Friday, January 25, 2013

Copy & Paste Medicine

Mostly unrelated to Emergency Medicine – but an interesting descriptive study of a downstream phenomenon I see on a frequent basis.  

For example, I'll intermittently follow-up a patient to see how they fared as an inpatient.  I'll read the inpatient documentation, consultant reports, etc. – and find the tiny EM HPI perpetuated throughout the chart with minimal modification.  This anecdotal experience is backed up by these authors who used text-compare software to identify copied passages in daily progress notes from an ICU setting.  In this ICU at MetroHealth in Cleveland, 82% of resident notes copied at least >20% of the text from the previous days' progress note – and copied 55% of the prior content on average.  Attending notes were slightly less frequently copied (74%), but tended to copy more content (61%).

There's no conclusive data regarding whether this copy/paste practice affects patient outcomes, but it's an interesting symptom of evolving medical care and documentation in the EHR era.  I hope that, as HIT evolves, documentation tools trend towards encouraging concise, effective communication, rather than this sort of (likely ineffective) chart bloat.

"Prevalence of Copied Information by Attendings and Residents in Critical Care Progress Notes"
www.ncbi.nlm.nih.gov/pubmed/23263617

3 comments:

  1. A hot topic with a lot of discussion among CMIOs on the AMDIS list server (non-public). For public, smart disputation see http://histalk2.com/2013/01/28/readers-write-in-defense-of-copy-forward

    Regards./Steve

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  2. Great points on that Copy-Forward defense – and absolutely true that certain repetitive elements ought to be auto-populated. Just need to rise to the challenge of generating clinically useful and readable documentation in the context of chart-bloat of perpetuated structured data.

    Still entertains me to see my ED HPI copied into a consultant note days after admission, however!

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    Replies
    1. Agree with your observations. These are the challenges those of us implementing these systems and coaching physicians confront. It was easier when we implemented our ED system in 2002--there was no one else from whom to copy!

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