Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
J Am Med Inform Assoc. 2018 Nov 1;25(11):1501-1506. doi: 10.1093/jamia/ocy105.
Electronic health record (EHR) simulation with realistic test patients has improved recognition of safety concerns in test environments. We assessed if simulation affects EHR use patterns in real clinical settings.
We created a 1-hour educational intervention of a simulated admission for pediatric interns. Data visualization and information retrieval tools were introduced to facilitate recognition of the patient's clinical status. Using EHR audit logs, we assessed the frequency with which these tools were accessed by residents prior to simulation exposure (intervention group, pre-simulation), after simulation exposure (intervention group, post-simulation), and among residents who never participated in simulation (control group).
From July 2015 to February 2017, 57 pediatric residents participated in a simulation and 82 did not. Residents were more likely to use the data visualization tool after simulation (73% in post-simulation weeks vs 47% of combined pre-simulation and control weeks, P <. 0001) as well as the information retrieval tool (85% vs 36%, P < .0001). After adjusting for residents' experiences measured in previously completed inpatient weeks of service, simulation remained a significant predictor of using the data visualization (OR 2.8, CI: 2.1-3.9) and information retrieval tools (OR 3.0, CI: 2.0-4.5). Tool use did not decrease in interrupted time-series analysis over a median of 19 (IQR: 8-32) weeks of post-simulation follow-up.
Simulation was associated with persistent changes to EHR use patterns among pediatric residents.
EHR simulation is an effective educational method that can change participants' use patterns in real clinical settings.
使用真实测试患者进行电子健康记录（EHR）模拟已提高了对测试环境中安全问题的认识。我们评估了模拟是否会影响真实临床环境中的 EHR 使用模式。
我们为儿科住院医师创建了一个 1 小时的模拟入院教育干预。引入了数据可视化和信息检索工具，以方便识别患者的临床状况。使用 EHR 审核日志，我们评估了居民在模拟暴露之前（干预组，模拟前），模拟暴露之后（干预组，模拟后）以及从未参与过模拟的居民（对照组）中访问这些工具的频率。
从 2015 年 7 月至 2017 年 2 月，有 57 名儿科住院医师参加了模拟，而 82 名住院医师未参加。模拟后，居民更有可能使用数据可视化工具（模拟后周的 73％比模拟前和对照组周的总和的 47％，P <.0001）以及信息检索工具（85％比 36％，P <.0001）。在校正以之前完成的住院服务周数衡量的居民经验后，模拟仍然是使用数据可视化（OR 2.8，CI：2.1-3.9）和信息检索工具（OR 3.0，CI：2.0-4.5）的重要预测因素。在模拟后的中位数为 19（IQR：8-32）周的中断时间序列分析中，工具的使用并未减少。
模拟与儿科住院医师的 EHR 使用模式持续变化有关。
EHR 模拟是一种有效的教育方法，可以改变参与者在真实临床环境中的使用模式。
