JAMIA -- Embi et al. 11 (4): 300 Table BL5

Table 5. Theme 4: Mistakes, Concerns, and Decreased Confidence: RepresentativeQuotations

Categories
Quotations
Data overlooked "Pulling (the data) in, I can'ttell you the number of times I've missed something because it's just thisblur of data."
Data Fog "We didn't see (the important lab data) untilmuch later in the day and didn't actually address it until much later inthe day... yet because (the student) just dropped in all the labs, I couldsee that it was there the day before and he just didn't even notice it."
"The act of writing (the data) makes you thinkabout them."
Uncertain whether data interpreted "In the past, at least they circled(the lab value); you knew they noted it was abnormal evenif they didn't address it in the assessment, butnow you don't know if they just didn't think it was worth mentioning orthey just didn't notice it."
"It's a data dump; without processing,... you can't tell exactly what people thought was important in the labdata."
Duplication and verification concerns and mistakes "I worry that people don't actually do their own history and physicals,but the notes imply that they have."
"You'll see exactly the samephysical exam in the intern's progress note, the resident's progress note,the attending's progress note, and then in subsequent subspecialist's progressnotes.
They're copied and pasted from onenote to another, and it's not simply that it isn't accurate, but probablythat it's not believable that it's accurate."
"(Residents) don't take medication histories anymore (relying insteadon pharmacy data in CPRS) ... , but what the computer thinks is not whatthe patient's actually putting in their mouth or injecting into themselvesor whatever."
"A medical student was having difficulty with the pace and actuallyplagiarized a whole note from one of the interns (using copy-and-paste)."
"You'll see people, as a diagnosis changes during a hospitalization,people will not change their written diagnosis because they're simply copyinginformation from a previous note."
"The housestaff simply copied that (inaccurate) history, withoutgoing back to verify the initial data, and the patient was started on Vanco(an antibiotic) inappropriately."

"I'm absolutely positive that there are cut-and-paste errors occurring."

"Ijust worry that people aren't thinking the way they used to."

Categories	Quotations
Data overlooked	"Pulling (the data) in, I can'ttell you the number of times I've missed something because it's just thisblur of data."
Data Fog	"*We didn't see (the important* lab data) untilmuch later in the day and didn't actually address it until much later inthe day... yet because (the student) just dropped in all the labs, I couldsee that it was there the day before and he just didn't even notice it."
	"The act of writing (the data) makes you thinkabout them."
Uncertain whether data interpreted	"*In the past, at least they circled(the lab value); you knew they noted it was abnormal evenif they didn't address it in the assessment, butnow you don't know if they just didn't think it was worth mentioning orthey just didn't notice it*."
	"*It's a data dump; without processing*,... you can't tell exactly what people thought was important in the labdata."
Duplication and verification concerns and mistakes	"I worry that people don't actually do their own history and physicals,but the notes imply that they have."
	"*You'll see exactly the samephysical exam in the intern's progress note, the resident's progress note,the attending's progress note, and then in subsequent subspecialist's progressnotes.* They're copied and pasted from onenote to another, and it's not simply that it isn't accurate, but probablythat it's not believable that it's accurate."
	"(Residents) don't take medication histories anymore (relying insteadon pharmacy data in CPRS) ... , but what the computer thinks is not whatthe patient's actually putting in their mouth or injecting into themselvesor whatever."
	"A medical student was having difficulty with the pace and actuallyplagiarized a whole note from one of the interns (using copy-and-paste)."
	"You'll see people, as a diagnosis changes during a hospitalization,people will not change their written diagnosis because they're simply copyinginformation from a previous note."
	"The housestaff simply copied that (inaccurate) history, withoutgoing back to verify the initial data, and the patient was started on Vanco(an antibiotic) inappropriately."
	"I'm absolutely positive that there are cut-and-paste errors occurring."
	"Ijust worry that people aren't thinking the way they used to."