Increasing Documentation and Performance of Diabetic Foot Exams at HOPES Clinic Through Implementation of EHR Templates

  • Abirami Thiyagarajan Eastern Virginia Medical School


Introduction: One of the top five prevalent diagnoses at the HOPES clinic in Norfolk, Virginia is diabetes. The clinic’s goal is to increase the number of diabetic foot exams performed and documented during diabetic patient encounters in an effort to prevent the complications of foot ulcers and amputations.  A template including components of the diabetic foot exam, history and follow up guidelines was made available in the clinic’s electronic health records (EHR) for student clinician teams to utilize when seeing a diabetic patient.  In addition, training videos were developed to instruct student clinicians on using the EHR and accessing the templates. The purpose of this study is to determine if there was an improvement in documentation of diabetic foot exams after the institution of EHR templates and instructional videos. 

Methods: A chart review was performed on all diabetic encounters between August 24th, 2016 and November 10th, 2016 after the implementation of both the EHR template and the EHR instructional videos. 

Results: A total of 15 diabetic patient encounters were reviewed.  At least one component of the diabetic foot exam was performed at 13 out of 15 encounters. 11 out of 15 encounters recorded at least a visual inspection of the foot for lesions and ulcers.  4 out of 15 encounters had 3 components of the foot exam.

Conclusion: A previous retrospective chart review at HOPES showed that only 27% of diabetic encounters included at least one component of the foot exam.  After the implementation of a template and instructional videos, 87% of diabetic encounters included some component of the foot exam.  Utilization of templates and instructional videos has improved the documentation of patient care and, more importantly, the quality of care.  While there has been progress in the documentation of these exams, further improvement is possible with more complete foot exams.  Future changes include tasking the check-in staff with pre-populating a diabetic patient’s chart with the template for a diabetes follow up encounter and including more components of the foot exam in the EHR template.



Virginia Department of Health. Diabetes Burden Report. 2010. Available at: Accessed September 28, 2016.

Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008; 31(8): 1679-1685.

Apelqvist J, Bakker K, VAN Houtum WH, Schaper NC. International Working Group on the Diabetic Foot (IWGDF) Editorial Board. Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) prepared by the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2008; 24 Suppl 1:S181–7.

Thaker VV, Lee F, Bottino CJ, Perry CL, Holm IA, Hirschhorn JN, et al. Impact of an Electronic Template on Documentation of Obesity in a Primary Care Clinic. Clin Pediatr (Phila). 2016 Oct; 55(12): 1152-9.

Mikulich VJ, Liu YA, Steinfeldt J, Schriger DL. Implementation of clinical guidelines through an electronic medical record: physician usage, satisfaction and assessment. International Journal of Medical Informatics. 2001: 63(3):169-178.

Boulton AJM, Malik RA, Arezzo JC, Sosenko JM. Diabetic somatic neuropathies. Diabetes Care. 2004;27:1458–1486.

How to Cite
Thiyagarajan, A. (2017). Increasing Documentation and Performance of Diabetic Foot Exams at HOPES Clinic Through Implementation of EHR Templates. Free Clinic Research Collective, 3(1). Retrieved from