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1Fix the driver behind crashes, sound loss and screen glitches2Repair Windows errors before they cause bigger problems3Scan for outdated or missing drivers - takes under a minuteChoose an EHR by testing it against your organization’s real documentation workflows—not by judging a polished demo or a vendor’s feature list. Ask each vendor to show how clinicians edit templates, identify and review reused text, check its source and date, correct stale content, and trace changes. Then compare the systems using the same realistic scenarios and your practice’s implementation resources.
Why note templates and reuse tools need a safety check
Templates and reused text can make documentation more consistent and efficient, but they can also carry forward irrelevant, outdated, or incorrect information. AHRQ’s summary of recommendations for copy-forward practices advises making copied content identifiable, training staff, and monitoring how the practice is used. A separate AHRQ PSNet commentary by Scott MacDonald, MD, warns that autopopulated and carried-forward information still needs accuracy review before the note is signed.
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Template design also involves a trade-off. AHRQ’s July 2024 diagnostic documentation issue brief describes potential benefits such as legibility, consistency, and completeness, while noting that rigid lists and drop-downs can inhibit a clinician from telling the patient’s full story. CMS’s 2016 EHR feature decision table cautions that templates can fit a clinical situation poorly, contribute to inaccurate or excessive documentation, or document services that were not necessary or performed. That older table is a documentation-integrity caution, not current legal advice.
The practical implication for procurement is to examine the note the system actually produces. A template that looks orderly in a demo is not enough if it obscures what was observed today, imports old findings without clear notice, or makes irrelevant material difficult to remove.
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What to evaluate in a vendor demonstration
ONC’s Health IT Playbook recommends a systematic selection process grounded in an organization’s needs and resources. It offers vendor questions, demonstration scenarios, testing plans, comparison resources, contract guidance, and pricing templates. Use the same scenarios and questions for every vendor so the comparison reflects your work rather than each vendor’s preferred presentation.
1. Reuse a small amount of still-accurate information
Ask a clinician to document a stable follow-up and reuse only the relevant portions of a prior note. Watch whether reused text is visibly distinguishable from newly entered content and whether it can be reviewed efficiently before signature. The point is not simply whether the system can copy information, but whether the user can tell what has been carried forward and decide what remains appropriate.
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2. Handle a changed medication or condition
Use a scenario in which the patient’s medication or condition has changed since the previous visit. Ask the vendor to show how the clinician finds and corrects outdated content, records the current state, and sees where the reused material originated. If the correction affects prior text, ask what history of that change is available to the user or reviewer.
3. Prevent an old normal finding from appearing as a new observation
Introduce a new abnormal finding while the prior note contains a normal finding for the same area. Confirm that the current note clearly distinguishes today’s observation from the previous one and that an old normal result cannot silently appear as if it were just examined. Ask the vendor to demonstrate removal or replacement of the stale text, not merely explain how a clinician should remember to do it.
4. Depart from a template that does not fit
Have the clinician document a visit that needs patient-specific narrative beyond the template’s structured fields. Check whether the system permits a clear account of the patient’s story without forcing a poor-fit choice or burying the narrative in a generic field. Inspect any defaults or generated statements for claims about examinations, services, or attestations that did not occur.
5. Review provenance, change history, and monitoring
Ask the vendor to show where a user can see the source and date of reused information, who recorded it, and what changed. Also ask what managers can monitor about reuse practices and whether the organization can assess patterns over time. The Joint Commission Journal on Quality and Patient Safety’s 2017 article on copy-forward recommendations identifies four relevant controls: copied-forward content should be identifiable; provenance should be readily available; staff should receive adequate training; and copy-forward practices should be monitored, measured, and assessed.
ONC’s SAFER Guides provide additional health IT safety guidance. Its resource on auditing actions on health information describes audit-log functions, including an example of a log that links to an original document and describes a modified state. Treat that as a capability to verify in the proposed product and configuration—not proof that every EHR records every note-reuse action in the same way.
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Use a consistent comparison scorecard
Rate each candidate against the same criteria, using evidence from demonstrations, testing, and the vendor’s written responses. A simple shared scale—such as meets, partly meets, or does not meet—can make gaps visible without implying precision the team has not measured.
| Evaluation area | What to verify |
|---|---|
| Clinical fit and flexibility | Can clinicians document the visit accurately, including when a template does not fit the case? |
| Visibility of reused content | Can users readily identify what was carried forward or autopopulated? |
| Provenance and dates | Can a user see where the text came from and when it was recorded? |
| Correction and change traceability | Can users correct stale material, and can reviewers determine what changed? |
| Efficiency of safe review | Can clinicians review relevant content and remove what does not apply without unnecessary friction? |
| Monitoring and reporting | Can the organization assess how reuse is occurring and identify patterns that need attention? |
| Training and configuration effort | What training, template design, and ongoing workflow oversight will the practice need? |
| Implementation and support cost | What costs and resource demands apply to implementation and continuing support? |
For auditability, ask the vendor to demonstrate the relevant log or report in the specific system being proposed. ONC’s audit-log example is not evidence that a particular product, configuration, or certification records every reuse event.
Make the decision using your workflows and resources
- Define the workflows first. Identify the visit types, note sections, and reuse practices that matter in your organization. Include clinicians who will document in the system, not only procurement and IT staff.
- Prepare repeatable scenarios. Include a stable follow-up, a changed medication or condition, a new abnormal finding, a template mismatch, and a review of provenance and audit information.
- Run the same demonstrations and tests. Ask every vendor to work through the same cases. Inspect the generated notes and test whether outdated or inapplicable content can be removed or corrected before signing.
- Record evidence against shared criteria. Score clinical fit, reuse visibility, provenance, change traceability, review efficiency, monitoring, training, configuration, and cost. Note what was demonstrated, what was only described, and what remains unclear.
- Include organizational capacity in the selection. Compare the required workflow redesign, training, configuration, implementation, and ongoing oversight with your actual resources. ONC’s Playbook includes selection and contract resources to support this broader comparison.
Do not treat a polished note as proof of a safe or accurate workflow. The configuration should be tested with realistic cases, including correction or deletion of stale material, before it becomes routine.
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