# Auditing Copying and Pasting Overview

In an effort to improve clinical documentation, CPRS now enables individuals designated by medical centers to review clinical documents to audit how much text within them has been copied and pasted from another document.

Note: This feature is new with CPRS GUI v31b and patch TIU*1.0*290. Only documents created after the installation of these patches will have copied and pasted text tracked.

Excessive copying and pasting has at least these impacts on healthcare:

- unnecessary duplication of information

- lengthening of notes and making chart reading more difficult

- slowing the retrieval of notes by the workstation

- improving accuracy of the note and the patient information

To help sites better audit what text is copied and pasted into clinical documents, CPRS defines

- who can view pasted text

- what constitutes tracked pasted text

- how CPRS will display pasted text

- how the auditor can view the pasted text

- how the person auditing can turn on or off the display of pasted text

Who Can View Pasted Text?

After signature, only individuals assigned to specific user classes will be able to view text that has been copied and pasted. With CPRS v31b, users in these User Classes are assigned to be able to audit copying and pasting by default:

- CHIEF, MIS

- CHIEF, HIMS

- PRIVACY ACT OFFICER

In addition, sites can give other user classes the ability to view copy/paste data.

What Constitutes Tracked Paste?

If a user pastes text into a clinical document within CPRS, CPRS will track that as a paste if it meets several criteria. When a user copies information within VistA or CPRS, CPRS will store characteristics about the copied text if it is available, such as the title and author of the document it came from, or whatever information it can about the source. The information gathered when text is copied can then be displayed if the text is pasted.

If text is copied from outside of CPRS or it is altered after being pasted into CPRS, the source information may simply read “Outside of current CPRS tracking”, meaning that CPRS does not know where it came from.

Character Limits for Pasted Text

A 20,000 character limit is hard-coded. If a paste exceeds 20,000 characters, CPRS will not try to track the source. It will still show on the report and the percentage will be calculated as discussed below. The text will still be tracked, but it will not be able to track the source.

Other Copy/Paste Characteristics that Sites Can Set

There are several criteria that determine whether a copy and paste will be tracked or displayed with identifying marks in CPRS. Sites have some control over how these criteria are set. The criteria are as follows:

- Minimum Number of Words: To be considered a paste, there must be at least the specified number of words. For example, if it is set at 15 words and a user pastes 14, CPRS will not identify it as a paste. The default is 5 words.

- Percentage Check: Because providers often edit text after it is pasted, CPRS checks what percentage of the original paste is in the document. For example, if this percentage is set at 85 percent and the user pastes some text but then edits it so that only 75 percent of the original text remains, it will not display as pasted text. The default is 90% unless changed by your site.

- Role: Until a note is signed, the author and cosigner can see highlighted pasted text. After the note is signed, only users in specified user classes will see the pasted text.

- Exclude Note Title: Site can specify notes that will not be tracked for copy/paste.

- Exclude Application: Sites can specify that specified applications are not tracked for copy/paste. One application (natspeak.exe) is already included in this parameter.

Clinical Application Coordinators (CACs) set the values for these parameters.

When Text Will Not Display as Pasted

In addition to these parameters, certain actions will determine whether pasted text displays in CPRS with its identifiers.

- After Signature: While the author of a note is writing the note or editing it, CPRS will identify pasted text with highlighting or other methods as set by the user, if it meets the criteria above. If the author or cosigner of the document signs the document and they are not in the designated user class that can view pasted text, the pasted text will no longer be identified for them as pasted. In other words, if it is highlighted, it will no longer be highlighted and the area showing the pastes will not display it. The pastes can still be identified to auditors in CPRS.

- Within the Same Note: When text is copied and pasted from within the same note.

- Lines with 2 words or less: Lines with only 2 words or less do not highlight even though they are tracked.

Related topics

Progress Notes

Setting How Pasted Text Will Display to Auditors, Authors, and Cosigners