Appl Clin Inform 2017; 08(01): 12-34
DOI: 10.4338/ACI-2016-09-R-0150
Schattauer GmbH

Safe Practices for Copy and Paste in the EHR

Systematic Review, Recommendations, and Novel Model for Health IT Collaboration
Amy Y. Tsou
1  ECRI Institute, Plymouth Meeting, PA
2  Division of Neurology, Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA
Christoph U. Lehmann
3  Departments of Biomedical Informatics & Pediatrics, Vanderbilt University Medical Center, Nashville, TN
Jeremy Michel
1  ECRI Institute, Plymouth Meeting, PA
4  Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA
5  Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Ronni Solomon
1  ECRI Institute, Plymouth Meeting, PA
Lorraine Possanza
1  ECRI Institute, Plymouth Meeting, PA
Tejal Gandhi
6  National Patient Safety Foundation, Boston, MA, USA
7  Department of Medicine, Harvard Medical School, Boston, MA, USA
› Author Affiliations
FundingThe Partnership for Health IT Patient Safety was funded in part through a grant from the Jayne Koskinas Ted Giovanis Foundation (JKTG) for Health and Policy.
Further Information

Publication History

Received: 08 September 2016

Accepted: 07 January 2016

Publication Date:
20 December 2017 (online)


Background: Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT).

Objective: To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste.

Methods: The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and

3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices.

Results: The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Conclusion: Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate staff training and education; 4) Ensure copy and paste practices are regularly monitored, measured, and assessed.