The need for academic electronic health record systems in nurse education

Implementation of High-Value Care for Physical Therapy Residents Through Systems-Based Practice Curriculum Development: Case Report

BACKGROUND AND PURPOSE

Systems-based practice is a core competency for physical therapy residents, best acquired through experiential learning. Peer health professions are further along than physical therapy in implementing curricula that support systems-based practice. Clinical and practice data in residency programs could provide for education in high-value care (HVC) as a foundation for systems-based practice. Our purpose was to develop and assess a HVC curriculum incorporating reflective practice to help residents achieve competency in systems-based practice.

CASE DESCRIPTION

The Logic Model, which evaluates key components needed for success and sustainability, was used to identify resources for a curriculum in HVC. Two orthopedic physical therapy residents and 5 faculty mentors participated in didactic and mentoring sessions. A practice dashboard for each clinician was developed to facilitate resident-mentor discussions. Focus group input was used to refine the curriculum. The validated Systems Thinking Scale, the Quality Improvement Knowledge Application Tool Rubric, and the American Physical Therapy Association Residency Core Competency Score were used to assess residents' progress and to make comparisons to prior years' residents.

OUTCOMES

The residents demonstrated increases in systems thinking and quality-improvement knowledge and improvements in clinical outcomes and practice efficiencies. Three themes emerged from semistructured interviews: challenges to HVC, current approach in HVC, and future-oriented thinking in HVC in practice.

DISCUSSION AND CONCLUSION

This study demonstrates that HVC activities and a personalized clinical dashboard in a physical therapy residency program can facilitate experiential learning of systems-based practice, a core competency for value-centered, inclusive practice.

Pre-Registration Nursing Students' Perceptions of Digital Health Technology on the Future of Nursing: A Qualitative Exploratory Study

BACKGROUND

Health informatics competencies, digital health education, and nursing students' perceptions of technology are critical to ensure a future digitally capable health care workforce.

PURPOSE

To explore preregistration students' perceptions of digital health technology impact on their role as nurses.

METHODS

Using a qualitative exploratory approach, students from 2 Australian universities were purposively sampled. Data were collected through photo-elicitation from 3 focus groups and thematically analyzed. Photo-elicitation provided reference points to encourage more in-depth exploration.

RESULTS

Themes included fear of the unknown and who am I? Nursing in a digital world . Human interaction was fundamental to their nursing role and digital health technology could depersonalize care, creating tension around their reason for choosing a nursing career.

CONCLUSIONS

Educators should prepare students to redefine their nursing identity by exploring how digital health technology augments their practice and critical thinking skills, while addressing fear of a perceived threat to the future of nursing.

Application of Failure Mode and Effects Analysis to Improve the Quality of the Front Page of Electronic Medical Records in China: Cross-Sectional Data Mapping Analysis

BACKGROUND

The completeness and accuracy of the front pages of electronic medical records (EMRs) are crucial for evaluating hospital performance and for health insurance payments to inpatients. However, the quality of the first page of EMRs in China's medical system is not satisfactory, which can be partly attributed to deficiencies in the EMR system. Failure mode and effects analysis (FMEA) is a proactive risk management tool that can be used to investigate the potential failure modes in an EMR system and analyze the possible consequences.

OBJECTIVE

The purpose of this study was to preemptively identify the potential failures of the EMR system in China and their causes and effects in order to prevent such failures from recurring. Further, we aimed to implement corresponding improvements to minimize system failure modes.

METHODS

From January 1, 2020, to May 31, 2022, 10 experts, including clinicians, engineers, administrators, and medical record coders, in Zhejiang People's Hospital conducted FMEA to improve the quality of the front page of the EMR. The completeness and accuracy of the front page and the risk priority numbers were compared before and after the implementation of specific improvement measures.

