The use of copy and paste functionality is introducing significant safety concerns for clinicians that use those capabilities in digital records systems in healthcare, according to a report from a federal agency.

Copy and paste, which is intended to help clinicians post information in patients’ records, can cause errors to be put into those records and then continued over time, according to a 63-page report by the National Institutes of Standards and Technology.

“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,” notes the report by the federal agency, which is part of the Department of Commerce. “However, in practice, current implementation of this functionality has introduced overwhelming and unintended safety-related issues into the clinical environment.”

Headquarters of the National Institutes of Standards and Technology.
Headquarters of the National Institutes of Standards and Technology.

NIST worked with patient safety organization ECRI and the U.S. Army Medical Research and Material Command on the study. Researchers interviewed physicians and nurses interacting with the military’s AHLTA EHR.

Also See: Why copying and pasting must stop now

Clinicians interviewed for the report had concerns about the integrity of information while using copy and paste and identified a high potential risk of entering wrong information in the wrong chart. In addition, care providers noted that too much documentation, or “note bloat,” makes it difficult to extract accurate, relevant and timely patient information.

A common error with copy and paste is that clinicians forget to review and edit all of the information they reproduce in records—clinicians interviewed for the report say this is likely because of frequent interruptions and many of the records systems they use do not have adequate editing capabilities.

The report includes numerous recommendations to prevent users from inadvertently copying only part of the intended information. Other recommendations include:

  • EHRs should be able to reconcile that copied information was read and edited by the provider.
  • Copy and paste must not be permitted when entering data into a blood bank information system.
  • Demographic information should never be copied but auto-populated in all interfaces in a patient chart.
  • Copying of demographic data from one chart to another should be prohibited.
  • Dates should never be copied and pasted.

Other recommendations cover specific functions for handling allergies, surgical notes, medication entry, discharge summary, and copying and pasting information from different departments and another patient’s electronic health record.

The NIST report is available here.

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