There is a lot of discussion recently about incorporating electronic health record (EHR) into simulations. Which vendor? Which product? What features are needed? The disturbing thing about most of these discussions in my mind is that no one is talking about what they are trying to accomplish with the inclusion of electronic health records into the simulation environment.
What is the purpose of the EHR in it in a simulation? Is it simply to provide realism? If so, is the EHR that is implemented likely to be the one in the practice environment experienced by the student? Because if not, it is missing the mark likely adding confusion as well as increasing the orientation time necessary for a given simulation. Is the EHR supposed to provide crucial information that will help make healthcare decision during the simulation encounter? Is the entire simulation designed around an efficient query for specific information of a patient’s history? Are entries in the EHR made by the participants of simulation going to be analyzed for knowledge or critical thinking regarding a case? There are so many possibilities! I would argue however that integrating the EHR into the simulation simply for reality will likely be a colossal waste of time.
Much like any other component included in simulation the EHR should be included thoughtfully and carefully driven by needs analysis based on the learning objectives of the educational encounter. EHR technology can be overwhelming by itself to understand and navigate, combined with the fact that there are many different types of systems for different practice environments make it unwieldy to become expert in all brands, systems or examples.
Similarly, it if you have successful implementation of the EHR into your simulations I would recommend that you carefully decide for each and every simulating counter whether you need to include it or not. Again, this decision should rest upon the learning objectives and the intended educational outcomes of the event. Interacting with the EHR can be a time-consuming, frustrating part of the delivery of healthcare and it is up to the creator of the educational encounter to determine the usefulness and necessity of such integration.
The thoughtful use of EHR into select simulated encounters can significantly lead to increased observations of critical thought process, attention to detail, as well as overall understanding of the depth and breadth of understanding of a given case. Additionally it could serve as another avenue for assessment. If the integration of the EHR is predicated around these efforts and clearly the addition of the EHR component is both worthwhile and necessary. Additionally, simulations involving workflow and human factors can possibly benefit from such integration knowing that in today’s delivery of healthcare the interaction with the EHR is a daily reality.
I must close however with reminding the simulation community it is not our job to re-create reality, it is our job to create an innovative educational encounter from which we can form opinions to engage in discussions to help healthcare providers on their quest towards excellence.