RESULTS

We identified 2 main processes and 6 subprocesses for improving the EMR system. We found that there were 13 potential failure modes, including data messaging errors, data completion errors, incomplete quality control, and coding errors. A questionnaire survey administered to random physicians and coders showed 7 major causes for these failure modes. Therefore, we established quality control rules for medical records and embedded them in the system. We also integrated the medical insurance system and the front page of the EMR on the same interface and established a set of intelligent front pages in the EMR management system. Further, we revamped the quality management systems such as communicating with physicians regularly and conducting special training seminars. The overall accuracy and integrity rate of the front page (P<.001) of the EMR increased significantly after implementation of the improvement measures, while the risk priority number decreased.

CONCLUSIONS

In this study, we were able to identify the potential failure modes in the front page of the EMR system by using the FMEA method and implement corresponding improvement measures in order to minimize recurring errors in the health care services in China.

Analysis of Inclusive Gender, Sexuality and Sexual Orientation Data Elements in Academic Electronic Health Records

Findings from an analysis of three vended academic electronic health records used in health science education are presented in this article. The quality assurance project examined the lexical and semantic fit and content coverage of gender, sexuality, and sexual orientation data elements within the academic electronic health records. A semantic comparative content analysis using a cognitive walkthrough was conducted as a means of comparing the ideal set of gender, sexuality, and sexual orientation data elements with those found in the three vended academic electronic health records. The results indicated a need for alignment to the research literature, expert consensus, and technical standards similar to what is expected for electronic health records used in clinical practice because of a lack of ideal state data elements. The findings align with ongoing issues with bias and disparities seen in the care of the lesbian, gay, bisexual, and transgender population and a lack of diverse, inclusive media and teaching technologies in health science education. The quality project and findings can inform academic electronic health record vendors on how they can create more inclusive systems and bring awareness to healthcare educators about the potential for implicit and explicit bias in their teaching technologies.

Promoting patient safety using electronic medical records in nursing/midwifery undergraduate curricula: Discussion paper

This discussion paper highlights the importance of Australian nursing and midwifery students' lack of exposure to electronic medical records during their undergraduate programs. There is pressure on universities offering nursing and midwifery programs to provide students with opportunities to learn to use patient electronic medical records. This will provide authentic rehearsal with the digital technology prior to clinical placements and increase graduate work readiness. Informed by contemporary literature, we describe the benefits of implementing electronic medical records (eMR) in health organisations and identify the challenges and barriers to implementing and integrating the education of electronic records into undergraduate nursing and midwifery programs. Undergraduate students who had not experienced eMR as part of on-campus learning felt unprepared and lacked confidence when commencing clinical practice. Some international nursing and midwifery programs have found that student's skills improve in decision-making and documenting patient observations when eMR is integrated into their university education program. Successful integration of an eMR program should consider academic/teaching staff skills and confidence in technology use, initial and ongoing costs and technical support required to deliver the program. In conclusion, Australian universities need to embed eMR learning experiences into the nursing and midwifery undergraduate curricula to increase students work-readiness with a focus on patient safety.

Nurse educators' and students' experiences on electronic patient records: A multiple-methods study

BACKGROUND

The storage of patient records in electronic media is one of the most outstanding developments of the 21st century. This transformation in health required the teaching staff and students in nursing to adapt to this change.

OBJECTIVES

To determine nurse educators' and students' views and experiences about electronic patient records.

METHODS

A multiple-method approach was used in the study. The research sample consisted of 133 nurse educators and 366 nursing students from three public and three non-profit private universities in Ankara during the fall term of the 2019-2020 academic year. In the quantitative stage, data were collected with a data collection form prepared by the researcher. Data were obtained via semi-structured interviews with 14 nurse educators and 14 students at the qualitative stage. Descriptive statistics (number, percentage) were used to analyze quantitative data, and the content analysis method was used to analyze the qualitative data.

RESULTS

91 % of the nurse educators and 96.4 % of the students stated that they learned about electronic patient records through observation in a clinical setting. >70 % of the participants noted that including subject matters about electronic patient records in the nursing curriculum would be beneficial. In the qualitative phase, most nurse educators and students (n > 9) reported that they could not access the system because they did not have credentials. They stated that their experiences depended on the current users and were limited to observation; therefore, regulations regarding access to electronic patient records should be made.

