Why Clinicians Copy-Paste: Designing for Persistence, Not Duplication

Anyone who’s worked in an EHR has seen it: the wall of text pasted from a prior note. Maybe you’ve done it yourself, cutting and pasting last week’s plan, an old problem summary, a good phrase that captured a patient’s history well.

We’re often told this behavior is the problem. That it’s dangerous, lazy, or bloats the chart.

But what if it’s actually a workaround for a deeper issue?

Copy-Paste as a Signal

In our peer-reviewed research on duplication in the medical record, we found that copy-paste wasn’t just a bad habit. It was a signal; a crude but rational attempt to make important clinical information persist across visits.

Clinicians weren’t trying to game the system. They were trying to preserve context.

In most EHRs, once a note is signed, it disappears into the archive. The next note starts from scratch. But the medical problems themselves don’t reset. They persist. And clinicians need a way to carry forward what still matters.

The Real Problem: Ephemeral Notes, Persistent Conditions

The traditional note model assumes the documentation is the primary unit of meaning. But in reality, the unit of meaning is the problem.

A patient with CKD Stage 3 doesn’t suddenly have CKD Stage 0 next week. A child with obesity doesn’t shed years of counseling just because it’s a new visit. Clinical work is longitudinal. But most documentation is trapped in disconnected episodes.

Clinicians copy-paste because they don’t want to lose track of what they’ve already said. What they’ve already planned. What still matters.

Our Response: Persistent Problems, Not Redundant Notes

That insight shaped how we designed Stream. Instead of treating documentation like a series of disconnected snapshots, we treat each medical problem as a living thread of documentation.

At the heart of this is a feature we call Problem Link.

Problem Link: Threads of Documentation Over Time

Problem Link is a quiet but powerful part of Stream. It automatically connects every piece of documentation related to the same medical problem, regardless of when it was written, so that clinicians can view, reuse, and update information without having to go digging through past notes.

No manual tagging. No templates. No searching.

Just click on a problem, and you see its story unfold (plans, edits, updates) all linked together.

It’s what clinicians have been trying to recreate with copy-paste, but done right. Structured, longitudinal, and reviewable.

The Payoff: Continuity Without Redundancy

By treating documentation as a thread, rather than a series of isolated notes, Stream gives clinicians the ability to:

• Maintain accurate, up-to-date problem lists and plans
• Avoid re-summarizing the same history over and over
• Preserve meaningful clinical decisions and reasoning
• Document once, and build on it over time

This approach isn’t just more efficient. It’s more clinically faithful to how care actually happens.

Reimagining the Medical Record

Copy-paste is a symptom. The real diagnosis is a system that forgets what matters. With Persistent Problems and features like Problem Link, we’re working to build a medical record that remembers and helps clinicians move forward without losing their place.