Automatic Template Loading with Easy Delete

This isn’t earth-shattering stuff, but I do think it’s a tidy illustration of how a small, easy-to-make change with a relatively minimal amount of hassle can nonetheless reap a small but measurable benefit—and in the long term, meaningful time and energy savings.

I appreciate/hope that this will all hopefully be irrelevant for radiologists very soon, but while thousands of us are still using Powerscribe, this is still part of our worklife.

While many practices have system-wide templates that auto-launch with the appropriate study in a wide variety of contexts, many radiologists practice under a different, more individualistic paradigm. You open up a case, and PowerScribe is a blank page. Any template you use—if you use one—is called up with some verbal shorthand, like “macro CT head” or “macro MRI knee without,” etc., etc., etc.

I know this is table-stakes for many rads, and yet…I’ve seen how some of you practice by using PowerScribe like an inaccurate transcriptionist.

What would be better is to instead link the templates you want to use with the exams you want to use them for, such that each case opens up with a template preloaded and ready to go—saving yourself a handful of extra words and a brief computer delay.

So autolaunching templates is absolutely a worthwhile step, though it can be somewhat tedious depending on the number of sites you read for and therefore the number of different exam orderables to associate. I described how to do that in my post on Making the Most of Powerscribe.

Depending on how orderables work in your system and practice, it may even be possible to launch a variety of relatively more specific templates for different use cases. In my practice, for example, we (sometimes) have specific MRI brain orders for MS, ARIA (anti-amyloid medication monitoring), and trigeminal neuralgia that are distinct from a generic MRI.

The reality is, though, that this auto-launching is almost always brittle. For example, you may use the same MRI pelvis template for most cases but have a special one you use for rectal cancer staging. You may normally want your CT head template to load for CT of the head, but often prefer to combine that with a CT of the head and face in cases where both exams are ordered (combo templates are technically possible but can be challenging depending on how your system is set up).

Therefore, what you want in addition is a way to undo the auto-launching quickly—so that you don’t end up wasting more than a milisecond undoing what you did to be more efficient in the first place. Too much time deleting what you don’t want is, I would say, more frustrating than just not having done it at all. There’s nothing more irritating than attempts to be more efficient resulting in being inefficient.

The trick in this situation is to use AutoHotkey to set up a macro or key combination to give you the blank slate you would normally have. This is mine:

^3::
WinActivate, PowerScribe
Send ^a
Send {delete}
Send {F4}
Return

In this quick macro, CTRL+3 (mapped to a button on my Shuttle) activates Powerscribe, highlights all of the current text, deletes it, and turns on dictation.

Excess Complexity

One optional layer is to autolaunch templates that are themselves just a picklist containing multiple autotexts (*inception horn*).

For example, if you know you’re always going to use one of several MRI pelvis templates for different indications, instead of a generic default for that particular exam, what you can do is have a template that loads up a picklist that itself contains all the auto-texts for your different MRI pelvis templates—and make that bare-bones envelope auto-launch with the MRI pelvis examination.

Then, all you’d have to do is say the one word for the picklist manager to launch the right template from that list. Instead of having to say “MRI pelvis rectal cancer” or “MRI pelvis uterine transplant” or “MRI pelvis osteomyelitis” or anything else, you would have each specific version of that special template as an auto-text within the picklist, and you can just say “rectal” or “prostate,” and that will launch the relevant one you want from the initial template launch.

This is still faster than saying everything out loud and, again, results in a small but measurable gain over time. Is this particular variation on efficiency worth it? In most cases, probably not?

(I don’t generally choose to do this. I think it’s easier to just use the default for the default and then use the macro to start from scratch when it’s wrong. But they’re all valid ways to approach this problem. One exception would be plain films where you might launch what amounts to the necessary variations on an entire finished report with a single word.)

Your mileage may vary, but the point is: you could do this. It would only take a few minutes, and it would—in the long run—undoubtedly be better than not doing it.