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DocAPProvED: Templates Save the Day with a Workaround for EMRs

Mohseni, Alex MD

doi: 10.1097/01.EEM.0000466619.85746.8a

Dr. Mohseniis an emergency physician in the Washington, D.C., metropolitan area and the chief innovation officer of Emergency Medicine Associates. He is the editor of his own blog, Follow him @amohseni, and read his past columns at





EMRs have solved certain problems, such as legibility and automatic allergy and drug interaction warnings, but it's no surprise that enterprise EMRs have failed dramatically in one important aspect: usability. Usability is so poor and productivity has been impaired so much that most providers have never returned to pre-EMR productivity levels and have been forced to seek workarounds, such as scribes.

If you are paying $18 per hour for a scribe and seeing two patients per hour, that means you are paying $9 per patient. We should be considering that this ongoing cost of enterprise EMRs has been transferred onto the physicians. When is the last time you received a survey from an enterprise EMR asking for your feedback on usability?

Thankfully, emergency physicians are an innovative bunch, and workarounds abound. One specific solution that is particularly well done is CD Notes (, the brainchild of Chris Davison, MD, an emergency physician. Dr. Davison has created a series of more than 100 templates that can be integrated into Epic, making documentation simpler, faster, and more thorough. Each template is thoughtfully designed with an intuitive layout and rapid and easy movement among input fields. Most fields have common answer choices already written that are selectable as dropdown fields. Templates include important elements critical for risk management and accurate coding, each specific to the complaint. Several videos demonstrating the product are available at

Using CD Notes, physicians can document a complicated chart in less than three minutes, which is significantly better than doing it from scratch, which takes about six to eight minutes. If you're not currently using scribes, CD Notes is a great option. If you are using scribes, you will have to calculate the value of three minutes of doctor time versus the cost of a scribe. Kudos to Dr. Davison for giving us a great workaround for the usability crisis in which we're stuck.

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