Fall 24 www.nvda.org 9 the overpayment, and the physicians involved are “contacted and educated,” she said. Copy-and-paste can also show up in malpractice lawsuits. In a 2012 survey, 53% of professional liability carriers said they had handled an EHR-related malpractice claim, and 71% of those claims included copy-and-paste use. One such case, described by CRICO, a malpractice carrier based in Massachusetts, took place in 2012–2013. “A patient developed amiodarone toxicity because the patient’s history and medications were copied from a previous note that did not document that the patient was already on the medication,” CRICO stated. “If you do face a malpractice claim, copying and pasting the same note repeatedly makes you look clinically inattentive, even if the copy/pasted material is unrelated to the adverse event,” CRICO officials noted in a report. Copy-and-paste is a great timesaver. One study linked its use to lower burnout rates. However, it can easily introduce errors into the medical record. “This can be a huge problem,” Dowling said. “If, for example, you copy forward a previous note that said the patient had blood in their urine ‘six days ago’, it is immediately inaccurate.” Practices can control use of copy-andpaste through coding clerks who read the medical records and then educate doctors when problems crop up. The Pennsylvania auditor, who now works for a large group practice, said the group has very few copyand-paste problems because of her role. “Not charting responsibly rarely happens because I work very closely with the doctors,” she said. Dowling, however, reports that many physicians continue to overuse copyand-paste. He points to a 2022 study which found that, on average, half the clinical note at one health system had been copied and pasted. One solution might be to sanction physicians for overusing copy-andpaste, just as they’re sometimes penalized for not completing their notes on time with a reduction in income or possible termination. Practices could periodically audit medical records for excessive copy-paste use. EHR systems like Epic’s can indicate how much of a doctor’s note has been copied. But Dowling doesn’t know of any practices that do this. “There is little appetite to introduce a new enforcement activity for physicians,” he said. “Physicians would see it just as a way to make their lives more difficult than they already are.” Some hospitals and health systems have gone as far as disabling copy-and-paste function in their EHR systems. However, enterprising physicians have found ways around these blocks. Some institutions have also introduced formal policies, directing doctors on how they can copy-and-paste, including Banner Health in Arizona, Northwell Health in New York, UConn Health in Connecticut, University of Maryland Medical System, and University of Toledo in Ohio. Definitions of what is not acceptable vary, but most of these policies oppose copying someone else’s notes and direct physicians to indicate the origin of pasted material. Santa Rosa Memorial’s policy is quite specific. It still allows some copyand-paste but stipulates that it cannot be used for the chief complaint, the review of systems, the physical examination, and the assessment and plan in the medical record, except when the information can’t be obtained directly from the patient. Also, physicians must summarize test results and provide references to other providers’ notes. Gore said he and a physician educator who works with physicians on clinical documentation proposed the policy about a decade ago. When physicians on staff were asked to comment, some said they would be opposed to a complete ban, but they generally agreed that copy-andpaste was a serious problem that needed to be addressed, he said. The hospital could have simply adopted guidelines, as opposed to rules with consequences, but “we wanted our policy to have teeth,” Gore said. When violators are identified, Gore says he meets with them confidentially and educates them on proper use of copy-and-paste. Sometimes, the department head is brought in. Some physicians go on to violate the policy again and have to attend another meeting, he said, but aside from the one case, no one else has been disciplined. It’s unclear how many physicians have faced consequences for misusing copy-paste features—such data aren’t tracked, and sanctions are likely to be handled confidentially, as a personnel matter. Geisinger Health in Pennsylvania regularly monitors copy-and-paste usage and makes it part of physicians’ professional evaluations, according to a 2022 presentation by a Geisinger official. Meanwhile, even when systems don’t have specific policies, they may still discipline physicians when copy-and-paste leads to errors. » Featured Article
RkJQdWJsaXNoZXIy Nzc3ODM=