Are Templates Good for EHR Clinical Notes, Clinician Burden?

While clinical note templates aim to streamline EHR documentation processes, their individualized nature could contribute to poor note quality and clinician burden, according to a study published in JAMIA.

Clinical note templates aim to mitigate EHR-related clinician burnout by reducing documentation time, supporting chart review, and providing clinical decision support. But this most recent study found clinical note templates aren’t always effective, and in fact can be counterproductive.

Researchers analyzed outpatient EHR metadata from an academic health center between 2018 and 2020 and found that clinicians used templates to document 89 percent of visits.

However, while template use was pervasive, it was also fragmented across the organization. Clinicians used 100,000 unique templates over the course of the two-year study period, and 83 percent of templates were only used by one clinician.

What’s more, even though EHR clinical note templates can aid clinician burden in the short term, such a large volume of individualized templates could present challenges during system updates.

“Individual template development can align documentation workflows with clinical workflows, but it may also duplicate effort and increase EHR burden, such as when policy changes require thousands of individual templates be updated simultaneously,” they suggested.

That fragmentation might also lead some clinicians to use templates with outdated guidance, resulting in poor note quality.

The study authors suggested reframing template use as a form of computer programming to maintain the benefits of personalization while still invoking standards to reduce clinician burden.

“Health systems might treat their collection of templates like an application programming interface by developing standards for naming, documentation, and scope of use,” the researchers wrote.

“Version control systems—which let individual developers ‘fork’ and edit documents while preserving a link to the original so changes can be propagated to their copy without overwriting their edits—might let individual clinicians tailor default templates to their unique workflows while still making it possible to quickly propagate changes across an organization when policies change,” they added.

Future studies should look at clinical note template use in multiple types of healthcare organizations, as opposed to a single academic medical center. Additionally, researchers might look into how other documentation aids—such as dictation, copy-paste, or form-driven note writer—change workflows.

The researchers noted there are many promising directions for future work related to clinical note templates.

They suggested researchers study documentation workflows further in terms of who invokes templates, when they use them, and how templates support team-based care.

The authors also said that future work should also examine template lifecycles; what prompts people to create templates, how others edit them, and what causes some templates to go “viral.”

Researchers should also investigate what training users receive on template design and how organizations monitor template use, as well as how features like version control can enhance note quality and reduce EHR burden for higher quality care delivery, they added.