Exploring Provider Perceptions and Attitudes toward Copy–Paste and Copy–Forward in Clinical Documentation

Abstract

Background

Copy–paste (CP) and copy–forward (CF) are common electronic health record (EHR) documentation tools that purportedly improve provider efficiency, but they can also contribute to documentation burden while increasing note bloat and errors. Our understanding of provider perceptions of these tools remains limited.

Objectives

This study aimed to increase understanding of provider perceptions and self-reported usage patterns of CP and CF across different clinical environments and provider roles, including the impact of these tools on clinical documentation quality and efficiency.

Methods

A survey was developed and administered at a large academic medical center from December 2022 to March 2023. The survey was distributed to medical students, trainees, and faculty. Questions addressed documentation practices, perceived benefits and risks of CP/CF, and attitudes toward future use. Data were analyzed both quantitatively and qualitatively.

Results

Among 913 respondents (22–28% response rate across levels of training), 82% reported using CP, and 52% used CF in clinical documentation. Usage varied significantly by environment, with the highest utilization in inpatient primary services (91% CP, 68% CF) and the lowest in emergency departments (70% CP, 14% CF). Eighty-six percent of providers believed that CP/CF improved efficiency. A majority felt that CP (59–70%) and CF (69–76%) worsened several types of documentation errors. Providers showed stronger acceptance of copying from their own notes (90% CP, 82% CF) compared with others' notes (61% CP, 47% CF).

Conclusion

Self-reported use of CP and CF is high by providers, driven by perception of improved efficiency despite recognition that these tools contribute to documentation errors and note bloat. Use varies by practice environment. CP is viewed more favorably compared with CF, as is copying one's own documentation compared with that of another provider. This suggests that solutions should be nuanced and workflow-specific. Future interventions must balance documentation quality with efficiency and take the practice environment and provider role into account.

Keywords

clinical documentation and communications - documentation burden - notes - electronic health records and systems - efficiency improvement

Protection of Human and Animal Subjects

This survey study maintained respondent anonymity, was reviewed by the Oregon Health and Science University Institutional Review Board, and was determined to be minimal risk and approved.

