EHR copy and paste? Better think twice

Diana Warner, AHIMADiana Warner, AHIMA

'It goes through your system. It goes through other systems. It gets sent to other care providers; it gets sent to insurance companies.'

Who would have thought that something so simple as copy and paste could have such serious consequences?
 
Speaking at the October MGMA annual conference in San Diego, Diana Warner, director at AHIMA, confirmed the seriousness of inappropriately using copy and paste functions in electronic health records. And the government agrees -- it's no laughing matter. 
 
Seventy-four to 90 percent of physicians use the copy/paste function in their EHRs, and between 20 to 78 percent of physician notes are copied text, according to a September AHIMA report
 
It's become such a compliance and payment problem that the U.S. Department of Health and Human Services Secretary Kathleen Sebelius together with Attorney General Eric Holder wrote a letter last year to industry medical groups underscoring the seriousness of doctors "gaming the system, possibly to obtain payments to which they are not entitled."
 
[See also: AHIMA to ONC: Better clinical documentation needed to ensure EHRs' efficacy.]
 
Sebelius and Holder pointed to reports of hospitals using EHRs to "upcode" patients' medical conditions, abuses which have been estimated to cost nearly $11 billion, according to a year-old report from the Center for Public Integrity. The two agency officials also reaffirmed the government audits for identifying improper billing practices. "A patient's care information must be verified individually to ensure accuracy: It cannot be cut and pasted from a different record of the patient, which risks medical errors as well as overpayments," wrote Sebelius and Holder in the Sept. 24 letter. 
 
In Warner's opinion, most physicians are not trying to "game the system" but rather are trying to simplify their workload that has already been inundated with new compliance regulations. Nonetheless, this doesn't excuse carelessness. 
 
She recalled an incident at her previous medical group where a patient went from having a family history of breast cancer to having a history of breast cancer, all from copy and paste errors. It was a nightmare, said Warner, and took months to fully resolve. "The insurance company caught it and was going to change (the patient) coverage because she lied," so they thought, said Warner. "We had to work for months to get that cleared up with the insurance company so that her coverage would not be dropped. We had to then find all the records that it got copy and pasted into" incorrectly. Then, they had to track down all the locations they sent that information. 
 
"It goes through your system. It goes through other systems. It gets sent to other care providers; it gets sent to insurance companies," added Warner. 
 
"The worst use I've seen of it was when a physician copied the exam from one patient into another patient," said Nancy Babbitt, consultant at Babbitt & Associates and co-chair of MGMA-ACMPE national board of directors, at the MGMA13 conference. 
 
Overusing the copy/paste function can not only be bad for patients, but it's not good for compliance or payments either. "If your billers cannot tell when the procedure was done, and it looks like it was done every visit, they'll bill that procedure code for every visit," said Warner. 
 
The Office of Inspector General will also be on the lookout for these abuses, as they affirmed in their 2013 work plan. 
 
Warner was careful to add: There are appropriate ways to use the copy/paste functionality, but be smart. Generally, the function can be used for copying patient regular medications, long standing allergies, demographics, problem list and labs and treatments if they're ongoing.
 
Using the functionality appropriately is key, and just as important is educating staff, conducting internal audits and actively crafting effective policies. 
 
"If you had bad behavior before EHR, you're going to have bad behavior after EHR," added Babbitt.