Michael Weiss, MD, Associate CMIO, Memorial Healthcare System; and Assistant Medical Director Pediatric Emergency Medicine Joe Dimaggio Children’s Hospital, is leading a push to curb idiosyncratic documentation that can undermine quality, compliance, and the value of emerging AI. In a wide-ranging discussion, he described a “Rogue Note” campaign that preserves clinician flexibility but insists that safety-critical information live in consistent, discrete fields that analytics and automation can actually use.

Emergency departments generate towering documentation volumes under intense time pressure. Custom note templates—often crafted by well-intentioned power users—were skipping standardized fields tied to mandatory screenings, regulatory reporting, and revenue integrity. That variability made it harder for quality teams to track performance in real time and jeopardized the data hygiene required for reliable decision support. Instead of revoking personalization outright, the initiative targets the few elements that must never be buried in free text—suicide risk screens, validated scores, time-sensitive care pathways—and anchors them directly inside the note.

Weiss has made cognitive load the design starting point. He argues that clinicians should not be asked to memorize dot phrases or manual shortcuts to ensure compliance. As he put it, “Don’t ever ask me to remember a smart phrase… Ask me to remember a dot phrase isn’t the best use of my cognitive powers.” That lens also shapes communication: rather than post-hoc audits weeks later, frontline teams see, in the moment, whether required items are present and where they belong in the chart.

Workflow-Embedded Triggers Over Memory Aids

Dynamic documentation—logic that pulls from discrete EHR signals to surface the right fields at the right time—sits at the center of the program. When a patient presents with undifferentiated chest pain and orders such as an EKG and troponin are placed, the note automatically calls for a HEART score before sign-off. That design moves compliance away from memory-dependent prompts toward data-driven nudges that appear only when clinically relevant. The result is fewer interruptive alerts, more consistent capture of critical data, and a cleaner foundation for quality reporting.



Weiss is candid about the limits of traditional alerts. Many organizations suffer low response rates because the tools fire too often or at the wrong moment. By contrast, workflow-specific prompts—surfacing inside the note and only when pertinent orders or diagnoses exist—prove far more effective. “Most health care systems are happy with 25%, 30% success rate,” he said, arguing that success requires re-engineering when and where guidance appears rather than multiplying warnings that clinicians learn to ignore. He also champions real-time routing of documentation fallouts to quality leaders, enabling at-the-elbow support within the same shift rather than retrospective remediation.

Balancing Standardization, Personalization, and AI Readiness

Ambient documentation and other AI-enabled tools are arriving quickly, but their usefulness depends on standardized, machine-readable data. That places new urgency on where information lives in the note. Personalization still matters—clinicians process information differently, and local teams should not feel boxed into a single presentation—but the backbone must be stable. Scores, mandatory assessments, time-bound tasks, and key orders need consistent, discrete capture tied to Epic Foundation wherever possible. When those anchors are in place, ambient tools and large models can generate summaries and suggestions without drifting into error-prone copy-paste workflows.

He favors vendor-integrated approaches that write natively into the chart over tools that require clinicians to shuttle text between windows. Copy-paste creates risk, including accidental placement in the wrong recor...