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We read with interest the article by Linder, Schnipper, and Middleton comparing dictation, free-text typing, and structured data entry to quality outcomes.1 The authors conclude that using dictation appeared to provide a lower quality of care, but that conclusion seems unsupported by the reported results.Most importantly, the authors themselves note that most of the differences found were not actually quality of care or clinical outcome measures. The authors write that ‘even if documentation style were only associated with better documentation quality, a complete and accurate record is important to demonstrate high-quality care and inform clinical decision support and population management.’ However, the methodology states that text notes were not used for quality assessment, so the ‘missing’ data elements might have been just as completely and accurately …

In response to: Method of electronic health record documentation and quality of primary care