Should you switch to template documentation?
Cut time in half and save up to $150,000
Template charting systems are a new approach to documentation, consisting of preprinted sheets for specific chief complaints. Checkboxes and diagrams are marked by the physician, which cuts documentation time in half compared to traditional methods, eliminates transcription costs, and ensures accurate coding.
"There is a definite trend of many EDs switching to this system," says Louis Graff, MD, FACEP, FACP, associate chief of emergency medicine at the University of Connecticut School of Medicine in Farmington.
The written chart is obsolete, Graff argues. "It may be cheap, but it cannot meet even the old, let alone the new, HCFA [Health Care Financing Administration] documentation requirements," he says. "The template system is readable, meets documentation requirements, and is quicker since much of the charting can be done at the bedside while interviewing the patient."
Here are some potential benefits of template documentation systems (see sample, p. 93):
• Reduced costs.
The costs are between those of traditional dictation and voice-activated dictation, or approximately $1 to $2.50 per page depending upon the vendor and product, says Graff.
EDs that switch to template charting from dictated transcription can save considerable amounts. "We saved our hospital between $125,000 and $150,000 in transcription fees," reports Wayne Christiansen, DO, FACEP, an ED physician at Charlton Medical Center in Fall River, MA.
• Quicker documentation.
Both voice-activated and traditional dictation take between four and six minutes, says Graff. "Template is purported to take half that. There have been no published studies, but the users who have switched from dictation are claiming great time savings," he notes.
Because there may be hundreds of different templates, a well-designed form enables clinicians to learn quickly where specific sections are. "Once they have learned that, when they pick up a template form, they instantly know where to look for a particular item," explains Randall B. Case, MD, FACEP, director of emergency medicine systems for Cerner Corp., a supplier of clinical information systems based in Kansas City, MO. "That isn’t the case when you are using a free-form paper chart." (See list of vendors, p. 94.)
• More accurate coding.
The information needed to qualify for various levels of care is already on the template. "That serves as a mental cue to remind you to ask for certain elements which are necessary for the patient history, or look for certain things on the exam," says Christiansen. "That ensures you qualify for whatever level of care is indicated for the problem."
For example, the diagnosis for a patient with a cold may seem straightforward, but specific questions may reveal additional problems that aren’t readily apparent. "For example, you may discover the patient has a sore throat, a rash, or headaches," he says. "When you start doing the physical exam, you find you have moved from just one single body system to several." The diagnosis is substantiated by a more extensive history and physical, and more time is involved, and it may qualify for a higher level, he explains.
However, a recent study showed that gross billing was $29.60 more per patient with template documentation, compared with standard written documentation, due to a higher level of evaluation and coding.1