Electronic health records (EHRs) have transformed healthcare delivery by providing real-time access to patient information, facilitating informed and prompt decision-making and enhancing care coordination. Most healthcare organizations rely on medical data entry services to capture patient demographic information and transcribe clinical notes, extracting relevant data from various sources and populating the EHR’s structured fields.
However, cloning errors in EHRs remain a significant concern, undermining the accuracy of patient data and the integrity of clinical documentation. Cloning or copy-pasting is the practice of electronically copying information from a previous patient record and inserting it into a new entry. Physicians often utilize this copy-paste feature to ensure timely data capture in the EHR. While it is simple, easy to use and time-saving, copy-pasting in EHRs is prone to errors that pose patient safety risks, compromise billing accuracy, and increase the risk of regulatory non-compliance.
The risks and consequences of EHR cloning errors are
- Inaccurate or outdated clinical information, compromising EHR data integrity
- Patient safety risks
- Increased risk of audits and compliance violations
- Fraud and abuse implications
- Can lead to claim denials and affect reimbursement
This post looks into why EHR copy-paste issues occur and discusses best practices to avoid EHR documentation mistakes.
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What Are Cloning Errors in EHRs?
A significant amount of physician time is spent on EHR documentation. According to a 2019 JAMA study, on average, physicians spend about 1.77 hours per day on EHR tasks outside of scheduled clinical hours. EHR tools like cloning and templates are designed to help physicians streamline EHR documentation. Studies show that copy-pasting in clinical notes is a common practice among busy providers.
However, while templates are a helpful documentation aid when used prudently, cloning poses a higher risk to data integrity, compliance, and patient safety. The report also discussed a 2020 study published by the American Medical Informatics Association (AMIA) in which researchers reviewed over 2.3 million inpatient and 6.6 million ambulatory notes in a large academic health system. They found that 42% of inpatient notes included copy-pasted content (accounting for 19% of the text), while 18% of ambulatory notes contained copied content (12% of the text). The study identified 110 cases with pre-populating or copy-paste errors between 2017 and 2021.
Common cloning errors include copying the wrong information and copying only part of the information. Here are examples of these situations:
- Copying the wrong information: The provider copies a progress note from a previous visit that states the patient has no allergies. However, at the current visit, the patient reports a new allergy to penicillin. The copied note is not updated, leading to inaccurate documentation and a potential medication error.
- Copying only part of the information: The provider copies the “Assessment” section from an earlier encounter that mentions “uncontrolled diabetes” but fails to copy or update the “Plan” section to reflect the current treatment changes. This results in a disjointed record that lacks complete clinical context and may mislead other providers.
Other issues that can cause EHR cloning errors:
- Doctors illegally upcode patients’ medical conditions and overcharge them for the care they are providing
- The cloning function can cause some part of the information to get truncated, which can lead to serious issues. For example, an article in Healthcare IT News reported on the case of a patient who had a “family history of breast cancer” wrongly entered as “a history of breast cancer”.
- Physicians accidentally copy exam result of one patient to the record of another patient
- Incorrect information recorded in the EHR will be widely distributed (EHR of patients can be transferred or connected to pharmacy section, lab section, and so on)
A major risk of copy-pasting notes is repeating old clinical reasoning—assuming a symptom is caused by an existing condition without considering a new diagnosis, notes Adam Schaffer, MD, MPH, hospitalist at Brigham and Women’s Hospital and Senior Clinical Analytics Specialist at CRICO (www.rmf.harvard.edu).
Acceptable Reuse vs Problematic Cloning
Understanding the differences between acceptable reuse and problematic cloning is essential for proper use of the copy-paste function. Acceptable reuse involves intentionally copying and updating information that remains relevant to the current encounter. Examples include:
- Copying a patient’s chronic condition list and updating it as needed
- Carrying forward the medication list with any new additions or discontinuations clearly noted.
Here the content is reviewed, edited, and validated, improving documentation efficiency without compromising accuracy or compliance.
Problematic cloning occurs when content is copied without proper review or updates, leading to inaccurate, outdated, or misleading documentation. Examples:
- Copying forward exam findings from a previous visit without re-evaluation
- Duplicating another provider’s note without verification
This can pose serious patient safety risks and cause compliance concerns.
Why Cloning Errors Happen
The common causes of cloning errors in EHR documentation are:
- Time pressures: Clinicians under time constraints may copy previous notes to speed up documentation.
- Overreliance on templates or macros: Excessive use of pre-filled templates can lead to generic or outdated information being reused.
- Lack of documentation training: Inadequate training results in improper use of EHR features and poor documentation practices.
- EHR system design flaws: Systems that make copying easy but reviewing difficult increase the risk of unchecked errors.
- Misunderstanding of compliance standards: Providers unaware of documentation guidelines may unknowingly clone data that violates regulatory policies.
How to Prevent Cloning Errors
To prevent cloning errors in EHR documentation, practices should prioritize comprehensive staff education and ongoing training to ensure proper use of documentation tools. Customizing the EHR system and enabling alerts can help flag potential copy-paste misuse. Regular internal audits and thorough documentation reviews are essential for identifying and correcting patterns of cloning. Encouraging best practices in clinical note-taking—such as personalizing content for each patient encounter—further supports accurate records. Additionally, leveraging natural language processing (NLP) tools or medical transcription services can reduce reliance on copying by ensuring accurate, patient-specific documentation.
Providers play a pivotal role in preventing cloning errors in EHR documentation. Physicians are responsible for ensuring that each patient note accurately reflects the current encounter. This means actively reviewing and updating copied content, personalizing templates, and avoiding the temptation to document findings that were not observed or assessed. Practitioners should preserve key patient history as well as updated notes so patients receive the most accurate care.
Providers should also stay informed about documentation standards and compliance regulations, participate in training, and promote accurate, patient-specific charting. This commitment to quality documentation not only supports patient safety but also protects the practice from billing and legal risks.
The Power of Automated Documentation Solutions
In a survey conducted by the American Medical Association (AMA), physicians identified documentation support as one of the most valuable applications of AI in healthcare. In addition to AI-powered transcription tools, physicians can also benefit from automated AI-led EHR data entry services, which help reduce administrative burden and enhance documentation accuracy—ultimately contributing to improved patient outcomes.
