​Nearly three-quarters of electronic health record (EHR)-related medical professional liability (MPL) claims in 2012 included copy-and-paste issues, found a survey conducted by PIAA, an association of medical professional liability insurers. More than half (53%) of respondents to the survey said they had seen EHR-related malpractice claims, and 71% of those included copy-and-paste practices. Among all EHR-related claims, failure to review all available EHR data was found in 52% of claims and breach of system was found in 24%. PIAA suggested the federal Office of the National Coordinator for Health Information Technology's (ONC) Safety Assurance Factors for EHR Resilience (SAFER) Guides for EHRs as a source "for analyzing and correcting possible patient safety issues." Strategies suggested by SAFER to decrease copy-and-paste related risk included requiring "a process to track the original copied source and user" and the institution of regular audits to identify issues. "Electronic patient records are here to stay," PIAA said, while noting that health IT-related contributing factors were found in 3.5% of the 3,375 sentinel events resulting in permanent patient harm or death reported to the Join Commission in 2015. By the end of 2014, 51% of office-based physicians and 76% of hospitals in the United States had adopted basic EHRs. PIAA said an overarching concern for its insurers is the large number of different types of EHRs, which makes it challenging for healthcare workers in more than one setting to become proficient.  Nearly one in five respondents surveyed by PIAA listed educating users as one of the greatest challenges in implementing EHRs. PIAA said that tools such as ONC's SAFER self-assessments can ensure continuous improvement, but cannot on their own support safe use of EHRs. The authors called for "situational awareness by all involved" and urged users to collaborate and report potential EHR hazards.

HRC Recommends: Clinicians copying and pasting notes in an EHR can turn into a case of "whisper down the lane," with the meaning changing drastically from the original version. ECRI Institute PSO's Deep Dive™ on health IT notes steps that can reduce the risks of copy-and-paste, including highlighting copy-and-pasted text with color or italics so that other providers are aware of how the information was obtained and have a heightened suspicion of its accuracy; auditing documentation practices, including copy-paste use; educating providers on instances of copy-and-paste misuse; and educating providers to question the need to import large segments of data into their notes. In addition, the Partnership for Health IT Patient Safety, a multi-stakeholder collaborative convened by ECRI Institute, recently announced the release of Safe Practice Recommendations for the use of copy and paste.