Clinical documentation was developed to track a patient's condition and communicate the author's actions and thoughts to other members of the care team. Over time, other stakeholders have placed additional requirements on the clinical documentation process for purposes other than direct care of the patient. More recently, new information technologies, such as electronic health record (EHR) systems, have led to further changes in the clinical documentation process. Although computers and EHRs can facilitate and even improve clinical documentation, their use can also add complexities; new challenges; and, in the eyes of some, an increase in inappropriate or even fraudulent documentation. At the same time, many physicians and other health care professionals have argued that the quality of the systems being used for clinical documentation is inadequate. The Medical Informatics Committee of the American College of Physicians has undertaken this review of clinical documentation in an effort to clarify the broad range of complex and interrelated issues surrounding clinical documentation and to suggest a path forward such that care and clinical documentation in the 21st century best serve the needs of patients and families.

ethnic minorities. 1 The lower initial uptake of the GDDP among racial/ethnic minorities raises the question: why would patients who gain more from GDDPs be less likely to use them? We aimed to determine whether the uptake of the GDDP increased as the program matured and to examine whether factors affecting the uptake of the GDDP have remained steady over time. Methods | The Medical Expenditure Panel Survey is a nationally representative longitudinal household survey of health care use and expenditures for noninstitutionalized US civilians. 2 The present study used 2010 Household Component and Prescribed Medicines files, which included information on the drug name, days of supply, and amount paid. Information on days of supply was not available before 2010. The institutional review board of the University of Tennessee Health Science Center approved the study and waived the need for informed consent. The study evaluated adults (aged >18 years) who had received at least 1 prescription drug in 2010. Users of the GDDP were defined as individuals who had used the GDDP at least once. If a prescribed medicine event had the total amount paid and days of supply equivalent to any GDDP offerings, the GDDP was coded as 1 (the coding was otherwise 0). Typical GDDP offerings were $4 for 30-day supplies and $10 for 90-day supplies as provided by Walmart, Target, and Kroger. Rite Aid, CVS, Walgreens, and Kmart had other GDDP offerings. Andersen's 3 behavioral model was used to identify factors associated with use of the GDDP. The logistic regression procedure in SAS, version 9.4 (SAS Institute Inc), was used to predict probabilities for different patient groups while controlling for complex survey sampling. We assumed that all prescription drug users had an opportunity to use the GDDP. We also assumed that physician prescribing behaviors, pharmacist practice styles, and pharmacy benefit designs occurred independently of each factor affecting use of the GDDP. Results | Of the 13 486 adults who had at least 1 prescription drug event in 2010, 3208 were GDDP users (Table); the weighted rate of GDDP use was 23.1%. Use of the GDDP was more likely among the elderly, sicker, and uninsured groups (Figure). Use of the GDDP was also more likely among people living in rural areas and central regions of the United States. However, the rate of GDDP use was not significantly different across different educational level, income, and racial/ethnic groups.