I’ve seen a number of side comments on the challenges of Copy and Paste functions in an EMR. However, I’ve seen very few people really address the challenge that is copy and paste functions that are built into almost every program in the world.
Before I talk about the challenges, of copy and paste with an EMR I will first profess my amazing love for these 2 functions. I use them probably 100+ times a day. On a good day it’s probably a few hundred times and on a bad day it might only be 50 or so. I can’t imagine doing what i do without copy and paste. Even in this post I’ll likely using copy and paste a dozen or so times.
I’ll admit that I probably use it more than most. However, it’s amazing how many people use copy and paste. It’s really become a major part of computer use. The fact that it is almost automatically integrated with every application is a testament to this fact. When used right, those two functions are an amazing utility.
Of course, when used wrong it can cause some really ugly problems. In your personal life it might just be an email sent to someone with someone else’s name on it. Usually not a major problem, but a minor annoyance. Now apply that same situation to an EMR.
Let’s say you copy a nice physical exam assessment. Despite the very best of intentions, many times you’re going to forget to change something after you paste it. Yes, it happens all too often. Not purposefully of course. Usually something happens to distract you right after you paste it. Maybe the phone rings, your cell buzzes, you get an IM, the nurse comes to talk to you, etc etc etc. Each of these distractions often lead you to forget to change/add something that you just copy and pasted. I don’t need to describe why it’s a problem to have it say “normal rhythm” when it’s not normal or why having other pertinent positives missing is a major problem.
Now, this is just the most obvious case. It’s pretty easy to see how it’s easy to miss things when you start copying and pasting into an EMR. However, the EMR copy and paste challenges don’t stop there. However, the problems might not be as obvious.
One example, is how the length of EMR notes BALLOON with the use of copy and paste. Yes, that means that you might have more robust notes, but that also means that we’re missing out on the “minimum necessary” documentation which makes those notes really useful and functional. Sure, insurance billing has ruined notes in this regard, but copy and paste hasn’t helped either.
I also haven’t talked about the potential HIPAA issues related to copy and paste. I’ll save that for the lawyers out there.
It’s amazing how a function which can be so useful can also be so dangerous. Although, I guess this is true of most tools.
Your blog brings up an interesting concern – the ballooning of EMR note length. One of my colleagues, a RN, recently blogged about her own EMR training experience, and subsequent concern over the use of copy and paste. You can read that here: http://www.billianshealthdata.com/Knowledge/Blog/2010/2010/April/EMRx_A_Nursing_Perspective.html
Is it safe to say this is an industry-wide concern?
Jennifer,
EMR pretty much touches all parts of the healthcare industry so it’s definitely a wide concern.
Regarding just the technical aspects of cut-n-paste, I’m always amazed
by how few people know how to use these tools effectively through the
keyboard. Instead, they use the ‘Edit’ pull-down menu, which really
slows you down if you have lots of transfers to make.
Window and Macs have a “clipboard”, which acts as a temporary storage
area for transferring text. Its use does NOT depend on the
application. In Windows, the ‘Control’ is held down simultaneously
with the A, X, C, or V keys to do the deed. On Macs, the ‘Command’
keys is used instead (where the ‘Alt’ key appears on PCs).
— First select the text with the mouse.
— Or you make Cntr-A to select all text.
— Use Ctrl-X to copy selected text to the clipboard and delete the
text from the screen.
— Or use Ctrl-C to just copy selected text to the clipboard.
— Select the text you want to replace, or position the cursor where
you want to insert the text in the clipboard.
— Use Ctrl-V to overlay/insert contents from the clipboard.
— You may do multiple Ctrl-V’s, as the text is still on the clipboard.
Powerful tools when you get used to them. Enjoy.
David, that explanation is very detailed!!!!!!!!! Yes it makes life easier.
Just to avoid the cut/paste and the oversight related to it, its safer if the EHR has the ability to string sentences together automatically based on Physician selecting key words. Complete sentences and paragraphs can be built within seconds. This is a good tool to have in any EHR. And usually such strings build over time semi-automatically thro’ the system/physician based on physicians usage.
Anthony Subbiah
David,
It is a sad thing that people use the edit menu. I’ve seen it even more common for people to right click and choose the option. The shortcuts you mention are the best. Except when you’re feeding a baby in one arm and using the mouse to do stuff online. Then, the right click option is a good one.
My only problem with your suggestion, is that you just made it even easier and faster for people to do copy and paste. This post was about the problems of copy and paste. So, does that mean that you just encourage more problems? LOL
Oh, where would my life be without Ctrl+c and Ctrl+v? I too am an addict, and I really never want to recover (anymore than I want to give up those nifty H2O and O2 molecules I consume all the time). Certainly these tools can lead to a host of problems if used without good judgement, just like you can drown in a cup of water.
But cutting off copy-paste all together (as I’ve seen some advocate) is a knee-jerk reaction. So now I type everything I want to copy again? How does that help with accuracy and efficiency? And just as people can crack their iPhones, someone will find a way to “reinstall” copy-paste into the system.
I’m tempted to say the answer is “education,” but that’s such an overused truism in discussions such as these. The truth is that a lot of us “know” we shouldn’t do something and do it anyway, or vice versa. Actually, Jennifer, I really liked the link you provided and the way the author acknowledged that with the ease of technology come certain temptations. I could, for example, routinely copy and paste other posts I read verbatim over at Occam PM’s blog. which would give me way more content but wouldn’t make our website a better supplier of HIT news (and probably tick John off, to say the least). We have to all be conscious of what the dangers are when using a tool, and potentially utilize whatever safety procedures are necessary.
A funny aside is that I was sending some generally mass emails, but partially customized to people after writing this post. I was of course heavily using copy and paste. By the fifth email I sent, I realized that I forgot to change one of the parts that needed customization. Luckily, it was just an email and not a clinical note where I accidentally made a man pregnant or something.
Michelle,
You’re welcome to copy and paste portions of my blog posts and use them as blog posts on your site. Just make sure you add a link back to the original post It also doesn’t hurt to have a little paragraph about why you’re quoting me;-) I love when people do that actually. That’s how blogs converse with each other.
Michelle,
Glad you liked the blog. Thanks for checking it out. I try to follow John’s suggestion when referencing other people’s blogs in my own – it lets your readers know you are keeping track of your industry. If the author you mention in your blog reads it, he/she may just tweet about it, increasing traffic to your site. Always a win.
Oh, well, in that case, I don’t have to write anything for weeks: sweet! 😉 Seriously, I have quoted other blogs before (including John!), but I was trying to say that simply passing off what I read as my own, without citation or commentary, isn’t the best way to “write” on a subject, any more than using Wikipedia as one’s sole source of information. But of course, showing that you’re well-read is a great way to reassure one’s readers, even if it somewhat contributes to the “reverbosphere,” as this week’s Grand Rounds’ host put it.
[…] “cut and paste” concept. I know this is out there for two reasons: one, because I have read a blog or two citing it, and two, because I have enjoyed doing it myself. In the cut-and-paste world of […]