​The majority of progress notes in electronic health record (EHR) systems are either copied and pasted or imported, according to a research letter published May 30, 2017, in JAMA Internal Medicine. Traditionally, the authors said, the goal of progress notes is to provide up-to-date, concise reflections on a patient's condition, as well as a physician's thought process. EHR systems allow users to supplement manual data in this system with copy-and-pasted or imported notes. The authors analyzed 23,630 inpatient progress notes written by 460 clinicians and found that in a typical note, just 18% of the text had been entered manually. Nearly half (46%) of the text was copied and 36% was imported. Medical residents copied text more frequently and manually entered text less frequently than did medical students or direct care hospitalists, the authors said. These results raise the issue, the authors said, that copying or importing text increases the risk of spreading information that is outdated, inaccurate, or unnecessary.

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-and-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, released safe practice recommendations for the use of copy and paste in 2016.