"Over the past five years, I led successful implementations of CPOE, electronic physician documentation, and multiple other EHR-related applications and initiatives," said board-certified emergency physician, Dr. Reid F. Conant, FACEP, in prepared remarks e-mailed to DOTmed News.

Conant practices clinically at a 400-bed acute care community hospital, Tri-City Medical Center in Oceanside, Calif.


"It has become increasingly clear that capturing what the physician is thinking at the point-of-treatment, including a detailed physician narrative, contributes to ongoing, high-quality patient care. Without an established regulation to require the inclusion of such detailed physician notes, there is validated concern amongst caregivers that patients' medical records will be reduced to point-and-click --'cookie-cutter'-- documents that do not differentiate from one patient to the next."

"While EHRs can provide real-time access to patient health records and support evidence-based caregiver decisions, the EHR is only as valuable as the information that is captured within it...HHS should have made a requirement for physicians who are considered meaningful electronic health records users, that each electronic patient note must not be limited to templated text alone."

"Without the physician's narrative, patients' medical records provide an incomplete picture of the medical encounter, which can lead to low-quality care, and high costs driven by non-specified, duplicated or unnecessary treatment," Conant said.

Janet Dillione, executive vice president and general manager of Nuance Healthcare in Burlington, Mass. also gave DOTmed News her take on the effect of the rules.

"For physicians overall, the challenge that remains is to their workflow," she said in prepared remarks e-mailed to DOTmed News. "There is one key requirement to have physicians use IT systems and have them use them with some sense of joy, and that is to protect their time. We need systems that are tremendously usable, and that's where technologies from Nuance, like speech recognition and transcription services, are a vital component to helping physicians achieve Meaningful Use. We can help, absolutely, physicians manage time."

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