ECRI: The rules on copying and pasting medical information

In 2016, the ECRI Institute’s Partnership for  Health IT Patient Safety released its Health IT Safe Practices: Toolkit for the Safe Use of Copy and Paste. The toolkit outlines the risks and benefits of reusing medical information in electronic health records (EHR), along with four safe-practice recommendations on copy and paste policies. It also provides checklists, educational materials, and implementation tools to assist in identifying hazards and adopting safety practices.

The toolkit and its recommendations were derived from evidence-based studies, reported events, and the expertise of organizations such as the American Health Information Management Association, the AMA, Agency for Healthcare Research and Quality (AHRQ), and the American College of Physicians. Its information and materials can be equally applied to facilities, healthcare organizations, vendors, and individual clinicians.

Lorraine Possanza, DPM, JD, MBE, program director of patient safety, risk, and quality at the ECRI Institute, says people are often unaware of the role copy and paste can have in adverse events and hazards.

“Oftentimes instances of copy and paste go unreported and are often under-recognized for their contribution to events and hazards,” she says. “This was one of the reasons that the Partnership chose to focus on this issue.” 

The ECRI toolkit says that between 2013 and 2015, there were only 12 copy and paste errors. However, Possanza says that’s just the number of events voluntarily sent to ECRI. Facilities aren’t required to report copy and paste errors, nor is there any guidance on whom they should report to; therefore, the exact number of errors is hard to determine. This is similar to how The Joint Commission’s Sentinel Events statistics only show a small portion of the never events that occur each year. And unlike other types of accidents (like medication errors or falls), it’s not always apparent when there’s been a copy and paste error. 

“Recognizing whether health IT, and in particular copy and paste, contributes to an event is not always straightforward,” she says. “The goal [of this toolkit] is to increase awareness of the potential safety implications associated with this functionality and to implement recommendations to mitigate those safety issues.”

While the exact number of copy and paste errors is unknown, she says, the use of copy and paste for EHRs is widespread. The ECRI’s special report on the topic discovered that:
•    90% of physicians used copy and paste to write daily progress notes 
•    78% said they used copy and paste functions “almost always or most of the time” 
•    81% of users frequently copied notes written by other physicians 
•    72% copied notes from prior admissions

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