Electronic Health Record Training Research Articles

Impact of an End-User-Designed Education Bundle for Electronic Health Records System Education of House Officers.

Introduction The benefits of Electronic Health Records (EHR)use in clinical care are well documented. However, without proper education and training on EHR systems, clinicians may face challenges in utilizing these technological tools effectively. Suboptimal usage of EHR systems can affect productivity.This study assesses the effectiveness of an end-user-designed education bundle as a supplement to existing training in EHR training for house officers. Additionally, it evaluates the effectiveness of using non-conventional teaching modalities (i.e., short TikTok-style videos)to see how effective and accepted it was in comparison to traditional educational material. Methods A single-armed pre-post-study design consisting of 36 house officers was employed to evaluate the effectiveness of the intervention bundle. The bundle consists of a series of EHR tips and tricks as identified by experienced senior medical officers. The three components of the bundle are a handbook with consolidated tips and tricks, a long-form lecture video, and a series of TikTok-style videos. Distribution was done through healthcare collaborative platforms such as TigerConnect™ (Los Angeles,USA) and email. Results Participants found that the inclusion of our supplementary education bundle results in more effective training for EHR usage, with mean effectiveness with and without the educational bundle being 7.77 and 6.44, respectively (p < 0.001). There were also significant improvements in ease of finding information (7.67 vs 7.14, p = 0.016), performing general functions (7.50 vs 6.89, p = 0.0050), and overall efficiency (7.39 vs 6.92, p = 0.022). We also found TikTok-style videos were non-inferior to more traditional forms of education such as a handbook and traditional long-form lecture videos (p = 0.250). Conclusion An end-user-driven education bundle focusing on high-yield, advanced functions may be useful in enhancing the overall EHR system experience for junior doctors. Of note, TikTok-style videos may be no less effective than traditional methods of EHR teaching.

Provider Perspectives on Adolescent Confidentiality and the Electronic Health Record Postimplementation of the 21st Century Cures Act Final Rule

PurposeThe 21st Century Cures Act Final Rule mandates increased transparency and accessibility of the Electronic Health Record (EHR). This mandate has exacerbated tensions in adolescent healthcare between transparency and confidentiality. This study evaluates clinicians' perspectives on how well the EHR maintains confidentiality for adolescents in the post-Cures Act era. MethodsA web-based survey was distributed via the national listserv of the Society for Adolescent Health and Medicine in March–April 2022. English-speaking members practicing in the Unites States who used an EHR to document clinical visits with minors were eligible. The survey included questions about EHR training, features, and approach to information sharing with adolescent patients and proxies. ResultsParticipants included 97 respondents from 32 states. Most participants were physicians (98%) and identified themselves as attending (89%). Several EHR vendors were represented, although the majority used Epic (76%). As has been seen in prior studies, there remains significant variability in approaches to patient portal access for adolescent patients and their adult proxies. Respondents report that training around adolescent-specific privacy issues remains infrequent and is perceived as inadequate. Adolescent providers, despite feeling confident in navigating the EHR generally, continue to report low rates of confidence in how well their EHR may protect adolescent privacy. DiscussionClinicians have persistent concerns about adolescent confidentiality postimplementation of the 21st Century Cures Act. Sharing sufficient information while protecting adolescent confidentiality might require standardization by EHR vendors to improve granularity of proxy information sharing. Healthcare institutions must also commit to training providers on management of adolescent confidentiality.

Increasing the assessment rates of the social determinants of health (SDoH) in patients with newly diagnosed breast cancer at a safety-net health system.

