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Distrust of "Templated" Physician Notes in EHRs; Implications for the Future

Posted Feb 05 2013 12:00am

Here's a note from Mr. HIStalk in which he quotes from a comment submitted by Hospitalist DZA MD about a Time Capsule article that Mr. HIStalk had previously posted (see: Monday Morning Update 2/4/13 ):

Hospitalist DZA MD left an insightful comment on my [May 2008]  Time Capsule article about doctors getting lost in the barrage of generally useless information cluttering up EMRs:

Anything that is templated has exactly zero clinical information value to me. I don’t care if Osler himself dropped in “dyspnea improved,” “no diarrhea” … If I want to know the validity of that kind of thing, I will look at the narrative part of the nursing note …The only data I look at that actually represents signal is the vital signs and lab data. The rest of the discrete data is noise …The narrative and visual graphics (including graphic displays of lab and vital signs data) are for us (clinicians). The templated stuff is for the suits and insurance grifters. QED.

Dr. DZA obviously does not trust "templated data" entered into the EHR by physicians. We will take this to mean distrust for computer-generated data relating to a patient that has been created on an automated basis and with a few keystrokes and frequently little forethought. Here's an excerpt from one of my previous notes about such automated data entry (see:  Three Ways to Document a Physician/Patient Visit in an EMR ):

So when exactly does an automated EMR feature designed to save time and energy when documenting physician care lead to a scam? The answer to this question seems obvious to me. A scam occurs when documentation in an EMR is generated automatically and with little or no forethought by the physician about the status of the patient. What is going through a physician's mind in such a setting is obviously hard to document. However, it often becomes evident ex post facto. For example, a note may indicate that a patient is doing well but lab or imaging studies performed at approximately the same time provide evidence to the contrary.

Here't another note on physician data entry into the EHR (see: EMRs and the Data Entry Paradox; Same Concept Not Applicable in the LIS World ). The irony surrounding templated data entry by a physician is that it's having the opposite effect than was intended for EHRs. Computer technology was intended  to emancipate physicians from the drudgery of entering hand-written notes into the paper chart. Instead, it now seems to be casting a shadow on the accuracy and integrity of some of the data being entered. Many complained previously about the legibility of handwritten physician physician notes but there was never any doubt about who wrote them and why.

Physician notes do not exist in a vacuum. There will frequently be other roughly contemporaneous entries into the EHR such as nursing notes, lab tests, and imaging reports. I am sure that inaccurate, templated physician notes will be closely scrutinized by plaintiff's attorneys in medical malpractice suits and used to discredit physician testimony. As a result, hospitals will be forced to place restrictions on the used of template-generated notes.

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