Training The Next Generation

Beckie Kelly Schuerenberg, Senior Editor
Health Data Management Magazine, July 1, 2008

Last fall, University of South Florida Health in Tampa added a new class to its medical school curriculum. But instead of focusing on an emerging disease or care regimen, the class provides instruction on how to use electronic health records.

The two-hour, single-session class covers various EHR topics, including security and specific uses. And now all USF medical students must take it at the beginning of each school year

USF Health created the EHR class at the suggestion of a new administrator who wanted the school to help prepare its students to work at clinics that use the technology. While the inaugural class didn’t require students to be tested on the material, the school plans to add tests next year, says Michael P. Williams, technical trainer at USF Physicians group, a 450-physician, multi-specialty group practice affiliated with the school.

USF Health also plans to expand the class to include information about different types of EHRs and how they integrate with billing systems, he adds. The inaugural class only focused on the use of an EHR from Allscripts LLC, Chicago, the software used at the USF practice. “Clinics are moving into EHRs,” Williams says. “So we want to keep our students the ones that clinics want to bring in.”

Medical students previously were exposed to clinical information systems only during their third and fourth years if they came into contact with them as part of their clinical training at hospitals or physician practices. But over the past few years, many medical schools have begun a new approach to teaching future doctors about electronic records, says Morgan Passimort, director of information resources outreach and liaison for the group on information resources for the Association of American Medical Colleges, Washington.

“There’s been a concern that students aren’t familiar with the situations they are going into with EHRs,” she says. “So now we are seeing institutions really evaluating what tools are most effective and sometimes learning from students how they want to use information in care.”

Medical schools, however, run the gamut in their approach to EHR instruction, Passimort says. Some, like USF Health, offer an introductory class at the beginning of each school year. Others integrate EHR training into their entire four-year curriculum.

The EHR training strategy medical schools take often is a result of the financial and technical resources available to support the effort, Passimort contends. But she believes medical schools will continue to ramp up their I.T. training.

Secure Environment

To enable students to use the records software at the USF practice without accessing private patient data, Allscripts duplicated the system on a separate server that could be populated with mock data. The duplicate system has the same features, functionalities and periodic upgrades as the application in use at the USF practice.

Students are given a user name and password to access the system on PCs during the class or via a Web portal if they want to refer to it later. While some have complained the class just adds to their busy schedules, others have embraced it, anticipating they’d need to use an EHR in their future practice, Williams says.

The school continues to teach future physicians how to use paper charts, just in case they find work in a facility lacking electronic records, Williams says. And while the class will continue to mostly focus on the Allscripts system, it also will help students prepare for using different EHR applications, he adds.

“We just want to give students some EHR exposure so hospitals will know they’ve been trained in it,” Williams says. “It will give them a foot up as they go into their practice.”

A broader Initiative

Several years ago, leaders at the College of St. Scholastica wanted to do more than just offer their medical students an introductory class in EHRs.

So the Duluth, Minn.-based school worked with Kansas City, Mo.-based Cerner Corp. to develop a model records system that’s now integrated into every medical course it offers. It began the Athens project in 2002 after receiving a $1.8 million grant from the Department of Education to conduct the initiative.

“We didn’t want our students going into medical organizations needing to be trained on EHRs,” says Shirley Eichenwald-Maki, the Athens project director and assistant professor of health information management. “We wanted to bring the EHR into the curriculum so it could support all our health professions. It was the primary central application that everyone can benefit from.”

After the model EHR was designed, the college solicited de-identified medical records of past patients from its alumni to use in the system. After receiving 50 responses, project leaders entered the mock data into the system and created training cases for it to be used with all levels of students.

The vendor then trained instructors on the system, which the college uses via the application service provider computing model.

In fall 2004, the college began giving each medical student a user name and password to access the system. Students use the application on mobile carts during classes and on their own via PCs or other mobile hardware.

“Students can use the EHR in any class as a tool for an assignment, demo or other hands-on experience,” Eichenwald-Maki says. “It’s embedded into all their courses. Our nursing program redesigned its curriculum to put EHRs in it.”

The college also worked with the vendor to develop a subscription service that would enable other medical schools to use the mock EHR.

Now in its sixth year of the project, the college has begun funding the maintenance of the mock EHR software with the revenue it receives from the subscription service.

Not For Everyone

Not all medical schools, however, have been as aggressive in formally educating students about EHRs.

While there’s a general move toward technology training, the formal education around EHRs has been lacking, contends Michael Ehlert, M.D., national president at the American Medical Student Association, Reston, Va.

“We haven’t seen education follow as closely as provider organizations in wanting to implement this technology,” he says. “There are some places that have done a good job. But most schools are just scratching the surface.”

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