CONCLUSIONS

The views and experiences of the nurse educators and students about the electronic medical record system were limited to getting help from observing clinical nurses since they could not be registered users in the system. Therefore, it is recommended to expand the teaching related to electronic patient records in the nursing education program, develop educational software, and make arrangements to provide access to electronic data during clinical applications.

Electronic Health Record Knowledge, Skills, and Attitudes Among Newly Graduated Nurses: A Scoping Review

Background This scoping review aimed to identify key characteristics related to electronic health record (EHR) end-user system optimization levels among graduating/newly graduated nurses. Method Using a systematic approach to conducting a scoping review, 11 articles were identified from three databases. Articles were reviewed for nursing level status, type of EHR used for research, type of assessment, and which EHR knowledge, skills, or attitudes were studied. Results The majority of the studies used a reported by evaluator approach that examined the accuracy of EHR documentation (e.g., skills). EHR knowledge was examined in two studies. No study examined EHR attitudes. Studies that reflected self-reported data mainly focused on EHR skills related to navigating, finding, utilizing, and showing and EHR knowledge gains. Conclusion Graduating/newly graduated nurses have gaps in EHR skills, knowledge, and attitudes. Simulation and EHR education are viable pedagogical approaches to building EHR end-user system optimization. [J Contin Educ Nurs. 2022;53(11):505-512.].

Using "Diraya" System as a Complementary Tool in Nursing Process Education: A Controlled Clinical Study

Background: Healthcare has been revolutionized by the application of information and communication technologies. The implementation of electronic health record systems improves the quality and safety of patient healthcare. Nursing students who start learning the nursing process without contact with real patients experience difficulties in its correct application. Purpose: To compare the acquisition of skills and competencies in the nursing process by undergraduate nursing students between conventional learning with books and learning with an academic electronic health record system (Diraya). Methods: A controlled experimental study was conducted and included 379 students with a mean age of 20.54 ± 5.09 years, enrolled in the “Nursing Process and Basic Care” degree course at the School of Health Sciences in Granada. All participants gave their informed consent and were allocated by convenience sampling to a control group (n = 187; 21.20 ± 5.77 years) or an experimental group (n = 192, 19.91 ± 4.24 years). Findings: The experimental and control groups did not differ in sex distribution (p = 0.20), mean age (p = 0.01), or previous knowledge of the nursing process (p = 0.96). The groups did not significantly differ in multi-choice test results on the acquisition of theoretical knowledge (p = 0.13). However, the experimental group scored higher on clinical case planning (9.47 ± 0.80 vs. 8.95 ± 1.17; p < 0.001), took less time to complete it (46.9 ± 8.76 min vs. 82.66 ± 13.14 min; p < 0.001), and needed fewer autonomous learning hours to prepare for the final examination (2.26 ± 2.41 vs. 9.58 ± 3.83; p < 0.001). Satisfaction with the program and the rating of its quality were generally higher in the experimental group, while greater difficulty with most phases of the nursing process was reported by the control group. Conclusions: The academic electronic health record system “Diraya” is a useful tool to improve the learning and implementation of the nursing process by undergraduate nursing students.

The critical need for advanced training of electronic records use: implications for clinical practice, education, and the advancement of athletic training

CONTEXT

The effective use of electronic records (ie, electronic health/medical records) is essential to professional initiatives and the overall advancement of the athletic training profession. However, evidence suggests comprehensive patient care documentation and wide-spread use of electronic records is still limited in athletic training. The lack of formal training and education for clinicians and students are often cited as primary barriers to electronic records use. Other healthcare disciplines have used academic electronic health records (AEHR) systems to address these barriers with promising results.

OBJECTIVES

To identify common challenges associated with the effective use of electronic records in clinical practice, discuss how an AEHR can address these challenges and encourage more effective use of electronic records, and describe strategies for deploying AEHRs within the athletic training profession.

