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

History-Taking, Plagiarism, and Epistemology

Joseph M. Pierre, MD

Disclosures

July 07, 2017

A 'Wikipedia' for Doctors

I suspect though that today's trainees remain unfazed by cautionary tales about copying and pasting, not because of any awareness of evidence (or lack thereof) regarding quality of care, but because of a more basic epistemological divide between our generations. As in the larger debate about plagiarism amongst millennials in the digital age, it appears that newer generations have come to view information, and electronic information in particular, as flowing from a kind of communal font.[8]

Within this "public commons" model of epistemology, knowledge doesn't belong to any one individual and is therefore free for the taking. This view makes good sense in medical practice, where information shared between different healthcare providers is a necessity and a detail obtained when taking a patient's history should hardly be considered a creation worthy of intellectual property protection.

Although some authors, such as me, have fantasized about disabling the copy-and-paste function within EMRs altogether,[1,7] and some medical centers have done just that,[4] one wonders whether it might be possible to minimize the perils of copying and pasting medical information while maximizing the benefits of multiple clinicians contributing to a store of knowledge. One suggestion has been to upgrade EMRs so that any copied-and-pasted information and its original source are readily identifiable.[7]

...another proposal could be to move away from an EMR rooted in the linearity of time...in favor of a Wikipedia-like medical record entry that is continually revised and updated...

In the spirit of merging legitimate old-school concerns about plagiarism with novel approaches to information sharing, another proposal could be to move away from an EMR rooted in the linearity of time, with its countless serial reproductions and modifications of a patient's history, in favor of a Wikipedia-like medical record entry that is continually revised and updated by a myriad of contributors whose edits can be tracked and logged.

This Wikipedia "commons" approach to the EMR could facilitate the integration of information from different sources all in one place, while encouraging the continuous correction of data in light of clarification and new information with each new patient encounter. Note that such a system could even incorporate contributions from patients themselves. With thoughtful development that considers the effects of such democratization on information quality, perhaps such a model could address the problems of perpetuating unreliable information and overlooking older data inherent to existing EMRs, while disincentivizing and therefore eliminating copying and pasting altogether.

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