Clinical templates are often seen as tools that help clinicians get through the day. It is important to recognize that they are much more than that.
The way we record our thought processes can shape how we approach complex problems. Clinical templates can contribute to anchoring bias and availability bias, or they can help us improve our metacognition—the way we examine and regulate our own thinking—and strengthen the diagnostic process.
James Clear writes in Atomic Habits: “You do not rise to the level of your goals. You fall to the level of your systems.”
Clinical templates are part of that system.
Templates initially promised a straightforward way to improve physician efficiency within the relatively new workflows of electronic medical records. Over time, however, they have become one of the principal tools clinicians use to complete their work. It is easy to reach a point where finishing the notes feels like more work than the patient encounters themselves. Documentation can leave physicians feeling more like data-entry personnel than clinicians.
Repertoire is a patient-independent clinical template-management tool, not an EMR or clinical decision-support system. Do not enter PHI or patient-specific information. Add and verify encounter details in your organization-approved EMR, and obtain appropriate organizational and clinical approval before use.
How template libraries develop
Many practices maintain a shared collection of dot phrases to help new clinicians start on the right foot without becoming overwhelmed. Clinicians often modify and customize those phrases over time to fit their own styles.
Modern EMRs can still make that process feel like a chore. It is possible to use the same system for years while continuing to feel that its templates could be improved—if only there were time to improve them.
Because of this burden, templates are often built primarily to capture common visits as quickly as possible. That is understandable, but it can have unintended consequences.
Templates affect what comes to mind
Simply put, the diagnoses for which we have good templates may influence what comes to mind in the moment. A diagnosis that is easy to find, document, and act on may become more cognitively available than one without a familiar template.
For many clinicians, one of the most valuable parts of writing a note is the opportunity to crystallize the thought process and review the reasoning one last time before signing. Templates are an important part of that process.
If a template includes a particular workup, the path of least resistance may be to order that workup—or that workup with only a small change. A prebuilt plan reduces friction, making it easier to select and document what is already present.
This is not wholly good or bad. Familiar structure can improve efficiency and consistency. At the same time, an inappropriate default can be accepted with less scrutiny simply because it is already there.
The important point is to recognize this effect while charting and to design clinical templates with it in mind. With greater intentionality and self-awareness, templates can become tools that prompt reflection rather than merely reproduce habits.
Diagnosis-based templates have both strengths and limitations
One approach is to organize templates primarily around diagnoses. This can work well when a diagnosis has been reasonably established and the clinician needs an efficient structure for documenting and carrying out the plan.
Diagnosis-based templates also have limitations. If a clinician must choose a diagnosis before opening a template, the process may reinforce an early conclusion. In uncertain cases, that can contribute to anchoring or premature closure rather than prevent it.
There is also an availability problem. Common—or important but uncommon—diagnoses without well-rounded templates may be less likely to come to mind because they are less available to one’s fingers.
Diagnosis-based templates are also less helpful when a patient presents with a generalized complaint such as abdominal pain and an extensive evaluation is being considered across a broad differential diagnosis. That challenge is also one of the great opportunities clinical templates provide.
Designing templates for diagnostic uncertainty
When the diagnosis is uncertain, a complaint-based template can serve a different purpose from a diagnosis-based template. Instead of beginning with a presumed conclusion, it can help the clinician organize the elements of an unresolved problem.
A well-crafted template might include brief prompts to consider:
- Whether the available findings support the working diagnosis
- Whether any finding does not fit
- What reasonable alternatives remain
- What additional information would change the plan
- Whether the proposed evaluation reflects the current clinical context
- What follow-up or safety considerations need to be addressed
These prompts should not attempt to make clinical decisions for the clinician, and they should not become long checklists that create additional documentation burden. Their purpose is to make important moments of reflection easier to remember.
Each clinician’s knowledge base and comfort with different topics is unique. Specialty, clinical setting, local policy, and organizational expectations also vary. Designing these templates well is therefore something clinicians and their organizations must do for themselves, with appropriate clinical review.
Repertoire’s goal is to make the technology side of that process as manageable as possible so clinicians can focus on the medicine.
A practical template-library review
A clinician reviewing a personal template library can begin with a few questions:
-
Does this template begin with an established diagnosis or an unresolved complaint?
The structure should fit the level of diagnostic certainty at the time it is used. -
What conclusions or actions appear by default?
A default should be intentional, easy to notice, and easy to remove. -
Does the template make one diagnosis or workup unusually easy to choose?
Consider whether that convenience could narrow thinking unintentionally. -
Are important alternatives visible when uncertainty remains?
A concise prompt may be more appropriate than another prewritten conclusion. -
Is the generated text easy to review on its own?
Read the output without looking at the template controls and confirm that every statement remains visible and understandable. -
Who is responsible for reviewing the template?
Clinical language, reminders, and defaults should have a known owner and an appropriate review process. -
When was it last reviewed?
Clinical content should be checked periodically against current evidence, applicable guidelines, and local policy.
The goal is not to make every template longer. In many cases, a shorter template with more intentional defaults and one well-placed prompt may be more useful.
Using reminders to support improvement
In addition to the general template-library features, Repertoire allows users to add private reminders. These reminders can appear alongside a template without being included in the generated or copied clinical text.
A reminder can help a clinician act on an intention they have already formed. It may be especially useful when testing a process change as part of a quality-improvement project.
It is important to distinguish the reminder from the measure. The reminder is an intervention intended to support the desired action. A process measure evaluates whether the relevant step is occurring as planned. A balancing measure can help identify unintended effects elsewhere in the system. The Institute for Healthcare Improvement provides an overview of outcome, process, and balancing measures.
For example, Repertoire’s default Acute Otitis Media template includes a private reminder to be thoughtful about antibiotic prescription duration. The reminder does not select a duration or make the clinical decision. It prompts the clinician to pause and apply current guidance, clinical judgment, and local policy to the individual encounter.
Reminders should remain brief, specific, and actionable. They should also be reviewed periodically so that outdated prompts do not become embedded in the workflow.
Building a better clinical system
Clinical templates will influence our work whether or not we design them intentionally. They affect what is easy to find, what is easy to document, and which paths require the least effort.
The opportunity is to treat templates not merely as shortcuts, but as part of the clinical system in which we think and work. Thoughtfully designed templates can reduce documentation burden while making important choices and moments of reflection easier to see.
Repertoire’s hope is to make clinical template management easier so clinicians can spend less energy managing the mechanics of documentation and more energy thinking carefully about patient care.
If you have suggestions for improving Repertoire, please share your feedback. If you have found Repertoire useful, please share it with a colleague.
Thank you for your support.