EHR Copy and Paste and Patient Safety
Shannon M. Dean, MD Jan. 1, 2018
Shannon explains a case that illustrated some of the problems associated with copy and paste
within a health record. The patient, with an alleged case of “PE” which was interpreted by
clinicians as pulmonary embolism, had received an unnecessary CT scan to rule out a suspected
recurrence of pulmonary embolus. Years earlier, the abbreviation PE had been used to indicate
that the patient had a physical examination, not a pulmonary embolism. The use of copy and
paste may contribute to inaccurate information within patient’s records. Many clinicians have
stated that progress notes are still considered the primary source of clinician communication,
which may contain inaccurate information. Shannon states that several professional
organizations have published consensus statements and toolkits, which can be used for
education as well as mentoring around this issue. Epic’s EHR can identify the source of every
character within a note, whether it is newly typed, imported from another source, or copied
and pasted. Although there are published guidelines and toolkits available regarding safe use of
copying and pasting, organizations need to start using these toolkits and auditing the features to
obtain a better understanding on how to best educate and implement change. The OpenNotes
initiative, which allows patients to read their clinicians notes, represents a real opportunity to
increase provider awareness of the need for documentation accuracy. Patients will now be able
to hold their providers accountable for quality documentation.
Dean, M. Shannon. (January 1, 2018). EHR copy and paste and patient safety. Agency for
Healthcare Research and Quality. https://psnet.ahrq.gov/perspective/ehr-copy-andpaste-and-patient-safety
Copy, Paste, and Cloned Notes in Electronic Health Records
Electronic health records are different from other electronic files because they record patients’
condition and adjustments to treatments. Physicians use EHRs to accurately and quickly
document a patient’s condition for their use as well as their colleagues (Weis and Levy, 2014).
The benefits of EHRs include improved access to records as well as an increased quality of care.
According to Weis and Levy, (2014) medical adoption has evolved with rapid growth in the use
of EHRs. Physicians spend 26% of their time on clinical documentation and 18 % of their time
writing on computers (Weis and Levy, 2014). In recent studies, the author’s concluded that the
diagnosis error rate due to the use of copy and pasting was around 2.6% (Weis and Levy, 2014).
Though these tools offer care providers many new efficiencies as well as opportunities to
improve care delivery, they also can be misused or deliberately abused, resulting in the
misrepresentation and misattribution of a provider's effort and guidance of patient care (Weis
and Levy, 2014). Since almost all EHR software allows for information to be moved from virtually
any part of a patient's record into another section, these documentation tools create an
environment where accurate tracking, attribution of authorship, or both can be lost (Weis and
Levy, 2014). Copying and pasting also has many other risks such as malpractice liability or errors
in data extraction in medical research. Patient care risks include inaccurate recording of a
patient’s symptoms, incorrect insertion of data from other parts of the medical health record,
and excessively long notes that distract the reader from key essential health information. The
highest risks include copying from one patient’s record to another and copying contents from
unlicensed providers and using it to support medical necessity.
Weis, J. M., & Levy, P. C. (2014). Copy, Paste, and Cloned Notes in Electronic Health
Records. Chest, 145(3), 632-638. https://10.1378/chest.13-0886
One way that electronic health records may adversely affect patients is by facilitating the
copying of patient information between progress notes (Thornton et al., 2013). Due to the
growing concern regarding copying in electronic health records has prompted publication of
journal editorials. This article explains the exploration of negative circumstances in copying and
pasting in medical records regarding patients in the ICU, due to the high acuity of patients and
the need for expeditious decision making. We focused on the assessment and plan portion of
the notes because we wanted the portion of the clinical record that most reflected physicians’
thoughts regarding each patient’s health status and treatment intentions (Thornton et al.,
2013). The study showed the copy rates were greatest in the physical examination, but the
assessment portion of notes were the fourth most common (Thornton et al., 2013). The article
explains that copying in the electronic health record may lead to less independent thought,
which could hamper the development of alternative diagnosis and treatments (Thornton et al.,
2013). Also, with the relative ease of copying information into progress notes, the possibility of
inaccurate or diluted information exists in which true patient assessments and treatment plans
may be missed and adverse patient outcomes may result (Thornton et al., 2013).
Thornton, J. D., Schold, J. D., Venkateshaiah, L., & Lander, B. (2013). The Prevalence of Copied
Information by Attendings and Residents in Critical Care Progress Notes. Critical Care
Medicine, 41(2), 382–388. https://doi.org/10.1097/CCM.0b013e3182711a1c