April Stouder, MHS, PA-C Julie Daniel-Yount, MHS, PA-C

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1 April Stouder, MHS, PA-C Julie Daniel-Yount, MHS, PA-C

2 Disclosures None

3 Learning Objectives Describe the educational benefits and challenges created by increased utilization of electronic health records at clinical training sites. Identify creative and efficient ways for educators to verify student competency of medical documentation skills in an increasingly digital age. Outline strategies and resources for including electronic health record training and meaningful use within the framework of clinical year education.

Identify creative and efficient ways for educators to verify student competency of medical documentation skills

4 Growth in EHR Use Non-federal hospital adoption has increased > 5 fold since % (2008) à 59.4% (2013) 34% increase between 2012 to 2013! Office-based physicians 72% adopted a partial or total EHR by 2012 Only 40% in 2008 SOURCE: ONC analysis of the National Center for Health Statistics National Electronic Health Records Surveys. SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement

Office-based physicians 72% adopted a partial or total EHR by 2012 Only 40% in 2008 SOURCE: ONC analysis of the

6 Impact on Clinical Education Loss of clinical placements Temporary vs. permanent Decreased student access to health records Less robust participation in patient care Prevents meaningful use à not proficient by graduation Fewer opportunities to practice medical documentation Formative assessment by preceptors Written & oral Creative approaches or extra assignments

care Prevents meaningful use à not proficient by graduation Fewer opportunities to practice

7 Competencies for the PA Profession Patient care use IT to support patient care decisions and patient education Systems-based practice - apply medical information and clinical data systems to provide effective, efficient patient care Practice-based learning & improvement use IT to manage information, access medical information & support own education Interpersonal & communication skills - accurately and adequately document information regarding care for medical, legal, quality, and financial purposes

learning & improvement use IT to manage information, access medical information & support own education Interpersonal &

8 ARC-PA Accreditation Standards, 4 th Edition B Standards Curriculum & Instruction The curriculum establishes a strong foundation in health information technology and evidence-based medicine and emphasizes the importance of remaining current with the changing nature of clinical practice.

information technology and evidence-based medicine and emphasizes the

9 Barriers Need to train learners on multiple systems Lack of faculty training No opportunities for practice Proficiency takes time! Poor documentation role-modeling by preceptors? Cut & paste à promotes errors Inherent limitations of some EHR systems Loss of critical thinking Clicking boxes, following templates Impair ability to synthesize information

Poor documentation role-modeling by preceptors?

10 Educational Literature Academic Med, Milano et al (2014) Much of the training occurs in clinical year Rudimentary introduction, not meaningful OHSU Simulated EHR curriculum, 2011 Uniform EHR experience with defined objectives & clear assessment measures Skills common to all EHR systems Chart maintenance, chronic dz mgmt/prev, order Rx/tests Virtual patient and simulated chart for practice Implemented during 3 rd yr FM clerkship, given 3 weeks to complete assignments Feedback: Time consuming, increased comfort with order entry and chart navigation, better to have earlier in training Study: no difference in scores in early vs later in training yr

mgmt/prev, order Rx/tests Virtual patient and simulated chart for practice Implemented during 3 rd yr FM clerkship, given 3 weeks to complete assignments

11 Educational Literature JPAE, Barnett et. al (2013) Proposal: AEMR implemented into the PA curriculum using case-based scenarios w/ virtual and standardized pts. Exposure early (throughout 1 st year) to develop core clinical competency and informatics skills needed to provide patient care Need to overcome fear of potential negative effect on decision-making skills Faculty need training in EHR systems

12 Educational Literature Academic Medicine, Wald et. al (2014) Focus on teaching EHR use within the context of providing competent patient- and relationshipcentered care Curriculum objectives proposed: Introduce students to presence of a computer w/in a clinical encounter Train students in EHR-related skills Empower patient- and relationship-centered interviewing skills while incorporating EHR skills Foster students appreciation for added value of integrated computer use w/in the clinical encounter

Curriculum objectives proposed: Introduce students to presence of a computer w/in a clinical encounter Train students in

13 Transition to Small Groups Consolidate tables if necessary Appoint a secretary & spokesperson 30 minutes Brainstorm the following: How to verify medical documentation competency? Creative ways educators can help train learners to use EHRs effectively? (didactic and clinical year) How can CC s use this training to their advantage when seeking clinical placements?

competency? Creative ways educators can help train learners to use EHRs effectively?

14 Summary

15 EHR simulation tools Neehrperfect.com EPIC playground Resources Cerner s academic electronic medical record system (AEMR) VA VistA free, downloadable, PC s only Used by Veteran s Affairs system Practice Fusion free for students & faculty Lippincott Docucare

medical record system (AEMR) VA VistA free, downloadable, PC s

16 References Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions. Tierney MJ, et al. Acad Med Jun; 88(6): Incorporating electronic medical records into the physician assistant educational curriculum. Barnett JS. J Physician Assist Educ. 2013;24(2): Charles D, et al. Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: , ONC Data Brief, no 16. Washington, DC: Office of the National Coordinator for Health Information Technology. May Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting. Wald HS, et al. Acad Med Mar;89(3): Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the HER for disease management and prevention. Milano CE, et al. Acad Med Mar;89(3):

Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013, ONC Data Brief, no 16.

17 April Stouder, Director of Clinical Education Duke University Thank You! Julie Daniel-Yount, Clinical Education Coordinator East Carolina University

Physician Assistant Studies MPAS. Cycles included in report: Cycle #2 9/1/13 to 8/31/14

Physician Assistant Studies MPAS Cycles included in report: Cycle #2 9/1/13 to 8/31/14 Xitracs Program Report Page 2 of 8 Program Name: Physician Assistant Studies Program Cycle: #2 9/1/13 to 8/31/14 1