Osler,
The letter writer is a disgrace, and by far, the weakest part of the program. It should open up in any program you wish, preferably Word. Most programs allow that.
It isn't just specialists, it is the referring doctors which hate the formatting of the letter. It is embarrassing. And, once you open the letter for printing, it is over. You can't change anything. Also, the preferences at the bottom should default to what one needs. I don't need the note to go with it and usually don't want it, where others may need it.
This is why I do not want the PM. Because as we move toward that and working on that for months and months, the little things don't get changed. I don't think the letter writer will ever change.