1. Join the conversation! Our Twitter hashtag is MSE12 Medical Student Documentation in the EMR: Controversial AAMC Recommendations and Practical Educational Issues Aaron Michelfelder, M.D. Loyola University Chicago Stritch School of Medicine David Power, M.D., M.P.H. University of Minnesota Medical School Scott Fields, M.D., M.H.A. Oregon Health and Science University

2. STFM Conference on Medical Student Education 2012 Objectives By the end of this presentation, participants will be able to… –Cite the latest recommendations from the AAMC Compliance Officer’s Forum in regards to medical student documentation in the EHR –Understand several models of how to approach institutional policies on medical student EMR documentation while maintaining educational benefit to the students –Take home ideas of how to modify her or his own institutional policies concerning medical student documentation in the EMR

3. STFM Conference on Medical Student Education 2012 AAMC Compliance Officer’s Forum Recommendations University of Minnesota Medical School Policy Oregon Health Sciences University Policy Discussion and Formulation of Response to AAMC Presentation Road Map

4. STFM Conference on Medical Student Education 2012 Who are the COF? What impact do they have? Is this a hard to locate PDF or will this impact policy significantly? Who cares?! Do we have a compliance officer at our school? Should we be talking with him / her?

5. STFM Conference on Medical Student Education 2012 Compliance Advisory: Electronic Health Records in Academic Health Centers Topic 1: Medical Student Documentation June 11, 2011 https://www.aamc.org/download/253812/data/appropriatedocumentationinanehr.pdf AAMC Compliance Officer’s Forum

6. STFM Conference on Medical Student Education 2012 Recommendations: The only parts of a medical student’s note that should become a permanent part of the medical record are ROS and PFSH AAMC COF Advisory

7. STFM Conference on Medical Student Education 2012 If scribing is allowed, the compliance officer should contact the Medicare contractor to determine whether it has a definition of a “scribe.” Scribing by a medical student is a distinct activity from allowing a medical student to write a note as part of his/her educational experience. If possible, the EHR should allow clear identification regarding whether a note is scribed or whether it has been written by a medical student as part of his/her educational experience. If this is not possible, then medical students themselves should be required to clearly indicate when they are acting as scribes rather as students. AAMC COF Advisory

8. STFM Conference on Medical Student Education 2012 After review of medical student documentation (other than review of systems and past, family, social history) by the resident and/or teaching physician is complete, permanently block ability to copy the note. Positive identification of services that have been repeated by the teaching physician and re- documented (No drop down box attestation of medical student note) AAMC COF Advisory

9. STFM Conference on Medical Student Education 2012 If possible, design a distinct security class for medical student. (block copy and paste except for ROS, PFSH) AAMC COF Advisory

10. STFM Conference on Medical Student Education 2012 Summary: –Only Med Student documentation of ROS and PFSH should become a part of the actual patient chart –Scribing needs to be clearly designated as such in the chart –No Copy and Paste (Except for ROS, PFSH) –System should automatically recognize med student documentation to apply limits AAMC COF Advisory

11. STFM Conference on Medical Student Education 2012 What concerns truly underlie this advisory? –That educators are trying to commit fraud? Are there real examples of abuse of medical students in clinical practice? Does faculty observing the medical student interaction with the patient make a difference?

12. STFM Conference on Medical Student Education 2012 Students are integrated and engaged in health care team, and are expected to fully engage in EPIC in both the inpatient and outpatient settings. Students, in both the ambulatory and inpatient settings, may: –Write progress notes; pend orders, enter information into all components of the patient database, including past medical, family, social history (PFSH) and the review of systems (ROS); access and view all data; use a student in-basket for purposes of receiving feedback about their documentation; initiate the discharge summary. The expectations for residents/attending involved in teaching students: –Supervising physician is expected to review the student notes and orders; provide the student with feedback –Supervising physician must approve and sign orders that are pended by a medical student –Supervising physician will write their own primary note, but may refer to a student’s note –Students are not to be used as scribes Students do not have the ability to do the following in EPIC: –May not cut, paste, or duplicate another person’s note in the medical record –Are discouraged from using pre-established completed note templates –May not sign orders http://www.ohsu.edu/xd/education/schools/school-of-medicine/academic-programs/md-program/upload/School-of-Medicine- Handbook.pdf http://www.ohsu.edu/xd/education/schools/school-of-medicine/academic-programs/md-program/upload/School-of-Medicine- Handbook.pdf (page 45, pdf p51/114) Oregon Health and Science Univ

13. STFM Conference on Medical Student Education 2012 Should medical student notes be a permanent part of the chart? Should scribing by a medical student be allowed? Should copy/paste be allowed? By students, residents, attendings? Discussion

14. STFM Conference on Medical Student Education 2012 Key Points from Discussion Will likely do survey of med school policies Will formulate response to AAMC COF Wrap-Up

15. STFM Conference on Medical Student Education 2012 Aaron Michelfelder, M.D. Loyola University Chicago Stritch School of Medicine David Power, M.D., M.P.H. University of Minnesota Medical School Scott Fields, M.D., M.H.A Oregon Health and Science University Thanks!