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ECRI to Talk EHR Copy and Paste, Patient Safety at HIMSS 2016

ECRI Institute's Partnership for Health IT Patient Safety will tackle copy and paste on EHRs, hoping to spark positive change in patient safety initiatives.

By Sara Heath

Providers need guidelines with regard to copy and paste functions in EHRs to help protect patient safety, according to the Partnership for Health IT Patient Safety.

The Partnership, which is a part of the ECRI Institute, will showcase its efforts to provide those guidelines later today at the HIMSS 2016 Conference. Leading up to that announcement, however, the Partnership released its written toolkit for providers using copy and paste functions on their EHRs.

The toolkit takes a simple approach, providing four basic principles to make copy and paste functions on EHRs safer for patients:

  • Provide a mechanism to make copy and paste material easily identifiable
  • Ensure that the provenance of copy and paste material is readily available
  • Ensure adequate staff training and education regarding the appropriate and safe use of copy and paste
  • Ensure that copy and paste practices are regularly monitored, measured, and assessed

Such suggestions, such as providing technical mechanisms to make copy and paste more easily identifiable, are certainly more easily said than done. By disrupting technical developments and approaches to provider workflow, the Partnership states that it will take time to make these kinds of safety provisions.

“The workgroup recognized that some of the recommendations will take time to implement, particularly those that require technology changes by developers and workflow changes for providers,” the Partnership stated.

The Partnership reportedly intends these toolkit guidelines to help health IT and EHR vendors, as well as providers and health IT experts, realign use focuses and develop detailed strategies for patient safety.

“The recommendations are designed to allow the stakeholders the opportunity to identify ways to address the issues as the technology changes, recognizing that external forces, including regulations and requirements, may impact the recommendations in the future,” the Partnership explained. “The toolkit provides an opportunity and a challenge to all of the stakeholders to work on making copy and paste activities safer.”

Industry stakeholders involved in the toolkit are starting these conversations for a good reason. The prevalence of copy and paste has grown in light of EHR usability issues.

“Providers have copied and pasted information as a means of improving usability,” the Partnership claimed. “Copied material is used when systems are not interoperable and information does not flow between those systems, in order to improve efficiency, provide for complete documentation, and avoid transcription errors.”

That said, this practice can potentially cause some adverse health effects. When a provider simply copies and pastes a patient’s entire health history, she runs the risk of perpetuating incorrect patient information, or pasting something in the incorrect spot, both of which could result in adverse health events.

“[T]he use of copied and pasted information may negatively affect patient safety by providing an opportunity for missed or delayed diagnosis; creating cognitive bias in clinical decision making; and inappropriately lengthening clinical documentation (note bloat), decreasing a note’s effectiveness as a communication tool,” the Partnership stated.

Thus the Partnership decided to tackle copy and paste functions in EHRs as the first of many patient safety efforts going forward.

“[T]he issue of copying and pasting health information (e.g., orders, notes, labels) was later chosen for the first workgroup because the practice is widespread and often underreported and has the potential to cause adverse patient safety events if “copy and paste” practices result in documentation containing inaccurate, irrelevant, or outdated information,” the Partnership said.

Copy and paste functions within EHRs are unavoidable, and as the Partnership pointed out, can be useful in a system that lacks interoperability and high usability ratings. Going forward, however, providers and health IT and EHR vendors must be cognizant of the safety issues associated with copy and paste, and work as an industry to create better technology and workflow practices to quell the problem.

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