Integrating the Electronic Health Record into high-fidelity interprofessional intensive care unit simulations

Real

Journal of Interprofessional Care

2017

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners’ experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one’s notes. Limitations in technology - including limited computer availability, documentation complexity, and sluggish sign-in processes - also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardized electronic medical record use across professions at the optimal level to support communication and patient care.

Section: Discussionmentioning

confidence: 99%

Perspectives of healthcare practitioners: An exploration of interprofessional communication using electronic medical records

Real

Journal of Interprofessional Care

2017

“…To amplify this paradigm, a number of studies conducted by our group and others have suggested that providers across multiple professions have difficulty in using the EHR as manifested by issues with data finding, recognition of patient safety issues, and impairment in clinical decision making [ 4 , 5 ]. Additionally, recent studies revealed that problems associated with clinicians’ selective data gathering or selective data interpretation can lead to increased patient harm, a phenomenon that has also been identified and replicated in simulation exercises [ 6 , 7 ]. These issues are not just isolated to physicians: recent work from our group has suggested that the phenomenon affects nurses and pharmacists at all levels of training, implying a global problem related to human EHR interfaces [ 5 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Use of Simulation Based on an Electronic Health Records Environment to Evaluate the Structure and Accuracy of Notes Generated by Medical Scribes: Proof-of-Concept Study

et al. 2017

Self Cite

BackgroundThe increasing adoption of electronic health records (EHRs) has been associated with a number of unintended negative consequences with provider efficiency and job satisfaction. To address this, there has been a dramatic increase in the use of medical scribes to perform many of the required EHR functions. Despite this rapid growth, little has been published on the training or assessment tools to appraise the safety and efficacy of scribe-related EHR activities. Given the number of reports documenting that other professional groups suffer from a number of performance errors in EHR interface and data gathering, scribes likely face similar challenges. This highlights the need for new assessment tools for medical scribes.ObjectiveThe objective of this study was to develop a virtual video-based simulation to demonstrate and quantify the variability and accuracy of scribes’ transcribed notes in the EHR.MethodsFrom a pool of 8 scribes in one department, a total of 5 female scribes, intent on pursuing careers in health care, with at least 6 months of experience were recruited for our simulation study. We created three simulated patient-provider scenarios. Each scenario contained a corresponding medical record in our simulation instance of our EHR. For each scenario, we video-recorded a standardized patient-provider encounter. Five scribes with at least 6 months of experience both with our EHR and in the specialty of the simulated cases were recruited. Each scribe watched the simulated encounter and transcribed notes into a simulated EHR environment. Transcribed notes were evaluated for interscribe variability and compared with a gold standard for accuracy.ResultsAll scribes completed all simulated cases. There was significant interscribe variability in note structure and content. Overall, only 26% of all data elements were unique to the scribe writing them. The term data element was used to define the individual pieces of data that scribes perceived from the simulation. Note length was determined by counting the number of words varied by 31%, 37%, and 57% between longest and shortest note between the three cases, and word economy ranged between 23% and 71%. Overall, there was a wide inter- and intrascribe variation in accuracy for each section of the notes with ranges from 50% to 76%, resulting in an overall positive predictive value for each note between 38% and 81%.ConclusionsWe created a high-fidelity, video-based EHR simulation, capable of assessing multiple performance indicators in medical scribes. In this cohort, we demonstrate significant variability both in terms of structure and accuracy in clinical documentation. This form of simulation can provide a valuable tool for future development of scribe curriculum and assessment of competency.

“…The objective of the majority (14/24) of the studies was either to improve learning skills of medical trainees and clinicians or to teach technical and non-technical skills. 4,[41][42][43][44][45][46][46][47][48][49][50][51][52] Of these studies seven had the objective of showing that simulation-based EHR training can enhance the teaching of students. [53][54][55][56][57][58][59] One study investigated the practicality of integrating an eye tracker into an EHR simulation environment, 60 one study sought to understand EHR-related communication and data management skills, 53 and one study used high-fidelity EHR-based simulation to understand learners struggling with clinical efficiency and decision making.…”

Section: Study Characteristicsmentioning

confidence: 99%

State of the evidence on simulation-based electronic health records training: A scoping review

Nuamah

Adapa

Mazur

2022

Health Informatics J

This study synthesized the available evidence of simulation-based electronic health records (EHRs) training in educational and clinical environments for healthcare providers in the literature. The Arksey and O’Malley methodological framework was employed. A systematic search was carried out in relevant databases from inception to January 2020, identifying 24 studies for inclusion. Three themes emerged: (a) role of simulation-based EHR training in evaluating improvement interventions, (b) debriefing and feedback methods used, and (c) challenges of evaluating simulation-based EHR training. The majority of the studies aimed to emphasize the practical skills of individual medical trainees and employed post-simulation feedback as the feedback method. Future research should focus on (a) using simulation-based EHR training to achieve specific learning goals, (b) investigating aspects of clinical performance that are susceptible to skill decay, and (c) examining the influence of simulation-based EHR training on team dynamics.