Why Your EHR Templates Are Destroying Your Functional Medicine Practice

This is a story about why I stopped using other people’s templates and built my own system completely instead. So when an EHR company is trying to sell you their software, they really brag about their template library. It’s like a big selling point as if you can’t write a template because you have to write a template. It’s a physical exam or a treatment plan. It’s not hard. But if you’d ever tried charting using somebody else’s templates, a functional medicine patient, oh my gosh, they just don’t fit. It’s a huge customization, right? And it’s not your fault, it’s that the architecture is wrong. So, in Espre,  we’re template friendly. We have them. but the templates are typically built by you. We provide a few of them, like a hundred or so, but usually they’re by you for your method of practice. And that’s not a subtle distinction. That’s the whole point, right?, Traditional EHRs, like the old school EHRs, were built to get providers paid. That makes sense. Chief of complaint, diagnosis code. That’s the template, right? Justify the visit for a 10-minute sick visit. and it’s awesome. But when you’re tracking all the parameters, gut health, hormones, environmental triggers, and 10 years of symptom history, um you don’t have a template for that, right? Oversimplifying the story is not a good answer.  you do is you wind up working around the templates, which that’s a time suck. It doesn’t make any sense at all. Right? ou’re going to spend hours working around those templates.The templates haven’t really helped you at all. I want to explain today why a billing first architecture in an EHR completely fails in functional medicine where the patient story center design really is amazing and you probably haven’t ever heard it or seen it before because I don’t know of any other software that really does it that’s like the core of the foundation and what will change if you actually think about someone who would actually hand you the patient’s story in a way if you had an amazing medical student who went into the patient’s room and asked them a two or three hour history and really worked through it and came out and said, “Here’s the top three things.” Documentation like that is absolutely critical and unbelievably valuable. Imagine if you could finish it all in the patient’s room during the visit and never have to work at night or weekends anymore, ever,? Generic templates oversimplify. And the EMR companies, the old school EMRs want you to believe that the answer is more templates and macros and drop downs. But the problem is not the quantity of that stuff. The problem is that none was built for you.?Functional medicine is built on understanding the individual. So you want to know that person and you want to know their story and how all those different symptoms and everything combine to make that person functionally adequate or functionally excellent., you need the timelines and you need when they took antibiotics and what exposures they had to environmental toxins and um did they have a treatment that worked because that’ll show you what direction you might want to go. Did they have a symptom or a treatment that failed because that might tell you where not to go. no prepackaged template library can possibly help you with that. what happens is you have this gigantic pile of templates and you have to pick one that’s close and you’ll get one that’s close but it’s never going to get it done. they become a problem all on their own. And Espre is different because though we use templates, they’re actually after the story. the template is for I’ve looked at this story and I think I’m going to do with this patient. I think I’m going to do a trial of an antifungal detoxification protocol. my template is here’s the risks and benefits of antifungal therapy and here’s why we expect it should work and here’s some of the ways that you can do it. That makes perfect sense,, all of that is built around the story. software should adapt to your workflow and you shouldn’t have to hunt for templates to try to make that thing work. the system works with you instead of against you, when the foundation is right, when it’s all about the story, it’s going to flow. Building first architecture forces the wrong workflow is built around maximize reimbursement not patient understanding not clinical clarity like oh man I know just what to do it’s going to be awesome it’s about revenue ICD10 CPTs reimbursement compliance so that chief complaint diagnosis billing code done wow that does not really tend to make people better that tends to get a single problem resolved possibly um different pathway the patient story that is the gem or the jewel of Espreand it’s done for you in a way that is so incredibly elegant. It’s fast. The patient can get it done typically if they’re computer savvy in 10 minutes. If they’re not, half an hour max. But you get so much information that would take you hours to extract. root cause is kind of sitting there in plain sight for you. And you can begin there and begin to refine thathistory just a little bit and build a healing plan. And you have templates for that if you want. You can build templates. Easy to do. content management is super easy. Practitioners end up managing health care rather than accounting systems and their thinking gets shaped instead of by billing requirements by what the patient needs and the difference is unbelievably dramatic. Going through a medical journal in the back there’s a whole bunch of equipment covered by insurance. Covered by insurance. So that’s what you think about because you know the insurance will at least cover it and you can keep your office open. That’s not healing.. You’re thinking about a business surviving. If you decide to make the switch and decide to go insurance free and actually get the incredible joy that comes with healing which is my primary job. I’m not running a data entry