79 Background: SDoH are non-medical factors that can influence health outcomes. The negative impact of SDoH on vulnerable populations such as racial and ethnic minorities contributes to health disparities; therefore, consistent, accurate, and comprehensive assessment of SDoH is a first step towards promoting health equity and eliminating disparities. This is particularly important in safety-net systems where the patients’ burden of SDoH is disproportionately high. In this quality improvement project, we aimed to increase the SDoH assessment rate from the initial visit for newly diagnosed breast cancer patients. Methods: Parkland Health (PH) is one of the largest safety-net systems in the US and is affiliated with the UT Southwestern Harold C. Simmons Comprehensive Cancer Center (NCI-CCC). PH provides a wide range of support services such as transportation, childcare, medication assistance, nutrition education, etc., to patients, however, these services are likely underutilized due to a lack of consistent and accurate assessment of patient needs. A multidisciplinary team, supported by the ASCO Quality Training Program and sponsored by the Susan G. Komen Foundation, mapped the relevant clinic processes and performed a root cause analysis. Interventions included developing the relevant policies and procedures, electronic health record training, and interview training (first PDSA cycle). SDoH assessment was initially included in the Oncology Nurse Navigator (ONN) workflow but later was expanded to include clinic nurses (second PDSA cycle). The goal of the project was to increase SDoH assessment within 2 weeks from the initial clinic visit to 50%. Results: In the year before the intervention, the SDoH assessment rate for newly diagnosed breast cancer patients was at 2.7%. Incorporating SDoH assessment into the ONN’s workflow resulted in an initial increase in the completion rate to 31%, however, we observed a subsequent drop in the assessment rate to a monthly average of 15%. Reasons included the ONN’s patient panel size (350 new breast cancer patients annually), competing navigation priorities, and concurrent clinics. In the second PDSA cycle, all RNs were trained on completing SDoH assessments. In the 7 weeks following the second PDSA cycle, the assessment rate rose to an average of 76% per week. Conclusions: We increased the SDoH assessment rate from a baseline of 2.7% to 76% by improving workflows and leveraging current resources. Based on the lessons learned, we plan to add another ONN position to make the patient panel size more manageable. In addition, we plan to use MyChart messaging and tablets to self-administer the SDoH questionnaire to patients during the visit. These strategies allow to expand of the SDoH assessment for established patients, accounting for evolving patient needs throughout their cancer journey.

Correctly structured problem lists lead to better and faster clinical decision-making in electronic health records compared to non-curated problem lists: A single-blinded crossover randomized controlled trial

BackgroundCorrectly structured problem lists in electronic health records (EHRs) offer major benefits to patient care. Without structured lists, diagnosis information is often scatteredly documented in free text, which may contribute to errors and inefficient information retrieval. This study aims to assess whether EHRs with correctly structured problem lists result in better and faster clinical decision-making compared to non-curated problem lists. MethodsTwo versions of two patient records (A and B) were created in an EHR training environment: one version included diagnosis information structured and coded on the problem list (“correctly structured problem list”), the other version had missing problem list diagnoses and diagnosis information partly documented in free text (“non-curated problem list”). In this single-blinded crossover randomized controlled trial, healthcare providers, who can prescribe medications, from two Dutch university medical center locations first evaluated a randomized version of patient A, then B. Participants were asked to motivate their answer to two medication prescription questions. One (test) question required information similarly presented in both record versions. The second (comparison) question required information documented on problem lists and/or in notes. The primary outcome measure was the correctness of the motivated answer to the comparison question. Secondary outcome measure was the time to answer and motivate both questions correctly. ResultsAs planned, 160 participants enrolled. Two were excluded for not meeting inclusion criteria. Correctly structured problem lists increased providers’ ability to answer the comparison question correctly (56.3 % versus 33.5 %, McNemar odds ratio 2.80 (1.65–4.93) 95 %-CI). Median time to answer both questions correctly was significantly lower for EHRs with correctly structured problem lists (Wilcoxon-signed-rank test p = 0.00002, with incorrect answers coded equally at slowest time). ConclusionsCorrectly structured problem lists lead to better and faster clinical decision-making. Increased structured problem lists usage may be warranted for which implementation policies should be developed.

Utilization of electronic health records and associated factors among nurses in a faith-based teaching hospital, Ilishan, Nigeria.

