Documentation Preferences

What Are Documentation Preferences?

Documentation Preferences (also known as custom instructions) personalize how palmER AI generates your documentation. They guide the AI to write notes in your preferred style, follow your preferred templates, include specific elements important to your practice, and align with your institutional requirements.

Why Use Documentation Preferences?

• Match your preferred documentation style and terminology
• Apply consistent templates, section headers, and structural formats
• Include elements you always want documented
• Emphasize specific clinical decision tools
• Customize documentation length and detail level

Documentation Preferences vs Follow-up Prompts

Documentation preferences and follow-up prompts are two valid tools for shaping output. They can both drive style, content, formatting, templates, and structure. The difference is persistence.

Use Documentation Preferences When You Want It Every Time

Preferences are persistent rules that apply to every generation from the chosen assistant. Use them for anything you want consistently across notes:

• Style: Use first-person active voice
• Content emphasis: Always include specific follow-up timelines
• Terminology: Use 'denies' instead of 'reports no'
• Clinical tools: Include HEART score for chest pain patients
• Institution-specific requirements: Troponin normal range < 57. Do NOT characterize as elevated when value < 57
• Detail level: Keep documentation short and concise for straightforward cases
• Templates and section structure: Structure MDM with these sections: Problems Addressed, Data Reviewed, Assessment, Plan, Risk Assessment
• Format rules: Use bullet points for Physical Exam findings, grouped by system

Use Follow-up Prompts For One-time Adjustments

Follow-up prompts are in-chat instructions that change a single generation. Use them when you want a variation for this specific note rather than a permanent rule:

• One-off variations: Make this note shorter
• Experimenting before committing: try a new format on a few notes before promoting it to preferences
• Save it as a Snippet: if you reach for the same follow-up prompt often but don't want it to apply to every note, save it as a Snippet for one-click insertion. See Snippets.

Example: After generating an MDM, you can ask Reformat this MDM using bullet points with these sections: Problems Addressed, Data Reviewed, Assessment, Plan, Risk Assessment for just this note. If you want it consistently, move it into Documentation Preferences. If you want it available as a one-click action without making it permanent, save it as a Snippet.

Getting Started

Start Simple: Begin with 1-2 basic preferences, test them, then add more.

Use first-person active voice throughout.
Always include specific follow-up timelines.

Writing Effective Documentation Preferences

If you can describe it clearly, you can put it in preferences. That includes content rules, terminology, templates, and formatting.

Best Practices

1. Use Positive Instructions: Tell the AI what TO do rather than what NOT to do. Or include both. Positive framing tends to produce more reliable results.

   • Good:
     Always OMIT the billing complexity statement
   • Less reliable:
     Do NOT document the billing complexity statement
   • Best: Combine both approaches:
     Always OMIT the billing complexity statement; Do NOT document "Medical decision-making was high complexity..." or similar.

2. Be Specific: Instead of better documentation, say include specific vital sign changes in risk assessment

3. Be Explicit About Templates: When defining a template, name each section, the order, and the format you want inside each section.

4. Test Incrementally: Add one instruction, test it on a few cases, then add more.

5. Think Workflow: What content do you find yourself adding manually? What follow-up prompt do you keep typing? Both are signals to move it into preferences (or save as a Snippet if it shouldn't apply every time).

When to Use Follow-up Prompts

Follow-up prompts are best when the change is for this note only. Three common cases:

• One-off variations: For this note only, condense the HPI into 3 sentences for the transfer summary.
• Experimenting before committing: try a new format on a few notes via follow-up, then copy it into preferences once it works.
• Patient or case-specific overrides: Now reformat this discharge summary as a plain-language patient handout with bullet points and no abbreviations.

Example Preferences

Emergency Department

Use first-person active voice throughout.
Always include HEART score for chest pain regardless of risk level.
Emphasize social determinants of health when relevant.
Include specific follow-up timelines (24-48 hours, etc.).
Troponin normal range < 57, Do NOT characterize as elevated when value < 57.
Always document patient understanding confirmation for high-risk discharges.

Clinical Decision Rules

Always include HEART score for chest pain patients.
Always include CHADS2-VASc score for atrial fibrillation patients.
Include CURB-65 for all pneumonia cases.
Include Ottawa ankle rules for all ankle injuries.

