Tim Cook wrote:
>
> "Daniel L. Johnson, MD" wrote:
>
> > > BTW: Did you see Chason's email about templates? If you aren't
> > > interested in writing your own he will do some if you send him
> > > some information that is in a checklist type format.
> >
> > Unfortunately, I am not in a position to use your wares within my group, for many
>reasons, most of which boil down to lack of time, lack of skill, and sure knowledge
>that whatever I do on my own will hit a dead end here.
> >
> > So my comments are purely for your benefit.
> >
>
> I appreciate that but are you not able to share some generalized
> checklists that could be used for building templates?
Well, I never use checklists or templates. My impression is that only what's in the
busy clinician's head is accessibly quickly enough to actually use regularly, and only
if it's
not in our head do we look it up.
Rare is the doc who, like Alex Caldwell, actually has the skill and time to create his
own progress notes either by typing or by picklisting. My chief experience is with
the FAA's
web-based data entry, which adds about 15 minutes to the airman medical exam, and
which I would never use if it were not mandatory, and is instructive on the
limitations to
ergonomics inherent in web-based data input.
I cannot imagine a busy, skilled physician actually using a template to manually
document all visits on a computer. I can imagine him looking at a template while
dictating, and a
transcriptionist entering boilerplate material at his direction.
I would judge that there are two drivers to the use of templates in clinical practice:
one is reimbursement. A template for coding based on the CPT guidelines would
possibly be
used sometimes ( <5% of visits, I'd guess), and a template used in ongoing chart
review for quality assessment would, especially if simple.
In general, templates cover what we already know and are not flexible enough to
accommodate the hundreds of individual variations we see daily.
In addition, there have been for at least 15 years some medico-legal reservations to
the use of boilerplate in making chart notes, as they reduce the credibility of the
doctor's
claim that he actually took the individual's personal unique needs into consideration
during the visit -- important when on the witness stand in the doctor's own defense.
The
proponents say it documents completeness; the opponents say it fakes completeness.
Templates may be based on practice guidelines.
For the US resource, see
http://www.guideline.gov/body_home_nf.asp?view=home
For the premier US private organization fostering guidelines, see
http://www.icsi.org/
and their list of templates is at
http://www.icsi.org/guidelst.htm#guidelines
I don't know if any are downloadable without a $$ contribution.
Each of our docs is supplied with their pocket edition. We may look at these on rare
occasion. (not much news in them)
Hope this helps clarify the world situation.
Best wishes,
DJ
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