Key ingredient missing from e-health records, advisers say

The Health and Human Services Department might have missed an opportunity to include a requirement for physician progress notes to be collected within subsidized electronic health records (EHRs) in its recent proposed regulation, according to members of a federal advisory committee.

HHS' Health Information Technology Policy Committee convened to discuss possible missed opportunities, areas needing clarification and other gaps in the proposed rule, which was released on Dec. 30, 2009. Physician progress notes are generally narrative notes written by doctors to describe a patient's concerns. Some doctors have been advocating for inclusion of such narratives within digital health records as a valuable tool for understanding and properly diagnosing a medical condition or injury. Typically, commercial digital record systems do not offer such a narrative, but instead allow doctors to check various boxes on a template to describe a patient's condition. HHS also apparently missed a chance to set up indicators within the rule regarding substitution of generic drugs, and for use of certain high-cost imaging tools for diagnosis, according to Tang and Hripcsak. Other areas needing further clarification include specifying when digital medication records must be reconciled among providers, and how long digital records on patient medications, problem lists and allergies should be maintained, among other concerns, Tang and Hripcsak indicated in their testimony.