“Whoops -Did I Say That?” Examples of Documentation Integrity Issues in the EHR – iData Medical’s Webinar Series Continues

It is often said that “Seeing is believing”. We can appreciate that idiom every day as we go about our personal and professional lives. In the Medical Documentation world, this is no less true about what integrity means, particularly “document integrity” especially as it relates to the EHR and the overall patient story.  Consider the documentation issues and problems that emerge for transcriptionists, coders, physicians, insurance, hospital staff, and yes, even the patients. So wouldn’t be nice to see and hear about how to avoid these problems in the first place?

Continuing with our live Webinar Series, iData is again proud to sponsor Darice Grzybowski, of H.I.Mentors, as she help us tackle the issue of Document Integrity by giving us specific examples of common document problems that diminish the value, and compromises the integrity of the EHR. The webinar, entitled “Whoops, Did I Say That” will also help us take steps to avoid, and if necessary correct, common EHR document integrity problems.

Join us on Wednesday, June 6, at 12 noon (eastern time zone) as Grzybowski drills deeper into the subject of medical document integrity. Mark your calendars!

Join nationally-renowned author and speaker
Darice Grzybowski, MA, RHIA, FAHIMA – President H.I.Mentors, talk about EHR Document Integrity

YOU DON’T WANT TO MISS THIS!

Grzybowski is a nationally recognized leader, author, and speaker on the topic of electronic health record management and document integrity.

Attend to learn actionable steps for improving productivity, risk mitigation, and revenue by improving your clinical documentation in the electronic health record. Appropriate audience include HIM & CDI professionals, Risk/ Compliance/ Quality Managers, Clinicians, IT Professionals, and Legal Experts.

Sponsored by iData Medical, Darice will facilitate the second part of a webinar series.

ABOUT THE PRESENTER:

Darice M. Grzybowski, MA, RHIA, FAHIMA, President and Founder, H.I.Mentors, since 2005 and is a certified AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer and Ambassador. Visit H.I.Mentors at www.HIMentors.com

Darice has spoken at numerous conferences, professional associations, government and corporate meetings over the past 30 years. Topics have included; HIM best practices, electronic health records, clinical documentation improvement, workflow performance data analytics, strategic marketing, and revenue cycle process improvement.

Previous engagements have included presentations at regional and national HIMSS, AHIMA, HFMA conventions, as well as other major conferences and international meetings. Darice has also presented in online interviews, webinars and numerous vendor users group meetings and is an Adjunct Assistant Professor at the University of Illinois at Chicago in the School of Biomedical and Health Information Sciences.

ABOUT THE SPONSOR:

Find iData Medical at www.iDataMedical.com

Now celebrating its 10th year as a medical document management leader, iData Medical specializes in transcription, speech recognition editing, and coding documents. Operating out of their offices in Florida and Maryland, iData’s success hinges on its rigorous focus on document integrity, a product of its trademark iD3 process, its focus on the customer, hiring and managing the best people, and operating its work flow using industry leading security.

iData focuses on creating quality clinical documentation documents and overall medical records (accurate patient’s “story”), performs document integrity audits for small and large facilities, and provides back-up services as part of facility contingency and business continuity plans.

Over the years, iData has partnered with leading professionals, consultants, speakers and industry experts to not only improve its work flow, but promote knowledge in the document integrity realm.

EHR Document Integrity Webinar

Join nationally-renowned author and speaker
Darice Grzybowski, MA, RHIA, FAHIMA – President H.I.Mentors, talk about EHR Document Integrity

YOU DON’T WANT TO MISS THIS!

Grzybowski is a nationally recognized leader, author, and speaker on the topic of electronic health record management and document integrity.

Attend to learn actionable steps for improving productivity, risk mitigation, and revenue by improving your clinical documentation in the electronic health record. Appropriate audience include HIM & CDI professionals, Risk/ Compliance/ Quality Managers, Clinicians, IT Professionals, and Legal Experts.

Sponsored by iData Medical, Darice will launch the first part of a WEBINAR series beginning with EHR Document & Data
Integrity:

• What is Document and Data Integrity?
• Identifying Integrity Issues in your EHR
• Current EHR/Integrity Issues
• Impact of Poor Documentation
• Recommendations to Improve Document Quality

ABOUT THE PRESENTER:

Darice M. Grzybowski, MA, RHIA, FAHIMA, President and Founder, H.I.Mentors, since 2005 and is a certified AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer and Ambassador. Visit H.I.Mentors at www.HIMentors.com

Darice has spoken at numerous conferences, professional associations, government and corporate meetings over the past 30 years. Topics have included; HIM best practices, electronic health records, clinical documentation improvement, workflow performance data analytics, strategic marketing, and revenue cycle process improvement.