system so that I can get paid by an insurance company that’s a third party designed to destroy my life basically. that is a broken system and you want to get out of it. duplicate entry is absolutely guaranteed in this situation because you’re trying to justify billing and coding and you have to make some kind of effort to handle healing in the treatment plan and how all that works. Traditional systems force the same information into a whole bunch of locations so that you can justify your payment structure. I’ll give you an example. The patient feels depressed. Now you need to show the flow and the complexity of the situation so that you can bill for a highly complex visit. So the nurse will document it. The patient’s depressed, they’re and now they’re being asked how depressed are you? Like I’m really sad. It’s been a really hard year. And then the doctor comes in and magnifies that and asks him how depressed are you? It’s not a good plan physician will document it again. Now your diagnosis code’s going to be somewhere else entered by probably a billing person. now you have the nurses, the doctors and the billing person stuff, all separate documentation About one issue Here’s a better approach. How about a system that captures that information once when the patient is  at home and then they answer questions derived from the Beck Depression inventory, maybe the PHQ9, You might have heard those, They’re part of the idea behind ESPRE validated questionnaires, questions that are derived and designed so that you can ask those questions subtly in a regular interview and really get the data you need to make a decision. Is this patient actually depressed? Once you know that and their depression score is high, you need not ask it again. What you may want to ask is, you know, have you ever thought of killing yourself? Is it that bad? Of course. So those relevant follow-up questions are yours to decide. and it comes through the workflow. you don’t have to repeatedly ask the question. You also don’t have to repeatedly write down the answer, which is amazing. You don’t lose details. They’re there. No conflicting documentation. The story is the story. Every time that you have to do these duplicate things, you have an opportunity for error, for miscommunication, and also for just annoying the heck out of the patient, which I think is disrespectful. when you do that Espre service, the answer is already for you before you even talk to the patient. You know before you go. When you have ESPREonline intake questionnaire, you’re able to get a dramatic shift in the way that 60 minutes is spent. When the patient provides you with all that basic data before that you can’t possibly get in a 60-minute visit. You can’t sit down with a patient for 60 minutes and do what ESPREwill do for you and provide for you in a 30 to second to maybe two minute evaluation of that ESPRE output. So you could spend 60 minutes in a patient room asking questions and hey’ll dillydally with some of those and they won’t quite have a good answer for you and they may not directly answer you or correctly answer you and that data will present it to you so that you can get all of that in 30 seconds to two minutes that you could not get in 60 minutes of of interview. The functional medicine work requires an understanding of all sorts of symptoms and hormones and antibiotic history and stress and previous treatments and gathering all of this live is unbelievably inefficient and incomplete. So a better idea is put it into an online questionnaire eliminate missed questions make it systematic because I know if I go to a thyroid conference that next week everybody’s a thyroid patient I got to prove they’re not or I have o prove that they are and that’s where my brain goes because I’m a human being. I can’t help it. But if you use a systematic questionnaire, you’re going to ask the proper questions. Do you get constipated? Do you feel chilly when everyone else is warm? The questions that are validated, you know that they’re common problems with a patient with a thyroid condition. Do you have a rapid heart rate? Do you have dry skin, the things that we know, To ask those questions of each patient in an interview, incredibly time consuming. Once you have that data and it’s clear that they have a very high probability, then you want to ask the other questions. What is your family of thyroid? You might not have answered it fully, right? You already know the story. The visit becomes a conversation instead of an interrogation. Hey, looks like you got some thyroid stuff going on. Did you note that? Oh, yeah. You ‘ve talked about that before. Does anybody you know have that? Your mom, your dad, your Right. So, they feel like you know them before you’ve ever really had a conversation. I mean, certainly you’ve had an interaction with the ESPRE output, which makes you unbelievably far ahead of the game., but providers will spend so much less time collecting information and way more time solving a problem and creating relationships. And I don’t know if you know this or not, but there’s a lot of focus on the power of a relationship being the medicine. When I walk into a patient’s room confident, they’re confident that I know them and know their story. That is a healing event for them. That is a step in the right direction. Their hope rises and their opportunity with it, right? The documentation moves everything forward for you and you don’t have to do all that basic stuff. Basically, it’s almost like a medical student in the hospital doing their first histories. It does that all for you and you don’t have to do it anymore, And finishing that documentation for you as you walk into the room makes it possible to do the next thing. You can actually complete the entire visit in the patient’s room with them at the time of the visit. So instead of asking the questions, even the refinement questions and then making some notes and then finishing your visit and