The EMR, from an expert user:
inpatient and outpatient efficiency

Why this session

The arithmetic is brutal and simple: minutes per note, times notes per day, times a thousand days of residency. An intern who documents at default speed donates hundreds of hours to the software; the intern who spends two focused sessions building their toolkit buys those hours back for patients, questions, and sleep. Interns themselves rank the electronic record among their biggest gaps — and the national consensus behind this bootcamp treats EHR skills as a first-class orientation domain (the evidence) — yet most orientations stop at access and compliance modules.

Two design rules make this session work. First, it is taught by expert users, not by the training department — the fast senior whose notes are done before noon, the superuser who rebuilt the team list, the informatics lead who knows what the system can actually do. Second, interns drive. Nothing on this page is a demonstration to watch; every item is a thing each intern builds, at a keyboard, before leaving the room. And because many programs run different systems for the hospital and the clinic, the session runs as two blocks — repeat the structure for each system you live in.

What interns leave with — built, not shown

1. A personalized patient list with the columns that answer rounds questions at a glance.
2. A working set of note templates and quick phrases for their most common documents — created during the session.
3. An order-favorites toolkit for the twenty things they will order most.
4. A results-review and inbox workflow that supports the one-touch discipline from the time-management session.
5. The name of the person to ask when the system fights them — because every program has one, and knowing them is a skill.

The format — and the localization rule

Small clusters at real workstations in a training environment, one expert per cluster, interns’ hands on the keyboards. The expert demonstrates a move for ninety seconds; every intern replicates it before the group moves on. The two blocks below are the national skeleton — the checklist of what any competent EHR session covers — and every line of it needs your program’s local click-paths filled in. Before running this session, walk the checklist with your informatics lead or superusers and turn each item into your system’s actual steps. A program that runs one EHR for everything can merge the blocks; a program that runs two systems should treat each block as its own session, scheduled inside the relevant first block.

Block one — the inpatient system

• The patient list is your cockpit — rebuild it first. Default lists show what the vendor guessed; expert lists show vitals trends, pending labs, code status, VTE prophylaxis, and the flags your program cares about, in columns, at a glance. Ten minutes of column configuration replaces fifty chart-openings a day.
• Note templates and quick phrases — build five now: the progress note, the H&P skeleton (the first-admission session’s version), the cross-cover note (the cross-cover session), the event note, and the discharge-summary frame (the hospital-machine session). The rule that keeps templates honest: a template is a scaffold for your thinking, never a substitute for it — auto-pulled data nobody read is how notes get long and wrong at the same time. Copy-forward is a loaded weapon: update or delete, never propagate.
• Order favorites and order sets: save the personal favorites for your twenty commonest orders, learn where the program’s admission and condition order sets live — and keep the first-admission session’s discipline: order sets are checklists to think against, not autopilot.
• Results review with a routing reflex: where results land, how to flag, and how each one gets its one-touch fate — act, route, schedule, acknowledge — so the inbox works the way the time-management session taught.
• The sign-out module — where the shared list lives, how if/then contingencies are recorded, and how updates propagate: the electronic half of the handoff session.
• Secure messaging norms: what belongs in a message versus a page versus a call — and the trap of clinical decisions buried in chat threads that the chart never sees.
• The rescue moves: what to do when the system is down (the downtime procedure exists — find it before you need it), and who the superusers are on each unit.

Block two — the outpatient system

• The schedule view and the pre-visit prep flow. Chart preparation is the clinic’s pre-rounding, and the EHR either supports it or fights it. Learn the fastest path through: last note, interim results and records, the medication list with fill history, the health-maintenance gaps, the visit’s agenda.
• Documentation in the room without losing the room: where the template carries the load so your eyes can leave the screen; which fields genuinely must be completed live; what can wait for the wrap-up minutes. The patient’s experience of your typing is part of the visit.
• Orders with the diagnosis attached — the mechanics of everything the clinic-business session taught: linking the order to the right problem, screening versus diagnostic coding at the point of entry, and where the formulary and coverage surface at prescribing.
• E-prescribing flow: pharmacy selection, refill mechanics, controlled-substance workflows where they apply — and the prescription-monitoring check your state expects, wired into the habit.
• The clinic inbox — the highest-stakes workflow in ambulatory life: results, patient messages, refill requests, and documents; the 24-to-48-hour response discipline; routing rules and coverage when you are on a ward month — because your panel does not pause when you do. This is where the time-management session’s ownership rule — you ordered it, you own it — lives or dies.
• Templates for the visit types: the problem visit, the annual, the Medicare wellness visit’s structured elements (the clinic-business session’s distinctions, operationalized), and letters — including the referral response that makes consultants love your clinic.

The expert habits — system-agnostic, career-long

• Watch a fast person drive, fifteen minutes, once a month. Shortcuts transfer by observation better than by manual. The fastest resident on your service is a free masterclass; ask for the ride-along.
• Invest ten minutes to save ten seconds. Anything you do more than five times a day deserves a shortcut, a favorite, or a template. The payback math is absurd in your favor.
• Never fight the same problem twice silently. The second time the system blocks you, ask a superuser or log the ticket — workarounds you invent alone are usually someone else’s solved problem.
• The chart is a clinical document, not a billing artifact — and it is also a billing artifact. Write for the next clinician first (sessions 05 and 20), let the template capture what the coding needs (the clinic-business session), and never let either purpose corrupt the truth of the note.

Pocket card

Notes

This page is a facilitation framework for program-run training. It names no vendor and endorses none; every workflow above must be localized to your systems, your policies, and your compliance rules before teaching. Last reviewed July 2026.