that those details fully reflect that specific encounter. So that's where, you know, template use could possibly get into some compliance risks. 

Yeah. That makes a lot of sense. And I like what you said about, you know, if the code requires it, make that a requirement. So, you know, if I go back to our critical care discussion, right, so to report those critical care codes, you know, we have to document time. 

Right? And there has to be a certain threshold of time that has to be met before you can do it. So maybe if I hear what you're saying is if I'm anticipating reporting critical care time, maybe there's some prompt that says, did you or here you know, report the minutes or report the time, you know, from to and from, so that it would it would help me know, oh, I only spent ten minutes. That doesn't qualify for critical care. 

Or or maybe it's you know, with critical care, you can report additional procedures if you did them, but you have to subtract those separately reported procedure times out of your critical care time. 

Are those the kinds of things that might be good, like prompts when, you know, the code yeah. 

Yeah. And those prompts, you know, the you can build those prompts within your system to also, you know, give some little, you know, tip tip and details on that. So if there is documentation of minutes and you only put ten minutes, maybe out to the side, it gives a tip. This is not critical care time. Report an e and m or, you know, something to that effect. 

So those can be built within those prompts to further give kinda education as they use the the tools as well. 

Gotcha. 

So now we're we're kinda talking about all the the beautiful things that go along with all this. Now but you might know some providers prefer prefer to avoid templates altogether. 

So if that's their preference, do you have any suggestions for maybe some alternative documentation tools or workflows that can still help those types of providers improve efficiency? 

Yeah. I would say that some type of voice recognition or the AS assisted note generation that that's come about now is definitely probably the first tool or tools I would recommend, you know, getting that documentation as quick as possible. Right? Right. 

So and also documenting the information during or immediately after is the best for getting those accurate details and for recall. Each time you have to stop documenting on a patient and revisit that note later, that's more recall time that you have to go back and and say, okay. Who was this again? What was going on? 

And and it's just, you know, more more time wasted to get it documented. 

So documenting during the visit as much as possible using the tools that can speed up the other activities whether it's ordering, chart review, we'll open up that time for documentation of the encounter details. 

Using maybe a template itself is not, what a provider prefers, but maybe, saved note pieces. 

So, you know Right. 

A a template is if if you're talking epic, a template is a smart phrase, and a smart phrase is also just a little snippet of Right. You know, saved information as well. So you could use little pieces of information, whether it's just patient instructions that you would give for, you know, their home treatment of a viral illness or Right. You know, a knee replacement, you know, surgery plan or plan, you know, going up to surgery. They can still be helpful to create the pieces of the note even if you don't want, you know, a full template. 

Yeah. No. That makes that makes a lot of sense. 

So, you know, we're getting a little bit towards the end of our time. I wanna ask you one more question, and then then you can maybe think of any last minute thoughts. But I wanted to ask you about provider training and ongoing support because my guess is you're you probably get involved in training in all of these areas too, and you might have, like, a variety of different kinds of providers. People who are just out of residency and now they're just starting with your system. Or you might have a a provider who's, you know, gonna be retiring two years and doesn't wanna learn all these bells and whistles because, you know, he's been doing it one way for fifty years. Any thoughts on the role of training, and what role that might play in in using EHR tools? 

I definitely think it's one of the most vital roles in, you know, ongoing support and training. So, you know, EHR systems our system, we do two major upgrades twice a year that implement a lot of changes all at once, but we also do weekly updates that enhance the system. So Okay. Just undergoing, you know, a one time training when you first start using that EHR system or you first, you know, join a health system, it's most likely not gonna be enough because all these new options and abilities that are added could, you know, they could change that one thing during the day that gives you the biggest headache. 

Yeah. So it could be so it could change your life to stay on top of the the ongoing support and training. 

But and that's a really good point because, you know, our sponsor here, Healthicity, they have software tools, and I know they're constantly updating those software tools. 

And so you might have gotten their tool two years ago and always wished for this one feature and thought, oh, that'll save my life or save my my day, maybe not my life, but save a lot of time in the day. And then they get that feature. And so staying on top of updates could be really important because my guess is, you know, EHRs are getting feedback from thousands and thousands of users, and you're probably getting some good feedback and making some good updates. 

Absolutely. Our, training and support team, we we have our mastery team that works is a part of that. And we do the visits with observation of a of a provider's workflow, and then we give recommendations and, you know, talk about efficiency tools that may work for them. Right. 

So having though the, the option to participate with the mastery team and to do it as many times as you like throughout, you know, your employment, that having that, available and repeating that, you know, occasionally, maybe just once a year to make sure any of the new upgrades you know about them and you can make those changes, you know, really kinda sets aside that time to say, alright. Let's review. Do I need to make changes? And this is the person that's gonna help me make those changes efficiently and Yep. 

Actually just set aside that time to make sure I'm doing it. 

Yeah. 

Such a good point. 

Well, Elizabeth, we're we are unfortunately out of time. We could talk all day about this, but I wanted to see if you have any last minute thoughts or or things maybe something we didn't talk about that you really wish we had. Any any last minute comments before we wrap up here? 

No. I think we pretty much covered it. Just, being open to, suggestions and utilizing your system's departments that are really there to help you. Mhmm. 

You know, either either make those changes, suggest and train you on new tools, or, you know, educate you on the new documentation requirements. 

You know, I think that's the the key to just making sure that it you know, making your day a little bit easier on that documentation burden since there's so many things that are asked of you besides just documenting that patient care. 

Yeah. 

Such a great point. Well, Elizabeth, thank you so much for taking the time to share your experiences and expertise. I really appreciate it. 

Absolutely. I enjoyed it. 

And thank you to all of our listeners. 

We appreciate your support and want to hear from you. If there's a topic you want to hear about, if there's a speaker you know that would make a great guest, please don't be shy in reaching out to us and sharing that information. 

And until, next time, everybody, take care. 

This transcript has been auto-generated. Please forgive any errors. 

This transcript has been auto-generated. Please forgive any errors.