A new study, published at JAMA Network Open and entitled ‘Prevalence and Sources of Duplicate Information in the Electronic Medical Record’, aims to set out how much duplicate content is present in electronic medical records (EMR), where the duplication comes from, and why it exists.
Authors Jackson Steinkamp, Jacob J. Kantrowitx and Subha Airan-Jayia sought to examine “the prevalence and scope” of duplication behaviour in clinical notes from across a large academic health system, along with the factors associated with duplication.
To achieve this, a cross-sectional analysis was performed on more than 104 million routinely generated clinical notes from across all medical specialties within the Penn Medicine Health System over the course of six years. The total text in the EMR was quantified along with how much of that text had been duplicated.
An important factor was the role of the note paradigm, the text documentation within EMRs that the US “largely uses” for information organisation. The study shares how the paradigm and its software assumes that each encounter with a patient requires a separate document to be created, and also that different authors should make their notes in separate documents. With this in mind, the study highlights two separate problems: text duplicated from a previous note by the same author, and text duplicated from a different author.
Overall, the study found that of the words contained in the clinical notes, 50.1 percent had been duplicated from prior documentation. “Duplicate content was prevalent in notes written by physicians at all levels of training, nurses and therapists,” the study states, “and was evenly divided between intra-author and inter-author duplication.” Expanding on their results, the authors shared how 54.1 percent of duplicate text came from a previous note by the same author, and 45.9 percent came from a note by a different author.
Further details show how there was a higher proportion of duplicated text in nursing plans of care notes and physician progress notes; these notes are “required to be comprehensive while also having to be updated at least daily.” There was a smaller proportion of duplicated text in notes designed to document single events, such as a telephone encounter or a result note.
“Information overload and duplication are severe hazards for practicing clinicians,” the authors state. “Our analysis shows that roughly half of text is directly duplicated, word for word, from elsewhere in the record, compounding the challenge of finding the right data to make appropriate clinical decisions.” Duplication “provides no new information, but also increases the time required for the reading clinician attempting to discern which information is accurate and timely vs false or irrelevant. Overworked clinicians may be disincentivised from reading such a bloated record, missing valuable clinical context not easily found elsewhere… and leading to wasted time repeating past interventions or directly causing patient har by missing findings requiring follow-up.”
In conclusion, the authors state: “The findings of this cross-sectional study suggest that text duplication is a systemic hazard, requiring systemic interventions to fix.” They commented that “simple solutions such as banning copy-paste may have intended consequences, such as worsening information scatter”, referring to the difficulty of finding and synthesising information because it is fragmented across numerous locations.
Ultimately, “information duplication is not primarily a mistake made by individual clinicians; rather, given its ubiquity, duplication must be viewed as a result of the documentation system. That system is made up of specific EMR software, institutional documentation practices, and an underlying paradigm. The note paradigm for documentation should be further examined as a major cause of duplication and scatter, and alternative paradigms should be evaluated.”
To read the study in full, please click here.
