TEACHING and the Electronic Medical Record: THREATS AND OPPORTUNITIES

Nicole Appelle, MD

Peter Chin-Hong, MD

Lindsay Mazotti, MD

Objectives• Recognize the paucity of literature and therefore the

opportunity in the field• Develop EMR education around content and strategies for:

• Communication and professionalism• Learner and patient• Learner and preceptor/attending• Learner and other health professionals

• Documentation and professionalism• Practice-based learning and improvement/practice management• Clinical reasoning

• Identify a framework to guide using the EMR in the evaluation and feedback of a learner

TimelineUntil 9:25 Intros, Goals

9:25-9:45 Literature, Framework

9:45-10:25 Small Group Activity #1

10:25-10:35 BREAK

10:35-11:15 Small Group Activity #2

11:15-11:30 Summarize, Evaluations

Flowchart, nicole

The Educator’s Challenges:• Communication• Documentation• Practice Based Learning/ Practice Management• Clinical Reasoning/ Professionalism• Responsibility/ Liability

Literature, or lack thereof:• Perceptions of EMR• Existing, or lack of existing, policies on documentation• Discussion of threats and opportunities• Evaluation methods of EMR use

Perceptions of the EMR

1. Rouf et al. BMC Med Educ. 2008.

2. O’Malley et al. JGIM. 2010.

3. Stephens et al. Med Sci Educ, 2011.

4. Knight et al. Acad Med. 1994.

Positives Negatives

Students reported the EMR improved1: o History taking (Prompts helped)o Order writing (options given, preventative services ordered)o Documentation

MD’s perceive negative effects on doctor-patient relationship2

Students perceive multiple downfalls3,4: o Frequent use to be proficiento Computer issueso Lack of availability to studentso Barriers to placing orderso Significant dissatisfaction with patient communication

Threat…

or Opportunity?

• How can we teach using the EMR? How can we make the EMR our friend?

• Leave here with one way to evaluate students on their EMR skills

Small Groups

Scenarios 1 and 2• Break into your small groups• One person per group read directions on front of envelope• Prepare to report back ONE pearl to share

BREAK

Small Groups

Scenarios 3,4,5• Break back into your small groups• Discuss AT LEAST 2 of the 3 scenarios on the handout• Prepare to report back ONE pearl to share

Objectives• Recognize the paucity of literature and therefore the

opportunity in the field• Develop EMR education around content and strategies for:

• Communication and professionalism• Learner and patient• Learner and preceptor/attending• Learner and other health professionals

• Documentation and professionalism• Practice-based learning and improvement/practice management• Clinical reasoning

• Identify a framework to guide using the EMR in the evaluation and feedback of a learner

Evaluation:The RIME EMR SchemeLevel Skill Set EMR-specific skills

Reporter Clinical Data Entry

Records complete history & exam

Reliably completes S/O portion of SOAP note

Records own findings rather than cut & paste

Reviews medical history in EMR

Interpreter Data Assessment

Reliably completes “A” portion of SOAP note

Interprets new data (labs, radiology, consults)

Independently constructs patient problem list

Discusses clinical assessment & diagnostic possibilities.

Manager Data

Assimilation

Constructs “P” portion of SOAP note

Requests appropriate services and consults

Articulates competent therapeutic plan

Decides on appropriate follow up and arranges it

Educator Clinical Decision Support

Uses embedded support tools to access current evidence related to patient care

Uses tools for patient-centered education

Modifies care plan in accordance with evidenceStephens et al. Acad Med. 2011.

The Future’s So Bright…

References1. O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records

helpful for care coordination? Experiences of physician practices. J Gen Intern Med. 2010; 25(3): 177–185.

2. Stephens MB, Corcoran TS, Motsinger C. Clinical Documentation in Electronic Medical Records: The Student Perspective. Med Sci Educ. 2011; 21(1): 3-6.

3. Rouf E, Chumley HS, Dobbie AE. Electronic health records in outpatient clinics: Perspectives of third year medical students. BMC Med Educ. 2008; 8(13).

4. Mitnz M, Navarte HJ, O’Brien KE, Papp KK, Thomas M, Durning SJ. Use of electronic medical records by physicians and students in academic internal medicine settings. Acad Med. 2009; 84(12): 1698-1704.

5. Knight AM, Kravet SJ, Harper GM, Leff B. The effect of computerized provider order entry on medical student clerkship experiences. J Am Med Inform Assoc. 2005;12: 554-560.

6. Morrow JB, Dobbie AE, Jenkins C, Long R, Mihalic A, Wagner J. First-year medical students can demonstrate HER-specific communication skills: A control-group study. Fam Med. 2009:41(1):28-33.

7. Peled JU, Sagher O, Morrow JB, Dobbie AE. Do electronic medical records help or hinder medical education? PLoS Medicine. 2009; 6(5): e10000069.

8. Stephens MB, Gimbel RW, Pangaro L. The RIME/EMR Scheme: An educational approach to cilnical documentaion in electronic medical records. Acad Med. 2011; 86(1): 11-14.