EMR Benefits: Medical education

Medical Education

While clinical and operational benefits of EMRs are obvious, their effect on medical education and trainees are not well documented. The few studies that have analyzed such effects have shown that there are advantages inherent in EMRs that can be leveraged and disadvantages in the current EMRs to education that need to be addressed in the future [22]. Implementation of EMRs in academic environments can benefit education of trainees by:

1. Increased accessibility to relevant and up-to-date literature for diagnosis and management plans via clinical decision support (CDS) systems within the EMR
2. Training the students to follow accepted clinical guidelines (best practices) using CDS
3. Monitoring clinical experience of trainees more efficiently in real time to optimize workflow for trainees and training programs. Use of EMRs to track patient care milestones achieved by trainees will identify that can be then addressed more efficiently in a prospective manner.
4. EMRs have been used to help physicians improve the quality of their clinical skills. An example of this has been in Radiology. Radiologists do not routinely receive information on clinical outcomes of patients for whom they provide radio-diagnoses. Alkasab et.al created an automated outcome tracking system for radiologists which allows them to review clinical outcomes of the patients whose images they reported on. Such a system can allow radiologists to improve self-assessment, accuracy and relevance of their reporting, and study interventions in their processes to improve outcomes [47].

The disadvantages of EMRs to education were noted by the following issues:

1. Problems with student access into the facilities systems such as obtaining log-ins and passwords
2. Concern that students will not learn skills of independently recognizing items that need to be documented, but rather the students would only choose from drop down boxes and pick lists.
3. Instructor's concern that EMRs allow portions or entire sections of notes to be copied and pasted, which in turn leads to ethical concerns with plagiarism and documenting procedures that were never performed.
4. Trainees overly attentive to patient’s EMR data versus gaining information from physical examination and patient interactions
5. Focus on engagement with computer terminal disrupts patient-physician relationship in exam room
6. Automation bias - too much trust in decision support systems without consideration of their limitations

As EMR use becomes standard fare in medical practice, the benefits of using EMR need to be harnessed by adapting the training curriculum of medical students and graduate medical education trainees to incorporate EMR-related sub-competencies

Improving Interpersonal and Communication Skills

Patients receive care from multiple providers/healthcare givers in the course of their illness. Effective communication is a must to provide optimal care. Interpersonal and Communication skills is one of the six competencies domain of the Accreditation Council for Graduate Medical Education (ACGME) in which medical trainees are assessed. In addition for medico-legal purposes and to allow continuity of care both effective written and oral communication are needed. This communication is not only with the other healthcare providers but also involves patients and their families in allowing them to take part in their own care. EMRs can improve written communication skills if designed appropriately and can allow a mechanism of free expression. EMRs may also reduce face to face time between the trainees and the patients as now medical students and residents can easily get most of the information from review of the patient medical records without leaving their call rooms/work stations. This may result in spending less time with the patients, and poor development of bedside skills. In an article by Tierney et. al the authors also highlight that the use of templates may impair critical thinking by limiting the trainees to set form of documentation via a predetermined template. They suggest that perhaps this can be mitigated by not allowing medical students to use a written template. Review of the historical data is eased through the use of EMR allowing the trainees to learn from the medical records.

Medical Knowledge and Practice Based Learning and Improvement

Medical Knowledge and Practice Based Learning and Improvement is one of the six competencies domains of the Accreditation Council for Graduate Medical Education (ACGME) in which medical trainees are assessed. Medical trainees, that include residents and medical students, are expected to learn from their daily patient care activities by reviewing the appropriate literature. Well-designed EMRs can provide links to a repository of appropriate preselected medical articles based upon patients’ medical diagnoses. This may not be practical as the new information is discovered and it is almost impossible to keep such a data repository current without a mechanism of active review and active involvement of the medical staff. However, EMRs can provide easy links to the online resources and allow the trainees to search these resources in a timely manner. In an article by Tierney et. the authors also point that the Clinical Decision Support Systems can either have beneficial effects or impair the training. Too many inconsequential alerts can cause alert fatigue and promote a culture of alert override resulting in medical error. However, thoughtful alerts will allow the residents to pause and think about their clinical care resulting in indirect education of the trainees.

Enhancing professionalism

Detailed data provided by EMR can help doctors or other medical workers to convince patients more easily. EMR documentation can enhance professionalism among medical personnel by increasing accountability on the part of the healthcare provider to offer quality healthcare to patients.

Access to knowledge resource

Today, clinicians can get access to medical literature on the internet while making clinical decisions or reviewing patient charts. EHRs can provide links in a patient record to internet resources like PubMed, NLM, and OVID to show clinicians the most up-to-dated information and knowledge in medicine.