Nuance, provider of clinical documentation and communication products to healthcare organizations, released a survey it conducted with nearly 1,000 physicians. It is somewhat self-serving - more on that later - but it does highlight issues to which EHR vendors need to pay attention.

The take-away from the study, according to Nuance, is that 96 percent of the surveyed physicians are "concerned about losing the unique patient story with the transition to point-and-click (template-driven) EHRs." The phrasing of the question, particularly "losing the unique patient story" is manipulative, but I get the gist of their concern. With a template-driven EHR, physicians lose the personalization between physician and patient, and personalization in the clinical notes.

Nuance is advocating for EHRs that aggregate structured and narrative data. That stance benefits the company because their communications product would produce narrative data. If the survey sponsor had been a third-party entity, the results would have had more credibility. I'm not saying that the results shouldn't be taken seriously. I actually believe that the results are valid. It's just too bad the entity conducting the survey wasn't objective.

What's worse, the survey showed respondents two different physician notes on the same patient. One was with a template-driven EHR and the other using Nuance's own speech-recognition product. Ninety-seven percent of the physicians surveyed chose the document produced with the speech-recognition product as the note they would "consider more valuable in treating this patient." The respondents then checked off other clinical communication objectives met by the speech recognition-generated choice. It might have been better had the survey used another vendor's product or at least not identified the speech-recognition tool. The idea, after all, is to prove that speech recognition is to difference.

Try to look past that part of the survey because Nuance's assertion that template-driven EHRs don't capture a physician's thoughts at the point of care is something the industry needs to address. While some EHRs allow additional documentation to be captured, admittedly the process adds to the physician's workload and disrupts their workflow. EHRs that can seamlessly capture additional clinical narrative documentation through an integrated speech-recognition tool would be an ideal solution. It's a good idea and maybe many EHR vendors are already integrating the capability into their product. If not, maybe they should to capture a larger piece of the market.

The Nuance senior vice president was quoted as saying that the Department of Health and Human Services should require that electronic patient notes not be limited to templated text and structured data elements alone. Making it a requirement by HHS might be a bit much to ask for. What makes sense is working with the EHR certification bodies. If the survey results are on to something, and I think they are, the market will drive EHR vendors to incorporate multiple types of clinical documentation.