Previous engagements have included presentations at regional and national HIMSS, AHIMA, HFMA conventions, as well as other major conferences and international meetings. Darice has also presented in online interviews, webinars and numerous vendor users group meetings and is an Adjunct Assistant Professor at the University of Illinois at Chicago in the School of Biomedical and Health Information Sciences.

ABOUT THE SPONSOR:

Find iData Medical at www.iDataMedical.com

Now celebrating its 10th year as a medical document management leader, iData Medical specializes in transcription, speech recognition editing, and coding documents. Operating out of their offices in Florida and Maryland, iData’s success hinges on its rigorous focus on document integrity, a product of its trademark iD3 process, its focus on the customer, hiring and managing the best people, and operating its work flow using industry leading security.

iData focuses on creating quality clinical documentation documents and overall medical records (accurate patient’s “story”), performs document integrity audits for small and large facilities, and provides back-up services as part of facility contingency and business continuity plans.

Over the years, iData has partnered with leading professionals, consultants, speakers and industry experts to not only improve its work flow, but promote knowledge in the document integrity realm.

First things first: In the coming weeks and months, iData will be hosting a livestream Clinical Documentation Webinar Series about a host of realtime hot-button topics including document integrity, auditing, security and business continuity, and backup vendor configurations. Remember, improvements always translate into uptick in patient satisfaction and revenues. Look for you invite!

Another year behind us, here are some things we’ve seen in 2017:

1. Inverted White House policies have giving way to ambiguous changes for insurance carriers, benefit allocations, physicians and hospital practices, and patients experience and costs. Several failed attempts to overhaul the Affordable Care Act have left stakeholders scrambling to predict what steps to take next.
2. The documentation field is almost all digital now, creating increased efficiencies, and giving way to greater opportunity for archiving, data analytics, improved efficiencies and revenue, and sadly, increased digital forensics.
3. Outsourcing both domestically and off-shore continues to grow substantially year-over-year. Despite HIPAA and international hacking allegations, improved and tightened digital security continues to outpace events like this year’s Nuance malware debacle.
4. The Nuance Petya malware revealed the width and depth of the cybersecurity vulnerabilities that exist in medical systems and platforms.  Moreover, it revealed that many facilities failed to employ (or even have) a robust Emergency Preparedness and Business Continuity Plans, including those that engage vetted backup vendors without missing a beat.
5. Litigation and enforcement around EHR and clinical documentation integrity faux pas (misdiagnosis and treatment, errors and data loss, underpayment and outright fraud, and other risky vulnerabilities) has caused an attention spike by just about everyone, including EHR and transcription system design vendors and providers.

So, what does it all mean in 2018? For iData, we see ourselves as part of the solution for healthcare facilities, clinics, and physicians. We’ll keep beating our drum:

1. Using proven audit systems and nationally-renowned facilitators, our Document Integrity Auditing process gives you clarity about the true vulnerabilities you have and offers you solutions that help you avoid risk, malpractice, litigation, enforcement, all the while ensuring that you maximize revenue. Let us audit your system and help you sleep at night.
2. Back-up vendor ready posture. We have a substantial team of Transcription QAs, Coders, and document integrity professionals. Our team is respected by dozens of small, medium and very large hospital systems delivering complaint-free documents for over 10 years!
3. Of our mature work-flow process in the transcription and coding space. Our services offer 99% Accuracy and TAT guarantees! Not words, but action.  How? Our 3-pronged ID3 systems employs intelligent and proactive business practices by means of our Client ID, Workforce ID, and Security ID. Learn more and experience ID3 here.
4. Our technology systems are HIPAA and ISO-27001-certified and secured. We laugh at viruses, hackers, spyware, and ransomware.
5. And don’t forget to look for your invitation to our planned Webinar Series!

Contact Kendall Tant, our CEO, today, and discuss with him how we can use the lessons-learned from 2017 and make 2018 the best year yet!

