is your physician guilty of sloppy and paste in your ehr

It’s a feature that anyone who has used a computer in the last 20 years is likely very familiar with: the cutting and pasting of text. From filling out an online shopping form to editing a document in a word processing program, just a few clicks of the mouse or series of keystrokes can save a person an appreciable amount of time.

As it turns out, casual Internet surfers, office workers and would-be writers are not the only ones utilizing this feature. A new study in the most recent edition of Critical Care Medicine determined that physicians are actually copying and pasting in electronic health records at an altogether alarming rate.

Researchers utilized a cutting-edge software program capable of recognizing identical word sequences to examine over 2,000 progress notes written by 62 residents and 11 attending physicians for 135 patients in the ICU unit of a large U.S. hospital.

They determined that 82 percent of the progress notes written by residents contained at least 20 percent or more copy and pasted text, while 74 percent of the progress notes written by attending physicians actually exceeded this copy and paste rate.

Not surprisingly, this practice of copying and pasting in EHRs — referred to as “sloppy and paste” in the medical community — can put patients at great risk.

Consider a 2007 case study submitted to the Agency for Healthcare Research and Quality by a practicing physician.

An intern taking care of a 77-year-old woman admitted to the hospital after undergoing chemotherapy noted that she would receive heparin to prevent blood clots in her EHR. This note was then copy and pasted for the next four days before being signed by two other physicians who mistakenly believed that the heparin had already been administered.

The woman was released from the hospital but readmitted only two days later for a pulmonary embolism. Here, the physicians finally determined that the patient was never given the heparin.

“[Sloppy and paste] is an epidemic,” said Dr. Robert Hirschtick, a professor at Northwestern University who has studied this phenomenon. “And it’s among people who should know better. The common characteristic is that it’s a tremendous time-saver to take this shortcut for people too busy to do it the right way. The right way is to make sure everything in that note you’re about to sign reflects what’s going on today.”

What makes this study so disconcerting is that it creates yet another risk associated with the use of EHRs. Patients already have to worry about medical mistakes caused human input errors, and display errors (missing data, data loss, alert failures, etc.). When does it end? Hopefully, hospitals and clinics will invest the necessary time to teach medical staff about the dangers of sloppy and paste.

Source: American Medical News, “EHRs: ‘Sloppy and paste’ endures despite patient safety risk,” Kevin O’Reilly, Feb. 4, 2013

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