Section 10.3: Building Templates, Macros, and Order Sets

10.3.1 The “Why”: The Compounding Cost of Clicks and Keystrokes

As a pharmacist, you have an intuitive understanding of the power of compounding. A small amount of interest, applied consistently over time, yields an enormous return. Unfortunately, this principle also applies to inefficiency. Every unnecessary click, every manually typed repetitive phrase, every moment spent searching for the same combination of orders is a small “tax” on your time and cognitive energy. Individually, these moments seem trivial—a few seconds here, a minute there. But compounded over the course of a 10-hour shift, across a 40-hour week, and throughout a 50-week year, this tax becomes monumental. This is the hidden cost of manual labor in a digital environment, and it is a primary driver of the phenomenon known as EHR burnout.

This section is dedicated to eliminating that tax. We are moving you from being a simple user of the EHR to being an architect of your own workflow. The tools we will discuss—templates, macros, and order sets—are not “shortcuts” in the sense of cutting corners. They are professional-grade efficiency instruments designed to achieve two critical objectives:

1. To Enhance Safety and Standardization: A well-designed template for a vancomycin dosing recommendation ensures that you never forget to include the patient’s weight, renal function, and target goal. A personalized order set for aminoglycoside monitoring guarantees that the correct peak, trough, and renal function labs are ordered every single time. By automating the process, you are hard-wiring best practices into your workflow, reducing the risk of human error and omission. Consistency is a form of safety.
2. To Achieve Cognitive Unloading: Your brain has a finite amount of high-level processing power in a given day. This precious resource is your “clinical judgment.” Every ounce of mental energy you spend on mundane, repetitive, clerical tasks—like typing out your contact information at the end of every note or looking up the standard orders for initiating warfarin—is energy that cannot be spent on solving a complex clinical problem, catching a subtle drug interaction, or having a crucial conversation with a provider. Automating these routine tasks is a deliberate strategy to “unload” the cognitive burden of the clerical so you can dedicate your full intellectual capacity to the professional.

Investing a few hours to build a robust library of personal automation tools will pay you back with hundreds of hours of reclaimed time and thousands of preserved cognitive cycles over the course of your career. It is one of the highest-yield investments you can make in your own professional effectiveness and well-being.

10.3.2 The Cornerstone of Efficiency: Note Templates (SmartPhrases / DotPhrases)

The single most powerful and frequently used automation tool in any EHR is the note template. The concept is simple: you create a pre-written block of text and save it with a short, easy-to-remember trigger phrase. When you type that trigger phrase into any text field and hit a key (like the spacebar or Enter), the system automatically expands it into your full block of text. This simple function will save you thousands of keystrokes every single day.

Masterclass Table: Common Terminology Across Platforms

For the rest of this course, we will use the generic term “DotPhrase” to refer to this functionality, as it is the most widely understood slang. The trigger is so named because it often begins with a period or “dot” to distinguish it from normal text.

Anatomy of a Powerful Pharmacist DotPhrase

A basic DotPhrase is just static text. A powerful DotPhrase is a dynamic template that prompts you for patient-specific information, pulling data directly from the chart and ensuring your note is both efficient and comprehensive. Let’s dissect the key components.

• The Trigger Phrase: This is the short code you type to call the template. The key is to create a naming convention that is logical and easy to remember. A good convention might be:
  • Start with a consistent prefix: Use your initials (e.g., `.jd_vanc`) or a department prefix (e.g., `.rx_vanc`) to keep your DotPhrases organized and avoid conflicts with system-wide phrases.
  • Be descriptive but brief: `.vancinitial` is better than `.v1`, and `.warfarinbridge` is better than `.warfarinprotocolnumberone`.
• Static Text: This is the boilerplate content that will be the same in every note. It includes your section headers, standard explanations, and your signature block.
• Wildcards (The “Fill-in-the-Blanks”): This is what makes a DotPhrase dynamic. A wildcard is a special code that acts as a placeholder. When the DotPhrase expands, your cursor will automatically jump to the first wildcard, allowing you to type in the patient-specific information. In Epic, the wildcard is three asterisks (***). In other systems, you might use a function key like F2. A well-designed template will have wildcards for every piece of unique information.
• SmartLinks (The “Auto-Fill”): Many EHRs can take this a step further with SmartLinks (Epic’s term), which are special codes that automatically pull discrete data directly from the patient’s chart into your note. For example, a `@NAME@` SmartLink will automatically insert the patient’s name. A `@LASTLAB(SCr)@` SmartLink will pull in the value of the most recent serum creatinine. Using these is the hallmark of a true power-user.
• Instructional Text: These are prompts or reminders to yourself, embedded within the template, that guide you on what information to include. A common convention is to enclose these in brackets `[ ]`. For example: `[Enter indication for vancomycin here]` or `[Ensure trough was drawn correctly 30 min prior to this dose]`. These instructional prompts are meant to be deleted from the final note before you sign it.

