1. The Electronic Health Record Lab: A Comprehensive Educational Intervention for Outpatient Electronic Records Bruce Britton M.D. Cy Cedar MS4 Christine Matson M.D. Mary Rubino M.D.

2. Disclosures The Electronic Health Record Lab was part of a Health Resources Services Administration (HRSA) Predoctoral Education Grant (D56HP20782) to create a simulated Patient Centered Medical Home for Family Medicine Clerks that ended December 2015

3. Learning Objectives List educational interventions that build knowledge and skill in ambulatory EHR note development. State ways that simulated patient encounters enhance patient care note development while promoting effective communications. State methods of evaluating student notes for formative and summative feedback of students.

4. Goals of EHR Healthcare notes Efficient transmission of important relevant healthcare information on patient for healthcare Effective Data Collection for quality improvement and population management Documentation for E&M CPT coding Do this while providing patient centered care

5. Challenges of Teaching Ambulatory EHR Notes to Medical Students SOAP versus EHR note education Creation of accurate notes in setting of busy ambulatory practice setting Maintaining patient centered communication while creating a note Evaluation of Patient Care, Patient Care Communications, and Patient Care notes

6. Patient Care Note Curriculum M1 and M2 Students Learn SOAP note format during Physical Examination training with Simulated Patients M1 and M2 Students observe Patient Care note created with Primary care mentorship Prior to start of M3 Clinical Rotations student receive Hospital based EHR training

7. Electronic Health Record Lab Curriculum Family Medicine Clerkship Patient Centered Medical Home Simulation Orientation to simulated PCMH site with simulated EHR system utilizing Simulations Center recording software Curriculum emphasis on communications skills as well as medical knowledge

8. Orientation Video Bring copy of orientation video Discuss methodology of student interaction during the video, note writing, and group feedback

9. Methods Schematic Medical management articles Pre-case SP and faculty feedback Communication skills and medical management feedback During case Ideal management note Ideal management video Post case video review and discussion Post-case

10. SP Assessment Scales MeasurementAssessment Master Interview Rating Scale (MIRS)Patient-centered communication Motivational Interviewing Treatment Integrity (MITI) Promotion of behavior change American Board of Internal Medicine (ABIM) Patient satisfaction Patient Compliance (PC)Medical management

11. Faculty Assessment Scales 9 point Likert scale, scoring students from 6 to 10 in half point increments Assessment of: –Patient-centered communication –Biopsychosocial management –Efficiency of history and examination –Efficiency, Accuracy and Effectiveness of EHR note

12. Student Simulations Assessment First simulations no points and can complete note up to midnight Second simulations 2% of total course evaluation-note completion by 5pm Third simulations 8% of total course evaluation-note completion by end of session Final simulations 15% of total course evaluation-note completion 15 minutes after feedback

13. Student Simulation Exercise Case Description and Main points sheet Observe video case (clips) 10 minutes Hand outs of evaluations and group discuss how they would evaluate based on the documents Student Note from case reviewed 10 minutes

14. Student Evaluations of Simulations and EHR training Research Question 1: “Is there a difference between the comfort level with integrating/using computers and EHR’s during patient encounter on the first day of FM clerkship vs end of clerkship?”

15. Student Evaluations of Simulations and EHR training Research Question 2: “Is there a difference between the ability to integrate/use computers into patient encounter on the first day of FM clerkship vs end of clerkship?

16. Student Evaluations of Simulations and EHR training Research Question 3: “Is there a difference between the ability to integrate the computer and EHR’s into patient encounter before the start of clerkship vs the end of clerkship”?

17. Class of 2012 USMLE CS

18. Class of 2013 USMLE CS

19. Class of 2014 USMLE CS

20. Class of 2015 USMLE CS

21. Questions and Discussion

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