Seeing double: Half of all electronic medical records contain duplicate text

Physicians spend a great deal of time poring over patient records, and much of that is because half of all electronic health records contain duplicate text.

Researchers examined more than 104 million clinical notes, and found that 50.1% of the records were duplicated from prior documentation, according to a recent study published by Jama Network Open.

It’s not just tiresome for doctors, the authors suggest. The excessive use of repeated text hampers patient care, because doctors are spending more time poring over notes to determine the information that is accurate and the notes that are out of date.

“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 authors wrote.

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The prevalence of duplication in medical records poses risks to patients, the researchers suggest.

“Overworked clinicians may be disincentivized from reading such a bloated record, missing valuable clinical context not easily found elsewhere (eg, reasons for past diagnostic or therapeutic decisions), and leading to wasted time repeating past interventions or directly causing patient harm by missing findings requiring follow-up,” they wrote.

In addition, if the duplicate text involves incorrect information, and it’s repeated over and over, the records become virtually impossible to correct because of the number of mistakes.

The use of duplicate text is rising, increasing from 33% for notes written in 2015 to 54.2% for notes written in 2020, the study found. More than half (54.1%) of the duplicate text came from text written by the same author, while the rest (45.9%) was duplicated from a different clinician.

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Researchers from the University of Pennsylvania conducted the study, which they said was the largest of its kind to their knowledge. They examined records within the Penn Medicine Health System over six years, from January 1, 2015, through December 31, 2020.

The prevalence of duplicate text can be time-consuming for doctors, not to mention confusing. The notes are rather lengthy, the researchers said..

“Information overload and duplication are severe hazards for practicing clinicians. Finding the right information is no longer a matter of flipping through a paper chart; it is more akin to reading large portions of a book,” the authors wrote.

The typical medical record is a little more than half the length of William Shakespeare’s “Hamlet,” his longest work, the authors noted.

The median record in the study contained 4,285 words. Doctors seeing 10 patients each day would have to review at least 85 pages of single-spaced text spread across 691 notes, the authors noted.

The duplicate content was produced by doctors at all stages of their careers, along with nurses and therapists.

While the amount of duplicate text in medical records is a problem, it’s not an easy one to solve, researchers said.

If health systems simply order clinicians to stop cutting and pasting, it could have unintended consequences, such as scattering information, the researchers said.

Ultimately, the healthcare industry needs better documentation systems, they wrote.

“Given the ubiquity of duplication, this practice cannot be attributed to individual authors behaving badly, nor could it be safely banned without larger changes to underlying paradigms,” the authors wrote. “Instead, our study suggests that duplication is a rational response of clinicians attempting to manage information in a documentation paradigm ill-suited to the task.”

Some information in notes remains relevant over time and should be visible in patient records, but the authors note that doctors typically copy the old information. “Unfortunately, this itself worsens information overload, leading to a vicious cycle,” the authors wrote.

The authors suggested designing documentation systems that can be used collaboratively, so clinicians and teams don’t need to create separate documents. They proposed building systems that display version history to show changes in a single document. This could allow records to be updated without creating new documents, but preserving older information if needed.