JMIR Publications

ABSTRACT

Background:

Accurate data retrieval is an essential part of patient care in ICU. The electronic health record (EHR) is the primary method of data storage and data review. We previously reported that residents participating in EHR based simulations have varied and nonstandard approaches to data finding in the ICU, with subsequent errors in recognition of patient safety issues. We hypothesized that a novel EHR simulation based training exercise would decrease variability in EHR use among intervention interns irrespective of prior EHR experience.

Objective:

To understand the impact of a novel, short, high-fidelity, simulation-based electronic health record learning activity on intern data gathering workflow and satisfaction.

Methods:

Seventy-two internal medicine interns across the 2018-19 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 an hour of guided review of a high-fidelity, simulated ICU patient chart focusing on best practices for navigation for data retrieval. Specifically, the activity focused on utilizing high and low yield data visualization screens determined by expert-consensus. Intervention group interns then had 20 minutes to review a new simulated patient chart before group review. EHR screen navigation was captured utilizing 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 as well as preferred EHR screen use.

Results:

Participants found the activity useful and enjoyable immediately and after six months. Intervention interns used more individual screens than reference residents (18 vs 20, p=0.008) but the total number of screens used were the same (35 vs 38, p=NS). Significantly more of the intervention interns used the ten most common screens (73% vs 45%, p=0.001). Intervention interns used high-yield screens more often and low-yield screens less often than the reference residents, which 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 persistently modify navigation patterns. This suggests that workflow specific simulation-based EHR training throughout training is of educational benefit to residents. Clinical Trial: n/a