Best option for medical documentation?

I throw myself on the mercy and wisdom of the community for this one.

I’m a pediatrician in Canada currently at a large institution that has a fancy, multi-million dollar electronic medical record (EMR). In my case, it’s “Epic Systems.” EMRs like this can be great and have a lot of automation built-in (I have no financial or other relationships with Epic or other EMRs). I have “SmartPhrases” for consult reports, follow-up letters, diagnosis and recommendations, etc. The EMR uses “***” (unfortunate choice in a Markdown world) as a wildcard you can use to tab through, filling it with text (I often use TextExpander to replace the *** as I go). The EMR also allows me to use “he/she/they” so that the documentation sounds more narrative and personalized. I use Dragon Medical to dictate (which is integrated in the EMR and works beautifully) and still harbour deep wounds from Nuance removing Mac support. I worry about what I’ll do in terms of voice to text when I leave this place…

Here is an example of part of a template I use for new consults:

You can see the *** that I advance through using Dragon. This is especially good for synopsizing the parent and school questionnaires during my chart reviews (ahead of seeing the patients). For the asterisk wildcards, I have been able to use a Find and Replace, Find Next KM macro to do this outside the EMR before, but it’s a bit wonky. I used something other than “***” because of the clash with Markdown.

I’ll be moving from this institution to working in a rural/remote setting with only a bare-bones EMR where you can look up lab results. I need to find ways to create documents like this on my own, or I’ll be forced to choose between thoroughness and having some semblance of a life.

I could create purpose-specific PDFs in PDFpenPro with text fields, checkboxes, radio buttons, etc. The upside is I already know how and could share them with team members, learners, etc. The downside is I don’t know how I could, for example, build in automation for personal pronouns. I also worry that even whole-page text boxes will be too restrictive for situations where I need to write a long impression and plan.

Word (or Pages) is an obvious option. David has talked about his use of templates for his law practice, and this would have the additional upside of being Windows/Mac compatible if I’m ever forced to (shudder) buy or emulate a PC to enable Dragon (I’ve done the emulation thing before and I didn’t like it at all).

I would love to use Drafts for this, but I have so little understanding of its capability. Do you think I could create documentation of the kind I’ve mentioned using Drafts? I’m willing to do the work of learning and creating if this seems feasible. The dictate option in Drafts is another attractive feature, although there are privacy issues there (everything flows through the US).

Going beyond this, do you counsel learning JavaScript or something? Would that help? You’re getting a sense of the limits of my understanding of this stuff…

Appreciate your thoughts and advice!



You might want to consider a light-weight database, stored locally to avoid privacy issues with a cloud-based solution. For example TapForms.

There is some dialog about using Tap Forms for EMR in the Tap Forms forum. There is a limited capability for scripting – it possibly would handle the pronouns issue, but I’ve not attempted that myself. Tap Forms has cloud sync between devices, including the iPad version, but no cloud access to databases.

Upleveling from Tap Forms, there is Ninox, which is more robust and does include an optional cloud component. (Be sure to check our their privacy provisions, though.)

And further upleveling from Ninox would be Claris FileMaker, which requires advanced skills – not impossible for an adept technical user, but could be very time consuming.

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Thanks @quorm! I’ve been speaking with FileMaker since your suggestion. Much appreciated.

@quorm Claris FileMaker has turned out to be perfect! I can basically create my own electronic medical record. I can make templates that staff, patients, and families can use that populate the databases. Most importantly, I can generate templated consult, follow-up, and other documents. Thanks again!