Time to Cut 'Copy and Paste' from Electronic Medical Records?

History-Taking, Plagiarism, and Epistemology

Joseph M. Pierre, MD

Disclosures

July 07, 2017

Research published in JAMA Internal Medicine[1] this past month confirmed what I've been seeing over the past decade or so, in which electronic medical records (EMRs) have increasingly replaced paper charting: Fewer than 20% of progress notes written by clinicians are original, manually entered text. The rest is either imported or copied and pasted from other sources.

Nearly 20 years out of psychiatry residency training, I often feel as if I'm now firmly in the curmudgeonly "stick-in-the-mud" phase of my career. I wonder, with more than my share of skepticism, whether going home post-call and repeatedly handing off clinical responsibility from one resident to another really makes for better doctors, medical training, and patient care. But that degree of skepticism has nothing on my feelings about copy-and-paste charting in the age of the EMR.

I sometimes remind trainees that the EMR did not create from dust the ability to copy and paste information.

To begin with, I sometimes remind trainees that the EMR did not create from dust the ability to copy and paste information. In the old days of paper charts, we could have photocopied existing notes, cut out portions of them with scissors, and taped them into newly authored progress notes. Sure, that would have been more cumbersome than the modern method of pressing Ctrl-C and Ctrl-V, but compared with writing a 5- to 10-page patient history by hand, it would have still been a time-saver.

But time didn't have anything to do with why we didn't copy and paste with scissors and tape back in the day. We didn't do it because it would have never occurred to us to plagiarize someone else's writing in the first place. And besides, the copied-and-pasted information was already in the chart—why duplicate it?   Don't get me wrong; I'm no Luddite. The modern EMR is a definite upgrade from the days of paper charts. Computer-generated text has liberated us from the illegibility of doctors' scrawl. The ability to quickly access "hard data," such as lab results, radiology reports, and active medication lists, and import them into notes makes for more complete documentation in the hospital setting. And the sheer volume of information—for example, with the ability to access "remote data" from medical centers across the country within the Veterans Affairs healthcare system—better equips a physician to make informed clinical decisions. But those upgrades come at a cost.

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