How copy and paste in electronic medical records affects patient care

With many hospitals and medical providers still in the early adoption stages of EHR, objections or problems with the various systems are still just coming to light. However, one particularly growing concern is providers using the copy-paste or copy-forward function in patient records. This is a shortcut that many physicians have found to be handy after the implementation of the new system, however using it actually can violate patient confidentiality and HIPPA rules, and lead to fraud or malpractice lawsuits and federal or payer audits. More importantly, the misuse of these functions can negatively affect patient care.

In using copy-forward or copy-paste incorrectly, physicians or nurses can affect patient care in several ways. The first problem is when providers copy more information than what is actually relevant – say pages of labs from an unrelated issue – and paste it with their notes. This creates “note bloat” in the EMR system, which makes it more difficult for other providers to interpret the last physician’s notes and decipher what the patient’s current issue is and what issues listed have already been resolved.

A more serious concern is when information is copied from one patient’s record to another. This can lead to incorrect information being stored on a patient’s EMR record, and can also lead to HIPAA violations if any of the original patient’s information is stored on another patient’s chart.

In addition, problems arise when the copied note includes errors, for instance if a surgeon indicates that the patient’s left knee is being operated on, when in actuality it is the patient’s right knee. Although the surgeon can go back and fix their mistake on the patient’s original record, if the note has been copied by other providers the wrong information is then contained within the patient’s current chart. This can lead to the improper care or diagnosis of a patient, and has the potential to lead to malpractice lawsuits.

Copy-pasting or copy-forwarding can also lead to the patient or insurance company being billed incorrectly, leading to payer audits and fraud lawsuits. For instance, if a physician sees a patient but doesn’t complete a new physical exam, and instead copy-forwards a physical exam provided by another doctor, the medical billing team doesn’t know the difference and can bill the patient or insurance company for a new physical. This is clearly unethical, and the patient or insurance company then has grounds to investigate fraud or file a lawsuit.

As patient care grows more intertwined with technology, medical facilities need to be aware of the potential hazards created when using shortcuts in these technological systems, and additional efforts need to be taken to reduce these shortcuts.

Elizabeth Hipp is Social Media Director, Transcription Outsourcing, LLC.  She blogs at the Transcription Outsourcing Services Blog.

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  • portia chalifoux

    This is an under-reported problem. It’s akin to the old telephone game where one person originates a message and whispers it in the next player’s ear. It’s passed in turn down the line of players and what results when the last player repeats back what was said has no bearing whatsoever to the original message. Hilarity ensues when it’s a game. Patient harm and death results when it’s a medical record.

    One corrective that could help is integrating an auto feature that time/date stamped and placed in a highlighted box any info that was transferred/copied outside of free texted entry. It should also reference the original entry time/date and author’s name/credential/department/specialty so that individual authors are fully identified and their entries are referenced as theirs wherever their information is used. Failing to fully and accurately attribute all medical record information to a specific human source is dangerous, and it leads to unnecessary risk and harm to patients.

  • Jonathan Govette

    Great article Elizabeth, lets chat further, I agree that the problem is only growing, most doctors and staff do not track or mange communication properly, most scribble it in a note pad or try to do it in excel but as you know, that is not effective.

    I wanted to get your feedback on a product we are launching soon called referralMD – (Google it) it is a simple, online healthcare referral program that works without using triplicate forms or faxes.


  • David Long

    I agree that this is a problem but I do not think the best answer is to try to prevent doctors from copy and pasting (by making it impossible in the program). Sometimes, copying and pasting can result in more accurate information: for example, copying and pasting a long and unfamiliar name rather than typing it out by hand is likely to be more accurate.

    I think the solution is allowing the physician to use links. That way, instead of copying all the information in a lab, the physician could instead type out the relevant information and say “look here to read more”.

    Trying to solve problems by reducing functionality is irritating to the physician and may result in worsened patient care in cases when the functionality is warranted.

  • Edward Pullen

    It seems a bit disingenious for an advocate of medical transcription to be critical of EMR processes. Self-serving to say the least.

    • Eliz Hipp

      Hi Edward,
      Although I do work for a medical transcription company, as you can see there is nothing in the article about transcritpion, which of course would be self-serving. Also, I am not anti-EMR, I just feel that there need to be some more controls in the EMR to prevent errors from happening. As you can see from the other comments, many other professionals have a similar experience with copy-pasting in EMR.

  • MarylandMD

    Any new technology, while solving some of the problems of the old technology, introduces new problems and opportunities for errors. EMRs are no exception to this rule. A single errant click can select a chemotherapy agent instead of an antibiotic, or the wrong finding on physical exam, or the wrong billing code. Only a millimeter on the screen can make a huge difference. We have made the text more legible, but since most doctors don’t touch type, they start using abbeviations and shorthand, which can sometimes be as opaque as bad handwriting. All of these problems can be avoided with some extra care and a quick look to review what we have done, but we are too rushed to do this consistently.

    And malpractice lawyers are well aware of the pitfalls of EMRs, including the copy-forward and copy paste issues described above. What you think of as a minor error can be painted as a sloppy doctor who is too busy to care to take proper care of the patient.

  • karen3

    You miss another major problem. Propagating errors. My mom had her “history” of CABG and “Pulmonary Embolism” spread like wild fire through out her medical record. Which she never had. Nobody in three months in the hospital could figure it out and fix it, even though we mentioned the PE as being wrong on a daily basis. Nobody discussed the CABG and apparently nobody noticed the lack of a scar on her chest. Things like this truly undercut confidence in the medical profession. Nearly a 100 doctors and no one took an honest history. Says volumes.

  • LeoHolmMD

    Who ever said EMR was safe? It’s never been tested. Documentation continues to overshadow patient care.

  • Rich Weisberger

    We live in a copy and paste world.

  • the Daily Medical Examiner

    Having worked in both fully written and fully electronic systems, there are evils on both sides of the digital divide. The evils of inadequate, illegible, or unintelligible written/transcribed charts are pitted against the woes of a verbose, electronic “template-land” where one must search for signs of intelligent life. Alas, even without the much needed copy-paste and template controls, I would still choose hunting through excess or unnecessary prose before I will go back to trying to interpret his or her chicken scratch.

  • buzzkillersmith

    Darn, I wish I had paid more attention in my typing class in med school. Uh, wait a minute….

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