going back to your room and then finishing them, you can actually do it in the room. We have a large screen TV.so instead of having the system failure that goes with turning your laptop away from the patient and writing while you’re talking to them once in a while, you can actually see what your schedule is and how the patient’s going to interact with you. You can see their health score. Basically its there if you answer every system question and you have an output and this patient is really well and they have no problems their health score is going to be 99%. But if they have a whole lot of problems in every system their health score is going to be 40 or 50% or less. So you have a visual indicator of what’s going on with the patient. You can prepare before you walk in the room but then when you do walk in the room you can show them that indicator and say man you really must be struggling. How do you feel? I feel horrible. And patients can see the large screen. Together you look at it. You pull the lab results up, huge, gigantic display. You know, it’s two feet wide by three feet long. I mean, it’s easy to see, And you can discuss what a hemoglobin A1C means. If they’ve had a few previous visits, you can just show them the graph and show them their trend as they’re getting better  you can see their A1C drop and you can compare it to any other value that you want. And then when you say to them, hey, you know what I think you should really consider? I’d like you to consider taking a GLP-1 because your A1C is going up or you don’t need to take that anymore. Your GLP1 medication is no longer necessary. You’re down where you need to be. They can see that and then they can watch you write a prescription and as you do that on the large screen, they can participate and say, I don’t want it right away. I want to wait a month because I have an anniversary, whatever., then supplements, same. Laboratory testing, same lifestyle recommendations, they can participate with every one of them. You know what? I think you should probably stop drinking. You know, I’ve tried before. I can get down to one beer a night. I say, “Well, start there. That’s your lifestyle recommendation.” And then they can watch and at each visit, enjoy the outcomes. But the nice part is your documentation is completed during the visit. Patients see what’s being recorded. You can actually do your invoicing and everything based on your primary interaction that Espre gives you. Press a button and you’re done. Confusion decreases. No late night charting,your relationship with your patient completely shifts. So rather than the provider documenting the patient, this is so cool. The provider and the patient build a plan together. And the benefit isn’t just efficiency, right? The benefit is building this incredible relationship with the patient in the patient room while in the background, little known to anyone else. You’re saving yourself that night, that whole night because you got all the charting done,  instead  can be at a family dinner or your kids baseball game or just taking a break, you know, and kicking it when you get home, it’s happening in the patient room and everybody benefits. Energy returns, your engagement with the patient, collaboration is better. the whole thing is entirely different and I don’t think it’s well understood and I haven’t seen another system do it. and burnout that we’re talking about in people working with EMRs. I the idea of an EMR is horrible. It’s just the EMRs that we have now, the old school EMRs, their architecture is horrible. It doesn’t take any of this into account any of the patients ability to actually connect with you during the visit and create an outcome of a collaborative chart. Unbelievable. When your tools stop draining you, everything changes. So before I go to the end here, one thing that you have to do, if you’re looking for EMR EHR, you need to know what kind of questions you need to ask f. Ask us. We’re happy to answer any question you have. These questions particularly ask because we’re great at answering these. you ask the question, how does your system capture the patient’s story and organize it? Most don’t, is your architecture built around the patient narrative or their story or is it around billing codes? Can the system organize that story? Does it track timelines? can practitioners build their own templates? How about supplements and special labs? Is that built in? how about collaborative documentation? That’s kind of a cheat. No other system has it, so you can ask, but it’s not likely they’re going to see it. Vendors are going to talk about billing, coding, claims, compliance. That’s pretty much it.the workflow starts with basically revenue cycle of the insurance collection and that really doesn’t lend itself to knowing the patient well. You might have figured that out pretty well for yourself. So this answer to this question reveals everything. It saves years of frustration and thousands of dollars and countless hours of administrative burden. Does your system help you understand a patient? And if it doesn’t, that’s probably not the one that you want. So you should see us free. So if you’re drowning in documentation and wondering if there’s a better way, yes, of course there is. And I think I’ve told you a lot about just the idea of shared documentation development. It’s unbelievable. Imagine working inside a system built around the patient’s story instead of the code, the billing code. Finishing your notes before the patient leaves the room, going home with charts are done. That’s what happens when your software is designed for the way you actually practice. And it takes about a week or two, maybe a month to really develop this in room documentation style. And you can learn how to do it if you start with a free trial of ESPRE. No  payment required and no commitment. Just experience what happens when your EHR is finally built for functional medicine. You’ll love it.