- As the healthcare industry continues to rely on strong EHR data and health IT use, it will be important that today’s medical students are prepared to work with this kind of technology. However, according to a group of researchers from Duke University, education in these areas is left wanting.
“In the emerging Learning Health System (LHS), the application and generation of medical knowledge are a natural outgrowth of patient care,” the researchers said in a recent study.
“Achieving this ideal requires a physician workforce adept in information systems, quality improvement (QI) methods, and systems-based practice to be able to use existing data to inform future care. These skills are not currently taught in medical school or graduate medical education.”
To rectify that issue, the researchers developed and deployed a Learning Health Systems Training Program (LHSTP) at Duke University School of Medicine.
The LHSTP helps participants build analytical, informatics, and systems engineering skills to enable them to better use health IT and EHR data, ultimately improving their ability to work within a Learning Health System and effectively boost care through health technologies.
The program, launched in 2013, enlists several medical residents from different clinical specialties to help build a well-rounded program. It engages those participants in several different areas, including biostatistics, biomedical informatics, quality improvement, and health system administration. After the year-long course, participants complete a final project to show their understanding.
To improve the program going forward, researchers from Duke assessed its acceptability, feasibility, and effectiveness.
In a retrospective analysis, the researchers discovered several common themes. For example, the program presented a steep learning curve for implementers and leaders, highlighting the importance of other key variables such as buy-in and quality training.
“Early successes relied on a supportive environment, health system buy-in, diverse expertise, and enthusiastic learners,” the researchers said. “Challenges we have encountered include irregular attendance, provision of faculty mentorship, and challenges inherent in immature data systems.”
To improve the program going forward, implementers have decided to “front-load” the course, putting more of the considerable assignments and lessons at the start of the course, allowing participants more time to complete their final projects. To that end, implementers have also decided to assign final projects at the start of the course.
“This should allow refinement of the approach and identification of additional supporting resources,” the researchers reasoned. “Along these lines, we will make additional statistical support available for groups who do not have skills in using statistical software.”
Additionally, the program implementers plan to add better mentor relationships for participants and a certificate of completion recognized by the Office of Graduate Medical Education.
Despite the room for improvements, the researchers said the LHSTP has been successful not only in educating new physicians in EHR data use and health IT use, but has made improvements in the School of Medicine’s overall data infrastructure.
According to the researchers, final projects completed in year one have informed final projects completed in year two of the program, each building on the next.
“The initial projects have taught both the learners and the course directors about limitations of the readily accessed data at Duke,” the researchers said. “Subsequent projects have addressed limitations in the data.”
For example, one project completed during year two of the program informed a current project aimed at connecting neonatal-maternal EHR data. LHSTP leaders were able to guide participants toward this subject matter based on data gaps previously identified and current students’ interests.
Other final projects have made strides in improving the School of Medicine’s EHR data quality.
“One such project has segued into a systemwide, health-system improvement effort with a focus on improving EHR data quality and accuracy of nursing assessments, which will allow rapid quality reporting and eventually accumulate a body of evidence to support comparative effectiveness,” the researchers reported.
Ultimately, the LHSTP has proven an effective method to improving EHR data and health IT use among graduate medical students. Going forward, the implementers expect the program to improve, not only assisting future physicians, but helping to boost EHR data quality across the School of Medicine.
“We hope that this identifies particularly valuable skills going forward or skills we could improve on developing,” the researchers concluded. “Realizing this, and in the spirit of continual improvement, we anticipate that the LHSTP will continue to rapidly evolve, improving our learners’ experience and adapting to future conditions.”