It has been documented that nurses' use of electronic health records (EHRs) impacts clients' health outcomes positively. Some health facilities, primarily privately owned institutions, introduced EHRs for optimal healthcare. Evidence of such and associated factors among nurses must be documented to improve utilization and quality. The study assessed the utilization of EHRs and associated factors among nurses in a faith-based teaching hospital. This sequential explanatory mixed-methods study involved a sample of all 240 nurses from a teaching hospital where EHRs have been introduced. Quantitative data through semistructured questionnaires were collected and analyzed using Chi-square and logistic regression. Qualitative data were collected from 10 purposively selected nurses using an in-depth interview guide and analyzed through content analysis. The majority of participants reported availability of EHR computer software (62.8%), internet facility (84.2%), and desktops (76.3%), but EHR was poorly utilized (27.3%). Factors significantly associated were nurses who were females [OR (odds ratio) = 1.5, 95% CI (confidence interval), 0.21-11.24], BNSc degrees holders [OR = 4.3; 95% CI, 1.06-17.43]; had computer EHR software [OR = 7.4, 95% CI, 0.83-3.81], and sponsored EHR training [OR = 2.10; 95% CI, 0.24-18.6]. Noncapturing of nursing tasks and nursing standardized language by EHR software, lack of institutional enforcement on EHR use, and absence of clear EHR policies were the main identified themes for the key barriers to using EHRs. EHR was poorly utilized among nurses. Gender, educational qualification, EHR resources, and sponsored training were factors significantly associated with the use. There is an urgent need for comprehensive EHR packages, sustained sponsored training, and formulation of EHR policy for effective EHR implementation.

Assessing Baseline Knowledge and Usage Patterns of Sexual Orientation/Gender Identity Affirming Electronic Health Record Modules Within a Urology Division at a Single Tertiary Care Institution

To evaluate how sexual orientation and gender identity (SOGI)-affirming electronic health record (EHR) modules (which enable seamless location and documentation of patientSOGI data) are being used by providers/staff within a urology practice. All 120 patient-facing providers/staff at a tertiary urology program were offered a 39-question Qualtrics-based survey, which assessed respondents' cultural competency, baseline knowledge of SOGI EHR modules, and SOGI module usage patterns. Cultural competency was assessed using the LGBT-Development of Clinical Skills Scale (LGBT-DOCCS). 96 qualified providers/staff completed the survey (response rate, 89%). Only 25% of respondents received training on finding/collecting SOGI data in the EHR. Respondents possessed high levels of LGBTQ attitudinal awareness (M=6.38/7) but low clinical preparedness (M=4.32/7), in large part due to perceived inadequate training to work with LGBT patients. Major drivers of clinical preparedness were respondent role and number of LGBT patients seen in the past year. While respondents uniformly report ease finding SOGI data, all providers/staff (particularly physicians) rarely use formal SOGI documentation tools. Few respondents partook in SOGI EHR training; those that did were significantly more likely to use formal SOGI documentation tools. This study revealed that providers/staff possess high general LGBTQ cultural competency and ability to find relevant SOGI data in the EHR, while also highlighting limited training in SOGI-affirming EHR tools and low usage of formal documentation tools. This framework could be a roadmap for evaluating SOGI-affirming EHR use by urology practices as such features increase in popularity.

The Impact of Training on Electronic Health Records Related Knowledge, Practical Competencies, and Staff Satisfaction: A Pre-Post Intervention Study Among Wellness Center Providers in a Primary Health-Care Facility.

The transition to electronic health records (EHR) has improved the quality of health-care delivery and patient safety. However, poor usability and incongruent workflow may impose a significant burden on documentation and time management, resulting in staff burnout. We aimed to (i) evaluate the effectiveness of personalized EHR training on wellness providers' knowledge and practical competencies, and (ii) assess staff satisfaction regarding the EHR usage post-training. An interventional study was conducted between July 15, 2021, and March 1, 2022, among 14 wellness staff (age: 38 ± 3.9 years; 7 males, 7 females) in the Wellness Center-Rawdat Al-Khail Health Center. Six months of blended training was delivered. The impact of training was assessed using a pre-post survey on the knowledge and practical competencies related to EHR usage. Staff satisfaction was assessed post-training. Majority of respondents had improvement in identifying the advantages of EHR: improve confidentiality of care (pre = 35.7% vs post = 100%, p = 0.001), reduce medical errors (pre = 35.7% vs post = 85.7%, p = 0.02), improve quality of health care (pre = 35.7% vs post = 100%, p = 0.001), and reduce wait time (pre = 42.9% vs post = 85.7%, p = 0.03). Time performing these tasks by massage therapists/receptionists was reduced: viewing/editing ambulatory organizer (pre = 20±0 s vs post = 10±0 s), access PM office (pre = 155±136 s vs post = 10±0 s), selection/access patient chart (pre = 75±30 s vs post = 30±20 s), check-in/out (pre = 120±0 s vs post = 60±0 s), and view/edit massage form (pre = 135±75.5 s vs post = 60±0 s). For gym instructors, time to access ambulatory organizer (pre = 30±0 s vs post = 10±0 s), view/edit the gym form (pre = 101±57 s vs post = 71±36 s), view patients' clinical data (pre = 60±70 s vs post = 10±3 s), and place referral orders (pre = 197±144 vs post = 82±23 s) was reduced. A mean percentage score of 65.4±38.7 indicated very good staff satisfaction. This tailored, hands-on training has been well received and effectively improved wellness staff knowledge, competencies, and satisfaction relative to EHR functionalities.

Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study

Electronic health records (EHRs) play a substantial role in modern health care, especially during prerounding, when residents gather patient information to inform daily care decisions of the care team. The effective use of the EHR system is crucial for efficient and frustration-free prerounding. Ideally, the system should be designed to support efficient user interactions by presenting data effectively and providing easy navigation between different pages. Additionally, training on the system should aim to make user interactions more efficient by familiarizing the users with best practices that minimize interaction time while using the full potential of the system's capabilities. However, formal training on EHR systems often falls short of providing residents with all the necessary EHR-related skills, leading to the adoption of inefficient practices and the underuse of the system's full range of capabilities. This study aims to examine the efficiency of EHR use during prerounding among pediatric residents, assess the effect of experience level on EHR use, and identify areas for improvement in EHR design and training. A mixed methods approach was used, involving a self-reported survey and video analysis of prerounding practices of the entire population of pediatric residents from a large teaching hospital in the South Atlantic Region. The residents were stratified by experience level by postgraduate year. Data were collected on the number of pages accessed, duration of prerounding, task completion rates, and effective use of data sources. Observational and qualitative data complemented the quantitative analysis. Our study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines, ensuring completeness and transparency of reporting. Of the 30 pediatric residents, 20 were included in the analyses; of these, 16 (80%) missed at least 1 step during prerounding. Although more experienced residents on average omitted fewer steps, 4 (57%) of the 7 most experienced residents still omitted at least 1 step. On average, residents took 6.5 minutes to round each patient and accessed 21 pages within the EHR during prerounding; no statistically significant differences were observed between experience levels for prerounding times (P=.48) or number of pages accessed (P=.92). The use of aggregated data pages within the EHR system neither seem to improve prerounding times nor decrease the number of pages accessed. The findings suggest that EHR design should be improved to better support user needs, and hospitals should adopt more effective training programs to familiarize residents with the system's capabilities. We recommend implementing prerounding checklists and providing ongoing EHR training programs for health care practitioners. Despite the generalizability of limitations of our study in terms of sample size and specialization, it offers valuable insights for future research to investigate the impact of EHR use on patient outcomes and satisfaction, as well as identify factors that contribute to efficient and effective EHR usage.

The Effectiveness of Scenario-Based Training of Clinicians in the Use of Electronic Health Records – A Systematic Literature Review

The digitalisation of healthcare represents another change challenge for clinicians, and the most prominent of these is the Electronic Health Record (EHR). Adopting the EHR, including the training of clinicians of all disciplines, often does not occur effectively, which increases the risk of adverse events and the reduction in the quality and safety of clinical care. The competent use of the EHR requires clinician user training. One form of training is scenario-based. The questions asked of the literature in this SLR are what evidence exists as to the effectiveness of using scenarios to train clinicians in using the EHR, and is there a research gap in this evidence to inform future research?&#x0D; To undertake this systematic review of the literature, the researchers implemented the PRISMA Method. Only highly ranked, health-related academic databases accessed through an electronic library catalogue were used to search for relevant peer-reviewed/refereed articles. The decision to apply the PRISMA method was based on the PRISMA statement, which safeguards comprehensive reporting and transparency to ensure inferred recommendations and interventions are based on the best available evidence. &#x0D; 6,898 records were returned from Boolean searches for articles published between November 2018 to November 2021. Five articles were included for greater analysis following exclusions by title review, abstract review, and quality assessment. Quality assessment of articles reporting empirical studies relating to the effectiveness of using scenarios in this type of training was performed using the standard quality assessment scoresheet by Kmet [48].&#x0D; Three themes emerged from the literature. The centrality of workflow, Clinician engagement are key, and scenario-based training is one of many training strategies implemented. &#x0D; The authors found that further rigorous research studies are required to enhance the evidence body for the continued usage of scenario-based training of clinicians to effectively use the EHR, particularly as the digital landscape within health continues to evolve. Moreover, the authors posit that further research on scenario-based EHR training of clinicians should include:&#x0D; &#x0D; Scenario-based training is just one part of a broader and blended EHR training suite.&#x0D; Ensuring future studies encompass a diversity of all fields of clinical roles within the research and,&#x0D; Include standardised terminology naming for clinicians' scenario-based EHR training within the studies.&#x0D;

