6 EHR Customizations That Will Significantly Improve Your Workflow
Electronic health record systems offer powerful customization features that most clinicians never fully utilize. This guide presents six practical EHR modifications that can streamline documentation and reduce time spent on administrative tasks, backed by recommendations from healthcare IT specialists and practicing physicians. These targeted adjustments address common workflow bottlenecks while maintaining compliance and improving patient care quality.
Use Single-Key Biopsy Entry Shortcut
In my dermatologic surgery practice, the EHR shortcut that saves the most time is a single-key biopsy macro that auto-populates the standard biopsy note with body-region tag, lesion measurements, anesthetic type and volume, and the structured pathology request. The technician sets the photo and measurements before I walk in. I press one shortcut. The note populates with the right fields, the photo attaches to the lesion entry, and the lab requisition fires.
Across the 15 to 25 biopsies my office runs in a typical clinic day, that macro saves roughly 2 minutes per biopsy in dictation time, which compounds to 45 minutes back in my day. The bigger gain is consistency. Every biopsy note has the same structured fields in the same order, which makes the chart legible to me on follow-up and protects the practice if a record is subpoenaed.
Build Smart Phrases Across Routine Encounters
I've been at Davila's Clinic for years, and the one EHR customization that's honestly been a game-changer for me is building out a set of smart phrases tied to our most common visit types. We see a lot of wellness visits, follow-ups for chronic conditions like hypertension and diabetes, and acute visits for things like URIs and skin complaints. Each of those had a pretty predictable documentation structure, but I used to type out the same paragraphs over and over, tweaking a few details each time.
So I sat down one Saturday and created template smart phrases that pull in the patient's name, current meds, and recent lab values automatically, then leave structured fields for me to fill in the exam findings and assessment. For example, my ".dmfu" shortcut pulls up the entire diabetes follow-up note skeleton with the patient's last A1c, current diabetic meds, and foot exam checklist already populated. I just add the vitals from that day, note any changes, and I'm done.
Before I built those templates, I'd estimate I was spending maybe 8 to 10 minutes per note on these routine visits. Now it's closer to 3 to 4 minutes. When you're seeing 20 to 25 patients a day, and most of those fall into maybe five or six common visit categories, that adds up fast. I figure I'm saving somewhere around 90 minutes to two hours on a typical clinic day. That's time I can spend actually talking to patients instead of staring at a screen.
The other thing I did was set up custom order sets. Instead of hunting through menus for the labs I order every day, like a basic metabolic panel or lipid panel, I grouped them into order sets by condition. One click and the orders are ready for staff to process. That probably saves another 10 to 15 minutes daily on the ordering side.
I won't pretend the EHR is perfect, because it's not. But I've learned that investing a few hours upfront into building shortcuts that match how I actually practice pays off every single day. If you haven't done it yet, start with the visit type that frustrates you the most and build from there.
Create Pre-Visit Context At First Screen
The single EHR customization that's saved me the most time wasn't a macro or a template. It was building what I call a pre-visit context block -- a one-screen summary the EHR auto-populates at the top of every patient encounter, pulling from the patient's last three visit notes, their most recent labs, and any flagged outstanding items.
Most EHRs make you click through multiple screens to assemble that picture before each visit. Five clicks. Sometimes more. Multiply by twenty patients in a day, and the cognitive load of reassembling the context is enormous. By the eighth patient, the level of attention I could give the assembly was visibly worse than at the first.
The customization itself was a templated SmartPhrase that pulls structured fields from the chart into a single readable paragraph on the first screen of the encounter. We built it once, refined it over about three months as we noticed what we were always reaching for and what we never used, and it's been stable for two years now.
Time savings in a typical day: roughly four minutes per patient, which works out to ninety minutes over a full clinic day. More importantly than the time, though, is the cognitive savings -- by the time I open the room to the patient, the relevant history is already in my head. The first thirty seconds of every visit go to "how have you been since last time," not to me re-orienting from the chart.
The advice I'd give: don't customize the chart for documentation speed. Customize it for the moment you walk into the room. That moment determines the quality of the entire visit, and most EHR customizations are aimed at the wrong stage of the encounter.
Draft Focused ED Notes With Snippets
The mantra I use when it comes to workflow during my shift in the Emergency Department is: "Sick, dispo, new. Chart as you go."
That is my workflow no matter the EHR or the customizations. That is how I manage a busy community ER with very high acuity patients. I see the sick ones first, then manage the dispositions, then see the new patients. If I ever need to reset, I manage the sick ones first. Then, before seeing that new patient, I get patients admitted, transferred or discharged. Then, after that, I see the new patient. If the new patient is in extremis or needs immediate stabilization, well.....then they are "sick" and I see them first anyways.
I love using macros and smart texts when charting in my EHR. I built a custom note that allows me to focus my dictation on the highlights of any note: the history, physical exam and medical-decision-making. I use smart texts and macros to support the note with other inputs like medical/social/family history, allergies, labs, imaging, vital signs, medications, consultants and scoring tools. That way, I can focus on what makes my note the most interpretable, understandable and defensible. It is not fluffed with with extraneous information and my colleagues can actual follow my patient care.
Specifically, I use smart texts for differentials diagnoses lists, social determinants of health, tobacco and alcohol cessation counseling, common physical exam findings, common procedures and language that ensure I am meeting the standards of CMS to ensure the note stands up to any coding query. This is not an exhaustive list, but covers the vast majority of instances I encounter during my charting.
Adopt Prefilled Consultation Form That Coordinates
One of the most helpful workflow improvements I have made recently was creating a pre-filled medical consultation form within our EMR. As an oral surgeon performing a high volume of IV sedation cases, especially in medically complex patients, I frequently need to communicate with physicians and specialists to ensure patients are optimized peri-operatively. Our old workflow involved handwriting the patient's information, planned procedure, and specific medical questions on a paper form, sometimes multiple times if I needed clearance from more than one provider. Then my front office staff had to scan the form into the chart and manually fax it, which honestly became very time consuming and inefficient.
Now, the template automatically populates the patient's demographics and treatment plan, and includes a prewritten request asking for perioperative recommendations, recent chart notes, and guidance regarding anticoagulants if applicable. I can still quickly customize it for the individual patient when needed, but having the structure already built into the EMR has streamlined the process tremendously. Since it is already digitized and attached to the patient's chart, it also makes faxing and documentation much easier for my staff. It probably saves us at least 10 minutes a day collectively, which adds up quickly over the course of a week in a busy surgical practice.
Elevate Telehealth Via AI And Templates
Utilizing AI and multiple tabs, along with using apps that can assist in typing for you while you talk, and creating multiple pre- templates have saved me tremendous time. A lot of my work happens on a telehealth platform. Ai has assisted in understanding the patient history and their need- by summarizing key point in one paragraph has helped me reduce time initially. Then pre made templates for each scenario that auto populates to each patient- which then i would just edit the key information has made it easy to see and understand for others, as it is a standardized document. This has saved me from working 10 hrs- to less than 2 hrs.
