Frequent but fragmented: use of note templates to document outpatient visits at an academic health center.
Recent changes to billing policy have reduced documentation requirements for outpatient notes, providing an opportunity to rethink documentation workflows. While many providers use templates to write notes-whether to insert short phrases or draft entire notes-we know surprisingly little about how these templates are used in practice. In this retrospective cross-sectional study, we observed the templates that primary providers and other members of the care team used to write the provider [...]
Author(s): Rule, Adam, Hribar, Michelle R
DOI: 10.1093/jamia/ocab230