The Dangers of Copy and Paste in the EHR

HM Epstein hmepstein at GMAIL.COM
Sat Oct 22 05:16:14 UTC 2016

 ​I was surprised by this report from ECRI. They did a retrospective look
at EHRs and found only 7.4% used cut-and-paste​. However, of that small
sample, 36% of the cut-and-paste entries contributed to Dx error.

Based on all of the complaints I've read about cut-and-paste use in EHRs, I
truly expected to see that the incidence was much higher. Has anyone seen
other studies to compare to this? Does it accurately reflect your
expectations from your own observations in your place of work?

Thank you.


The Dangers of Copy and Paste in the EHR
October 21, 2016
By Erica Sprey <>

By nature of design, EHR systems encourage physician users to copy old
patient data, like medication lists and chronic conditions, and copy and
paste the information into the current note. In doing so there are benefits
and risks for both physicians and patients, according to Lorraine Possanza,
DPM, JD, and Robert Giannini, NHA, of the nonprofit ECRI Institute
<>. Possanza and Giannini were
co-presenters at the American Health Information Management Association's (
AHIMA <>) annual conference in Baltimore, Md., held on
Oct. 17, speaking on "Safe Practices for Copy and Paste."

The ECRI Institute's mission is to provide physicians and other health
professionals evidence-based guidelines on the most effective medical
procedures, devices, and drugs, via scientific research. In order to
understand the affect that potentially unsafe practices like "copy and
paste" have on patient safety, ECRI applies a three-prong approach, says
Possanza. This includes data collection; data analytics; and leveraged
learning that reaches out to both EHR vendors and medical staff.

While reporting can seem onerous to overworked staff, it is vital to
understand the extent of the problem. Possanza provided conference
attendees an example where copy and paste can hinder the physician and her
staff as she treats a hospitalized patient who suffers from pressure
ulcers. If the initial assessment is copied and pasted forward in the note
on subsequent patient visits, the physician does not have a true picture of
the progression of the ulcers and may not trust the validity of the
information in the note.

Copy and paste also contributes to "note bloat" says Possanza, making it
difficult for a physician to pick out pertinent information that is
swallowed up by redundant information. It is vital that patient information
is accurate, timely, and easily assessable she says, adding that a dense
note can contribute to diagnostic error.

The ECRI Institute did a retrospective study on diagnostic error that found
7.4 percent of audited charts contained copy and paste information, and of
that group, 36 percent contributed to diagnostic error. "How does copy and
paste influence [diagnostic error]? Through note bloat, through those
internal inconsistencies, through the propagation of errors," says
Possanza. "If I pasted information and it's incorrect and I repeatedly
paste that information that is incorrect, I now have errors that are

In order to minimize the chances of error, Possanza says physicians and
other clinicians must be accurate in their notes, concisely document the
patient information, attribute where copy and paste material came from, and
give context where appropriate.

It is essential that physicians and other medical staff feel that they can
report health information technology (HIT) related-errors in a non-punitive
environment, so that management can address any systemic problems. And it
is also equally important that staff are trained on copy and paste best
practices. To that end, the Partnership for HIT Patient Safety
<> has
released the first "Health IT Safe Practices: Toolkit for the Safe Use of
Copy and Paste,"
examines the scope of the problem, defines the various stakeholders and
provides safe-practice guidelines for providers.

The Partnership has developed four recommendations for providers and their
staff, says Possanza:

A: Provide a mechanism to make copy and paste material easily identifiable;

B: Ensure that the provenance (and chronology) of copy and paste material
is readily available;

C: Ensure adequate staff training and education regarding the appropriate
and safe use of copy and paste; and

D: Ensure that copy and paste practices are regularly monitored, measured,
and assessed.

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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