Perhaps we are complacent about copy and paste because we remain unconvinced that there is a correlation between its use and patient safety. Although restricting the copy-and-paste function is technically feasible within the EHR itself, clinicians typically oppose such drastic measures.( 4) The fact that we continue to use a tool that we acknowledge as unsafe without taking real action to improve its use is a blot on our profession. Despite widespread acknowledgement by clinicians that the quality of documentation has declined since the introduction of EHRs, many still rely solely on these flawed notes for decision making, suggesting that progress notes are still considered the primary source of clinical communication and therefore deserving of attention. Copy and paste also makes it easy to create long, rambling notes that do not clearly convey the current status of a patient and can, in fact, distract a reader from important concerns. As in the case discussed by Hirschtick, the use of copy and paste may contribute to the introduction of inaccurate information within patients' records and cloud the judgment of subsequent providers. The use of copy and paste in medical documentation raises many concerns.
Unfortunately, Hirschtick's call to action at the time, along with those of others over the years ( 2,3), has not resulted in the kind of improvements in provider documentation that might prevent harm from copying and pasting. As it happens, years earlier, the abbreviation "PE" had been used in the electronic note to indicate that the patient had had a physical examination, not a pulmonary embolism! In a vivid example of copy and paste, once the diagnosis of pulmonary embolism was mistakenly given to the patient, it lived on in the EHR. It has been 5 years since Hirschtick wrote a WebM&M commentary on a remarkable case that illustrates some of the problems associated with copy and paste.( 1) In that case, the patient with an alleged history of "PE" (interpreted by the clinicians as pulmonary embolism) received an unnecessary CT scan to rule out a suspected "recurrence" of pulmonary embolus. Although the ability to copy and paste text is a central benefit of computing in general, and electronic health records (EHRs) in particular, the widespread adoption of EHRs has led to concerns about how copy-and-paste functionality is being employed in health care.
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