EMR Patient Notes - Lessons Learned

The single biggest push back I've had to a completely digital office is from the providers who have to make patient notes. Many cannot type well and all are bankrupt of time. Here are the lessons I've learned from trying to convert people:

1. Finding a patient needs to be easy. Making notes is done from the calender (right click on the patient and hit Add>>Note). Making the providers hunt for a patient by name or number is too time consuming. There needs to be a direct link from the schedule.
2. Total time counts. The providers don't care about login times, response times, printing times. They only care about the total time to takes to get into the system, make a note and get out. Further, it is proportional to the length of the appointment. I find they will tolerate making a note for 10% of the total appointment time. If it is a very short appointment they want an instant note (drop down notes) and if it is an exceptionally long note they will want to dictate it.
3. Logging in takes time. Originally we would have the provider log into the computer than the EMR software so that the active directory could be used for authentication. It was too time consuming so we switched to a 'kiosk' system where the provider just has to log into the EMR software
4. Some things have to be dictated. There are some notes that need to be dictated. Either the provider is a slow typist, the note is detailed, long or requires a lot of thought. It should be as easy to dictate as type a note.
5. Templates are great if they are personalized. We use Word templates with data merged from the EMR system and Fill-In boxes. Most of the providers prefer to learn how to modify the template and make their own.

Of all of the road-blocks I've run into time is the biggest. Keeping the start-to-finish time to make a note about 10% of the total appointment time is critical. That means having different ways to make a note. Boiler plate text, templates, free-hand and dictation all play a role to achieve the 10% goal.