The Risks of the Cut and Paste!

This interesting editorial appeared in the recently.

Electronic records prone to error, docs write in New England Journal of Medicine

By Bernie Monegain, Editor 04/17/08

Electronic health records could be a tool for perpetuating errors, warn two Harvard physicians in an article published Thursday in the New England Journal of Medicine.

The physicians urge their colleagues to take an unvarnished look at EHRs even as they are championed by President Bush and companies like Microsoft and Google.

The article, written by Pamela Hartzband, MD, and Jerome Groupman, MD, who both work at Beth Israel Deaconess Medical Center in Boston and teach at Harvard Medical School, outlines the pitfalls of using electronic records. It is published along with other articles on EHRs.

One of the major problems with EHRs, the authors say, is that they invite users to cut and paste information. While some information has to be repeated, and cutting and pasting can seem efficient, it also can compromise accuracy.

"Many times, physicians have clearly cut and pasted large blocks of text, or even complete notes, from other physicians; we have seen portions of our own notes inserted verbatim into another doctor's note," the authors write. "This is, in essence, a form of clinical plagiarism with potentially deleterious consequences for the patient. "

The impetus for this type of wholesale cutting and pasting into the record is usually to pass scrutiny for billing, they say.

More here:

http://www.healthcareitnews.com/story.cms?id=9081

On the basis that many readers will have access to the full text – the reference is as follows.

Off the Record — Avoiding the Pitfalls of Going Electronic. Pamela Hartzband, M.D., and Jerome Groopman, M.D. New England Journal of Medicine Volume 358:1656-1658 April 17, 2008 Number 16.

One really has to worry about some editorialists.

It seems pretty clear to me what their main concern is that some clinicians will use the technology to create unreliable and un-thought through clinical notes.

Well I have some news for them. In the old days of written records there was widespread use of both clinical note templates – of the type being cited here - and the widespread use of abbreviations and shortcuts to minimise the effort of note taking and record keeping. It was just as possible then as now to keep the mind in neutral.

There is nothing new under the sun as the saying goes.

As an example, it was always a toss-up as to whether the widely used abbreviation N.A.D. meant No Abnormality Detected or Not Actually Done!

The solution here, as it is in so many other situations, is education combined with basic common sense and a recognition that in-accurate documentation is a risk to both the patient and the clinician’s career.

This editorial would have been greatly improved by an emphasis on clinical responsibility in record keeping rather than being a whinge about the misuse of ‘cut and paste’!

David.