JMIR Publications

ABSTRACT

Background:

Effective Electronic Health Record (EHR) use is crucial for effective, efficient, and frustration-free pre-rounding. However, formal training on EHR systems rarely provides residents with all the EHR-related skills they need. Instead, residents often rely on informal methods such as adopting the practices of more experienced residents to acquire the required skills.

Objective:

The goal of this study is to observe how pediatric residents currently use the EHR and identify how the pre-rounding process and training could be improved.

Methods:

We recruited thirty pediatric residents were tasked to preround two patients. Video and audio recordings of the residents pre-rounding were analyzed to evaluate participants’ performance in terms of data omission, task completion time, and effective use of data sources. Survey results and participants’ comments were also collected.

Results:

Eighty percent of the participants omitted some data while pre-rounding, with the most omitted data being those related to prior and upcoming orders and medications. Participants accessed on average 20.5 pages to pre-round both patients and spent an average of 6.5 minutes on each case. Most importantly, other than reduced data omission rate, we found no significant difference in pre-rounding performance and efficiency between participants with higher experience and those with lower experience.

Conclusions:

We list performance issues in EHR use and suggest multiple recommendations to improve EHR based pre-rounding which include creating pre-rounding checklists and providing ongoing iterative training programs for residents. We hope that our work would shed the light on EHR training issues and inspire more efforts in this domain.