MP06-08 ASSESSING BASELINE KNOWLEDGE AND USAGE PATTERNS OF GENDER-AFFIRMING ELECTRONIC HEALTH RECORD MODULES WITHIN A UROLOGY DIVISION AT A SINGLE TERTIARY CARE INSTITUTION

You have accessJournal of UrologyCME1 Apr 2023MP06-08 ASSESSING BASELINE KNOWLEDGE AND USAGE PATTERNS OF GENDER-AFFIRMING ELECTRONIC HEALTH RECORD MODULES WITHIN A UROLOGY DIVISION AT A SINGLE TERTIARY CARE INSTITUTION James Ding, Rosemary Thomas, Thomas Guzzo, and Daniel Lee James DingJames Ding More articles by this author , Rosemary ThomasRosemary Thomas More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , and Daniel LeeDaniel Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: No studies evaluate how gender-affirming electronic health record (EHR) modules (which enable seamless integration of patient sexual orientation and gender identity [SOGI] data) are being used by providers/staff within a urology practice. METHODS: All 120 patient-facing providers/staff with EHR access within a urology division at a tertiary care center were offered a 39-question Qualtrics-based survey, which assessed respondents’ cultural competency, baseline knowledge of SOGI EHR modules, and SOGI module usage patterns. Cultural competency was assessed using the LGBT-Development of Clinical Skills Scale instrument. Chi-squared tests and linear regression models were used to determine differences in SOGI module use between roles and drivers of cultural competency. RESULTS: 96 providers completed the survey (response rate, 89%). Only 25% of respondents received training on using SOGI data in the EHR. Respondents possessed high levels of LGBTQ attitudinal awareness (M=6.38/7) but low clinical preparedness (M=4.32/7), largely due to perceived inadequate training to work with LGBT patients. Major drivers of clinical preparedness were respondent role and number of LGBT patients seen in the past year (R2:30.8%, p=0.02). While respondents uniformly report ease finding SOGI data, all providers/staff (particularly physicians) rarely use formal SOGI documentation tools. Few respondents partook in SOGI EHR training; those that did were significantly more likely to use formal SOGI documentation tools. CONCLUSIONS: This study revealed that providers/staff possess high general LGBTQ cultural competency and ability to find relevant SOGI data in the EHR, while also highlighting limited training in gender-affirming EHR tools and low usage of formal documentation tools. This framework could be a roadmap for evaluating gender-affirming EHR use by urology practices as such features increase in popularity. Source of Funding: This research was funded through a FOCUS Student Fellowship in Women’s Health supported by the Bertha Dagan Berman Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e56 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Ding More articles by this author Rosemary Thomas More articles by this author Thomas Guzzo More articles by this author Daniel Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Crowdsourcing Electronic Health Record Improvements at Scale across an Integrated Health Care Delivery System

Despite widespread adoption of electronic health records (EHRs), these systems have significant room for improved efficiency and efficacy. While the idea of crowdsourcing EHR improvement ideas has been reported, little is known about how this might work across an integrated health care delivery system in practice. Our program solicited EHR improvement submissions during two timeframes across 10 hospitals and 60 clinics in an upper-Midwest integrated health care delivery system. Submissions were primarily collected via an EHR help feature. A total of 262 and 294 submissions were received in 2019 and 2022, with a majority initiated from physicians (73.5 and 46.9%, 2019 and 2022) specializing in family medicine (52.0 and 59.3%). In 2022, the program reached a larger variety of personnel than 2019, with 53.0% of submissions from advanced practice providers, nurses, administrative staff, and other roles (p < 0.0001). Many ideas (36.4 and 50.0% in 2019 and 2022) reflected a lack of user understanding of EHR features and were addressed through training/education. Significant (27.1 and 25.9%) or simple (24.0 and 14.7%) EHR optimizations were required to address most remaining suggestions, with a number part of planned EHR improvement projects already (16.3 and 17.6%). Our experience using a crowdsourcing approach for EHR improvement ideas provided clinicians and staff the opportunity to address frustrations with the EHR and offered concrete feedback and solutions. While previous studies have suggested EHR technology improvements as paramount, we observed large numbers of users having a misunderstanding of EHR features, highlighting the need for improved EHR user competency and training.

