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Cited by 100Electronic Health Records SystemsPatient Safety and Medication ErrorsNursing Diagnosis and Documentation

Safe Practices for Copy and Paste in the EHR: Systematic Review, Recommendations, and Novel Model for Health IT Collaboration

Open access
Tsou, Amy, Lehmann, Christoph, Michel, Jeremy, Solomon, Ronni, Possanza, Lorraine, Gandhi, Tejal·2017·Applied Clinical Informatics
DOI 10.4338/aci-2016-09-r-0150PMC PMC5373750
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Abstract

Summary: Background: Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT). Objective: To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste. Methods: The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices. Results: The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Conclusion: Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate staff training and education; 4) Ensure copy and paste practices are regularly monitored, measured, and assessed.

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  • The copy-paste function in EHRs allows clinicians to reuse existing medical notes without carefully reviewing them again.

    “Another contributing factor to missing data is the “copy-paste” function in EHRs, which allows clinicians to reuse existing medical notes without carefully reviewing them again [180,181].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [180]

    The Introduction says copy and paste lets clinicians insert existing information into EHR notes. The Description warns that failure to curate copied text can leave outdated or inconsistent information, and the safe-practice recommendations call for verification before submission. These passages support the risk of reuse without careful review, but do not establish the citing sentence’s broader claim that copy and paste contributes to missing data. (LLM, conf=0.82)

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Research works printed but not linked: 5

  1. O'Reilly KB. EHRs: "sloppy and paste" endures despite patient safety risk. [internet]. Chicago (IL): Ameri- can Medical Association; 2013 Feb 4 [cited 2015 Mar 23]. [p]. Available from: http://www.amednews. com/article/20130204/profession/130209993/2/.
  2. Copy and Paste in ED: "Dangerous Practice". ED Legal Letter 2012; 23(11): 129-132.
  3. ACDIS releases EHR position paper. cdi J 2013; 7(4): 1-8. Available from: http://www.hcpro.com/con tent/297249.pdf.
  4. No need to disable ctrl-c/ctrl-v in EHRs. Healthc Risk Manag 2014; 36(3): 43-44.
  5. 'Copy-and-paste' fraud targeted by CMS and OIG. Healthc Risk Manag 2014; 36(3): 41-43.

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Authors
Tsou, A., Lehmann, C., Michel, J., Solomon, R., Possanza, L., & Gandhi, T.
Affiliations
  • ECRI Institute (US)
  • Vanderbilt University Medical Center (US)
  • Harvard University (US)
Corresponding author
Tsou, Amy
ORCID
Venue
Applied Clinical Informatics
Publisher
Georg Thieme Verlag KG
Published
2017
Volume
26
Issue
01
Pages
12-34
ISSN
1869-0327 (ISSN-L)
DOI
10.4338/aci-2016-09-r-0150
PMC
PMC5373750
OpenAlex
W2576811268
Cited by
100
References
37
Citations by year
2026: 10 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 23 · 2020: 16 · 2019: 11 · 2018: 8 · 2017: 7
FWCI
2.25
Type
journal article
Language
en
Open access
Locations
  • Applied Clinical Informatics (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Jayne Koskinas Ted Giovanis Foundation
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
Keywords
copy and paste, electronic health records, clinical documentation, patient safety, medical errors, error propagation, provenance, employee training, health information technology
MeSH terms
Stakeholder Participation, Cooperative Behavior, Documentation, Humans, Medical Informatics, Electronic Health Records, Patient Safety

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