Templates and order sets are where an EMR earns or loses clinician trust. Well-built ones turn a five-minute note into ninety seconds and standardize safe ordering. Poorly built ones generate bloated, note-bloat documentation and dangerous default orders. The build matters, and so does the governance around it. For the administrator, this is one of the highest-leverage areas of the entire system: a template touched dozens of times a day repays good design — or punishes bad design — at enormous scale. Treat the build as a clinical product decision, not a clerical configuration task.
Start from real workflows, not blank canvases
Sit with clinicians and watch how they actually document a visit type. The default content that ships with most systems is generic and rarely matches how a particular practice works, so starting from it tends to bake in mismatches you will spend months unwinding. Build templates around their highest-volume encounters first — a primary care template library might start with acute visits, chronic disease follow-ups, and well visits. Capture the discrete data the practice needs for quality reporting and billing, but do not force discrete fields where free text is clinically appropriate. The clearest sign you have gotten this right is that a clinician can document a typical visit without reaching for a workaround or a free-text box stuffed with structured data the template should have captured.
Design for discrete, reusable data
- Use structured fields for data you will report on or send to other systems (vitals, problems, meds, smoking status).
- Pre-populate sensibly, but avoid auto-filling clinical findings that were not actually assessed — that is how note bloat and inaccurate records happen.
- Keep templates short; layer optional detail behind expandable sections rather than one giant form.
- Name and organize fields consistently so the same data point looks and behaves the same everywhere a clinician meets it.
The discipline that separates a good template from a frustrating one is restraint. Every field you add is a field someone must read past, tab through, or decide whether to complete. Capture what the practice genuinely needs for care, billing, and reporting, and resist collecting data simply because the system makes it easy to ask for.
Build order sets that encode good defaults
Order sets bundle the orders for a condition or visit type — labs, imaging, medications, referrals — into a single, reviewable set. Good order sets reflect current evidence and your practice's protocols, and they make the safe choice the easy choice. AHRQ and ONC describe order sets as a form of clinical decision support, which is exactly the right framing: a well-designed set quietly steers ordering toward the evidence-aligned option without the clinician having to recall every element each time. The flip side is that a careless default — a pre-checked test that is not always indicated, or a dose that does not fit every patient — propagates that mistake at the same scale, so each default deserves deliberate clinical review.
| Element | Good practice |
|---|---|
| Defaults | Pre-select common, evidence-aligned orders; require clinician confirmation |
| Dosing | Use weight/age-based logic where supported; avoid hard-coded risky doses |
| Alerts | Reserve interruptive alerts for high-severity issues |
| Review | Date each set and assign a clinical owner |
Govern the library
Make change requests a managed intake
Most sprawl starts informally: a clinician asks a builder for one small change, the builder obliges, and a near-duplicate is born. Give people a single, lightweight way to request a change, and route every request through the clinical owner who decides whether to modify the shared asset, create a personal variation, or decline. Even a short form and a weekly review keeps the library coherent.
Maintain over time
- Version templates and order sets; record who changed what and when.
- Review against current clinical guidelines and updated code sets at least annually.
- Retire duplicates and unused content aggressively.
- Tie changes to a change-control process so updates are tested before release.
Treat your template and order-set library as a maintained product, not a one-time build. The investment in governance pays off every single visit, and the cost of neglect compounds just as quietly — outdated guidance, dead fields, and duplicate content that slowly erode the speed and trust the library was supposed to deliver.