Standard MOI.11.1.1: The hospital has a process to address the proper use of the copy-and-paste function when electronic medical records are used.
The term copy and paste refers to the process of copying (or duplicating) patient information from a previous note in an electronic medical record (EMR) and pasting it into a new note in the patient’s EMR. Additional terms found in the literature include copy-forward and cloning. Auto-populate, which may be considered as a form of copy and paste, refers to programming an EMR to capture data from a previous form and automatically populating that information into a new form. This often occurs in outpatient clinics when information such as demographics, allergies, and medications recorded from a previous visit are automatically populated (or coped) into a new visit.
The use of copy and paste and auto-populate in EMRs can provide a benefit of increasing the efficiency of documenting important patient information. In addition, copy and paste may offer other potential benefits such as a more detailed and complete recording of a patient reassessment and the ability to more accurately track the patient’s progress. However, when not used with caution, copy and paste and auto-populate can pose significant risks to patient safety.
The ECRI Institute, in its October 2015 report on Copy/Paste: Prevalence, Problems, and Best Practices, identified four ways in which copy and paste may decrease the quality and accuracy of clinical documentation and pose significant challenges to patient care: “1) facilitating introduction of new inaccuracies, 2) accelerating the propagation of inaccurate information, 3) promoting creation of internally inconsistent notes, and 4) generating lengthy notes that may obscure important clinical information.”1 The report, on pages 10-11, provides an explanation and example for each of the four identified problematic areas of copy and paste.
The Journal of General Internal Medicine conducted a survey of 302 physicians on physician attitudes towards copy and paste.2 The survey revealed that when copy and paste was used, 183 (61%) of physicians found it more difficult to find new information, 215 (71%) believed the EMR contained more outdated information, and 214 (71%) thought the EMR contained more inconsistent information.
Despite physicians reporting several concerns about the information contained in the EMR when copy and paste was used, the same survey reported that ninety percent of the 253 physicians generating electronic notes indicated they used copy and paste when they wrote their daily progress notes.
The integrity of the patient medical record is critical to the quality and safety of patient care as this is the tool used for communication between health care practitioners and facilitates medical decision making, clinical follow-up, transitions of care, and medication ordering and dosing. A new standard, MOI.11.1.1, was introduced in the JCI Accreditation Standards for Hospitals, 6th Edition addressing the use of copy and paste in EMRs. The requirements include developing a process which includes guidelines, for the use of copy and paste, educating and training staff on the proper use of copy and paste, and monitoring compliance with copy and paste guidelines.
ECRI Institute. Copy/Paste: Prevalence, Problems, and Best Practices. Special Report. 2015 Oct. Accessed: Oct 10, 2017. https://www.ecri.org/Resources/HIT/CP_Toolkit/CopyPaste_Literature_final.pdf
O’Donnell HC, Kaushal R, Barrón Y, et al. Physicians’ Attitudes towards Copy and Pasting in Electronic Note Writing. J Gen Intern Med. 2009 Jan; 24(1): 63–68. Accessed Oct 10, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2607489/