Definition of Integrity: 1) The quality of being honest and having strong moral principles; moral uprightness; 2) the condition of being unified, unimpaired, or sound in construction.

“Integrity” is a lonely word these days.

Needless to say, the news is saturated by events that stem from a lack of “integrity”, a lack of sound judgement, and honest and healthy conduct.  No matter how we feel about these events, no one can disagree that “integrity” has an ever increasing value in our society these days, yet remains elusive for people and businesses alike.

At iData, we strive to provide the best possible products and services for medical documentation including transcription and coding, using the highest codes of conduct, internal and external to our business. This is an essential value that permeates everything we do from keeping our word to you, treating our employees as family, conducting our affairs ethically and legally, and supporting the work-life balance of our team. No less important is our attention to the integrity of our medical documents.

IT ALL BEGINS AND ENDS WITH INTEGRITY.

Contact iData to learn more about how we can employ our corporate culture that values integrity at all levels of the business, and incorporates it into the very things we do: maintain the integrity of your documents! For more information about Document Integrity Auditing, and back-up vendor solutions, check us out at iDataMedical.com.

In Related News:

Medscape Malpractice Report 2017 Finds the Majority of Physicians Sued

Cooperative of American Physicians Publishes Second Edition of ‘Medicine on Trial’ 

Malpractice Claims Involving Electronic Health Records on the Rise

CDI Queries: Why Must They be Compliant?

Best practices for mitigating the risks of EMR eDiscovery

Improving Clinical Data Integrity through EHR Documentation

How Strong Health Data Governance Ensures EHR Data Integrity

Practice Matters—Electronic Medical Records: An EHR System Widely Used by Neurologists Settles a Federal Lawsuit 

Coding, CDI Outsourcing Improve Case Mix, Healthcare Data Integrity

So you’re thinking: “Another article about Document Integrity and the Electronic Health Record (EHR). Haven’t we had enough?” Granted, there’s a lot out there: Opinions, Vendors and Insurance “drivers”, Physicians, and Hospitals. Caught in between the cross-fire? Patients! So how does this translate into meaningful take-aways for you, for iData… really for all of us? Let’s get into the facts.  Below are excerpts from an article by Hermann W. Børg, M.D., in the Journal of American Physicians and Surgeons, Summer 2017, which scream against the outlandish propagation of EHR systems and related requirements. As Dr. Børg concludes,

“Well-designed research studies refute the enthusiastic expectations about EHR. Such studies provide very valuable evidence in discussion of its future directions. However, the research studies per se will not rectify the accelerating EHR debacle. Powerful EHR proponents will not be persuaded by scientific data. They have an agenda, and the EHR serves it well. “

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To wit, here is a blow-by-blow evisceration of the “perceived” benefit of EHRs:

• “The gulf between optimistic projections and the disappointing reality of mandated EHRs became blindingly obvious.”
• “The EHR controversy is not a struggle between “backward physicians” and “forward-thinking technologists.” It is a dispute of pragmatic physicians who have hard work to do in limited time with serious obligations and liabilities, versus the profit-driven, liability-free EHR pushers.”
• “Government and corporations claim to be ardent followers of evidence based medicine. Yet, they did not bother to adhere to such principles while promoting EHR. When this cognitive dissonance was noted, they produced several studies favoring EHR use… the conclusions presented in those papers were immediately considered to be questionable by the medical community… summarized as “exercises in wishful thinking.”
• “EHRs have many drawbacks for patients. The principal disadvantage is a decreased quality of medical care and increased medical risks resulting from overly enthusiastic implementation of EHR.”
• “Because the EHR combines the medical and billing information, the data at stake includes health and financial information. Compromising the EHR does not require sophisticated hackers. People with access to the record can be bribed, or may simply act recklessly, compromising the privacy of millions.”
• “Research demonstrated that Clinical Decision Support (CDS) has actually decreased physicians’ efficiency and quality of care. Those counter-intuitive results were caused by the inability of the CDS modules to emulate the thinking process of the physician.”
• “[The EHR] transformed concise, clinically relevant medical record notes into a voluminous, redundant, and convoluted billing justification document. Medically pertinent data are lost in the sea of clinically irrelevant information and erroneous auto-generated texts.”
• “The need for the government to bribe and coerce physicians to adopt the EHR by mandates and regulations is a sign of its low value.”
• “EHR-related hardware, software, support, and training are very expensive.44 This puts serious nancial hardships on medical practices, which are already struggling with massive government regulation, bureaucracy, constant changes…”

Conclusions

Amalgomating the findings of this article, couldn’t be better articulated than the synthsized conclusions made by Dr. Børg:

Call us at iData to see how we fill the gaps in your EHR, accurately complete the patient’s story, increase deserved revenues, and avoid unintended liabilities.

