Emergency Department Consulting and Management

System	Advantages	Disadvantages
Handwritten charts	Cheap - essentially no cost up front Quick (the more incomplete, the quicker they are)	High risk of inadequate doumentation Lower quality of care Increased malpractice exposure Lower reimbursement Slow charting (if done properly)- poor physician productivity Often illegible and leads to: Poor medical staff relations High risk of poor continuity of care Slopping appearing charts Poor risk management> JCAHO citations for illegibility
Dictation	Very legible Medical staff loves them JCAHO preference EMR compatibility - text can be searched improving QI integration	High cost Often unavailable Requires transcription Delaying availability Potential for poor continuity of care Potential risk management issues Very slow - poor productivity High risk of inadequate documentation Requires quiet area to dictate Any bedside work (notes) must be redone
Templates	Variable costs - some are low Substantial increased productivity Rapid attention to billing requirements Can incorporate risk management coaching Can incorporate QI adherence directives	Variable cost - some present significant cost considerations Often poorly accepted by medical staff Cluttered appearance makes key info hard to see Can present a steep learning curve. The higher the number of templates and the more cluttered the template, the worse the problem. Often offer little ability to indivdualize chart to address specific needs of a patient or case The greater the number of templates, the greater chance of using the wrong one (they are selected before the encounter). Unexpectedly high complexity visits may be undercoded as template not designed to capture the higher level of required elements. Lost revenue. Unexpectedly high complexity visits may be undercoded as template not designed to capture the higher level of required elements. Lost revenue.

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