Simulated Electronic Health Record (Sim-EHR) Curriculum: Teaching EHR Skills and Use of the EHR for Disease Management and Prevention

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Electronic Health Records (EHRs) are digital charts that contain patient health information and other pertinent information, such as laboratory values, radiology imaging, medications, patient past medical and social history, and so forth, that can help a healthcare provider (physician) create an evidence-based care plan to prevent and manage diseases. [1]

Simulation in the EHR has been used for user training in patient safety and provider efficiency, user characterization, and testing the acceptance of clinical decision support. This article describes the development, implementation, findings, and lessons learned with the incorporation of Simulated Electronic Health Record (Sim-EHR) Curriculum at Oregon Health and Science University (OHSU). [2]

The OHSU Sim-EHR Curriculum


The OHSU Sim-EHR curriculum was developed in 2010 and incorporated in the 2011-2012 academic year of the third-year medical students’ family medicine clerkship. These students had received some EHR training during their first year at OHSU.


The main focus OHSU Sim-EHR curriculum was to establish a uniform EHR education system with specific objectives (refer to appendix for objectives).

Simulated Chart and Virtual Patient

A Sim-EHR chart, which mimicked the OHSU EHR System (EPIC Production), was created along with a virtual patient designated chronic diseases with expansive evidence-based guidelines; detailed medical and social history; and family history.


IT Specialists created copies of the Sim-EHR charts and virtual patient at the beginning of the academic year, and medical students are assigned charts and patients during the first week, along with a 30 minute overview orientation with faculty. Students then meet on a weekly basis, with sessions ranging from one to two hours, to evaluate their progress and discuss any problems encountered.

Student Assessment

The students were assessed by faculty based on a standardized rubric that accounted for 5 percent of the family medicine clerkship grade. Refer to the appendix for the assessment criteria.


The Sim-EHR curriculum was funded by the National Institutes of Health (NIH).

Chart Completion to date

406 medical students, as of January 2014, have completed the Sim-EHR curriculum, as well as 21 interns who received the Sim-EHR curriculum over four hours of internal medicine clinic orientation at OHSU in July 2012 and 2013.


In December 2011, faculty-facilitators, who had been meeting on a regular basis during the year, discussed the overall experiences and reported positive feedback with students described as “actively engaged” and some negative feedback, such as students experiencing frustration over specific EHR functions. Revisions were made based on the feedback.

A survey, hosted at SurveyMonkey, was sent via email in August 2012 to 129 medical students and 12 internal medical interns who completed the Sim-EHR curriculum. Of the 129 medical student, 67 (52 percent) responded, as well as, all 12 interns. 51 percent of the medical students and 92 percent of the interns rated the curriculum as “effective” and “very effective,” while 49 percent of the medical students rated it as “neutral” and “ineffective.”

Lesson Learned

Analysis conducted in September 2012, showed that students and interns were performing poorly in the areas of knowledge of disease prevention, which could have been as a result of the ineffective use of the clinical decision support tools and evidence-based guidelines identification. Brief sessions were held with the students and interns to help familiarize them with those tools. The Sim-EHR curriculum plans to increased emphasis in the future.

Changes in the duration of activity helped improve student participation and performance. Students were previously given four weeks to complete their Sim-EHR chart work, but after a focus study conducted in June 2011 discussing the problems with this model, the duration and activity timing were changed to a weekly model, proving more effective. Prior to the Sim-EHR counting as 5 percent of the clerkship grade, it was graded as pass or fail. This change, instituted six months into the curriculum’s implementation, marked a significant improvement in the overall participation and performance of the students and interns.


The OHSU Sim-EHR curriculum is an effective tool in EHR training tool and can be used for disease management and prevention. For instance, medical students can use the simulated charts as an educational tool to teach about disease processes, management, and treatment for specific chronic diseases such as diabetes mellitus. This curriculum can also be introduced at any year of medical school depending on the objective of the training. First year students can identify medical errors, second year can develop differential diagnoses based on test results, and third year students can customize evidence-based treatment plans for the patients.


Sim-EHR Curriculum Objectives and Assessment Measures [3]

My Comments

I found this article interesting because the EHR training was incorporated into the student curriculum using simulation, with encourages active participation. I however, would have liked further studies to be conducted on a larger group of medical students in all the academic years, not just third year. I would have also liked the study to involve a higher number of interns, to evaluate the curriculum’s effectiveness in the clinical (real world) setting.

Related Articles


  2. Milano, C. E., Hardman, J. A., Plesiu, A., Rdesinski, R. E., & Biagioli, F. E. (2014). Simulated Electronic Health Record (Sim-EHR) Curriculum: Teaching EHR Skills and Use of the EHR for Disease Management and Prevention. Academic Medicine: Journal of the Association of American Medical Colleges.
  3. Milano, C. E., Hardman, J. A., Plesiu, A., Rdesinski, R. E., & Biagioli, F. E. (2014). Simulated Electronic Health Record (Sim-EHR) Curriculum Objectives and Assessment Measures, Oregon Health & Science University. Academic Medicine: Journal of the Association of American Medical Colleges.