Appendix: Physicians’ Attitudes towards Copy and Pasting in Electronic Note Writing

Copy and Pasting in Inpatient Electronic Health Records

The purpose of this survey is to understand how physicians write and read notes in inpatient electronic health records. Specifically we want to understand how the copy and paste function plays a role in these processes in order to optimize the use of this function. This survey will take only 5-10 minutes of your time.

This survey is confidential and your participation in this study is purely voluntary.Individual responses to the survey will not be reported. All of the questions in this survey relate to writing inpatient notes in your hospital’s current electronic health record (EHR) system.

Definitions:

Computerized Physician Documentation: Direct entry of physician documentation into electronic health records (EHR) via computer keyboard and mouse. Does not include dictated note transcribed into EHR or paper records scanned into EHR.

Copy and Paste Function (CPF): Copying a patient note or a portion of a note, pasting it into a new note and then altering the note as necessary. Includes the copy forward function (bringing parts of an old note into a new note by section) available on <Hospital B’s documentation system>. Also, includes copying a note into another program, such as word or wordpad and altering it there before pasting back into <the hospital documentation system>. Does not include the automatic importation functions including patient’s most recent vitals, laboratory values and radiology results.

Use of Computerized Physician Documentation:

Please answer the following questions regarding how you write your inpatient notes:

  1. How do you currently write your inpatient notes?

OOn paper only (if you have never written an electronic note, please skip to question 9)

OElectronically

OCombination of electronically and on paper

  1. How comfortable are you writing inpatient notes electronically on your hospital’s EHR system?

Very comfortable / Somewhat comfortable / Somewhat uncomfortable / Very uncomfortable
O / O / O / O
  1. Do you know how to use the copy and paste function (CPF) when entering an electronic inpatient note?

O Yes

ONo (if you do not know how to use the copy and paste function, please skip to question 8)

Use of the Copy and Paste Function (CPF)

Questions 4 through 7 ask you about how you write your inpatient electronic notes. If you have never written an inpatient electronic note or if you have never used the copy and paste function, please skip to question 8.

  1. How often do you use the copy and paste function (CPF) when writing an inpatient daily progress note?

Almost Always / Most of the time / Sometimes / Rarely / Never
O / O / O / O / O
  1. When you copy and paste a progress note, do you copy the whole note?

O Yes (If yes, please skip to question 7)

ONo

  1. If not, please select the portions you usually copy. (Please choose all that apply, DO NOT include parts that you import using an automatic import function):

OSubjectiveOAssessment

OPast medical historyOProblem List

OPhysical examOMedication List

OVital signsOPlan

OLab/radiology studiesOOther: please specify:______

  1. Have you used the copy and paste function (CPF) to do the following things?

Yes / No
a)Copy parts of my own note from previous days during the same admission / O / O
b)Copy parts of an intern or resident physician’s notes / O / O
c)Copy parts of an attending’s notes / O / O
d)Copy parts of a medical student’s note / O / O
e)Copy parts of notes from another admission/outpatient visit / O / O

Electronic note reading:

Questions 8 through 10 ask you about reading electronic inpatient notes.

  1. Do you ever read electronic inpatient notes?

O Yes

ONo (If you have never read an electronic note, please skip to question 19.)

  1. Please indicate how strongly you agree or disagree with each of the following statements regarding readinginpatient electronic notes that have been created using CPF compared to notes written without using CPF:

Strongly agree / Agree / Neutral / Disagree / Strongly disagree
a)The information contained in notes written using the CPF is more trustworthy than in notes written without using CPF / O / O / O / O / O
b)It is more difficult to find new information in notes written using CPF / O / O / O / O / O
c)Notes written using CPF contain more outdated information than notes written without CPF / O / O / O / O / O
d)Notes written using CPF contain more inconsistent information (Text within a note that clearly contradicts another part of the note: such as ‘d/c ASA’ and ‘continue ASA’ in the same note) / O / O / O / O / O
e)Notes written using CPF lack justification for clinical decisions (such as ‘start lasix’ without any explanation for this change) more often than notes written without CPF / O / O / O / O / O
f)Notes written using CPF lead to more confusion about the condition, status or plan of a patient than notes written without CPF / O / O / O / O / O
g)Notes written using CPF increase the likelihood of a mistake occurring in the care of a patient compared to notes written without CPF / O / O / O / O / O
  1. Have you ever made a mistake in patient care that you feel was a result of being confused by a note that contained copy and pasted text?

O Yes

ONo

OUnsure

If yes, please describe a specific example: ______

______

______

Overall opinion:

Questions 11 and 12 ask you about your overall opinion of the copy and paste function.

  1. How has CPF affected the ability of progress notes to serve the following functions?

Greatly Improved / Slightly Improved / No effect / Slightly Worsened / Greatly Worsened
a)To accurately communicate patient’s day to day course to other current inpatient providers / O / O / O / O / O
b)To document patient’s entire hospital course / O / O / O / O / O
c)To document a patient’s course for legal purposes / O / O / O / O / O
d)To facilitate billing / O / O / O / O / O
  1. Overall, how do you think the CPF has impacted physician documentation?

O Very Positively

O Somewhat positively

O Neutral or the positives and negatives are about even

O Somewhat negatively

O Very negatively

The future of electronic note writing:

Questions 13 and 14 address what you believe would help improve electronic note writing.

  1. Please indicate how strongly you agree or disagree with the following statements regarding the

future of the copy and paste function (CPF):

Strongly Agree / Agree / Neutral / Disagree / Strongly Disagree
a)The use of CPF should be continued and facilitated in future documentation systems / O / O / O / O / O
b)Education should be provided to physicians regarding how to use the CPF responsibly / O / O / O / O / O
c)Copy and pasted text should be readily identifiable (for example, highlighted or in italics) / O / O / O / O / O
d)Alerts should pop up notifying the provider that a note is not significantly different from an old note / O / O / O / O / O
e)Other ideas, please describe: ______
______
______
  1. Please indicate how strongly you agree or disagree that the CPF should be restricted in the following ways:

Strongly Agree / Agree / Neutral / Disagree / Strongly Disagree
f)Don’t allow copy and pasting of certain parts of the note (for instance physical exam) / O / O / O / O / O
g)Don’t allow a provider to copy and paste notes from another author / O / O / O / O / O
h)Don’t allow the use of copy and paste for certain types of notes (progress notes) but allow for others (discharge summaries) / O / O / O / O / O
i)Other limitations, please specify: ______
______
______

Demographic information:

  1. What year did you graduate from medical school? ______
  1. In what year were you born? ______
  1. Please indicate your gender:

OMale

OFemale

  1. Please indicate your current position (academic year 6/06-6/07):

OIntern/PGY-1

OPGY-2

OPGY-3

OHouse Doctor / Hospitalist (with primarily inpatient responsibilities)

OHospital Faculty Attending with < 3 months inpatient responsibility per year

OHospital Faculty Attending with 3-6 months inpatient responsibility per year

OHospital Faculty Attending with >6 months inpatient responsibility per year

OVoluntary Attending (Care for your private patients when admitted)

  1. Date survey completed: ______/ ______/ ______

MonthDayYear

Page 1 of 6