Using the copy and paste function in EHRs presents significant safety concerns, according to a National Institute of Standards and Technology (NIST) report released last month.

For the report, NIST partnered with the ECRI Institute and the U.S. Army Medical Research and Materiel Command to conduct an in-depth analysis of how providers use the copy and paste function in EHRs, as well as providers' perceptions of whether the function could cause errors that could potentially affect patient safety. Researchers between July 2016 and August 2016 interviewed nurses and physicians who used the military's AHLTA EHR application.

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Findings

The researchers found that although EHRs' "copy and paste functionality is intended to allow medical practitioners to easily and efficiently reuse information in patient EHRs without having to retype the information, ... in practice, current implementation of this functionality has introduced overwhelming and unintended safety-related issues into the clinical environment."

According to the researchers, the clinicians involved in the study cited several accuracy concerns with copied and pasted data, such as:

• Information being copied and pasted into incorrect areas; and
• The potential for "'hyper-documentation' or 'note bloat,'" which can make it hard for clinicians "to extract accurate, relevant, and timely information on a patient."

The researchers found that when clinicians are copying and pasting in EHRs, they have an "unconstrained ability to extract a large amount of information" from patients' records. This "can present users with convoluted and/or irrelevant information impairing situation awareness" and cause users to "miss important pieces of information," the researchers found.

In addition, the researchers found that when clinicians use the copy and paste function in EHRs, they sometimes "forget to properly review and edit all of the information they have copied and pasted," which can result in users copying and pasting incorrect information. The researchers added that EHRs do not provide users "with system features that promote efficient editing."

Recommendations

To improve the copy and paste function's "safety-related usability," the researchers recommended that EHR systems should:

• Allow users to view a chain of custody for information that has been copied and pasted;
• Be able to note when a user read and edited information that was copied and pasted;
• Make data selected for copy and paste more visible so users do not unintentionally copy and paste too much or too little information;
• Not allow users to use the copy and paste function in certain areas of an EHR;
• Not allow users to copy and paste dates; and
• Not allow users to copy and paste demographic data from one chart to another, though such information should be auto-populated in all of the interfaces included in a patient's record.

According to Health Data Management, the researchers also included specific changes EHR developers should make to the copy and paste function for when users are transferring data between different departments or different patients' EHRs, as well as when providers are copying and pasting information related to:

• Allergies;
• Discharge summaries;
• Medication entries;
• Surgical notes; and
• Vital signs.

Overall, the researchers in their specific recommendations reiterated that EHR systems should allow users to view clear chains of custody for copied and pasted information. The researchers also recommended that EHR systems should:

• Enable users who are copying and pasting information between different patients' EHRs to easily transition between charts "with unrestricted access to input information to another chart" by a user's deliberate action;
• Ensure all data copied and pasted from surgical notes is, in fact, copied and pasted and allow users to edit the data; and
• Ensure that when users are copying and pasting information between different patients' EHRs, the users know which patient's EHR they are accessing at any given point.

For vital signs, the researchers recommended that EHR systems should indicate how vital signs are measured and include timestamps for when they are measured, as well as for when:

• The vital signs are documented in an EHR;
• The EHR is signed;
• The vital sign is revised; and
• The vital sign is retrieved (Goedert, Health Data Management, 2/7; NIST report, January 2017; Miliard, Healthcare IT News, 2/7; EHR Intelligence, 2/7).

Why the EHR life cycle is just like raising a child

A successful EHR system requires budget, resources, and planning—not only before it goes live, but after as well.

In fact, the process of implementing, deploying, maintaining, and optimizing an EHR system is similar to that of raising a child—each stage of the process requiring a unique subset of people to ensure its success. Learn more about the seven stages of the EHR life cycle in this infographic.

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