An Appropriate Use of Copy Forward, with a Caveat
In a June print story on bad documentation practices in electronic health records, Stephen Levinson, MD, warns against poorly designed systems that encourage busy physicians to copy old information forward with a single click, speeding them past performing and documenting care.
Copying forward a previous review of systems without reviewing changes in the patient’s status, for example, is noncompliant and potentially fraudulent, Levinson says. Above all, it is poor care. “The tool has taken away what the doctor is supposed to do, which is to obtain information on the review of systems since the last visit,” he says.
Is there ever an appropriate use of copy forward?
Levinson says yes, with an important caveat.
While copy forward is inappropriate for addressing a patient’s medical history and physical examination findings, it can offer a benefit in bringing forward a patient’s problem or medication list, Levinson says. However, such functionality should require a second click for error proofing.
“If you bring the information forward with a single-click, the machine is doing the thinking, not the doctor,” Levinson says. Instead, with the first click, the software should provide the list of medications and then prompt the physician to review the list with the patient.
Once reviewed, the physician should then perform a second click to copy forward only those medications that are unchanged, while entering details about new or discontinued medications as well as any changes in dosage.
The same could be applied to copying forward from the actively managed problem list. Levinson offers the example of a physician acting as a medical home, providing care for a patient with five diseases.
It would be okay for that physician to copy and paste from the problem list—which the physician actively manages and knows is accurate—into that day’s impression section, Levinson says. But the system must require a second click to confirm the problems actually treated that day.
Editing information at this stage offers a benefit, Levinson says, “because if I have something I want to add I type it in, it appears on today’s list, and I’ve actively managed the problem list back in the other part of the record.”
These are limited, actively managed situations that rely on good system design, which takes clinical practice and information management into account. As Levinson warns in the print article, “speed is not the same as efficiency, which requires tools that help physicians work quickly while maintaining optimal care and compliant documentation.”