EHR Simulation Training Garners Positive Resident Feedback

Workflow-specific EHR simulation training is a more enjoyable and beneficial EHR training tactic for residents than traditional approaches, according to a study published in JMIR Publications.

Quality EHR training is essential to clinicians and users, and especially those new to the technology. An effective EHR training program can reduce the likelihood of clinician burnout and boost EHR satisfaction.

According to the study authors, a resident can boost her EHR skills by emulating peer EHR use, which typically focuses on documentation, but it does not focus on clinical reasoning or quantifying the patient’s clinical status.

“The utilization of EHR simulations that feature patient records has gained traction as a solution for these problems in EHR education because, as stated by a national consensus conference, simulation is capable of matching EHR training with provider-specific workflow,” the study authors explained. “Critical to this is to ensure that the EHR chart has the appropriate degree of realism (which is termed Fidelity) to allow for reproduction on workflow.”

The research team implemented EHR training and simulation-based training sessions at Oregon Health and Science University for 71 first-year internal medicine residents in 2018 and 2019.

Using a copy version of Epic Systems EHR, the research group developed high-fidelity simulated ICU patient charts with patient data that included vital signs, fluid intake and output, laboratory values, test results, imaging reports, medication lists, and previous encounters. The users were also given an EHR self-assessment test prior to training to gauge previous EHR experience and exposure.

In post-training surveys, respondents described the activity as enjoyable, useful, meaningful, appropriately paced, and appropriately challenging.

“Fantastic to help us optimize the EHR...Please have more of these sessions throughout residency,” said an anonymous resident respondent.

The research team surveyed the respondents after six months and received a similar response.

“[It was] very valuable,” said a second anonymous respondent. “Wish I’d had a session like this in medical school.”

Although the number of EHR screens were the same, intervention interns utilized more individual screens than residents in the control group. Furthermore, 73 percent of intervention interns used the 10 most common screens compared to 45 percent of control residents.

Intervention interns also used more high-yield screens and low-yield screens than control residents.

“In this study, we report the development of a novel, dedicated 2-hour EHR training focused on physician workflow while preparing to evaluate a patient at the beginning of the day (prerounding) using high-fidelity simulation-based learning, with special attention to high-yield and low-yield screens available in the EHR interface,” wrote the study authors.

“We observed high and sustained learner satisfaction with the activity, which was associated with significant and sustained changes in navigation patterns with respect to the established workflow previously seen in reference residents. Most importantly, these perceptions were sustained 6 months after the activity,” the authors continued.

The most significant difference from previous EHR training studies focused on the historically low engagement and enjoyment rates from past EHR training courses. The simulation model resulted in high user satisfaction and high usefulness.

“In addition, most EHR education traditionally focuses on the basic functionality of the clinical information system, whereas our lesson focused on practical, systematic approaches to data gathering consistent with learners’ realistic workflow,” the study authors explained.

“Qualitative comments elicited from participants indicated that the experience was enjoyable and pertinent because of factors such as challenging and realistic cases, layout of the lesson (guided review of a case, solitary review of a case, and then group debrief), learner engagement during the guided review, focus on systematic data extraction, and timing of the lesson a few months after real-world exposure,” the study authors added.

The study was limited in that there was no pre-activity assessment to evaluate navigation patterns before and after the study, which could have supported a clear pattern change. Also, the study was based on information retrieval and it overlooked important EHR usability areas such as data entry, EHR alerts, and documentation.

Nevertheless, the notable findings offer a solid base for retooling EHR training.

“These findings are important given the historical inadequacy of EHR training,” concluded the study authors. “The ability to deliver this content in a short time frame allows for the rapid expansion of this methodology not only during onboarding but also throughout the continuum of their training. Future directions may focus on using this technique to optimize other resident interactions with the EHR.”