Building Your First Template: A Step-by-Step Guide for a Vancomycin Dosing Note

Let’s walk through the creation of the most common and essential pharmacist DotPhrase: an initial vancomycin dosing recommendation. Our goal is to create a template that is fast, comprehensive, and guides us to follow best practices every time.

10.3.3 Pharmacist Template Library: Essential DotPhrases to Build on Day One

To accelerate your efficiency, here is a comprehensive library of high-yield DotPhrases that will cover a significant portion of your daily documentation needs. You should use these as a starting point and customize them to fit your institution’s specific policies and your personal preferences. For brevity, we will show the final, complete template text.

Category: Pharmacokinetics & Dose Adjustment

Category: Anticoagulation Management

10.3.4 Beyond Notes: Building Personalized Order Sets and Favorites

While DotPhrases streamline your documentation, Order Sets streamline your therapeutic interventions. An order set is a pre-configured group of related orders (medications, labs, nursing instructions) that are commonly prescribed together for a specific condition. Hospitals and health systems invest enormous resources in developing evidence-based, official order sets for conditions like Sepsis, Community-Acquired Pneumonia, or Acute MI. You will use these official sets every day.

However, most EHRs also allow you to create your own personal order sets or “favorites.” These are not meant to replace official protocols, but to make your own common workflows more efficient. Think of them as your personal “go-to” bundles for tasks that you, as a pharmacist, perform repeatedly. The goal is to take a multi-step, multi-order process and turn it into a single, one-click action.

Step-by-Step Guide: Building a “Pharmacist Aminoglycoside Monitoring” Order Set

Let’s say a provider orders tobramycin for a patient, but forgets to add the necessary monitoring parameters. This happens frequently. Instead of manually entering 3-4 separate orders every time, you can build a personal order set to do it instantly.

The Result in Practice:
Before: The provider places the tobramycin order. You see it in your queue. You realize there is no monitoring. You then have to manually search for and create four separate orders: trough lab, peak lab, daily BMPs, and the nursing communication. This can take 2-5 minutes of clicking and searching.
After: You see the tobramycin order. You go to your personal favorites, click “RX AMINOGLYCOSIDE MONITORING.” All four pre-configured orders populate the screen. You review them for appropriateness, sign, and you are done. The entire process takes 20 seconds.

10.3.5 Advanced Tools: Macros and Workflow Optimization

While DotPhrases and personal order sets will account for 80% of your efficiency gains, true power-users can leverage even more advanced tools to automate their workflows. These tools often exist at the operating system level or are deeper features within the EHR that require more setup.

• Macros: A macro is a recorded sequence of user actions—mouse clicks, menu selections, and keystrokes—that can be played back on command. Unlike a DotPhrase, which just inserts text, a macro can perform actions. For example, you could create a macro triggered by a keyboard shortcut (e.g., Ctrl+Shift+C) that performs the following sequence:
  1. Navigate to the “Results” activity.
  2. Click the filter for “Chemistry.”
  3. Find the row for “Serum Creatinine.”
  4. Click the button to graph the result over the last 7 days.
  This turns a 5-10 click process into a single command. Tools like AutoHotkey (for Windows) are popular for creating these system-wide macros.
• Personalized Toolbars & Views: Most EHRs allow you to customize your workspace. You can often create personalized toolbars with one-click buttons for your most-used activities. Instead of hunting through a menu, you can have a “Vancomycin Calculator” button right at the top of your screen. You can also set up default “views” in sections like Results Flowsheet, so that every time you open it, it automatically displays your preferred set of labs (e.g., renal function panel + CBC + LFTs) without you needing to select them each time.