DESCRIPTION

The AEHR is an electronic records system specifically designed for educational use to support simulation learning among all types of learners (eg, practicing clinicians, students). Mimicking the form and function of an EHR, the AEHR offers various educational tasks including patient care documentation projects, critical reviews of standardized patient cases, and assessments of patient care data for quality improvement efforts. Clinical and Research Advantages: Recent evidence suggests the use of an AEHR can improve knowledge and enhance skills. Specifically, AEHR use has been associated with enhanced attitudes toward EHR technology, enhanced informatics competencies, and improved documentation skills. Also, the use of an AEHR has been associated with improved critical thinking and decision-making skills. AEHRs appear to be valuable tools for health professions education and athletic training stands to benefit from AEHR use to better train and upskill clinicians and students alike for clinical practice. Although the implementation of an AEHR will require much time and large-scale coordinated efforts, it will be a worthy investment to address current challenges and advance the athletic training profession.

Restrictions on Nursing Students' Electronic Health Information Access

BACKGROUND

Restrictions on students' use of electronic health information have been anecdotally reported as a threat to clinical learning, development of informatics competency, and adherence to personal health information privacy laws. However, evidence on which informatics education and policy strategies can be designed is lacking.

PURPOSE

This study describes the scope of nursing students' access to and use of electronic health information systems as reported by clinical instructors.

METHODS

Clinical faculty (n = 193) in prelicensure programs from 25 states completed the online survey.

RESULTS

Students are often restricted in retrieving patient health information, charting assessment data and delivered care, and using medication administration systems. Students alternatively use faculty or staff nurses' system security access.

CONCLUSIONS

Results suggest the need for critical review of nursing curriculum related to informatics competency and clinical site health records access policies.

Use of academic electronic medical records in nurse education: A scoping review

BACKGROUND

Use of academic electronic medical records is internationally recognised as a means for preparing health professional students for the digital healthcare environment. Reported practice benefits include skills for electronic documentation, health informatics, point-of-care clinical decision support systems, as well as preparation for information technology-enabled clinical settings, while challenges include lack of access to simulation software, faculty-related barriers, limited finances and educational software costs. However, little is known about best practices related to its use within pre-licensure or entry-to-practice nursing curricula and impact on clinical practice outcomes.

OBJECTIVE

This review sought to explore how academic electronic medical records are used in entry-to-practice nursing curricula.

DESIGN

A scoping review guided by the Joanna Briggs Institute three-step search strategy, exploring existing publications and grey literature.

INCLUSION CRITERIA

Quantitative and qualitative studies related to use of academic electronic medical records in pre-licensure nurse education.

INFORMATION SOURCES

A range of databases were searched including CINAHL, Medline, Proquest Central, ERIC, ScienceDirect, PubMed, IOS Press, as well as grey literature, reference lists and handsearching.

REVIEW METHODS

The search yielded 580 articles, from which inductive thematic analysis of 34 included studies was conducted.

RESULTS

Included articles were nine qualitative, 21 quantitative and five mixed methods studies. Most originated from the USA. Academic electronic medical records are mainly used to teach documentation, safe use of health technology, and for clinical preparation. Most are used for fundamental or junior levels courses, with problem-based learning and simulation embedded. Institution's technology resources and faculty capability are essential to implementation.

CONCLUSIONS

There is a need for more research that examines optimal timing and duration of use of academic electronic medical records in curricula, and their impact on critical thinking and clinical performance. Finally, there is a need to explore greater academic-clinical partnerships in the education process.

Quality Improvement Project to Enhance Student Confidence Using an Electronic Health Record

BACKGROUND

As the largest health care workforce, nursing is positioned to improve the health of populations using health information technology (HIT). Nurse graduates often lack confidence using HIT in practice, specifically, the electronic health record (EHR). Nurse scholars endorse the use of an academic electronic health record (AEHR) in nursing programs to provide students a safe learning platform to build levels of confidence using an EHR.

METHOD

A quality improvement project was completed to evaluate student learning outcomes, satisfaction, and sustainability of an AEHR. Using an interprofessional approach, nurse educators incorporated the Systems Life Cycle Model to adopt an AEHR in two prelicensure nursing programs.

