Copying common in electronic medical records: study
scribbles into easy-to-read, searchable standardized documents that could be shared among hospital staffers and a patient's various other health care providers.
Many electronic record keeping systems allow text to be copied and pasted from previous notes and other documents, a shortcut that could help time-crunched doctors but that could also cause mistakes to be passed along or medical records to become indecipherable, critics argue.
To see how much information in patient records came from copying, Thornton's team, in a study published in Critical Care Medicine, examined 2,068 electronic patient progress reports created by 62 residents and 11 attending physicians in the
intensive care unit of a Cleveland, Ohio hospital. Progress notes are typically shared among doctors, nurses and other hospital staff and are meant to document the progression of a patient's tests and treatments. Using plagiarism-detection software, the researchers analyzed five months' worth of progress notes for 135 patients.
They found that 82 percent of residents' notes and 74 percent of attending physicians' notes included 20 percent or more copied and
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