A Teaching EHR for Delivery of Small Group Cases

Currently there is no organized, systematic approach to teaching health professions students how to use electronic health records (EHRs). In developing curriculum for the new Dell Medical School (DMS) at University of Texas‐Austin, we decided to create a simulated electronic health record (“teaching EHR”) for the 1‐year pre‐clinical curriculum to facilitate transition to the clinical world. The teaching EHR is used in two required courses: hybrid case‐based learning (CBL)/problem‐based learning (PBL) small‐group sessions and a clinical skills course. The teaching EHR was developed in partnership with the UT Health Informatics and Health IT program. An independent contractor modified the open‐source platform OpenEHR. Specifications were created by a collaboration of basic science and clinical faculty plus the DMS Director of Informational Technology & Design. The EHR contains patient demographics plus dated encounters. The typical encounter page has optional fields that include visit location, chief complaint, history of present illness, patient history, review of systems (ROS), vitals, physical exam, assessment and plan. There are sections for medications, allergies, and immunizations. Lab tests and panels can be selected from a menu and include normal values. Tests and procedures are uploaded in multiple document and image formats as well as audio and video files. A DICOM reader allows inclusion of diagnostic imaging such as x‐rays and computerized tomography scans in *.dcm and *.jpg formats. CBL/PBL cases traditionally are written in narrative format with images and lab results embedded in the text. In our EHR cases, students must navigate the sidebars and dropdown menus of the patient's record to find or enter the relevant information, just as they will in the clinical world. The teaching EHR is used for case presentation in our CBL/PBL sessions, a required component of each integrated basic science course. Each week small groups of 7 students, with guidance from a facilitator, are presented with 1 or 2 cases. For each case they have one hour to read the case and develop learning objectives that range from basic science to pathology, pharmacology, and psychosocial or population health issues. Students independently research each objective for the case, then present and discuss in a 2‐hour follow‐up session. The initial cases are presented in the traditional paper‐based format to allow students to learn the process and dynamics of small group CBL/PBL. In week 7 the students are assigned an online introduction to the EHR before they come to the group session and log into the EHR for their case. The EHR cases follow the narrative format of the paper cases initially, with dialogue between patient and provider or attending physician and students, but as the year progresses and students learn more clinical skills, the cases transition to a more realistic format with less dialogue and expanded history, ROS, and physical exam entries. In parallel with this transition, the students are learning to enter their own data from simulated and real patients into the teaching EHR. Feedback from students and facilitators after one year indicates that the students found using the teaching EHR was a valuable introduction but it did not accurately replicate the complexity of a true hospital‐based EHR. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .