Now what….• You carefully analyzed your office needs• Submitted an RFP• Negotiated the contract• Purchased the hardware, installed the

network and then the software• They have tested it and trained your staff• You are in the process of implementing it• and……

It is time to tailor the system to your personal needs• This section is about templating

• You can customize parts of your program

• This is important because…

Smooth workflow

Saves time

Reduces errors

Tailoring - Like a fitting

• Template - Interact with database

• No two doctors work the same way

• Templates help doctors manage patients

• They help the administrators manage and analyze the practice

First some background Anatomy of the Database

DictationAnother computerVoice Recognition

Keyboard

MACHINE READABLE MATERIALSTORED IN CONNECTING

(RELATED) TABLESCREATED, READ, UPDATED

OR DELETED(CRUD)

MONITORFILE

PRINTE-MAIL

Essentially, it is a form

Paper form used by Kidney Associates to

document dialysis visits

Who builds the template?

Plan form to follow function

and workflow

Buttons toother

templates

Classifyby

stage

Link to web resource

mdrd.com

Modality

choice

Action plan by stage

Can select diag-nostic &

therapeuticoptions for CKD

1+

Anatomy of a template form - CKD

After designing the form, it can be saved and either used

or quickly changed again.

Templates must be modifiable

They are not set in stone

• Not set in stone– Avoid Macromedia Flash– Use design object

oriented, popular design tools

– Modifiable within a few minutes

– Scalable - move quickly across the Enterprise

Template relations

• Relate to a large database of medical standards– Medcin

• Relate to laboratory/Imaging– The template must be able to access fields in your lab

data - NPI, ID patient, lab definition, date

• Relate to your Practice management software– Images, demographics, medications, vital signs

• Relate to the patient’s central record or PHR

HPIAllows free text.

Boxes assurecompleteness

HPIAllows free text.

Boxes assurecompleteness

Common diagnoses are listed. The browse feature

allows access to others.

Common diagnoses are listed. The browse feature

allows access to others.

Form includes Common treatment

options

Form includes Common treatment

options

Buttons link to additional forms

for each CKD component

Buttons link to additional forms

for each CKD component

Completed form for CKD

Completed form for CKD

Templating Practice Analytics

• Database reports– Demographics– Filters– Diagnoses– Labs

• Assist in marketing, trend analysis, planning• Extra cost for application from some vendors

Example: Using a template to capture dialysis billing

Drag and Drop file into right box in order you want reported. Will sort ascending if box is checked

COMMENTS HOSP Number Visits Practice ID Health Plan Vascular surg Guest Shift day Shift time Location

COMMENTS HOSP Number Visits Practice ID Health Plan Vascular surg Guest Shift day Shift time Location

Name Age ZIP FDOD

Name Age ZIP FDOD

Report name____________________Report name____________________

The Future:From paper to algorithm to system

Equitable

Efficient

Patient

Centered

Timely

Effective

Safety

Corrigan, JM.;Donaldson, MS.;Kohn, LT.;Maguire, SK.; Pike, KC. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington, DC: Institute of Medicine, National Academy of Sciences, National Academy Press; 2001.

Measures• Timeliness - Does the form improve patient access, cut waiting

time, move data quickly?• Patient centered - Spend more time, understand, explain, show

empathy and respect• Effectiveness - Will it facilitate practicing evidence based

medicine? • Patient safety - improve workflow and information exchange,

reduce distraction, improve volume• Equity - Expand access to service• Efficiency

– Technical - increase functionality through technology– Productive - improve operations and increase value/time– Allocative - can reassign resources doing duplicative tasks

Take home messages

• The template is a form structure that you or your staff modify to increase the value quality of your practice, efficiency and effectiveness of your service.

• The form must follow your workflow, be easily modifiable, and will be changed frequently as you discover better ways to handle your patients.