Is cutting and pasting a 'modern medical illness' or an attempt to fix an old malady?

A letter to the editor in the May issue of the American Journal of Medicine calls the copy-and-paste function of EHRs a "modern medical illness."

"Medical diagnosis in previous admissions that have no relevance for the present hospitalization are repeated and copied from one summary to the other. Previous medications are copied and printed as if they were the patient's current treatment even if the patient is no longer taking them. Data presented in a previous hospitalization are repeated without changing the details or actualizing the date; subsequently the reader may not be able to understand or may misinterpret the data. Much information from past reports, for example, in admitted patients with coronary heart disease, is copied from previous charts and presented in the history of the present illness as a never-ending paragraph that is repeated to exhaustion with each hospitalization, whereas the actual and relevant history of the present illness is briefly presented in one small single line," writes Israeli physician Dr. Arie Markel.

(Wouldn't you know, I just copied and pasted that long paragraph?)

Markel was responding to a June 2009 article in the same journal that calls copying and pasting in an EHR "hazardous." The authors of that paper suggests that the copy-and-paste functionality hurts the narrative aspect of clinical notes. "Because charts have become capacious warehouses of disorganized, irrelevant, or erroneous data, the story of the patient and the patient's illness is no longer easy to read or likely to be read. In a most compelling and perhaps unintended way, we are witnessing the 'death' of the health record narrative, as many of us have known it," say Dr. Eugenia Siegler and Dr. Ronald Adelman of Weill Cornell Medical College in New York.

As you can tell, I copy and paste plenty to put together each issue of FierceHealthIT. But I also make sure I read each pasted item carefully to make sure the information flows well as part of a coherent story. I'm a writer. That's what I do.

Physicians generally are not professional writers. They often can't or don't take the time to proofread for anything other than medical accuracy. Plain English is not exactly a hallmark of medical records. Doctors do like to have lots of information available to make their decisions, but it has to be the right information. If their records are cluttered with extraneous notes, they risk making bad decisions, and medical liability comes into play.

So what's the solution here? Templating and drop-down menus can help get right to the point, but more than a few physicians have complained that such an approach also detracts from the traditional clinical narrative.

And is the clinical narrative even worth saving? Poor decision-making leads to hundreds of thousands of serious medical errors and deaths each year, suggesting that old ways aren't working. Couldn't a little bit of standardization help? Physicians, what do you think? - Neil

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