How Much of the EMR Contains Duplicate Information?
BACKGROUND AND PURPOSE:
Much of the patient information in the electronic medical record (EMR) is duplicated text
Previous study has shown that when physicians make a new note, they may duplicate over half of their last note
This duplicated text is the result of EMR software design, physician use behavior, and billing and legal requirements, but it wastes physician time and can cause information overload and scatter
Steinkamp et al. (JAMA Network Open, 2022) examined the prevalence and scope of duplication behavior in clinical notes
Retrospective, cross-sectional analysis
All inpatient and outpatient notes written in a single health system
From January 2015 to December 2020
Number of notes in the patient record
The authors used a set of 10 adjacent word tokens (ie, a 10-gram) sliding-window approach to identify spans of text duplicated exactly from earlier notes in a patient’s record
2 Different types of hazard
Information overload: “…difficulty of finding relevant information because there is too much information in the EMR”
Information scatter: “…difficulty of finding and synthesizing information because it is fragmented across numerous locations and leads to wasted time retrieving data, or worse, missed information because clinicians lack time to adequately search the EMR”
Total, novel, and duplicate text
Mean intra-author and inter-author duplication per note
1,960,689 unique patients | 104,456,653 notes | 32,991,489,889 words
Total duplicated text in the record: 50.1% (duplicated from prior text written about the same patient)
The duplication fraction increased year-over-year
Text duplicated, by author
Duplicated from text written by same author: 54.1%
Duplicated from text written by different author: 45.9%
Records with more notes had more total duplicate text: Approximately 60%
Note types with high information scatter tended to have low information overload, and vice versa
Duplicate text in the EMR is a pervasive issue
Over 50% of text in the records being classified as duplicate
Duplicate text has increased since 2015
Authors duplicate own previous text as well as those of others
The authors state
Duplicate text casts doubt on the veracity of all information in the medical record, making it difficult to find and verify information in day-to-day clinical work
The findings of this cross-sectional study suggest that text duplication is a systemic hazard, requiring systemic interventions to fix, and simple solutions such as banning copy-paste may have unintended consequences, such as worsening information scatter
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