Publication History

Received: 13 December 2024

Accepted: 03 April 2025

Article published online:
06 August 2025

• References

• 1 West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018; 283 (06) 516-529
• 2 Apathy NC, Rotenstein L, Bates DW, Holmgren AJ. Documentation dynamics: Note composition, burden, and physician efficiency. Health Serv Res 2023; 58 (03) 674-685
• 3 Sloss EA, Abdul S, Aboagyewah MA. et al. Toward alleviating clinician documentation burden: A scoping review of burden reduction efforts. Appl Clin Inform 2024; 15 (03) 446-455
• 4 Rotenstein LS, Apathy N, Holmgren AJ, Bates DW. Physician note composition patterns and time on the EHR across specialty types: A national, cross-sectional study. J Gen Intern Med 2023; 38 (05) 1119-1126
• 5 Steinkamp J, Kantrowitz JJ, Airan-Javia S. Prevalence and sources of duplicate information in the electronic medical record. JAMA Netw Open 2022; 5 (09) e2233348
• 6 Rule A, Bedrick S, Chiang MF, Hribar MR. Length and redundancy of outpatient progress notes across a decade at an academic medical center. JAMA Netw Open 2021; 4 (07) e2115334
• 7 Wang R, Carrington JM, Hammarlund N, Sanchez O, Revere L. An evaluation of copy and paste events in electronic notes of patients with hospital acquired conditions. Int J Med Inform 2023; 170: 104934
• 8 Cheng CG, Wu DC, Lu JC. et al. Restricted use of copy and paste in electronic health records potentially improves healthcare quality. Medicine (Baltimore) 2022; 101 (04) e28644
• 9 Digan W, Wack M, Looten V, Neuraz A, Burgun A, Rance B. Evaluating the impact of text duplications on a corpus of more than 600,000 clinical narratives in a French hospital. Stud Health Technol Inform 2019; 264: 103-107
• 10 Nijor S, Rallis G, Lad N, Gokcen E. Patient safety issues from information overload in electronic medical records. J Patient Saf 2022; 18 (06) e999-e1003
• 11 Tsou AY, Lehmann CU, Michel J, Solomon R, Possanza L, Gandhi T. Safe practices for copy and paste in the EHR. Systematic review, recommendations, and novel model for health IT collaboration. Appl Clin Inform 2017; 8 (01) 12-34
• 12 Fanucchi L, Yan D, Conigliaro RL. Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record. Appl Clin Inform 2016; 7 (03) 653-659
• 13 Heiman HL, Rasminsky S, Bierman JA. et al. Medical students' observations, practices, and attitudes regarding electronic health record documentation. Teach Learn Med 2014; 26 (01) 49-55
• 14 O'Donnell HC, Kaushal R, Barrón Y, Callahan MA, Adelman RD, Siegler EL. Physicians' attitudes towards copy and pasting in electronic note writing. J Gen Intern Med 2009; 24 (01) 63-68
• 15 Glaser B, Strauss A. The Discovery of Grounded Theory Strategies for Qualitative Research. Mill Valley, CA: Sociology Press; 1967
• 16 Ash JS, Corby S, Mohan V. et al. Safe use of the EHR by medical scribes: a qualitative study. J Am Med Inform Assoc 2021; 28 (02) 294-302
• 17 Rowlands S, Tariq A, Coverdale S, Walker S, Wood M. A qualitative investigation into clinical documentation: why do clinicians document the way they do?. HIM J 2022; 51 (03) 126-134
• 18 Vawdrey DK, Cauthorn C, Francis D, Hackenberg K, Maloney G, Hohmuth BA. A practical approach for monitoring the use of copy-paste in clinical notes. AMIA Annu Symp Proc 2022; 2021: 1178-1185
• 19 Stewart E, Kahn D, Lee E. et al. Internal medicine progress note writing attitudes and practices in an electronic health record. J Hosp Med 2015; 10 (08) 525-529
• 20 Hirschtick RE. A piece of my mind. Copy-and-paste. JAMA 2006; 295 (20) 2335-2336
• 21 Yackel TR, Embi PJ. Copy-and-paste-and-paste. JAMA 2006; 296 (19) 2315-2316 , author reply 2315–2316
• 22 Winn W, Shakir IA, Israel H, Cannada LK. The role of copy and paste function in orthopedic trauma progress notes. J Clin Orthop Trauma 2017; 8 (01) 76-81
• 23 Vogel L. Cut-and-paste clinical notes confuse care, say US internists. CMAJ 2013; 185 (18) E826-E826
• 24 Graber ML, Siegal D, Riah H, Johnston D, Kenyon K. Electronic health record-related events in medical malpractice claims. J Patient Saf 2019; 15 (02) 77-85
• 25 Hilliard RW, Haskell J, Gardner RL. Are specific elements of electronic health record use associated with clinician burnout more than others?. J Am Med Inform Assoc 2020; 27 (09) 1401-1410
• 26 Ma SP, Liang AS, Shah SJ. et al. Ambient artificial intelligence scribes: utilization and impact on documentation time. J Am Med Inform Assoc 2025; 32: 381-385
• 27 Shah SJ, Devon-Sand A, Ma SP. et al. Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden. J Am Med Inform Assoc 2025; 32 (02) 375-380
• 28 Monahan K, Ye C, Gould E. et al. Copy-and-paste in medical student notes: Extent, temporal trends, and relationship to scholastic performance. Appl Clin Inform 2019; 10 (03) 479-486
• 29 Warner JL, Smith J, Wright A. It's time to wikify clinical documentation: How collaborative authorship can reduce the burden and improve the quality of the electronic health record. Acad Med 2019; 94 (05) 645-650
• 30 Steinkamp J, Kantrowitz J, Sharma A, Bala W. Beyond notes: Why it is time to abandon an outdated documentation paradigm. J Med Internet Res 2021; 23 (04) e24179