RESULTS

Students' levels of confidence using an EHR in clinical settings increased markedly. Satisfaction rates for using an AEHR were high.

CONCLUSION

Integration of an AEHR in nursing education contributes to building a proficient nursing workforce confident in using HIT for health care quality. [J Nurs Educ. 2021;60(6):337-341.].

Integrating an Innovative, Cost-Effective Electronic Documentation System for Undergraduate Nursing Students

Over the past 15 years, the use of electronic medical record systems in the healthcare setting has grown exponentially. Accurate input of patient data is critical to facilitate safe care and effective communication among all members of the healthcare team. To keep pace with the practice environment, nursing students must have the opportunity to document health-related information in an electronic medical record early in the educational program. The purpose of this project was to create a cost-effective electronic medical record system for undergraduate nursing students to learn appropriate documentation of patient-related findings. Patient-centered care, informatics, and safety were the focus topics from the Quality and Safety Education for Nurses project included in the development of this endeavor. Faculty worked in collaboration with the university's information technology department to develop an innovative electronic medical record to be used in physical assessment, which is the first course in the nursing curriculum. Positive feedback was obtained from students and faculty about the project. It is important to provide students with the opportunity to experience electronic documentation to effectively prepare them for the ever-changing practice environment.

Using virtual simulation and electronic health records to assess student nurses' documentation and critical thinking skills

INTRODUCTION

Electronic health records have become a standard documentation platform to house patient information in most US hospitals. To improve documentation, providers suggest establishing electronic health record user education at the classroom level so students can interact with patient data early. The purpose of this study was to assess student nurses' clinical documentation and critical thinking skills using virtual patients and a simulated electronic health record system.

METHODS

Eighty-four undergraduate nursing students completed assessments on four assigned virtual patients and entered their findings into a simulated electronic health record system. Benner's five stage novice to expert theory was used to evaluate performance of six assessment items.

RESULTS

Significant differences (p = 0.046) were seen in median scores between the first and second assignments, and between the second and fourth assignments (p = 0.021) with minimal improvements from one assignment to the next.

DISCUSSION

Data entered in the electronic health record showed that students started at an advance beginner's level and moved to be proficient in documenting basic patient information using critical thinking skills by the end of the first semester.

CONCLUSION

It is important to expose students to electronic health record systems before entering the workforce or while training in a hospital setting to enhance readiness for clinical practice with electronic documentation and critical thinking skills.

Introduction of patient electronic medical records (EMR) into undergraduate nursing education: An integrated literature review

BACKGROUND

To prepare student nurses for clinical practice where patient electronic medical records (EMR) competence is required, nursing undergraduate curricula must provide simulation access to developing this skill set. At this stage, however, the integration of electronic documentation into the Australian undergraduate nursing curriculum has been piecemeal. Aim The aim of this integrated literature review was to identify benefits and challenges for faculty nursing staff and nursing students in relation to the integration, use and evaluation of EMR in an undergraduate nursing program.

METHODS

A systematic search of relevant peer-reviewed research and project report articles was conducted in the electronic databases. Generic qualitative thematic analysis was then undertaken with themes generated from the data itself.

RESULTS

Fifty eight articles were identified, of these 23 were found to meet the inclusion criteria. Three major themes were identified: 1) Advantages of using EMR in academic settings, 2) Identified Challenges and Limitations of EMR programs; and 3) Developing an academic EMR program and implementing EMR education program in stages. All papers acknowledged that EMR will be standard in healthcare and should be viewed as an 'essential tool' for inclusion in undergraduate nursing programs.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

There is a significant increase of electronic technology in healthcare settings, especially relating to patient documentation. Therefore, teaching the use of EMR in the simulated clinical learning environment for new healthcare providers such as nursing students is essential. The papers reviewed identified an urgent need for higher education nursing programs to support undergraduate nursing students and faculty staff to ensure EMR can be implemented effectively into the undergraduate nursing curriculum.

