The State of EHR Training: Are You Prepared?

Marcia Frellick

Disclosures

August 28, 2018

Although most new doctors will use electronic health records (EHRs) from the first day of practice, the vast majority of medical students and residents do not receive comprehensive training in how to use them to improve care. That tradition is slowly changing with innovative training models.

EHR education moved further into the national spotlight this summer with a resolution passed by the American Medical Association's (AMA's) House of Delegates, which called for the AMA to urge medical schools and residency programs to provide clinical documentation and EHR training "that can be demonstrated as useful in clinical practice."

"Unfortunately, despite a growing awareness within the medical education community that medical students and residents need to learn how to ensure quality clinical documentation within an electronic health record, some institutions continue to restrict access to the EHR due to a variety of concerns," AMA Board Member and medical student Karthik V. Sarma, MS, said in a statement.

Medical students and residents helped put the issue before the House of Delegates in June, but advocacy has been building for years.

Many Schools Restrict Student Access

Experts cite many reasons why change has been slow. Susan Skochelak, MD, MPH, AMA's vice president for medical education, told Medscape that several barriers have kept schools from letting students use data within EHRs, beyond learning how to sign on and get a quick overview of how it works. One is what she calls an "overinterpretation of privacy issues in HIPAA" (the Health Information Portability and Accountability Act).

Because students are not employees, compliance officers at healthcare systems have been hesitant to let them do their own work in the EHR, she said, which has led to workarounds. "A workaround could be that someone shares their password with them, and that's actually worse than training them," she said.

Other barriers include demands on supervising physicians' time. Part of that burden has been alleviated with a rule change earlier this year by the Centers for Medicare & Medicaid Services. Before the rule change, students would evaluate patients and write detailed notes; however, supervising physicians had to completely redocument the material and not simply verify the student's assessment, even when their own assessment was the same. With the change, effective in March of this year, physicians no longer have to redocument, decreasing the workflow burden.

Another barrier is the lack of clear understanding regarding the best teaching methods because models are still in early stages. Skochelak says she hopes that will become clearer as schools share their experiences. As part of the AMA's plan to build the medical school of the future, the association began partnerships with 32 schools in the Accelerating Change in Medical Education Consortium in 2013. An estimated 19,000 medical students—18% of all US allopathic and osteopathic medical students—study at schools that are part of the consortium, according to the AMA.

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