Establishing Electronic Health Record Competency Testing for First-Year Residents

Abstract

Despite widespread use of electronic health records (EHRs), it is unclear whether residents possess the EHR skills to perform required tasks. We assessed first-year residents' skills on specific EHR tasks. Incoming residents were required to participate in EHR training before starting clinical rotations. The training team developed an assessment tool for 19 EHR tasks. Senior residents used a structured template to assess interns. For ambulatory workflow skills, most participants (range, 70%-100%) demonstrated competence. The 3 skills for which interns needed the most assistance were (1) creating and routing a result note (17 of 68, 25%), (2) deleting a medication or changing a dose in reconciling medications (10 of 68, 15%), and (3) finding results for the past 90days (10 of 68, 15%). For inpatient workflow skills, most interns (range, 63%-100%) demonstrated competence. The 3 skills in which interns needed the most assistance were (1) placing a referral order at discharge (23 of 68, 34%), (2) finding a temperature on a flow sheet and trending it over time (14 of 68, 21%), and (3) creating a discharge summary, having it reviewed, and forwarding it to the primary care physician (14 of 68, 21%). Our results should help EHR training teams at other institutions to better understand the strengths and weakness of EHR training approaches and to target training on tasks with the greatest performance deficits as well as toward underperforming individuals or groups.