Effect of Electronic Health Records Training Program Via Using Advanced Mobile Devices on Career Success among Intern-Nurses

Effect of Electronic Health Records Training Program Via Using Advanced Mobile Devices on Career Success among Intern-Nurses

Physician Note Composition Patterns and Time on the EHR Across Specialty Types: a National, Cross-sectional Study.

The burden of clinical documentation in electronic health records (EHRs) has been associated with physician burnout. Numerous tools (e.g., note templates and dictation services) exist to ease documentation burden, but little evidence exists regarding how physicians use these tools in combination and the degree to which these strategies correlate with reduced time spent on documentation. To characterize EHR note composition strategies, how these strategies differ in time spent on notes and the EHR, and their distribution across specialty types. Secondary analysis of physician-level measures of note composition and EHR use derived from Epic Systems' Signal data warehouse. We used k-means clustering to identify documentation strategies, and ordinary least squares regression to analyze the relationship between documentation strategies and physician time spent in the EHR, on notes, and outside scheduled hours. A total of 215,207 US-based ambulatory physicians using the Epic EHR between September 2020 and May 2021. Percent of note text derived from each of five documentation tools: SmartTools, copy/paste, manual text, NoteWriter, and voice recognition and transcription; average total and after-hours EHR time per visit; average time on notes per visit. Six distinct note composition strategies emerged in cluster analyses. The most common strategy was predominant SmartTools use (n=89,718). In adjusted analyses, physicians using primarily transcription and dictation (n=15,928) spent less time on notes than physicians with predominant Smart Tool use. (b=-1.30, 95% CI=-1.62, -0.99, p<0.001; average 4.8 min per visit), while those using mostly copy/paste (n=23,426) spent more time on notes (b=2.38, 95% CI=1.92, 2.84, p<0.001; average 13.1 min per visit). Physicians' note composition strategies have implications for both time in notes and after-hours EHR use, suggesting that how physicians use EHR-based documentation tools can be a key lever for institutions investing in EHR tools and training to reduce documentation time and alleviate EHR-associated burden.

Training physicians and residents for the use of Electronic Health Records-A comparative case study between two hospitals.

Despite widespread use of Electronic Health Records (EHR), the promise of benefits has not been clearly realised due, in part, to inadequate physician training. Training for EHR use is a highly complex intervention that occurs in a dynamic socio-technical health system. The purpose of this study was to describe and critically assess the interplay between educational activities and organisational factors that influenced EHR training and implementation across two different hospitals. Based in a socio-technical framework, a comparative qualitative case study was undertaken as well suited to real-world processes. Semi-structured interviews were completed (n = 43), representing administrative leaders, staff physicians, residents and EHR trainers from two Canadian academic hospitals. Thematic analysis was employed for analysis. Similar findings were noted at both hospitals despite different implementation strategies. Despite mandatory training, physicians described limited transferability of training to the workplace. Factors contributing to this included standardised vendor modules (lacking specificity for their clinical context); variable EHR trainer expertise; limited post-launch training; and insufficient preparation for changes to workflow. They described learning while caring for patients and using workarounds. Strong emotional responses were described, including anger, frustration, anxiety and fear of harming patients. Training physicians for effective EHR utilisation requires organisational culture transformation as EHRs impacts all aspects of clinical workflows. Analytic thinking to consider workflows, ongoing post-launch training and the recognition of the interdependency of multiple factors are critical to preparing physicians to provide effective clinical care, and potentially reducing burnout. A list of key considerations is provided for educational leaders.

State of the evidence on simulation-based electronic health records training: A scoping review.

This study synthesized the available evidence of simulation-based electronic health records (EHRs) training in educational and clinical environments for healthcare providers in the literature. The Arksey and O'Malley methodological framework was employed. A systematic search was carried out in relevant databases from inception to January 2020, identifying 24 studies for inclusion. Three themes emerged: (a) role of simulation-based EHR training in evaluating improvement interventions, (b) debriefing and feedback methods used, and (c) challenges of evaluating simulation-based EHR training. The majority of the studies aimed to emphasize the practical skills of individual medical trainees and employed post-simulation feedback as the feedback method. Future research should focus on (a) using simulation-based EHR training to achieve specific learning goals, (b) investigating aspects of clinical performance that are susceptible to skill decay, and (c) examining the influence of simulation-based EHR training on team dynamics.

