Association Between Copy-Paste Behavior and Physician Service: Who Does It? Who Does It?

Background:

The use of copy-paste in the medical record is ubiquitous, potentiated by the explosive increase in use of electronic health record systems. Copy-paste events (CPE) decrease the readability of the medical record (e.g. “note-bloat”) and have safety (e.g. perpetuation of outdated information) and professionalism implications. The potential utility of CPE (e.g. a reminder to your colleague to discontinue antibiotics after a specific date) is not well-represented. We hypothesized that if such “place-holding” utility were present, CPE would be more frequent within a single service than between two different services.

Methods:

A pilot study was initiated of 41 randomly selected adult patients who met inpatient criteria and admitted to a general medicine service in 2009. CPE representing system-generated material inserted into each note (e.g. name, registration number) were classified as “boilerplate”, which allowed every source-destination note combination to be identified. All notes were then electronically analyzed for exact copies on a single-line level and tagged with an “active CPE”, if the recipient of an actual CPE. Notes from consultants as well as primary teams were included. We then classified each CPE based on the “self” and service relationship between the copying and the copied provider: did the physician copy self (same-service, same-physician), other physicians on the same service (same-service, different-physician) or other physicians on a different service (different-service, different-physician). We performed a Z-test of proportions between the three categories of CPE behavior.

Results:

Using two-sample test of proportion comparisons between the 3 types of physician CPE behavior, physicians were significantly less likely to copy from another physician on a different service, compared with a different physician on the same service or themselves. Physicians were not statistically more likely to copy themselves compared with copying another physician on the same service.

Conclusions:

CPE is frequent but physicians copy each other on the same service much more freely than from other services. One possible explanation is a practical benefit accrued by physicians who “place-hold” medically useful information for one another on the same service. This preliminary information supports exploring a more nuanced understanding of copy-paste physician behavior.