Copy and paste

Copy and paste function in EHR allows physicians to copy a patient note from a previous time, insert it under a new date and time and alter it, rather than writing a new note each day. (Article 2- page 63)

History

Although physicians have always been able to hand copy previous patient notes, copy and paste functionality of EHR facilitates this process in a greater magnitude and has been noted to do so without the same sense of personal ownership as it would in paper records (Article 1-page 3/8)

Initially, the word processing tool of copying and pasting, as well as using templates, aided the transition to use of the EHR for electronic documentation. This also was noted to lead to “lengthy, hard-to-read records stuffed with data already available on line.” (1) This author completed a VA study of Computerized Patient Records System (CPRS) charts that showed that nine percent of progress notes they inspected contained copied or duplicated text, and that high-risk author copying occurred once in every 720 notes, and one in ten electronic records contained an instance of high-risk copying. A series of 11 suggestions were made on a ways to decrease the risks associated with copy and paste. Another author has noted that “…the use of NLP may allow a much more precise method to carry text forward from previous notes, which may alleviate some problems caused by uncontrolled cutting and pasting of text.” (2)

Prevalence and perceptions among providers

In a cross sectional survey, it was noted that 90% of providers used the copy and paste EHR function. 70% reported using it almost always or most of the time. 71% noted that this function led to inconsistencies and inaccuracies in documentation. Only 24% felt CPF led to mistakes in patient care and 19% felt CPF had negative impact on patient documentation. 80% providers wanted to continue using CPF. (Article 2 O’Donnell,2008)

Benefits

Studies report physicians spend more time in indirect patient care, specifically fulfilling the responsibility of data entry than at the patient bedside. (ER 4000 click study). Copy and paste functionality is a legitimate timesaving tool when used appropriately. (article 1, page 2/8)

Limitations and concerns

Copying a note in EHR without editing or updating it creates opportunities for error and patient harm. Such practice has been referred to as “sloppy and paste” in a commentary published by the Agency for Healthcare Research and Quality (AHRQ) patient safety network. (Article 1 page 2/8). Medication reconciliation errors fall under the high risk category in EHR copy and paste errors. (Mazer 2011, acad emerge med)

“Note bloat” issue

significant redundancy from duplication of prior information making it harder to find new and meaningful information (Article 3- O’Wrenn- quantifying clinical narrative)

Possible solutions

Technological solutions such as automatic EHR highlighting of copy-and-pasted text in the form of color coding or italicizing has been proposed. This difference in appearance of a copied-and-pasted text would prompt readers to heighten their skepticism regarding the text’s accuracy.

Increased focus on regular auditing and feedback on provider noted has been proposed to improve clinical documentation practices.

References

Submitted by (Raghavendra Mishra, MD)