Spooner acknowledges cut-and-paste probably does get used in some situations. "If that's all that's happening, that's totally wrong; but if in fact the patient's condition hasn't changed in 24 hours, then do you want to write all this stuff, or do you want to use cut-and-paste?" Spooner says.
Templates are smart productivity-enhancing tools, Spooner says. And while he says the Holder-Sebelius letter "was kind of overreaching," he adds, "At the same time, there's no excuse for somebody using it to cheat the documentation in any way."
Meanwhile, rural hospitals such as 100-staffed-bed St. Claire Regional Medical Center in eastern Kentucky still struggle just to get CPOE and electronic medical record systems adopted by doctors.
Six months after implementing CPOE, "we have some physicians … who just can't get past that point of using a computer to take care of a patient," said Randy McCleese, CIO of St. Claire Regional Medical Center, speaking at a July 2013 hearing of HHS' HIT Standards Committee. "We have had huge issues with some of those physicians being able to use a computer to take care of that data rather than writing it down."
And yet, if EMRs have achieved anything so far beyond producing incentive checks, it is probably the banishment of illegible physician notes, which have been the scourge of healthcare since its inception.
"I think the biggest benefit of CPOE as it stands is that the orders are legible and clear, and it's menu-driven," says William Park, MD, senior general surgeon and former chief medical officer at North Hawaii Community Hospital, a 33-bed rural hospital in Waimea.