Although EHRs provide many benefits to patients and physicians, one of their negative aspects is that they provide the opportunity to erroneously copy-and-paste entries from older records into current records. I have addressed some of these copy-and-paste problems in previous notes (see: OIG Says Cut-and-Paste in EHRs Can Lead to Medicare Overcharges; Veteran Clinician Critiques the Current EHR -- Both Good and Bad). A recent article provides some new insights into this issue as well as some possible solutions (see: Report highlights errors caused by copying, pasting in medical records). Below is an excerpt from it:
Copying and pasting electronic text in health care documents can perpetuate initial errors or introduce new mistakes, according to a report from the group, known as the Partnership for Health IT Patient Safety. "It's a huge problem," said Dr. Dean Sittig, a professor at UT-Health School of Biomedical Informatics in Houston and a member of the group....Many physicians use a template for entering patient information, copying it into the record and then changing the entries for each patient. But if one of those entries is not updated, it can lead to a missed diagnosis.That's in part what happened with the Ebola case in Dallas in 2014....A review of Veterans Affairs medical records between 1993 and 2002 found that 9 percent of notes included copied information, and 13 percent of the copied material was deemed so misleading or incorrect that it posed a significant risk to the patient. Experts say cut and paste errors have become more prevalent with the push toward electronic medical records and the need to provide detailed documentation for billing purposes....A recent federal report found that only 24 percent of hospitals had cut-and-paste policies, and fewer than half used software that captured the method used to enter text into a medical record....Malpractice attorneys, meanwhile, are mining medical records for copied material....Copying and pasting in medical records can save the time of physicians burdened by documentation requirements. Often, a patient's situation doesn't change much from visit to visit.....[It is recommended that] physicians use highlighting or quotation marks so that copied material is easily identified. He also recommends that hospitals monitor how much physicians copy and paste.
First of all, lets suggest that the copy-and-paste feature of EHRs was initially developed to allow physicians to work more efficiently. It enabled the copying of relevant information from previous notes into new notes without laboriously entering the data via keyboard. Let's agree that the feature is now causing major problems with EHR records. As noted above, physicians may copy templated data or previous text into the current record and then not make the necessary edits so that it's accurate. Another problem is that physicians may copy-and-paste previous data into the current record, perhaps for billing documentation, which may not be relevant or accurate. Most agree that all of this constitutes a significant problem. The article quoted above provides some concrete steps that can be take to help correct this problem. They are the following:
- Every hospital needs policies governing copy-and-paste features into their EHR that may compromise patient welfare.
- Every EHR entry should "capture the method used to enter text into a medical record." In other words, which type of text entry was used: keyboard, a phrase from a pick list, a copy-and-paste from a previous EHR note, or some other option? In addition, copied material could be highlighted or enclosed in quotation marks. Adoption of such an approach could suppress the inappropriate use of the copy-and-paste feature.
- In addition, hospitals need to "monitor [on a continuing basis] how physicians copy-and-paste." It may be that they continue to develop workarounds to the hospital rules and these need be understood as they occur in order to prevent future EHR errors.