If you keep up with the Health Information Management world, you may have seen the headlines recently:
Your reaction to these headlines likely depends on your familiarity with EHR usage in addiction treatment.
If you’re on the insurance side of the equation, you might be thinking: “Wow, that’s worse than I thought!”
If you’re an addiction treatment executive, you might be thinking: “Wow, that’s terrible. I hope that’s not what MY staff is doing!”
If you’re a clinician, you’re probably relieved. You might be thinking: “Oh good, it’s not just me!”
Copy and Pasted Text in Clinical Addiction Treatment EHR Notes is Not a New Phenomenon
In the addiction treatment community, the fact that a majority of clinical notes is copy-and-pasted is hardly revelatory. It’s an open secret that so-called “boilerplate” notes exist and are in heavy usage in the field despite official warnings against such practices.
Savvy supervisors will certainly disavow any knowledge of the practice but they tend to be well aware that most notes aren’t exactly 100% original.
The vast majority of efficiency-minded providers make the rational choice to shave time off their workload by reusing particularly valuable clinical text again and again in their day-to-day.
Veteran clinicians even forward frequently used note segments to new hires as useful “welcome” gifts at many addiction treatment centers.
Which Addiction Treatment Professional is Most Likely to Copy and Paste Notes?
The truth is, the practice of copy and pasting clinical notes is present at all levels of training and all levels of care within the addiction treatment community. Physicians, psychiatrists, psychologists, drug and alcohol counselors, peer mentors, RNs, and addiction techs of all kinds engage in copying and pasting notes into EHR fields everyday.
One study in particular looked into the breakdown of copy-and-pasted notes and found that physicians wrote the most “novel” notes and used copy-and-pasted text with less frequency than clinicians with lower levels of training and experience. Still, though, physicians were found to copy up to 51% of their notes from chart to chart. Not surprisingly, students and those newer to clinical care wrote the longest notes of all - not necessarily the most “novel” notes, but the least concise notes of all clinicians studied.
Why do Addiction Treatment Providers Copy and Paste Notes?
There are many reasons to introduce copy-and-pasted text into an addiction treatment EHR entry.
For one, clinicians are often hard-pressed to meet documentation requirements while providing excellent patient care within the time allotted to them. Copying and pasting duplicate information from one chart to another helps save time while meeting medicolegal and insurance payer documentation standards.
Another reason clinicians resort to boilerplate text is that SUD patients often share similarities that lend themselves to parallel descriptions. Many SUD patients share commonalities in affect, treatment planning and recovery trajectory. This is certainly not always the case, but there is a great deal of overlap in how SUD presents itself and how it impacts the lives of patients.
Finally, clinicians who are experiencing burnout from high caseloads, emotionally draining work, and, often, clunky outdated technology, are more likely to cut corners within their notes. Working conditions like these tend to lend themselves to the proliferation of copy-and-pasted EHR notes.
How Do Copy and Pasted EHR Notes Affect the Quality of Addiction Treatment Patient Care?
While boilerplate notes are convenient for providers, they do present several problems for patient care.
Most obviously, when copy-and-pasted text is used poorly, it can mischaracterize the patient’s condition, their progress and the nature of their overall recovery journey. SUD is a complex, chronic condition that often prompts many episodes of care. Relapse is a common feature of the disease, so patients frequently seek care from many providers over the course of their treatment. This leads to a very complex, often scattered, assortment of charts that can be difficult for providers to access, let alone interpret usefully. Erroneous boilerplate text further diminishes the clinical value of addiction treatment notes.
Furthermore, when notes are overly verbose - as is often the case with copy and pasted entries frankensteined from other sources - clinicians are less likely to actually read them. The average EHR note for a single episode of care is about a page and a half of text. Combine all of those entities together and you have a very lengthy document which few providers will read in full - ever.
Finally, copy-and-pasted EHR text encumbers coordination of care between providers. When charts are not quick and easy to digest they are easy to ignore. When charts are not useful enough to share, ongoing issues that deserve followup are dropped, ineffective treatments are repeated without regard for past performance, and co-occurring disorders are ignored.
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