Five configuration changes that buy back an hour a day

Five changes, and why configuration beats willpower

Most documentation-time advice tells a solo clinician to type faster or complain to the vendor; the more durable fix is inside settings you already have access to, not a new EHR. Five specific configuration changes — none requiring a system replacement — account for most of the time a well-run solo practice buys back from its notes.

1. Delete the exhaustive-exam fields the 2021 rules no longer require

The single biggest time sink in most templates is history and exam fields the 2021 evaluation-and-management framework stopped using to set the visit level: office and outpatient E/M codes are now selected by medical decision making or total time, not by counting review-of-systems boxes 1Ref 1American Medical Association (2023).CPT evaluation and management (E/M) revisions.That the 2021+ E/M revisions eliminated history/exam as level-setting elements for office visits in favor of MDM or time, supporting the case for deleting exhaustive exam template fields.. If your template still forces ten organ systems before you can save a note, that requirement is the template's habit, not the code's 2Ref 2Centers for Medicare & Medicaid Services (2023).Evaluation and Management Services Guide.That E/M levels are selected by MDM or total time under the 2021+ framework and what must actually be documented, supporting the claim that most exam templates over-collect..

Go through your template field by field and ask what it's actually doing: documenting something your judgment needs, or documenting something an older coding rule used to require. Delete the second category. Keep the first.

2. Build a personal smart-phrase library for your ten most common assessments

A personal library of smart phrases — templated language you insert and then edit, rather than compose from scratch — is the highest-leverage change most solo clinicians haven't made, because it takes an afternoon up front and pays back daily. Start with your ten most common assessments and plans, not an exhaustive library; a library of two hundred phrases you never open helps no one.

Building that library well is its own skill — template craft is worth treating as a deliberate exercise rather than something you back into during a busy week. And if your current system locks you out of building or editing phrases at all, that's a real limitation worth weighing: customization control is exactly the kind of term ONC's EHR contracting guide flags for negotiation before your next contract, and worth revisiting during the ehr migration if this one won't bend 3Ref 3Office of the National Coordinator (2016).EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print.ONC's guidance that customization and configuration control are contract terms to negotiate, supporting the point that a system locking out phrase-library editing is a legitimate factor in a future EHR decision..

3. Turn on confirmed carry-forward for the problem and medication lists

Turning on carry-forward for the problem list and medication list means you're editing what's already there instead of retyping a stable regimen at every visit — the single most repetitive task in a typical note. Configure it to require an active confirmation each visit rather than a silent copy-forward, so the list stays accurate instead of just fast.

The distinction matters: a silent copy-forward is how a discontinued medication survives on a chart for a year. A confirmed carry-forward gives you the same typing savings while forcing one deliberate look at the list every visit.

4. Automate the signature and attestation step

Automate the routing step that gets a note in front of you for signature, and set the system to flag anything unsigned past a short window rather than discovering a stack of unsigned notes at month end. Medicare requires authentication by handwritten or electronic signature for every service, and an unsigned note is one of the most common findings in a documentation review 4Ref 4Centers for Medicare & Medicaid Services (2023).Complying with Medicare Signature Requirements.That Medicare requires authentication by handwritten or electronic signature for every service, supporting the recommendation to automate signature routing and flagging..

Most EHRs already have this flag built in and simply leave it off by default. Turning it on converts a signature backlog from a recurring dread into a same-day housekeeping task.

5. Filter in-basket alerts so charting isn't interrupted

Alert fatigue eats documentation time indirectly: every low-value pop-up you dismiss mid-note breaks your train of thought and adds the seconds it takes to reorient, which compounds across a full day of notes. Configure notification tiers so only what genuinely needs same-day attention interrupts you, and route everything else to a batch review — the same discipline that keeps audit logs and inbox review from becoming their own full-time job.

The goal isn't fewer notifications overall; it's separating "interrupt me now" from "I'll see this in my afternoon batch," which most EHRs support but few solo practices ever configure past the factory defaults.

What efficiency shouldn't touch

None of these five changes should shrink what the record actually contains — configuring a system to auto-populate an exam you didn't perform, or to delay a patient's portal release past what's required, trades a real problem (your time) for a worse one (a false record or an information-blocking exposure) 5Ref 5Office of the National Coordinator / ASTP (2026).Information Blocking.That the information-blocking rule prohibits interfering with access to electronic health information, supporting the caution against efficiency settings that delay required patient access.. Efficiency settings should compress your typing, never your clinical judgment or the patient's access rights 6Ref 6HHS Office for Civil Rights (2026).Individuals' Right under HIPAA to Access their Health Information.That patients have a right to access their records within defined timeframes, supporting the caution that efficiency settings must not compress the patient's access rights..

A useful test before adopting any efficiency setting: would you be comfortable explaining it to a chart reviewer in one sentence? "I stopped documenting an exam element no code depends on" survives that test. "I set the system to auto-fill an exam I didn't do" does not.