Medical Student Use of Electronic Health Records to Track Former Patients

Brisson, Gregory E.; Tyler, Patrick D.

doi:10.1001/jamainternmed.2016.3878

Cited by 12 publications

(17 citation statements)

References 4 publications

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“…Students actively followed and wrote notes for 3 patients per day, but additional patients on the team were peripherally followed which accounted for almost half of their total EHR activity. The EHR could thus be serving as an educational resource as tracking additional patients can expand the volume and variety of cases students are exposed to and add to learning beyond the immediate patient encounter [12]. Documentation from experienced physicians and consultants can serve as a resource for students while access to real-time data can empower students to feel more involved as they are often not the primary contact for patient care.…”

Section: Discussionmentioning

confidence: 99%

How are medical students using the Electronic Health Record (EHR)?: An analysis of EHR use on an inpatient medicine rotation

et al. 2019

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Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers for Medicare and Medicaid Services (CMS) most recent provisions now allow student notes for billing which will likely increase the role of medical student use of the EHR over time. To gain a better understanding of how medical students use the EHR at our institution, we retrospectively analyzed 6,692,994 EHR interactions from 49 third-year clerkship medical students and their supervising physicians assigned to the inpatient medicine ward rotation between June 25 2015 and June 24 2016 at a tertiary academic medical center. Medical students spent 4.42 hours (37%) of each day at the on the EHR and 35 minutes logging in from home. Improved understanding of student EHR-use and the effects on well-being warrants further attention, especially as EHR use increases with early trainees.

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Section: Discussionmentioning

confidence: 99%

How are medical students using the Electronic Health Record (EHR)?: An analysis of EHR use on an inpatient medicine rotation

et al. 2019

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“…It permits making a long-term follow-up of patients from diagnosis up to the treatment, even once the direct relationship is over. However, this post-control has caused some ethical reactions related to the duty of training students in the right to intimacy and autonomy of patients [34][35][36]. Students need to access the CH to develop their abilities in its use and maintenance, as well to understand the nuances of the EMR itself during a medical consultation [37].…”

Section: Guarantees In Accessing Clinical Historymentioning

confidence: 99%

The Role of Undegraduate Medical Students Training in Respect for Patient Confidentiality

Beltrán-Aroca

Ruiz-Montero

Labella

et al. 2020

Preprint

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Background: Encouraging professional integrity is vital in providing a standard of excellence in the quality of medical care and education, promoting a culture of respect and responsibility. The main objective of this work consisted of studying the relationship of medical students with the right to intimacy of patients in Spain, specifically analysing the conditions of accessing patients’ Clinical History (CH).Methods: A questionnaire was sent by e-mail to final-year students at 41 Spanish universities. It had 14 multiple choice and closed questions framed in 3 large blocks. The first one addressed basic general knowledge issues on the right to intimacy and the obligation of confidentiality. The two remaining blocks were made up of questions directed towards evaluating the frequency with which certain requirements and steps of action related to the students in attending the patient were performed, and regarding the guarantees in accessing and handling their CH both on paper and in the Electronic Medical Record.Results: A total of 245 valid replies was considered. 67.8% of participants were women, with an average age of 24.05±3.49 years. Up to 90.6% were aware that confidentiality affected the data in CHs, although 43.3% possessed non-anonymized photocopies of patients’ clinical reports outside healthcare context, and only 49.8% of the students were always adequately identified. 59.2% accessed patients’ CHs on some occasions by using passwords of healthcare professionals and 77.2% of them did not have patients’ express consent and 71.9% accessed a CH that was not anonymised.Conclusions: The role of healthcare institutions and universities is considered to be fundamental in implementing educational measures regarding the risks and ethical and legal problems arising from the use of CHs among professionals and students. A profound study of medical ethics is needed through the analysis of clinical cases, and direct exposure to situations in which the patient’s confidentiality is questioned.

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“…26,27 Educational registries offer benefits of both longitudinal clerkships and virtual patients. Hirsh et al noted that, BIn order to anchor clinical learning in caregiving, students must have relevant involvement with patients at the site and time of initial medical decision making, ideally before the diagnosis is made, and be able to follow patients for the duration of an illness episode (and beyond), ideally across care venues.^1 9 With EdRs, any patient encounter has potential to evolve into such a learning opportunity.…”

Section: Rationale For Edrsmentioning

confidence: 99%

“…They are not required to track, though 96% report doing so. 9 Ideally, students would be coached by faculty who meet with students to discuss their EdRs: which patients they enrolled in the registry, and why; how the permission conversation was conducted; and what they learned. However, EdRs are a new educational resource, and incorporating them into formal training will take time.…”

Section: Implementing Edrs and Future Directionsmentioning

confidence: 99%

“…To date, the sole educational outcome that has been measured is the perceived utility of tracking by learners themselves. 9 McLaughlin and Coderre observe that the clinical impact of tracking is Bdistant and dilute^and therefore difficult to measure, so they suggest studying proximal outcomes. 20 Examples could include the impact of tracking on clinical reasoning, such as generating a differential diagnosis or using appropriate testing; or the impact on ethical decision-making, which may be strengthened, because tracking offers regular opportunities to manage ethical conflicts.…”

Section: Implementing Edrs and Future Directionsmentioning

confidence: 99%

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A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry

et al. 2018

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One challenge of contemporary medical education is that shorter lengths of stay and time-limited clerkships often interrupt a student's relationship with a patient before a diagnosis is made or treatment is completed, limiting the learning experience. Medical students sometimes use electronic health records (EHRs) to overcome these limitations. EHRs provide access to patients' future medical records, enabling students to track former patients across care venues to audit their diagnostic impressions and observe outcomes. While this activity has potential to improve clinical training, there is a risk of unintended harm to patients through loss of privacy. Students need guidance on how to perform this activity appropriately. This article describes an ethical framework for tracking using an "educational registry," a list of former patients housed within the EHR that one follows longitudinally for educational purposes. Guiding principles include obtaining permission from patients, having legitimate educational intent, and restricting review of records to those essential for training. This framework could serve as a foundation for institutions seeking to develop a policy on tracking former patients, and may facilitate research on the use of EHRs to improve medical education, such as reducing diagnostic error and promoting self-directed learning.

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Medical Student Use of Electronic Health Records to Track Former Patients

Cited by 12 publications

References 4 publications

How are medical students using the Electronic Health Record (EHR)?: An analysis of EHR use on an inpatient medicine rotation

How are medical students using the Electronic Health Record (EHR)?: An analysis of EHR use on an inpatient medicine rotation

The Role of Undegraduate Medical Students Training in Respect for Patient Confidentiality

A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry

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