Home Forums Discussions General Discussion Issues with templates

I have a number of templates for the various chart fields. I have noticed inconsistencies in the appearance of the template information, when it is entered into the section, primarily in regards to spacing between lines. Sometimes, this is altered, with a skipped line being left out. An example would be a template I have for patient instructions, as follows:

PROBLEMS DISCUSSED:
-

MEDICATIONS TO START:
-

MEDICATIONS TO CHANGE:
-

MEDICATIONS TO STOP:
-

LIFESTYLE INSTRUCTIONS:
-

OTHER INSTRUCTIONS:
-

TESTS SCHEDULED:
-

FOLLOW-UP:

Turns into:

PROBLEMS DISCUSSED:
-
MEDICATIONS TO START:
-
MEDICATIONS TO CHANGE:
-
MEDICATIONS TO STOP:
-
LIFESTYLE INSTRUCTIONS:
-
OTHER INSTRUCTIONS:
-
TESTS SCHEDULED:
-
FOLLOW-UP:

Usually, this is more frequent when my nurses enter the templates. I have noticed it more frequently when I have entered the template but then delete it and then go back and click the template again. It happens under the physical exam portion as well as the patient instruction portion of the chart. I cannot find an explanation as to why this is happening. It does become a nuisance because we use templates daily.

Has anybody else had problems with this?

I probably can't help but am interested in your situation. First, and I am thinking this must be a dumb question, but I don't see any different except that there is one less line. Reading your statement, am I right to understand that sometimes it doesn't skip a line?

So, is it a hardship that use it normally when it is formatted correctly, but when missing a line, you just hit the enter key once or twice more? And, the nursing template was an exact copy?

I have to give you props. This is a lot of information to add. I wish I could be as thorough.

Just some ideas to try. I tried to reproduce the problem, but I couldn't. Three questions:

1. Are you double-clicking on the template so it goes directly into the plan box?
2. Are you checking the box in the template window where it goes to the right view box and then clicking on Move to Chart? You could at least see if it formatted correctly.
3. Have you tried opening the Enlarge Textbox, and using the template from there and then doing one of the two above?

I usually click the box in the template window to move it to the chart. I think that is when I see the inconsistency. Usually, I have the enlarged text box view open when I do this. I will have to experiment a little more and observe it, because I cannot give the answer with 100% certainty.

Although it may seem to be no big deal when I have to return more than once, it does become time-consuming if I am doing a Medicare wellness visit, for example, where there are multiple sections that are templated, such as a physical exam, followed by lab work, followed by diagnostic studies, and the line spacing is incorrect. If my nurse imports the template before I touch the chart and does not catch the altered templated text, multiple lines will run together and I then have to spend extra time hitting the return bar to space things properly. This is about as frustrating as having to click buttons multiple times just to print an invoice after I have signed off on the chart. There are only so many hours in a day.

Have you had the experience where, after you click to transfer the template text to your field, the first word is moved over one space instead of being even with the rest of the text, in the box where the template was entered? This happens all the time to me.

UPDATE: So far, I have noticed that the spacing is as per the original template, when I click the selection from my template. However, when the same template is selected from the practice-wide templates, the in-between line spacing disappears. This has been a consistent finding.

I can confirm this spacing bug also. When I insert a template created on my account, on my computer, the spacing stays the same. When I insert the same template from practice-wide (ie on another workstation), the empty line between the paragraphs in the template is lost.

However the one space indent of the first line in any template is occurring both locally & practice wide.

I have found the templates overall to be a bit cumbersome. My nurse uses mine, but she imports them. My ROS is set up to where you they list 10 ROS, and you can click on Y or N. Because earlier I set mine up where the Y and N were "tabbed over" they always come out straight Hers always come out crooked as she just spaced over so many lines.

Maybe somehow you can import yours into your nurses rather than from global. This was one of the "Big 83" from years ago that had many good ideas (John remember the II folder tree issue -- opened open by default). At least it was fixed. Most of the others were squashed, because they were not requested by enough new people. No, they weren't requested, because they had been talked about for months and month.

I have one place where the cursor is one to the right on the second line. But, I do know that with diagnoses, the cursor could go anywhere.

AC's biggest issue, IMHO, has been formatting. That't the one problem when one doctor creates the program. The program is awesome because it was developed by a doctor who knows medical flows, but there is also a bias. JB just wasn't into good formatting. This shows up in messaging and plan. I brought up at a meeting well over a year ago about custom printed labs, because our lab wants labs in a column so they can work with them. Check them off, etc. It was cool, because in the GoToMeeting we had a screen with an AC employee showing another thing on AC. I asked her to do the lab thing, and it showed the horrible formatting you get.

ORDERED/ADVISED: - Custom Order (
CBC with differential
LDH
ESR
LDH
Uric acid) ICD Codes (R50.9)

Sometimes the CBC would be in the Custom order slot, and the lab will miss it. This is how it appears in the chart. The parentheses were designed for labs made from the lab tab, where all of the labs would be in a sentence-type style. But, here just because we use Custom Orders, does it have to say that? And, is the EMR smart enough to know it is a custom order and get rid of the parentheses? And, does it have to say Ordered/Advised? Is that for legal purposes?

Sorry to hijack the thread. It's similar. And, I know developers hate when we say, it is just one line of code, but I don't think it isn't because they can't do it, they just aren't doctors, so they don't see it as a problem. I remember for years, having the time on the allergy change. And, now with the updated by.... it has the date (good) and the time (do we need that)?

The II default open folder, ah...just a bad memory.

Whew! Finally, I can go home. I have been sitting here waiting for your comment, lol. If I recall, it was number one of the Big 83. At least one thing on the Big 83 got done.

I've spent a great deal of time constructing templates, and I'm wondering if anyone else has done this? No, they are not a substitute for charting, but they are a place to start.