# Copy Tools in the Electronic Health Record: Perceptions, Implications, and Future Directions

## TL;DR

This study explores how healthcare providers use copy tools in electronic health records, highlighting both their benefits and risks, including moral concerns and suggestions for improvement.

## Contribution

The study identifies moral angst and unintended consequences of EHR copy tools and suggests AI as a potential solution.

## Key findings

- Providers use copy tools for efficiency but face risks like documentation errors and patient safety issues.
- Moral injury and inner angst are reported among providers due to organizational documentation pressures.
- Artificial intelligence is suggested as a way to improve documentation tools and reduce burdens.

## Abstract

Electronic health records (EHRs) can aid in provider efficiency, but may also lead to unintended consequences, such as documentation burden and increased length of notes. To combat issues related to documentation, copying and pasting (CP) and copying or carrying forward (CF) are tools that have been used to aid in documentation burden. Multiple studies have identified the benefits and challenges of using these tools; however, few studies have identified the unintended consequences of CP and CF, and how the adoption of these tools may affect users.

The objective was to describe providers’ perceptions and use of copying tools available in the EHR and describe their suggestions for improvement on these copying tools.

Research team members conducted semistructured interviews with faculty members, advanced practice providers, residents or fellow trainees, and medical students at a single academic health sciences center. The Diffusion of Innovations Theory of Unintended Consequences guided the analysis and interpretation of interview results.

A total of 22 semistructured interviews were conducted in 2023 and analyzed during 2024. The findings showed that respondents use and value these tools for efficiency and communication purposes. The negative unintended consequences include inaccuracies and errors in documentation and increased patient safety risks. Some respondents experience inner angst or moral injury related to using CP/CF, but they feel that they must use them to satisfy organizational requirements surrounding documentation. The respondents suggested that artificial intelligence will likely help improve documentation tools, as would further training around these types of documentation tools.

Some respondents noted feeling both internal and external pressures that influenced when and how they use CP/CF. Respondents noted that they value EHR copying tools for efficiency purposes, but they also understand the risks involved. This tension may lead to moral angst or moral injury. They offered numerous suggestions for lowering the risk, especially by improving the documentation capabilities of the EHR through artificial intelligence. Future research should investigate both technical and educational solutions to relieve the documentation burden and moral angst they are experiencing.