What should a re-evaluation inherit?
Roughly half the text in a typical hospital progress note is copied from a previous one. Blanket copy-forward and blank-slate re-entry are both the wrong answer, and the right one is a field-level policy, not a habit.
Every therapist who has opened a re-evaluation knows the temptation, because the previous evaluation is sitting right there. Most of the patient's story hasn't changed since last quarter. So the chart gets built the way charts actually get built: copy the last note forward and edit what's different.
How much copying? Measured: about half the note.
When researchers at UCSF instrumented their EHR to trace the provenance of every character in 23,630 inpatient progress notes, the typical note turned out to be 18% manually entered, 46% copied from previous notes, and 36% imported from other parts of the record. Less than a fifth of the note was written fresh. That study looked at hospital medicine, but the workflow it describes, "start from the last note and edit," is the default everywhere, therapy included.
Copying context forward isn't laziness. It's a rational response to documentation load, and re-keying a stable medical history for the fourth time this year adds typos, not accuracy. The safety problem is narrower than "copying is bad," and the ECRI Institute's Partnership for Health IT Patient Safety wrote a whole safe-practice toolkit on exactly this: the danger is copied material whose origin you can't see, carried forward without review, in places where it silently substitutes for work that was supposed to be redone.
The question isn't whether a re-evaluation should start from the last one. It's which fields are allowed to.
A field-level answer
Because an evaluation is structure, not prose (a single templated PT eval runs past 200 discrete fields), you don't have to answer the inheritance question with a habit. You can answer it per field. When we audited every field across our evaluation templates, PT, OT, speech, nutrition, psychology, each one landed in one of three categories:
Contextual
Stable clinical context: diagnosis codes, medical and social history, precautions, equipment, goals, and the plan-of-care shape (visit frequency and duration). The clinician reviews and updates rather than re-types. Some of these are the most important fields to carry: a food allergy or a documented history of suicide attempts must never depend on someone remembering to re-enter it.
Objective measurement
Range-of-motion grids, muscle testing grades, balance scores, standardized scale results, vitals, labs. These start blank every time, because a re-evaluation exists to produce new measurements. An inherited Berg score isn't a data point, it's last quarter's data point wearing today's date.
Administrative
Evaluation dates, signatures, attestation. Carrying these forward is how a chart ends up asserting something nobody did today.
The split is roughly what you'd expect and still clarifying to see written down: in our PT template, every one of the 17 base measurement fields is do-not-inherit, while nearly all of the history block carries forward. The point isn't our particular list. It's that the list exists as an explicit whitelist the software enforces, instead of living in each clinician's copy-paste discipline on a busy Friday.
Why this beats both defaults
Blanket copy-forward fails on the objective fields: it pre-fills the exact values the payer, and the patient, need freshly measured, and fluently wrong pre-filled values are the hardest kind to catch. Blank-slate re-entry fails on the contextual fields: it burns clinician time re-typing stable facts and gives safety-critical history a fresh chance to be forgotten. A field-level inheritance policy takes the half of the note that was always going to be copied anyway and makes it deliberate, reviewed, and bounded, while guaranteeing the measurements section is exactly as empty as a re-evaluation requires.
If you're evaluating documentation software for a therapy practice, it's a revealing question to ask a vendor: when I start a re-evaluation, which fields come pre-filled, and who decided? "All of them" and "none of them" are both answers that mean nobody decided.
Sources
- Wang, Khanna, Najafi, JAMA Internal Medicine (2017), "Characterizing the Source of Text in Electronic Health Record Progress Notes": 23,630 notes; typical note 18% manually entered, 46% copied, 36% imported.
- ECRI Institute, Partnership for Health IT Patient Safety (2016), "Health IT Safe Practices: Toolkit for the Safe Use of Copy and Paste."
- StructuredEval Insights: "The therapy documentation problem isn't writing. It's structure."