591 Transition to an Advanced Practice Provider led burn service: process and lessons learned

IntroductionBurn is not a required rotation for general surgery residency training. Additionally, mandates on resident work hours have created a deficiency in resident support for many burn programs across the country. Subsequently, the need to transition to an Advanced Practice Provider (APP) service was identified. At our institution, a medium volume (~250 admissions/year) burn center, we created an APP service and evaluated the evolution and lessons learned during the transition.MethodsTimeline of recruitment of APPs was reviewed along with the recruitment process, onboarding process and orientation process. Exit interviews were conducted with all APPs who resigned to delineate strengths and weakness of the APP program. Functionality of the institution’s APP recruiter, manager and Lead Burn APP (LAPP) were reviewed as well.ResultsBetween 2014 and 2021 the daytime burn APP service expanded from two to six APPs and the Night House Officer (NHO) APP service was created and expanded to four APPs. Based on thorough review of the APP program, key changes were made including improvements in team communication, daily nurse-driven rounds, the 90-day focused professional performance evaluation (FPPE), enhanced and structured education, and critical care exposure.The need for a LAPP was identified and designated in 2019. The LAPP is responsible for making an equitable schedule, execution of new APP orientation, organizing the 90 day FPPE and ongoing professional performance evaluation (OPPE), monthly APP peer review and APP meetings, coordinating OR coverage, and functioning as an APP advocate at division leadership. The LAPP enacted changes to the existing hiring/onboarding process as described below.All APPs are now recruited through an APP recruiter who discusses the hospital contract and salary as well as organizes the logistics of the interview, formalizes the offer, and aids with the transition to credentialing. All new APPs are given a hospital onboarding checklist, that includes hospital orientation, APP boot camp, simulation and electronic health record training classes. In addition they are given a clinical orientation checklist, which includes BLS/ABLS/ACLS/ATLS certification, exposure to various phases of patient care, tracking of quantitative patient care metrics, participation in monthly burn APP peer review and burn triage simulation. There are subtle differences with the NHO APP clinical checklist. After 90 days of employment a new employee FPPE is held with the LAPP and burn director. This allows for direction of areas to focus on, comprehensive feedback, and discussion about increasing autonomy.ConclusionsThrough a focused process, APPs can play an integral role in the daily functioning of a burn center. We believe that a similar effective and financially sound model can be created for similar sized units.

Usability challenges with electronic health records (EHRs) during prerounding on pediatric inpatients.

ObjectivePrerounding is critical for a healthcare team to develop a shared understanding of the patient’s condition and to develop a care plan. However, the design of electronic health records (EHRs) often makes prerounding inefficient, ineffective, and time consuming. The goal of this study was to observe how residents use the EHR while prerounding to identify usability challenges associated with the design of EHRs.Materials and MethodsThirty residents were tasked to preround 2 pediatric patients using the think-aloud protocol. The data from the surveys, video recordings, and think-aloud comments were analyzed to identify usability issues related to EHR. The time it took for participants to complete the 6 required prerounding tasks were calculated and the pages most commonly accessed were noted.ResultsParticipants spent on average 6.5 min prerounding each patient with the most time spent on checking lab results and reviewing notes. Twenty-eight distinct pages were visited by at least 2 participants, mostly due to a lack of interconnectivity between related data across pages. Usability issues with the most commonly used pages include: data overload, missing/hidden information, difficulty identifying trends, and having to conduct manual calculations.ConclusionsWe list usability issues and provide a set of recommendations to remedy these issues that include: reducing information access cost, creating a checklist, automate calculations, and standardizing notes and EHR training. Ideally, the outcome of this work will help improve EHR design to maximize the time clinicians spend interacting with and providing care to their patients.

Virtual Sprint Outpatient Electronic Health Record Training and Optimization Effect on Provider Burnout.

