The Dangers of Copy and Paste in the EHR

Hoffer, Edward P.,M.D. EHOFFER at MGH.HARVARD.EDU
Wed Oct 26 14:14:03 UTC 2016


Probably the greatest danger from cut-and-paste is loading the note with so much extraneous material (full text of pathology and imaging notes, discharge summaries, etc), that the reader of the note has no idea what transpired at the actual visit!  One of our local specialists produces notes that can run 8-10 pages, and I then have to telephone him to find out what happened at the patient visit.  Some EMR users seem to think that a very long note justifies higher visit code.
Ed
Edward P Hoffer MD, FACC, FACP, FACMI

From: rkoppel [mailto:rkoppel at SAS.UPENN.EDU]
Sent: Saturday, October 22, 2016 4:58 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] The Dangers of Copy and Paste in the EHR


You may be interested in this piece on cut and paste from Chest.



Ross Koppel, PhD, FACMI

UNIVERSITY OF PENNSYLVANIA

Sociology Dept;  LDI Senior Fellow, Wharton; &

Affil Fac. Sch. of Medicine.

Chair, AMIA Clinical Information Systems Working Group.

Ph: 215 576 8221; Cell 215 518 0134



________________________________
From: Elias Peter <pheski69 at GMAIL.COM<mailto:pheski69 at GMAIL.COM>>
Sent: Saturday, October 22, 2016 8:12 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] The Dangers of Copy and Paste in the EHR

I am curious about their precise definition of copy/paste, and how they identified it operationally. Specifically, did it include things like:


  *   A clinical list (problems, medications, allergies) that automatically populates a note without the user actively copying/pasting.
  *   A social history that carries forward without a specific copy/paste action by a clinician.
  *   An immunization record that carries forward without a specific copy/paste action by a clinician.
  *   Problem-specific history or findings that auto populate a note based on internal EHR logic, often seen with chronic problems documented with templates: chronic pain, fall risk, services due, hypertension, CHF.

These have the same implications as copy/paste by a clinician, but may not have been captured. They may also be very hard for a clinician to identify or remove from a note.

Peter

On 2016.10.22, at 1:16 AM, HM Epstein <hmepstein at GMAIL.COM<mailto:hmepstein at GMAIL.COM>> wrote:

 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.

Best,
Helene

http://www.diagnosticimaging.com/ehr/dangers-copy-and-paste-ehr

The Dangers of Copy and Paste in the EHR
October 21, 2016
By Erica Sprey<http://www.diagnosticimaging.com/authors/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<https://www.ecri.org/Pages/default.aspx>. Possanza and Giannini were co-presenters at the American Health Information Management Association's (AHIMA<http://www.ahima.org/>) 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 propagated."
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<https://www.ecri.org/resource-center/Pages/HITPartnership.aspx> has released the first "Health IT Safe Practices: Toolkit for the Safe Use of Copy and Paste,"<https://www.ecri.org/Resources/HIT/CP_Toolkit/Toolkit_CopyPaste_final.pdf> which 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.




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