In a recent article in the American Journal of Medicine (AJM), the problems found as a result of the copy and paste functions in electronic health record (EHR) applications resulted in loss of new input, repeated errors, and loss of narrative function. Subsequent responses by healthcare professionals concurred with the analysis stating specific incidents of recorded error as a direct result of providers copying and pasting the notes of previous reports.
If copy and paste is a problem, then the built-in intelligence of some of the newer EHR applications creates an even larger problem to the medical community. In several of the EHR applications I have reviewed, the application will attempt to auto-populate a physicians notes and response to diagnosis based upon common notations or even based upon past notes. For example, as the physician begins to type in a diagnosis of a sinus infection, the application will begin to suggest or auto-populate observations and notes based upon the diagnosis into the patients electronic health record. If physicians become used to the application attempting to suggest content for a medical record then the AJM article is correct in assuming the medical records will lose accurate diagnostic records and the importance of a narrative health record trending the patient’s trajectory.
In an effort to make the EHR applications easier to use, save time and attractive to use in an industry where paper documentation has been the norm for so long, the technology may actually be harming the industry and therefore harming the effectiveness of healthcare. The AJM article suggests corrective action by disabling the copy and past features which may solve the problem but may also set back the usefulness and efficiency touted by the EHR movement. Selective copy and paste functionality for personal patient record information such as social security, name, address and non-health related information has bee suggested as permissible to maintain the efficiency of an EHR.
Once question not yet addressed is the potential for malpractice. If a record is recorded improperly as a result of copy and paste, does that constitute malpractice? If an incorrect or inaccurate diagnosis is perpetuated in the EHR as a result of copy and paste even though the patient’s trajectory has changed and an improper treatment is issued resulting in permanent injury or death then does this constitute gross negligence? EHR has the potential to transform the healthcare industry and improve the effectiveness of healthcare providers but only if the technology progresses in response to the needs and unique requirements of the healthcare profession.