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Document Integrity – Racing the Tour de Fact

If you’re like most people, we just keep moving with the inertial forces thrust upon us.  Indeed, we’re creatures of habit.  After all, most of us resist, if not fight change, because its hard: Change of schedule, locations, food, routines, people, jobs, friends, status, and so forth.

But deep down, we know that change is often necessary to move the pedals of our life’s “bicycle”. One pedal is depressed called “knowledge”. The other pedal depressed is called “action”.  Both are necessary and both must be depressed in sync to make our so-called bike roll down the road.

And so it is with Medical Document Integrity.  Knowledge that things can be better, problems can be avoided, quality can be enhanced, patient care can be  improved, liability can be reduced, and an accurate patient story can be told – that Knowledge isn’t enough. We also need Action. Let us no longer perpetuate the habits that replicate substandard results in our industry.

iData is focused on gaps caused by changes (and the related bad habits) related to the Medical Record, which often occur whenever a facility moves to an new EMR system. iData wants to come alongside your existing solution and fill those gaps with Action and nurture positive change!

Our method is pretty simple. It includes:

• Use documentation audits as needed to identify the problems.
• We provide specific feedback so specific solutions can be implemented.
• We show our clients how traditional transcription reporting avoids these oversights.
• We guide Physicians on the same – paying special attention to avoiding EMR shortcuts.
• We show Doctors where and how transcription safeguards this entire process.

Contact us now for more information and be sure to check out our latest White Paper entitled, “The Emerging Role of Medical Transcription in the Electronic Health Record” authored by Darice Grzybowski (H.I.Mentors, LLC) – a nationally renowned author and speaker in the field of medical health documentation, processes, and systems.

And don’t forget to check out our latest blog: Documentation Integrity and Healthier Patients

Why is it that we often fail to have Plan B’s in life? Backup plans, third string players, an emergency battery or generator, a standby flash light, hidden emergency money, backup for your family photos, an extra key to your front door, or a backup parachute? Yet, just when we need them, we don’t often have them.

Do You Have A Medical Transcription Backup Vendor?
It’s The Intelligently Veiled Value Proposition!

Medical Transcription is no different. You’re a hospital or an MT service with many important clients that depend on your uninterruptible service pipeline. Patients, and your reputation and revenue stream depend on it. You simply can’t afford to experience service interruption from your current MT vendor and have no contingency plan in place.

This is where iData comes in. We pride ourselves with offering not only superlative front-end MT service, but we also offer a streamlined, plug-and-play backup transcription service for your hospital or document business at the flip of a switch. Power outage? Cake. Internet disruption? Easy. Did someone in the work-flow get hacked or data become irreparably compromised? You’re secure with iData’s proprietary iD3 Process!

Uninterruptible Transcription is your
Risk Management Plan. So, why wait?!

iData would love to be your backup parachute (okay, vendor)!  Let us show you our consistent and reliable approach to uninterruptible work-flow, and higher quality and TAT using iD3.  Don’t let MT supply chain interruptions strangle you or threaten your business continuity cycle. It’s time. It’s your turn to call.

Recommendations for the Safe Use of Copy and Paste

Article published in AHDIONLINE MAY/JUNE 2017 Magazine

(Volume 13, Issue 3)

Lorraine Possanza, DpM, JD, MBe
and Maura Crossen-Luba, B.S., MpH, CpH

Copying and pasting information is a familiar, time saving computer function. However, errors in copy and paste can occur quickly and may not be readily recognizable. When a copy and paste error occurs in the context of patient care, the consequences can be devastating—patients may need to undergo additional or repeated procedures or may receive the wrong medications or treatments. The risks associated with using copy and paste in health care include the following (Partnership):

• An overabundance of information (i.e., “note bloat”), which makes relevant information unclear or hidden
• Propagation of internal inconsistencies and errors
• Delay in diagnoses
• Inaccuracy in billing
• Documentation in the wrong patient chart

[read more]Although copy and paste is not a new or exclusive function in the electronic health record (EHR), the patient safety issues surrounding the practice are not well recognized. For example, in 2013, the U.S. Department of Health and Human Services Office of Inspector General found that only about one-quarter of hospitals had a copy and paste policy (OIG). Professional associations are increasingly cautioning about the use of this functionality and about its associated pitfalls (AHIMA; EHRs: ‘Sloppy and Paste’), and healthcare organizations are only now beginning to recognize and address the issue.

