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

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.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.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.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).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.