A doctor’s daily workload has changed completely in the last 20 years. The digitization of patient data has shifted the majority of a doctor’s time away from patients and towards EHRs. In fact, a recent study in Family Medicine concluded that providers are spending, on average, 18.6 minutes in front of an EHR and only 16.5 minutes with a patient during each visit.
For physicians to be most effective and efficient with their time, they now need to be technically capable along with being clinically capable. This change in workplace norms must be reflected in the education of those entering the healthcare field. So how are medical schools preparing new doctors for the technology onslaught? Let’s take a look.
Why teaching technology is critical
Training EHR input and analysis has been overlooked by medical school in recent years. A 2017 study in the Journal of Association of American Medical Schools (AAMC) points out the lack of emphasis on digital literacy in medical school clerkships: “only about a fourth of directors (27%) reported that students could use the EHR to view patient records, write notes, and enter orders (which a supervising physician had to cosign); less than half (41%) allowed students to view the EHR and write notes; and a nearly a third (32%) allowed students view-only access. Limiting students’ access to the EHR diminishes their potential contributions to patient care teams.” The increased role EHRs play in the daily life of a physician only exacerbates this problem.
This lack of EHR exposure manifests itself in the workplace through an increase in physician burnout. This is the disillusionment with caregiving brought about by doctors not doing the tasks they signed up for. Physicians thought they were going to be dealing with patients, but because of the shift to value-based reimbursement and the digitization of medical records, they spend a large portion of the day entering data.
If a young clinician enters the workforce today with no EHR experience, he or she is more likely to incorrectly enter medical data, thus making an already tiresome procedure even worse. This seems like double jeopardy for new entrants because they are realizing how much of their job requires the use of data and their own lack of knowledge of the subject. Both of these contribute to greater physician burnout. The real-world effects of this mental fatigue are lower patient satisfaction, greater risk of physician error, and decreased revenue as doctors fail to enter valuable information into their dreaded EHRs.
The teachingEMR – bringing technology to the classroom
Before all hope is lost for efficiency in medical data usage, there is a team at Indiana University who has been working on a solution. In conjunction with the Regenstrief Institute, a health research organization, IU Medical School has created The Regenstrief EHR Clinical Learning Platform (teachingEHR). The teachingEHR is a fully operational EHR populated by mis-identified patients from the IU Health University Hospital. By allowing students to interact directly with a functioning EHR, the teachingEHR is the perfect tool to counter the digital unpreparedness of many of many medical students.
The teachingEHR has been adopted by a consortium of 32 schools across America including Harvard, Brown, and University of Connecticut. Speaking to the American Medical Association’s “Innovations in Medical Education Webinar Series,” Senior Associate Dean of Education at the University of Connecticut School of Medicine Susan Rose perfectly summarizes why the teachingEHR can be so effective. She points to the fact that the tool employs more “adult learning” because students are exposed to real-world data in the format that they will actually consume it during clinical care. Taking notes in a book can be helpful, but it does not reflect what a doctor must work with every day.
Teaching pop health in medical school
Getting familiar with the tool is all first-year medical students will be exposed to, but in subsequent years it will be used for its most impactful subject: population health. The digitization of medical data has made analysis of psychosocial factors easier and more diffuse. With large family tree data in an EHR, physicians can pinpoint family trends that affect any given patient.
While this data is useful, it is only valuable if the doctor is familiar with EHR data analysis and is able to spot trends in psychosocial issues. The teachingEHR is so useful because learning to manage the complexity of population health data is challenging, and any leg up can go a long way. This skill is so useful that every student who passes the course at the University of Connecticut School of Medicine receives a Public Health Certificate from the School on Social Determinants of Health and Disparities.
A doctor’s ability to work with data is clearly an invaluable skill in today’s medical workplace. Medical schools, through the teachingEHR and other similar tools, are trying to bring graduates up to speed. The tool familiarizes future physicians with the process of data entry, which, when done poorly, can lead to hours spent in front of a computer correcting errors and a more burnt-out hospital workforce.
Learning the EHR system early can also give students a head start in burgeoning fields such as population health that have taken off during the digital era of healthcare. Medical schools are not perfect and have places to expand into as Susan Rose from UConn Medical School explains her plans to employ the teachingEHR, “across the whole continuum of care.” This new field of study for medical schools is just getting started and the future looks bright.
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