Academic electronic health records as a vehicle to augment the assessment of patient care skills in the didactic pharmacy curriculum

INTRODUCTION

Standards 2016 state students must be "practice-ready" upon graduation and utilizing health information technology is one skill needed to ensure students are practice-ready. Incorporating academic electronic health records (EHRs) into the didactic pharmacy curriculum is one tool for preparing students to be practice-ready, but it is unclear if this technology is used to facilitate assessment of students' patient care skills.

METHODS

A 35-question electronic survey was distributed to each school/college of pharmacy (S/COP) with questions focused on general use of EHRs and characterizing EHRs as a tool to assess students' patient care skills in the didactic curriculum. Aggregate, anonymous data was reported and analyzed using descriptive statistics.

RESULTS

Fifty-nine survey responses were suitable for inclusion in the analysis (43.8% response rate). Of those, 37 S/COP (62.7%) used an EHR in the didactic curriculum. Frequently performed and assessed EHR functions were collecting information and documentation, and EHRs were most commonly utilized to assess students' abilities to perform the collect (96.9%) and assess (93.8%) steps of the Pharmacists' Patient Care Process. EHRs were perceived to be most effective in assessing the following Center for the Advancement of Pharmacy Education Educational Outcomes: patient-centered care (93.9%), problem solving (83.9%), and learner (80.6%).

CONCLUSIONS

Optimizing the use of EHRs in S/COP is critical. Determining which outcomes are best suited to be assessed utilizing this technology and the optimal method to do so is an appropriate next step.

Using simulation and electronic health records to train nursing students in prevention and health promotion interventions

BACKGROUND

Prevention and health promotion activities are key to reducing prevalence and halting the progress of many chronic diseases. Standardised patient simulation is a useful option for training nursing students in this area.

OBJECTIVE

To evaluate skills related to prevention and health promotion activities acquired by third-year nursing students through standardised patient simulation and electronic health records.

DESIGN

A descriptive, cross-sectional study.

SETTINGS

A nursing faculty at a public university.

PARTICIPANTS

The study population consisted of all third-year nursing students in the academic year 2017-2018 (N = 142).

METHODS

The students attended three seminars on health promotion and prevention activities in adults, involving standardised patient simulation and electronic health record use. Skill acquisition was then evaluated through clinical case simulation in a fourth seminar.

RESULTS

A total of 137 (96.5%) students participated in the study. The mean score for all cases evaluated was 6.76 (standard deviation 1.85) out of 10. The most frequent activities were greeting and self-introduction, checking vaccination status, assessing physical exercise and eating habits, and calculating body mass index. The least frequent activities were questions about high-risk sexual behaviour, drug use, bowel cancer screening and sun protection recommendations. When writing the nursing report, students found it hardest to plan future patient interventions. Also, 108 students made notes to set reminders of case-related activities.

CONCLUSIONS

Third-year nursing students acquire good skills in health promotion and prevention activities. Some activities requiring a greater degree of confidence with the patient need to be reinforced, such as investigating high-risk sexual behaviour and drug use. Reinforcement is also needed in activities that are encountered less often in clinical practice, such as sun protection recommendations and bowel cancer screening. The use of electronic health records in conjunction with simulation enhances self-study.

A Review of Clinical Informatics Competencies in Nursing to Inform Best Practices in Education and Nurse Faculty Development

AIM

The aim of this literature review was to determine the state of the science related to clinical informatics competencies of registered nurses and to determine best practices in educational strategies for both nursing students and faculty.

BACKGROUND

Continued emphasis on the provision of evidence-based patient care has implications for requisite informatics-focused competencies to be threaded throughout all levels of nursing educational programs.

METHOD

Whittemore and Knalf's five-step integrative review process guided this research. An extensive search yielded 69 publications for critical appraisal.

RESULTS

Results suggest nursing educational programs do not adhere to standardized criteria for teaching nursing informatics competencies. Another identified literature gap was the scarcity of research related to informatics training requirements for nurse educators.

CONCLUSION

Findings support the need for continued research to provide clear direction about the expected clinical informatics competencies of graduate nurses and what training faculty need to facilitate student learning.