The lagging emphasis on the patient safety risk associated with copy and paste may be partially explained by the dearth of research on the subject. ECRI Institute’s Health Technology Assessment group performed a literature review related to copy and paste in 2015 and found only a handful of case studies on adverse effects of copy and paste and no research studies on the prevalence of adverse outcomes from copy and paste (ECRI Institute). Use of copy and paste among clinicians, however, appears to be high, with one study finding 90% of physicians that used electronic notes used copy and paste for daily inpatient progress notes (O’Donnell). The ECRI Institute literature review found studies indicating that use of copy and paste appeared in “nearly all aspects of the medical note (e.g., history of present illness, physical examination, assessment, plan)” (ECRI Institute).

With knowledge of the safety issues surrounding the use of the copy and paste functionality, the Partnership for Health IT Patient Safety (the Partnership), a multi- stakeholder collaborative convened by ECRI Institute, formed a workgroup to evaluate the issue. This workgroup, chaired by Tejal Gandhi, MD, MPH, CPPS, IHI Chief Clinical and Safety Officer, comprised of a diverse group of participants, including individual practitioners, hospital safety leaders, health information technology (IT) vendors, professional societies, academic researchers, patient safety organizations (PSOs), and medical malpractice insurers, investigated the use of this functionality.

To study this issue, the workgroup first defined the scope of copy and paste, with the focus on information that is reused from other areas or from different systems but that is volitionally obtained and used elsewhere without having to retype that information. Next, the workgroup reviewed de-identified events associated with copy and paste, further illustrating how this practice can compromise safety. For example, one report indicated that lab information was identified but copied into the incorrect chart. Finally, the workgroup identified vendor functionalities available for information reuse. The workgroup also looked at the challenges and successes others had in addressing the use of copied and pasted information (Partnership).

Although using copy and paste can interject discrepancies and incorrect information and can create diagnostic bias and impede communication, it also can help clinicians by allowing for the efficient entering of complex information and completeness of documentation and reducing transcription errors. Therefore, the copy and paste functionality can be used, but with caution (Partnership).

The Partnership workgroup issued the following four recommended safe practices in February 2016 related to using the copy and paste function in the EHR:

• Provide a mechanism to make copy and paste material easily identifiable.
• Ensure that the provenance of copy and paste material is readily available.
• Ensure adequate staff training and education regarding the appropriate and safe use of copy and paste.
• Ensure that copy and paste practices are regularly monitored, measured, and assessed.

Providers, vendors, professional organizations, and others are encouraged to examine and implement the safe practice recommendations, which are freely available at ECRI Institute’s website.

The caution offered in the use of copy and paste by the four safe practice recommendations are in many ways common sense. Copied and pasted information should include only accurate, timely, and pertinent information reflecting the care provided. Making copied information readily visible lets the reader evaluate the information

in the appropriate light and helps prevent inaccurate selection of information (i.e., truncation). Knowing the origin of copied information and knowing when a note was written allows the reader to place that information in context. Moreover, it is essential that copied information be reviewed to ensure that the information is as intended. However, without adequate staff training and assessment of current practices, those using the functionality will remain unaware of the volume of information reused and the potential for safety issues.

Following the Partnership’s publication of the Safe Practice Recommendations in 2016, the National Institute for Standards and Technology (NIST) examined the functionality of the recommendations. In conducting its analysis, NIST observed copy and paste-related tasks performed by clinical providers and interviewed these same clinical providers regarding their experience with the EHR and the copy and paste functionality. The NIST study supported the human factor aspects of the recommendations, mainly the visibility of the functionality and knowledge about the provenance of the materials copied. It was impossible to fully test the recommendations concerning training and monitoring (Lowry).

