According to a recent editorial, the copy and paste function of an electronic health record (EMR) is "one of the most egregious dangers of electronic charting," The editorial was published in the American Journal of Medicine (AJM).
Arie Markel, MD, director of one of the departments of internal medicine at a hospital in Israel, wrote a letter entitled "Copy and Paste of EHRs: A Modern Medical Illness" . The letter came in response to the AJM editorial in which he said he "identified strongly" with the subject of the editorial written by Ronald Adelman, MD, medical director of the Irving Wright Center of Aging and co-chief of the Division of Geriatrics Medicine and Gerontology at The New York-Presbyterian Hospital, and Eugenia L. Siegler, MD, medical director of the Geriatrics Inpatient Service at the Weill Cornell Campus of New York Presbyterian Hospital.
Both Adelman and Siegler mentioned that some of the problems with copying information from a prior note and pasting it into a new one are that it decreases the credibility of the recorded findings and reduce the chart of its narrative flow and function. However, Markel said that while reviewing patient charts at his hospital he noted that the copy and paste function was of the "same magnitude" as described in the AJM editorial.
Markel said "Medical diagnosis in previous admissions that have no relevance for the present hospitalization are repeated and copied from one summary to the other. Previous medications are copied and printed as if they were the patient's current treatment even if the patient is no longer taking them. Data presented in a previous hospitalization are repeated without changing the details or actualizing the date; subsequently the reader may not be able to understand or may misinterpret the data,"
Moreover, Markel confirmed that not just the copy and paste function that is causing problems, but all computer functions that permit automatic copying of previous chart diagnoses, physical examination results, and anything else is in the chart. The AJM editorial had a suggestion that when disabling the copy and paste function in the EHR, this problem would be solved. Yet, the editorial added that staff were still able to copy and paste from documents saved in text formats outside the electronic chart.
Markel said that the copy and paste function was a serious problem at his medical center. He said "As computer techniques advance and are of immeasurable help in our work as physicians and investigators, the way to overcome uses and abuses of this medium in our routine work seems to remain beyond us," The AJM editorial recommended "thinking creatively" about charting as a communication tool. The article added "An electronic health record can document a patient's course, foster meaningful patient narratives, free up more time for direct patient contact, and advance care by enhancing both intra-disciplinary and interdisciplinary communication. To do so, we must change not only the health record but also the way we create it, evaluate it and use it,"
