Simulated Electronic Health Record (Sim-EHR) Curriculum

Abstract

Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum’s general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts. In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

“…With reforms in medical education, there has been increasing emphasis on simulation training as it has been shown to increase knowledge and skills in invasive procedures as well as communication in a realistic environment (Wayne, Barsuk, O'Leary, Fudala, & McGaghie, 2008;Wayne, Didwania et al, 2008;Zendejas, Brydges, Wang, & Cook, 2013). Prior studies in EHR simulation have suggested EHR simulation promotes quality patient care as well as improvement in the identification of patient safety issues in critically ill patients (Landman et al, 2014;Milano, Hardman, Plesiu, Rdesinski, & Biagioli, 2014;Stephenson et al, 2014).…”

Information and Communication Technology to Facilitate Learning for Students in the Health Professions: Current Uses, Gaps and Future Directions

“…In 2009, Chertien and colleagues surveyed U.S. medical schools on incidence of unprofessional postings on social media by medical students. Sixty percent of the schools responded and of the respondents, 60% of the schools (Milano et al, 2014) reported unprofessional postings. This included violations of patient privacy, evidence of intoxication or substance abuse, profanity, discriminatory language and sexually suggestive content.…”

“…Educational training programs struggle with efforts to incorporate use of operable EMRs in their curricula (Milano, Hardman, Plesiu, Rdesinski, & Biagioli, 2014;Wald, George, Reis, & Taylor, 2014). Student documentation in an actual patient EMR raises concerns related to patient safety, liability and accurate billing and reimbursement (Mintz, Narvarte, O'Brien, Papp, Thomas, & Durining, 2009).…”

“…As an alternative, an academic EMR (AEMR), which has similar functionality as the EMR (Johnson & Bushey, 2011) can be used as a tool in the educational setting to introduce students to this technology while also fostering student development of core professional competencies (Barnett, 2013;Wald et al, 2014). Health informatics (Borycki et al, 2013), effective communication (Bowers et al, 2011;Morrow et al, 2009) clinical documentation (Stephens, Gimbel, & Pangaro, 2011) and disease prevention and management (Milano et al, 2014) can all be addressed with an AEMR, however barriers exist with implementation of an AEMR as well. Faculty familiarity with the systems, lack of institutional personnel trained to implement and manage this technology, cost, and EMR vendors with different training requirements (Borycki et al, 2013) make adoption of this technology challenging.…”

Electronic Health Record System Implementation in a Health Informatics Program: A Case Study

“…Several others have called for hands-on EHR practice in medical education for documentation, specifically with an emphasis on balancing EHR documentation with patient engagement, practicing order entry in the EHR and utilizing decision aids that accompany EHRs (Atwater et al, 2016;Hammoud et al, 2012;Wald, George, Reis, & Taylor, 2014). Despite the transforming nature of the EHR in healthcare, its impact on patient care, and the numerous calls to adopt the EHR in medical education, EHRs have yet to be routinely integrated into medical curricula to teach optimal use to medical students (Kushniruk et al, 2012b;Milano, Hardman, Plesiu, Rdesinski, & Biagioli, 2014). More should be done to prepare individuals before they enter healthcare practice or the healthcare industry.…”