Date Published: May 12, 2009
Publisher: Public Library of Science
Author(s): Jonathan U. Peled, Oren Sagher, Jay B. Morrow, Alison E. Dobbie
Abstract: Background to the DebateBackground to the debate: Many countries worldwide are digitizing patients’ medical records. In the United States, the recent economic stimulus package (“the American Recovery and Reinvestment Act of 2009”), signed into law by President Obama, includes $US17 billion in incentives for health providers to switch to electronic health records (EHRs). The package also includes $US2 billion for the development of EHR standards and best-practice guidelines. What impact will the rise of EHRs have upon medical education? This debate examines both the threats and opportunities.
Partial Text: While the electronic health record (EHR) is a long-overdue innovation in medicine, studies have shown that such records may lead to frustration on the part of health care providers and even harmful outcomes in patients ,. We also believe that the EHR could have a harmful impact upon medical education.
EHRs are the future of health delivery in the United States, although their current adoption is far from universal . The potential benefits of EHRs in terms of improved patient care outcomes have yet to be realized. In a 2007 study of 1.8 billion ambulatory visits, use of an EHR resulted in no better outcomes in 14 of 17 health measures . Why have EHRs so far failed to deliver on much of their promise?
Morrow and Dobbie make a case that with appropriate training of faculty and students, EHRs can enhance medical education. We welcome their recent small pilot study suggesting that teaching medical students EHR-specific communication skills may improve their communications with patients (as assessed using a standardized patient) . We hope that faculty will be as receptive to similar interventions. In Morrow and colleagues’ study, the researchers assessed whether or not students organized the clinical setting in a way that allowed the standardized patient to see the computer monitor. This aspect of their study underscores the importance of installing equipment (that is often physically secured and immobile) with an eye toward how it will affect the interactions of the humans who use it.
We end this collegial debate on the role of EHRs in medical education with consensus on several fundamental points: (1) The EHR holds an inexorable, prime role in the heath care environment of the 21st century; (2) “The EHR is only as good as its user”; (3) Faculty development around EHR education is key; and (4) It is the role of medical education to provide “standardized knowledge metrics and skills assessments.”