How an EHR Teaching Tool Can Transform Medical Education



Imagine taking a driving test before you’ve spent any time driving a car. You would be afraid. You would be frustrated. You would be confused. And you certainly couldn’t expect to pass the test.

This is kind of how medical students feel when they enter their clinical years and have to interact with the EHR. And then, when they enter residency, they have to use the EHR, a tool of dizzying complexity on which they have often received insufficient training, while trying to care for patients and develop their clinical knowledge.

A recently published study in the review JAMIE Open examines how medical schools and other health-related schools are using an educational EHR to support a successful transition from medical school to residency. It also points to systemic reasons why more and more schools are not using it.

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The platform, the Regenstrief Teaching Electronic Medical Record (tEMR), also known as the Regenstrief EHR Clinical Learning Platform, was developed by Indiana University School of Medicine (IUSM), Regenstrief Institute and Eskenazi Health in central Indiana with support from WADA as part of the WADA’s Accelerating Change in Medical Education Initiative.

This is not a simulated EHR. TEMR is a functional web-based educational EHR with a pseudonymized patient database with 12,000 real patient records and a cohort generation tool.

Its data can be modified to meet the needs of the program, and educators can use it to create and deliver automated, context-specific, and educational messages, as well as contextual links to resources. It also allows multiple users to work on a single recording simultaneously and includes automated learner assessment functionality.

TEMR has been piloted in 12 schools of medicine, public health, and health information technology (HIT) with more than 11,800 unique student users to help them understand common tools and issues. HIT. But the goal is not to train computer scientists, noted the authors, researchers at the Regenstrief Institute, IUSM, the Fairbanks School of Public Health and the Indiana University Center for Global Health.

The ultimate goal is to “create tools through which our students – future educators, administrators, leaders and primary care physicians – can develop enough knowledge of HIT to influence how HIT should be used in healthcare. , rather than HIT dictating how health care is delivered, “says the JAMIE Open to study.

“Physicians, nurses, social workers and other clinical trainees who have been rapidly exposed to EMRs will think differently about patient care and future development of EMRs due to this early exposure. It creates a different state of mind. said Debra K. Litzelman, MD, MA. Dr Litzelman was the lead author of the study and is associate director and researcher at the William M. Tierney Center for Health Services Research at Regenstrief Institute Inc.

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Schools use tEMR with preclinical students to acclimate them to EHRs and bring clinical relevance to their courses, and with clinical students for presentation of cases and to develop diagnostic and therapeutic plans, as well as to practice their skills. in documentation.

The IUSM, for example, uses tEMR in courses on health systems science, such as health care financing and how to avoid inappropriate prescribing. The University of Connecticut School of Medicine, another school that has received support from the AMA Accelerating Change in Medical Education initiative, is using it to teach the social determinants of health by following a family of patients in such a way longitudinal.

Still, with over 190 accredited medical and osteopathic schools in the United States, adoption of the platform is low. One reason is that there is no requirement to provide EHR training, and without a requirement, schools have little incentive to incorporate it into their already busy curricula.

But that does not negate the need for it.

“During the first two years [of medical school], the students concentrate on the success of their boards. Most think, “I don’t care about learning an EHR, it’s not on my tests,” said Chris Frederick, director of strategic partnerships at the Regenstrief Institute. “Then they come into grade three and have their first interface with the EHR, and they say, ‘Oh, my God, why didn’t you teach me that stuff? I don’t know what I’m doing.

Frederick argued that preparation for EHRs could be integrated throughout the undergraduate program, citing a metaphor he learned from Paul N. Gorman, MD, professor of medical informatics and clinical epidemiology in the faculty of medicine from Oregon Health & Science University.

“You are already teaching them one block on this system and one block on this system. Instead of thinking of them as blocks, think of them as bricks, with EHR as mortar, ”Frederick said. “You deliver the EHR file. You find the symptoms in the EHR. You teach the same content, but it is conveyed the medium that they will live and breathe throughout their careers.

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