A Pilot to Improve Professional Competence and Safety through the Use of Clinical Information Systems and Healthcare Technology in Nursing and Allied Health Clinically-Based Courses

Purpose: The goal of this project is to develop, implement, and evaluate an innovative teaching strategy designed utilizing a simulated clinical information system (CIS), specifically a simulated electronic health record (EHR), within the classroom and simulation lab. Concepts central to utilization of clinical information systems are introduced early in the program, but hands on experience with these technologies is limited. Providing access to and experience in the use of a simulated EHR as part of the curriculum will allow faculty to guide students in developing the skills necessary to become safe, competent practitioners. Although simulation has been used in medical and nursing education, the use of the EHR as part of that educational experience is just beginning to be explored. The proposed integration of the EHR technology into the curriculum has the potential to decrease student anxiety and increase student confidence. Preparing students to care for patients in a variety of clinical settings through experiences that are focused on improving their knowledge, skills, and attitudes has the potential to demonstrate a positive impact on patient safety and quality of care now, as well as after graduation. 

Methods: This interprofessional pilot is being implemented in the fall and spring semesters of the 2014-2015 academic year. Junior level nursing and respiratory students will receive access to a web-based, simulated EHR system for one academic semester. The EHR may be accessed from any computer or smart device and will be utilized within the classroom and simulation lab. Within the classroom the EHR will be used in conjunction with assignments designed to guide students in preparing for lecture. In the simulation lab students will experience a simulation session each week for 10 weeks. The EHR will be incorporated into each patient scenario and will focus on common conditions not often experienced or managed by undergraduate students in the clinical setting. Each scenario will require student utilization of the EHR to enhance assessment of the patient through accessing Past Medical History (PMH), current orders, and lab/test results. Students will use this information to guide patient care, safely administer medications, and refine documentation skills. Additionally, faculty is developing a senior-level special topics healthcare course (3 credit hours) which will be implemented during in fall 2015. Students enrolled in this pilot will be given the option to enroll in the healthcare course. The capstone project for these students as seniors will include the development and implementation of their own unfolding case study. 

Evaluation includes a pre-post test on navigation of the EHR system in the form of a scavenger hunt developed for Neehr Perfect®. The Lasater Clinical Judgment Rubric will be utilized by faculty viewing video of the lab simulation to determine if students are showing continued improvement in the development of their clinical judgment. Use of this tool will also provide students with an understanding of expectations within a simulation experience and faculty with a means of discussing with students their progress towards developing this essential skill. The last evaluation method will be a faculty developed satisfaction survey related to the experience of utilizing the EHR in the classroom and simulation lab settings. This survey will be utilized to gather data from students in a focus group format led by a faculty member not directly involved in the simulation portion of the study. 

Results: This is an ongoing study. Data from the first semester has been collected. Recordings of the focus groups are currently in the process of being transcribed. Data analysis will occur in May 2015 and the results from phase one of this pilot (implementation of the ERH in the 2014-2015 academic year) will be available in June 2015.

Conclusion: This is an ongoing study. Conclusions from phase one of this pilot will be available in June 2015.