This study aimed to develop a virtual electronic health record (EHR) training and optimization program and evaluate the impact of the virtual model on provider and staff burnout and electronic health record (EHR) experience. UCHealth created and supported a multidisciplinary EHR optimization and training program, known as the Epic Sprint Program. The Sprint Team conducted dozens of onsite Sprint events over the course of several years prior to the pandemic but transitioned to a fully virtual program and successfully "sprinted" 21 outpatient clinics from May to December 2020. Core program components of group and 1:1 training, workflow analysis, and new or adjusted EHR build were unchanged from the onsite model. Pre- and post-Sprint surveys provided detailed, objective data about EHR usability, EHR proficiency, job satisfaction, and burnout. The EHR Net Promoter Score (NPS), a likelihood to recommend metric, increased by 39 points (-3 pre and 36 post; p < 0.001) for providers and 29 points (8 pre and 37 post; p = 0.001) for staff post-Sprint. Positive provider (NPS = +53) and staff (NPS = +47) NPS scores indicated a high likelihood to recommend the Sprint Program. Post-Sprint surveys also reflect an increase in providers (10%; p = 0.04) and staff (9%; 0.13) who indicated "no burnout" or "did not feel burned out." The UCHealth Sprint Team transitioned this comprehensive, enterprise level initiative from an onsite model to a fully virtual EHR training and optimization program during the first few months of the novel coronavirus disease (COVID-19) pandemic. Despite this change in program delivery, survey data clearly demonstrated improved EHR satisfaction, a high likelihood to recommend a sprint to a friend or colleague, and a trend toward burnout reduction in providers and staff. Changing an existing on-site EHR optimization program to a purely virtual format can be successful, and this study showed improved provider and staff EHR satisfaction with reduced burnout.

Primary care physicians' electronic health record proficiency and efficiency behaviors and time interacting with electronic health records: a quantile regression analysis.

This study aimed to understand the association between primary care physician (PCP) proficiency with the electronic health record (EHR) system and time spent interacting with the EHR. We examined the use of EHR proficiency tools among PCPs at one large academic health system using EHR-derived measures of clinician EHR proficiency and efficiency. Our main predictors were the use of EHR proficiency tools and our outcomes focused on 4 measures assessing time spent in the EHR: (1) total time spent interacting with the EHR, (2) time spent outside scheduled clinical hours, (3) time spent documenting, and (4) time spent on inbox management. We conducted multivariable quantile regression models with fixed effects for physician-level factors and time in order to identify factors that were independently associated with time spent in the EHR. Across 441 primary care physicians, we found mixed associations between certain EHR proficiency behaviors and time spent in the EHR. Across EHR activities studied, QuickActions, SmartPhrases, and documentation length were positively associated with increased time spent in the EHR. Models also showed a greater amount of help from team members in note writing was associated with less time spent in the EHR and documenting. Examining the prevalence of EHR proficiency behaviors may suggest targeted areas for initial and ongoing EHR training. Although documentation behaviors are key areas for training, team-based models for documentation and inbox management require further study. A nuanced association exists between physician EHR proficiency and time spent in the EHR.

Start using EHR, how satisfy are the doctors and nurses?

Electronic health record (EHR) system has many advantages. However, the implementation of it is challenging in a limited resources. Alongside with the challenge related to big change that clinicians have to adapt with. This causes hospital around the world changes the patient documentation, from paper based health record to EHR system. Evaluation about EHR system implementation is a crucial things. One of her evaluation implementation can be seen through measuring EHR user satisfaction. To determine physicians’ and nurses’ satisfaction in EHR implementation. This was a cross-sectional designed descriptive analytical research. There were 52 respondents consists of physicians and nurses who work in the out patient unit involved in the study. Data were collected using Electronic Health Record Nurse Satisfaction (EHRNS) developed by Sockolow et al. The mean of the effect of EHR in patient outcomes is equivalent to M = 3.9 ± 0.7 in nurses and M = 4.1 ± 0.8 in physicians. The effect of EHR usage on the patient's comfort is equivalent to M = 3.8 ± 0.5 in nurses and M = 3.7 ± 0.8 in doctors. EHR training is equivalent to M = 4.6 ± 0.6 in nurses and M = 4.3 ± 0.7 in doctors. There is no significance difference in satisfaction between nurses and doctors. Overall, nurses and physicians were satisfied with some functions in EHR system. However, there are some functions that didn’t satisfy the users and need to be improved.