NIST weighs in on EHR copy-and-paste safety

In collaboration with ECRI, a new report outlines best practices, suggesting that copy-and-paste data should be easily identifiable, with its original source easy to discern.
By Mike Miliard
12:54 PM
NIST EHR copy paste

The National Institute of Standards and Technology's recent study, "Examining the Copy and Paste Function in the Use of Electronic Health Records" aims to shed light on the widely-used but controversial copy and paste functionality in EHRs, exploring how care providers use it and seeking ways to ensure it maintains patient safety.

Previously, ECRI's Partnership for Health IT Patient Safety has issued four recommendations for clinicians' use of copy and paste: Provide a mechanism to make copied/pasted data more easily identifiable; make sure the provenance of such data is readily available to anyone accessing the EHR; ensure staff are trained about the appropriate and safe use of copy and paste; and work to ensure those practices are regularly monitored and measured.

In this report, researched in partnership with ECRI and the U.S. Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center, NIST's human factors research uncovered some potentially problematic trends with regard to volume, attribution and veracity of clinical data when copy/paste is used.

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By examining the AHLTA electronic health record platform used by TATRC, NIST found that an essentially unlimited ability to extract volumes of data with copy and paste can cause important pieces of patient data to be missed in overpopulated fields full of "convoluted and/or irrelevant information."

But clinicians need to know where that data came from: "who copied and pasted it, what was added to/edited in the information and the date and time the information was copied and pasted."

[Also: AHIMA calls for curbing copy-and-paste]

Given that EHR end-users sometimes forget or neglect to properly review and edit all the data they've copied and pasted, and that oftentimes they're not provided with system features that enable efficient editing, that can lead to issues with the material's accuracy and usability, according to NIST.

As such, the report offered several recommendations for safe use of copy and paste.

First, it bolstered ECRI's call to develop a way to make copied/pasted data more easily identifiable.

"EHR systems must be designed to enhance the visibility of the information being selected for copy and paste to prevent users from inadvertently copying only part of the information that was intended to be copied which could minimize the possibility of incomplete reuse of information that could lead to morbid/mortal errors," according to the report. "EHR systems should provide a concept for reconciling that the copied information was read consciously and edited by the clinical provider which would promote the attribution of the source of the information."

Next, it also agreed with ECRI that the source of duplicate material should be made readily discernible.

"User interface must display the 'chain of custody' of the information associated with the use of copy and paste," said NIST researchers. "However, this information should not be displayed by default, and be shown only on user demand to avoid the possibility of overwhelming clinical users and contribute to errors of commission (taking an incorrect action)."

NIST also offered additional human factors recommendations for other key clinical areas such as vital signs, allergies, surgical notes, medication entry discharge summaries and more. They can be seen in the full report at

Twitter: @MikeMiliardHITN
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