Examining the Copy and Paste Function in the Use of Electronic Health Records
Svetlana Z. Lowry, Mala Ramaiah, Sandra S. Prettyman, Debora Simmons, David Brick, Ellen Deutsch, Lorraine B. Possanza, Ollie B. Gray, Betty A. Levine, Kinsey Gimbel, Kyle Andrews
The National Institute of Standards and Technology (NIST) in collaboration with ECRI conducted a study titled Examining the Copy and Paste Function in the Use of Electronic Health Records which was intended to help fill the gap in understanding the implications of the copy and paste functionality by providing a more in-depth examination of how practitioners utilize the copy and paste function in EHRs, exploring if and when they use, what they think about and the ways in which it may or may not lead to errors that could affect patient safety and finally, substantiating the ECRI Partnership recommendations for the safe use of copy and paste function in health IT by providing human factors based recommendations for the safe use of the copy and paste function based on the study findings and collegial discussions with clinical experts. Major findings resulting from a Human Factors assessment derived from empirical data obtained from this study of the copy and paste function are identified as follows: Length of information: Unconstrained ability to extract a large amount of information using copy and paste can present users with convoluted and/or irrelevant information impairing situation awareness. Users may miss important pieces of information. Attribution of information: Clinicians need to know the source of the copied and pasted information, who copied and pasted it, what was added to/edited in the information and the date and time the information was copied and pasted. Wrong information: A common error in the use of copy and paste is that users forget to properly review and edit all of the information they have copied and pasted (frequent interruptions in the clinical environment being one of the major causes of this error) and users are not provided with system features that promote efficient editing. This report provides specific recommendations for user interface design to ensure safety-related usability for the copy and paste function.