The Impact of Electronic Health Record–Based Simulation During Intern Boot Camp: Interventional Study

Abstract

Background Accurate data retrieval is an essential part of patient care in the intensive care unit (ICU). The electronic health record (EHR) is the primary method for data storage and data review. We previously reported that residents participating in EHR-based simulations have varied and nonstandard approaches to finding data in the ICU, with subsequent errors in recognizing patient safety issues. We hypothesized that a novel EHR simulation-based training exercise would decrease EHR use variability among intervention interns, irrespective of prior EHR experience. Objective This study aims to understand the impact of a novel, short, high-fidelity, simulation-based EHR learning activity on the intern data gathering workflow and satisfaction. Methods A total of 72 internal medicine interns across the 2018 and 2019 academic years underwent a dedicated EHR training session as part of a week-long boot camp early in their training. We collected data on previous EHR and ICU experience for all subjects. Training consisted of 1 hour of guided review of a high-fidelity, simulated ICU patient chart focusing on best navigation practices for data retrieval. Specifically, the activity focused on using high- and low-yield data visualization screens determined by expert consensus. The intervention group interns then had 20 minutes to review a new simulated patient chart before the group review. EHR screen navigation was captured using screen recording software and compared with data from existing ICU residents performing the same task on the same medical charts (N=62). Learners were surveyed immediately and 6 months after the activity to assess satisfaction and preferred EHR screen use. Results Participants found the activity useful and enjoyable immediately and after 6 months. Intervention interns used more individual screens than reference residents (18 vs 20; P=.008), but the total number of screens used was the same (35 vs 38; P=.30). Significantly more intervention interns used the 10 most common screens (73% vs 45%; P=.001). Intervention interns used high-yield screens more often and low-yield screens less often than the reference residents, which are persistent on self-report 6 months later. Conclusions A short, high-fidelity, simulation-based learning activity focused on provider-specific data gathering was found to be enjoyable and to modify navigation patterns persistently. This suggests that workflow-specific simulation-based EHR training throughout training is of educational benefit to residents.

Just-in-Time Electronic Health Record Retraining to Support Clinician Redeployment during the COVID-19 Surge

“…4 Additionally, previous studies reported that high-fidelity simulation-based EHR training allows learners to gain critical EHR skills relevant to their clinical setting while simultaneously being a high-quality educational activity that could mitigate provider burnout. [5][6][7] We applied this paradigm during the operational crisis to rapidly facilitate our redeployment of the advanced practice providers.…”

“…and based on prior curricula used for employee onboarding, for in-person training sessions. 5,7,9,10 The curriculum emphasized efficient information retrieval, order entry, note creation, and other strategies to ensure patient safety. The content was prioritized based on the purposed workflow for the CRNAs in the surge ICU as determined by their clinical leader (KB) and knowledge of prior institutional patient safety vulnerabilities from EHR use through an author's institutional patient safety role (JAG).…”

“…This group helped define learning objectives and iteratively refine the curriculum, using Moore's expanded outcomes framework and based on prior curricula used for employee onboarding, for in-person training sessions. 5,7,9,10 The curriculum emphasized efficient information retrieval, order entry, note creation, and other strategies to ensure patient safety. The content was prioritized based on the purposed workflow for the CRNAs in the surge ICU as determined by their clinical leader (K.B.)…”

Using a New Model of Electronic Health Record Training to Reduce Physician Burnout: A Plan for Action

“…This model allows for instant debriefing as well as formative and summative feedback and coaching, and promotes retention of concepts learned during the session [ 22 ]. Coupling clinically relevant content to workflows familiar to the learner during EHR training is critical to successfully implementing this stage [ 27 ].…”

Pilot Testing of Simulation in the Evaluation of a Novel, Rapidly Deployable Electronic Health Record for use in Disaster Intensive Care

“…We have previously described the ability to integrate EHRs into high fidelity simulation to understand its usability, also to understand the workflows of multiple professional groups, as well as test the effectiveness of education and onboarding. [9][10][11] Therefore, the purpose of this study was to assess the clinical usability of a comprehensive, rapidly deployable electronic health record in a field intensive care unit, and provide capacity for remote export consultation through the use of simulation.…”