Billing and Complexity

Always OMIT the billing complexity statement; Do NOT document "Medical decision-making was high complexity..." or similar.
Emphasize data review elements that support complexity levels.
Document independent interpretation when performed.

Full MDM Template

Structure MDM with these sections, in this order:

**Problems Addressed:** Bulleted list. One line per problem with brief clinical reasoning.
**Data Reviewed:** Bulleted list grouped by category (labs, imaging, prior records, outside communications).
**Assessment & Plan:** One paragraph per problem, addressing assessment and plan together.
**Risk Stratification:** Explicit risk level (low / moderate / high) with one to two sentences of supporting rationale.
**Disposition:** Disposition decision, follow-up plan, and patient instructions.

Use bold section headers exactly as written above.
Do not document the billing complexity statement.

Assistant-Specific Tips

HPI Assistant

• Focus: Terminology, information you always want included, narrative vs structured format, section headers, length caps
• Example content rule: Always include family history of cardiac disease for chest pain patients
• Example format rule: Open HPI with one-sentence chief complaint summary, then chronological history in narrative form
• Follow-up prompt for: One-off variations like a transfer summary

Physical Exam Assistant

• Focus: Preferred abbreviations, level of detail, exam components, bullet vs narrative, system groupings
• Example content rule: Use 'alert and oriented x3' instead of 'AAOx3'
• Example format rule: Use bullet points grouped by system: General, HEENT, Cardiovascular, Pulmonary, Abdomen, Extremities, Neuro, Skin
• Follow-up prompt for: A specific note where you want a more abbreviated or expanded format than usual

MDM Assistant

• Focus: Clinical documentation style, content emphasis, risk stratification, full section templates, paragraph vs bullet structure
• Example content rule: Emphasize shared decision-making process details for complex cases
• Example format rule: Structure MDM with these sections in order: Problems Addressed, Data Reviewed, Assessment & Plan, Risk Stratification, Disposition
• Follow-up prompt for: Reformatting a single MDM for a non-standard purpose, like a peer review packet

Testing Your Preferences

What to look for:

• Your preferred terminology is used
• Required content elements are included
• Documentation style matches your preference
• Templates and section structures are applied consistently

Troubleshooting

"My formatting or template preferences aren't being followed"

• Be more explicit: Name every section, the order, and the format you want inside each section
• Test the format rule in isolation: Temporarily remove other preferences and confirm the format alone works, then layer the others back in
• Watch for conflicts: A "keep concise" rule alongside a multi-section template will pull the output in two directions
• Use positive framing: Use bullet points grouped by system works better than Don't use narrative format

"Output structure doesn't match my template"

• Spell out the template literally: Include the exact section names and order in your preference
• Specify the format inside each section: Bulleted list, single paragraph, table, etc.
• Reduce competing instructions: Consolidate into a single, clear template rule

"Output is consistently bizarre or wrong"

• Check your documentation preferences first: They apply to every generation and can cause unexpected behavior
• Look for conflicting instructions: Multiple preferences may contradict each other
• Try deleting preferences: Remove all preferences temporarily to see if output improves
• Rebuild incrementally: Add preferences back one at a time to identify the problematic instruction

"Output is too long/short"

• Add length guidance: Keep HPI to 4-5 sentences for straightforward cases
• Specify detail level: Use detailed documentation for complex cases only

Quick Start

Write your full preferences once, including content rules, style, terminology, and your preferred template or format. Generate as usual. Reach for follow-up prompts only when you want a one-off variation for a specific note.

• Choose one assistant to start with
• Write 2-3 specific preferences (content, style, or format)
• Test with a familiar case, then refine
• Add template or format rules once content rules are stable
• Save a backup of working preferences

Remember: you have three tools for shaping output. Documentation Preferences are persistent rules that shape every generation, including content, style, and format. Snippets are saved prompts you can invoke with one click when you want reuse without persistence. Follow-up prompts are best for one-time variations you don't expect to need again. Lean on preferences for anything you want consistently; use snippets for repeatable but optional reuse; reach for follow-up prompts for genuine one-offs.