Learning to navigate through an electronic medical record (EHR) can be daunting for any student and while becoming proficient in healthcare technology is a must for those pursing certain careers in healthcare, it takes time and practice in order to fully become comfortable navigating through different systems and networks.
Medication reconciliation is one of the National Patient Safety Goals set forth by The Joint Commission1. It is defined as a process of comparing the medications a patient is taking (or should be taking) with newly ordered medications1. Poor, or lack of, medication reconciliation constitutes a significant risk for medication discrepancies that can result in adverse drug events, and it has been shown that pharmacist involvement in admission and discharge medication reconciliation can significantly reduce medication errors. However, this requires students not only know how to appropriately gather information, but to also understand how to effectively navigate through electronic health technology as well.
The goal of meaningful use technology is to improve clinical outcomes by reducing errors related to the patient’s medications through the use of electronic health records (EHR) technology2. In an era where 95% of critical access Medicare hospitals participate in meaningful use technology, and Medicare and Medicaid programs have now offer financial incentives to hospitals and providers that utilize meaningful technology, it is essential for pharmacy students to have exposure to electronic health records (EHR) technology prior to graduating given its high use in the real world2. While advanced pharmacy practice experiences (APPEs) provides students access to EHR technology throughout the year, students are extremely limited given they cannot legally perform final verification checks and the concern for patient safety and privacy, which is where simulation and order verifications activities can bridge the gap2.
Simulation exercises have the potential to provide a more in depth learning experience for students, which has the impact to improve learning outcomes and enhance performance for students not just on APPEs, but also in the classroom. Prior to EHR simulations, many students had reported feeling inadequate with regards to EHR technology. For example, a University reported that approximately 70% of their pharmacy students had stated having some experience in using HER technology, but still possessed low confidence when having to perform typical pharmacist duties3.
Previous studies on EHR technology in pharmacy describes its use primarily for collecting subjective and objective data in order to develop assessments and plans for SOAP notes2. In 2019, the American Joint Task Force on Informatics (AACP) recognized that EHR technology played a vital role in the pharmacy curriculum and could be used as a tool to ensure new pharmacy graduates are prepared for their duties when “Fulfilling a mediation order4.”
Recent studies have taken a closer look at EHR simulations to determine their effectiveness in the pharmacy curriculum. In 2018, a prospective study conducted in a cardiovascular therapeutics course set out to evaluate the impact virtual EHR technology had on students capabilities compared to patient based scenarios alone. Students were randomized to use a virtual EHR with patient simulation or to a patient simulation alone. The efficiency of learning was assessed by the time to optimal recommendation for each scenario. The use of the virtual EHR decreased the amount of time needed to provide the optimal treatment recommendations by 25% compared to the control2. The virtual EHR also significantly improved students’ perceptions of their clinical skills, communication, and satisfaction compared to the patient simulation alone2. The virtual EHR established value in learning productivity while also providing students the opportunity to engage with technology comparable to the technology in today’s health care practice2.
There have been various studies at other institutions, such as McWhorter School of Pharmacy, Concordia University Wisconsin, and even the University of Maryland that have all demonstrated significant changes in performance and confidence in pharmacy students after exposure to simulated EHR technology5. As the field of pharmacy and healthcare continues to change and become more technologically advanced it is crucial that the pharmacy curriculum takes every opportunity to ensure its students can keep up with an ever changing field.
References:
1. Barnsteiner JH. Medication Reconciliation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 38.
2. Ives AL, Tucker SR, Trovato JA. Using Electronic Health Record Technology to Teach Inpatient Medication Order Verification to Pharmacy Students. Am J Pharm Educ. 2020;84(8):ajpe7534. doi:10.5688/ajpe7534
3. Coons JC, Kobulinsky L, Farkas D, Lutz J, Seybert AL. Virtual Electronic Health Record Technology with Simulation-Based Learning in an Acute Care Pharmacotherapy Course. Pharmacy (Basel). 2018;6(4):123. Published 2018 Nov 28. doi:10.3390/pharmacy6040123
4. Haines ST, Pittenger AL, Stolte SK, et al. Core entrustable professional activities for new pharmacy graduates. Am J Pharm Educ. 2017;81(1):ArticleS2
5. Skelley JW, Wulz JL, Thibodeaux AM. Implementation of an electronic medical record simulation activity aligned with the Pharmacist Patient Care Process in an ambulatory care elective course. Pharm Educ. 2018;18(1)91-98
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