TEACHING and the Electronic Medical Record: THREATS AND OPPORTUNITIES Nicole Appelle, MD Peter...
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Transcript of TEACHING and the Electronic Medical Record: THREATS AND OPPORTUNITIES Nicole Appelle, MD Peter...
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
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
• 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
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.
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.