The NIST report and the Partnership workgroup emphasized that some materials should never be cop ied and pasted, such as dates, signature lines, and blood bank information. Other information must be properly reviewed and edited when it is copied and pasted. Some information is more appropriate for copying and pasting with review, such as stable information that changes in frequently (i.e., past medical, surgical, or social history). Additionally, NIST reported that copying and pasting a medication with its dosing is much safer than selecting a medication from a dropdown menu, but that pasting new medication orders should be discouraged (Lowry). NIST published its findings from this study in January 2017 as report NISTIR8166, Examining the ‘Copy and Paste’ Function in the Use of Electronic Health Records.

The takeaway message from the Partnership’s safe practices and the NIST report is that it is important to visualize what has been copied and pasted to be aware of the source of the information. Further, any copied and pasted information should still be reviewed and edited for accuracy and completeness. The work of the Partnership underscores the importance of multi-stakeholder cooperation and collaboration across all aspects of health care and health IT. The workgroup and the resulting safe practices have shown not only that all health IT stakeholders have distinct roles to play in health IT patient safety, but also that they can come together to make the use of this technology safer. More information regarding the Partnership and additional Safe Practice Recommendations and work- groups can be found at the ECRI Institute website.

——————-

Dr. Possanza joined ECRI Institute in 2013 and is the project director for the Partnership for Health IT Patient Safety, a project that is convened and operated by ECRI Institute. Dr. Possanza is a board-certified podiatrist who has served on the staff of numerous hospitals, surgical centers, and nursing facilities and provided care in the VA Hospital system. Dr. Possanza attained her law degree while working full time in her podiatry practice. After leaving her practice, she served as the director of risk management at a 400-bed teaching hospital and transitioned into the practice of law, defending physicians and hospitals in professional liability actions and subsequent ly working in a regulatory and transactional health law practice focusing on Stark, Anti-kickback, HIPAA, and HITECH issues. She is admitted to practice in Pennsylvania and before the United States Patent and Trademark Office and maintains an active podiatric medical license in Pennsylvania. Additionally, Dr. Possanza holds a Master of Bioethics (MBE) from the University of Pennsylvania, with interests in clinical ethics mediation and end-of-life care.

Ms. Crossen-Luba is a business development/patient safety analyst at ECRI Institute and is responsible for project management and the development of risk management guidance on a variety of topics for ECRI Institute’s Patient Safety, Risk, and Quality group. Her quality improvement project experience for healthcare facilities includes project management, recruitment of hospitals, and implementation of best practices. Ms. Crossen-Luba has also researched and written numerous healthcare risk, quality, and patient safety guidance articles, and has been involved in developing various other educational and training materials for healthcare professionals.

References

AHIMA. “Appropriate use of the copy and paste functionality in electronic health records.” American Health Information Management Association (AHIMA), 2014 [cited 2016 Mar 2], www.ahima.org/topics/ehr.

ECRI Institute. “Copy/paste: prevalence, problems, and best practices.” 2015 Oct [cited 2017 May 2], www.ecri.org/Resources/HIT/CP_Toolkit/CopyPaste_Literature_ nal.pdf.

“EHRs: ‘sloppy and paste’ endures despite patient safety risk.” Chicago: American Medical Association; 2013 Feb 4 [cited 2017 May 2], www.amednews.com/article/20130204/profession/130209993/2/

Lowry SZ, et al. “Examining the ‘copy and paste’ function in the use of electronic health records.” National Institute of Standards and Technology (NIST). U.S. Department of Commerce. NISTIR 8166, 2017 Jan [cited 2017 Jan], http://nvlpubs.nist.gov/nistpubs/ir/2017/NIST.IR.8166.pdf

O’Donnell HC, et al. “Physicians’ attitudes towards copy and pasting in electronic note writing.” NCBI, J Gen Intern Med 209 Jan;24(1):63-8, www.ncbi.nlm.nih.gov/pubmed/18998191.

Of ce of Inspector General (OIG), U.S. Department of Health and Human Services. “Not all recommended fraud safeguards have been implemented in hospital EHR technology.” OEI-01-11-00570. 2013 Dec [cited 2016 Mar 2], http://oig.hhs.gov/oei/reports/oei-01-11-00570.pdf.

Partnership for Health IT Patient Safety. “Health IT safe practices: toolkit for the safe use of copy and paste.” 2016 Feb [cited 2017 May 8], www.ecri.org/Resources/HIT/CP_Toolkit/Toolkit_CopyPaste_final.pdf.

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