- Over the past few years, the Regenstrief Institute and the Indiana University (IU) School of Medicine began to notice a problem. While EHR technology had become ubiquitous in the healthcare industry, medical school curricula had not evolved to reflect this reality.
This realization became the impetus for the Regenstrief Institute’s EHR Clinical Learning Platform.
“It didn’t start out as this,” Regenstrief research scientist and Assistant Professor of Clinical Medicine at IU School of Medicine Blaine Takesue told EHRIntelligence.com.
“It started from a different project here at IU,” he continued. “We’ve had proprietary EHR for decades and we noticed we didn’t do much in the way of direct instruction through the EHR, although our house staff and students sit in front of the EHR for up to hours a day. We were thinking of projects we could do to address that problem.”
Then in 2013, the American Medical Association (AMA) launched the Accelerating Change and Medical Education Initiative to prepare medical students for healthcare’s current health IT landscape. Members of the institute saw AMA’s interest in improving EHR literacy as an opportunity to innovate a technology geared toward incorporating EHR training into medical education.
“There’s a gap between what medical students are taught traditionally and the skills they’ll need as residents and practicing physicians,” said Takesue. “So they put out a request for applications to look at innovative ways medical schools can close that gap. We were one of the lucky grantees to receive one of the initial grants.”
With AMA’s financial support, Regenstrief and IU School of Medicine developed a program to familiarize students with EHR technology in an accessible, customizable way. “We could use an EHR that most practitioners use everyday in their practice as a way to deliver content to medical students,” said Takesue.
Expanding the EHR Clinical Learning Platform nationwide
The objectives for the project evolved over the course of the year, with Regenstrief researchers initially designing the program specifically to suit the needs of IU medical students.
Educators at IU would use the program to deliver personalized content to their students and give them experience using EHR systems for clinical decision-making, entering physician notes into patient EHRs, and test ordering as part of classroom exercises.
Eventually, the user-base for the program expanded—and so did its capabilities.
“It’s changed in content delivery and also expanded into the systems being used at seven other schools outside IU,” Takesue explained. “The scope is wider, not only medical schools but also some colleges of pharmacy, nursing, or health IT.”
“What’s also become apparent is the ability of the system to do learner evaluations. By looking at the actions a learner takes within the system, like continuing the right medications, curriculum teams can assess if students have the right knowledge to care for patients — at least virtually,” Takesue added.
Individual schools control the kind of content students have access to as well as the incentives for students to use the program. Some schools grade students on their ability to use the system while others use it simply for case presentations.
The program assists educators in teaching medical students strategies for using EHR systems for population health management, quality improvement, patient safety improvement, and other areas of patient care.
In an effort to enable schools to use the program independently, its design allows for a simple implementation and onboarding process.
“Onboarding is easy,” said Takesue. “It’s a web app — all you need is internet access and the right credentials and you can log onto the system.”
However, Regenstrief does offer additional assistance to schools interested in implementing more specialized features.
“If they want to use it for looking at patient data, they can do that. But if they want to create alerts and things like that, we have tools for them to do that but we help them out in developing those tools,” he noted.
Presently, Regenstrief is working to develop a toolkit schools can use to create their own content. The institute will offer schools the necessary training to use the toolkit and then let schools further customize their learning platform to fit their specific needs.
“The primary goal is to improve the skill set kids graduate with. We’re not trying to train them on how to use our system. We want to train them on how to use any EHR,” said Takesue.
Raising provider expectations for EHR capabilities
While the EHR Clinical Learning Platform is partly designed to acclimate students to existing EHR technology, it also possesses some capabilities commercial EHRs don’t yet have.
“One of our other goals is to show kids what a system can do,” said Takesue. “It doesn’t work like most commercial systems work — it works from the provider point of view.”
Regenstrief researchers want to expose future practitioners to high-quality, user-friendly technology to raise students’ expectations of EHR technology and push them to advocate for better product offerings from health IT companies in the future.
“We don’t think providers should be satisfied with the current state of EHRs,” said Takesue. “Doctors don’t like their EHRs; nurses don’t like their EHRs. So why are we sitting still, especially when there’s technology that could make our technology easier instead of harder?”
While federal regulation is largely responsible for fueling many advancements from health IT companies, Takesue believes provider demand could eventually become a more significant motivation for change in the future.
“There are lots of little things here and there that are more advanced than what is in commercial EHRs,” said Taeksue. “For example, we use real-time natural language processing to analyze text as a provider is entering text into the system and integrates it right into the workflow.”
Some features unique to the EHR Clinical Learning Platform include 11,000 misidentified patient records, clinical decision support infrastructure, real-time natural language processing, and a forthcoming user evaluation feature.
“We never consider ourselves a final product for better or for worse,” said Takesue. “We try to improve the system based on what the user needs — sometimes they’re big steps and sometimes they’re not. In this case, it’s about helping curriculum teams and students learn how to use EHRs.”
According to Regenstrief researchers, medical students using the EHR Clinical Learning Platform will most likely be accustomed to more advanced technology than will be available upon their graduation.
“These are functions that users need to be asking for,” said Takesue. “If we have users asking for better workflow, theoretically a vendor will have to implement these changes or else another vendor will do so and have a competitive advantage.”
Takesue reasons the platform has the potential to improve faster than real EHR systems designed by health IT companies partially because the technology is not influenced by vendors or policymakers. Here, innovators and users have complete control over how the technology is used, customized, and implemented.
“It’s all about improving care,” said Takesue, “We don’t have shareholders to satisfy.”