1. SIM-EHR (Simulated EHR): A Virtual Case-based Educational Tool S9. Medical Student Education Conference Society of Teachers of Family Medicine February 4, 2012 Frances Biagioli, MD; Christina Milano, MD; Kathryn Chappelle, MA biagioli@ohsu.edu

2. Definition of SIM-EHR Simulated Electronic Health Record SIM-EHR is: Virtual patient records built in a training EHR A tool for teaching disease prevention and chronic disease management A tool for assessing clinical reasoning and EHR skills

3. Objectives. By the end of the Seminar you will be able to : Describe a SIM-EHR. List objectives and methods used with SIM-EHR. Discuss how SIM-EHR can be used to augment existing education and distance-learning options. Discuss ways SIM-EHR can be used to teach and assess clinical concepts. Identify resources needed to implement SIM-EHR and ways to overcome barriers.

4. Background for SIM-EHR With the onset of EHR implementation Despite a policy …

5. Background for SIM-EHR With the onset of EHR implementation Students graduate without hands-on experience : – Writing in the chart – Placing orders – Writing prescriptions – Correcting Charts – (rarer) Reviewing charts that are fully electronic

6. 2009 - Present 2009 Stimulus Grant (NIH K07 RFA-OD-001, Strengthening Behavioral and Social Science in Medical Schools) teach BSS EHR concepts. 2009 Implement EHR Communication OSCE 2010-2011 SIM-EHR module + 2 small groups 2011- Present SIM-EHR module + 1 small group

7. Assignment New patient – scheduled in 1 week Students perform a Chart Review Review chart Correct the Chart Research patient’s best-practice care Pend orders to discuss with the patient Small Group Discussion

8. Competency Based Objectives Medical Knowledge – Interpret data, Identify Problems, and Create a Plan of Care for: Diabetes, HTN, COPD, CAD, Hyperlipidemia…. Practice-based learning and Improvement – Research, Apply, and Cite the evidence Systems-based practice – Discuss EHR use as a systems asset Professionalism – Discuss the importance of Chart Maintenance – Improve the EHR, identify errors and correct them Patient Care – Order diagnostic, treatment and preventive measures

9. Logistics: On Campus & Distance SIM-EHR content fits well with the existing small group case discussion format of the clerkship. – Previously 5 afternoons for case discussion. One of those sessions is replaced with the SIM-EHR – Students oriented 1 week prior (30 minutes) – Completed SIM-EHR charts due 8AM morning of discussion – A rubric is used to grade SIM-EHR chart 5% of final grade – SIM-EHR Small group participation is also graded

10. Logistics: On Campus & Distance Distance learners can get to EHR training environment through Citrix server Distance discussions held with local students as well as remote students the EHR screen can be shared with all participants Students share SIM-EHR charts with others The virtual patient is identical, but the charts are not

11. Distance Set-Up 1 Projector 2 Camera 3 Computer 4 Conference Call Router 5 ADOBE Connect 6 Operator

12. Shared Screen

13. Small Group Discussion Instructor Demonstrates SIM-EHR

14. Demo SIM-EHR Curriculum Dr. Christina Milano

37. What are Mary’s problems? Diabetes, HTN, Hyperlipidemia, LVH/EKG abnormalities, COPD, Obesity, Tobacco Dependence, Hypothyroid, LSIL pap, any of the following liver issues: (elevated enzymes, hepatic steatosis, exposure to Hepatitis B), Headache, Insomnia/Snoring/OSA, GERD, Anemia, Obesity, h/o pre-eclampsia, h/o multiple abdominal surgeries

38. Which are Chronic Diseases? Diabetes, HTN, Hyperlipidemia, LVH/EKG abnormalities, COPD, Obesity, Tobacco Dependence, Hypothyroid, LSIL pap, any of the following liver issues: (elevated enzymes, hepatic steatosis, exposure to Hepatitis B), Headache, Insomnia/Snoring/OSA, GERD, Anemia, Obesity, h/o pre-eclampsia, history of multiple abdominal surgeries

39. What should we prioritize in 1 st visit? Diabetes, HTN, Hyperlipidemia, LVH/EKG abnormalities, COPD, Obesity, Tobacco Dependence, Hypothyroid, LSIL pap, any of the following liver issues: (elevated enzymes, hepatic steatosis, exposure to Hepatitis B), Headache, Insomnia/Snoring/OSA, GERD, Anemia, Obesity, h/o pre-eclampsia, history of multiple abdominal surgeries

40. What we are seeing…

44. What we are hearing…

45. Lessons Learned & Adapting Technical Support is CRITICAL Communicate the assignment repetitively – Emphasize actually placing orders – Emphasize actually correcting the chart – Frustration is part of the assignment Grading and Deadlines (verbally and written) Log-In Instructions – Emphasize testing login EARLY – Technical Support (who to contact)

46. Questions Direct questions about the SIM-EHR educational tool: Frances Biagioli, M.D. (bee-uh-joe-lee) Associate Professor Oregon Health & Science University biagioli@ohsu.edu