Doc calls EHR copy and paste function a "modern medical illness"

By Molly Merrill
10:53 AM

The copy and paste function of an electronic health record is "one of the most egregious dangers of electronic charting," according to a recent editorial in the American Journal of Medicine.

Arie Markel, MD, director of one of the departments of internal medicine at a hospital in Israel, found out first hand the ill effects of copying and pasting in patients' charts.

Markel wrote a letter entitled "Copy and Paste of EHRs: A Modern Medical Illness" in response to the AJM editorial in which he said he "identified strongly" with the subject of the editorial written by Ronald Adelman, MD, medical director of the Irving Wright Center of Aging and co-chief of the Division of Geriatrics Medicine and Gerontology at The New York-Presbyterian Hospital, and Eugenia L. Siegler, MD, medical director of the Geriatrics Inpatient Service at the Weill Cornell Campus of New York Presbyterian Hospital.

Adelman and Siegler said some of the problems with copying information from a prior note and pasting it into a new one are that it reduces the credibility of the recorded findings, clouds clinical thinking, limits proper coding, and robs the chart of its narrative flow and function.

Markel said that in reviewing patient charts at his hospital he found that the copy and paste function was of the "same magnitude" as described in the AJM editorial.

"Medical diagnosis in previous admissions that have no relevance for the present hospitalization are repeated and copied from one summary to the other. Previous medications are copied and printed as if they were the patient's current treatment even if the patient is no longer taking them. Data presented in a previous hospitalization are repeated without changing the details or actualizing the date; subsequently the reader may not be able to understand or may misinterpret the data," said Markel.

But Markel says it is not just the copy and paste function that is problematic, but all computer functions that allow automatic copying of all previous chart diagnoses, physical examination results, and whatever else is in the chart.

The AJM editorial suggested that disabling the copy and paste function in the EHR could be a way to eliminate the problem, but said that staff were still able to copy and paste from documents saved in text formats outside the electronic chart.

Markel said the problem became so serious at his medical center that they did just that, but came up against the same problem of not being able to completely eliminate the use of copying and pasting from other documents.

"As computer techniques advance and are of immeasurable help in our work as physicians and investigators, the way to overcome uses and abuses of this medium in our routine work seems to remain beyond us," said Markel.

The AJM editorial called for "thinking creatively" about charting as a communication tool.

"An electronic health record can document a patient's course, foster meaningful patient narratives, free up more time for direct patient contact, and advance care by enhancing both intradisciplinary and interdisciplinary communication. To do so, we must change not only the health record but also the way we create it, evaluate it and use it," the article concluded.