March 1, 2021

Teaching EHRs: Tool gives medical students hands-on experience with electronic health records

Electronic health records (EHRs) are widely used in healthcare settings, yet they have not been widely integrated into the curriculum at most medical schools. That is why Regenstrief Institute worked with Indiana University School of Medicine through the American Medical Association (AMA) Accelerating Change in Medical Education initiative and then directly with the AMA to create the Regenstrief Teaching Electronic Medical Record (tEMR). 

tEMR currently contains more than 12,000 real patient records — all of which have been mis- or de-identified to protect patient privacy. This allows students to gain hands-on experience with EHRs. tEMR allows them to navigate records, document encounters, place orders and complete other tasks that reproduce the feel and capabilities of a real EHR. 

tEMR is being used at 12 universities across the country. 

Incorporating tEMR in the curriculum  

For example, last academic year, students from all nine Indiana University School of Medicine campuses participated in an online course utilizing tEMR. As part of the three-day exercise, students were presented with a case scenario. Their first task was to access the patient chart to review key information about the encounter and to write an admission order. At the conclusion of day, the case was advanced to simulate care progression.  

On the second day, students again accessed the chart and found the patient’s condition had changed. This staged the opportunity for chart review and clinical reasoning to determine what action should be taken. A progress note was created for capturing all the aspects of care. On the final day, students followed up with the patient case to prepare a discharge summary.  

“I believe using the tEMR was a very useful experience for the students as they were able to weave the EMR into all aspects of patient care,” said course leader Esteban Ramirez, D.O., MBA, a clinical assistant professor of medicine at IU School of Medicine. “Everything from admission orders, progress notes, to discharge summary were able to be put into the EMR in real time. This is a great tool for teaching our students how to appropriately use an EMR.” 

Research has shown that primary care physicians spend more than half of their workday interacting with EHRs. tEMR gives students necessary practice before they enter residency.  

“tEMR helps our students ready themselves for the clinical environment and approach their first rotations with more confidence and less anxiety,” said Bradley Allen, M.D., PhD, senior associate dean of medical education at IU School of Medicine.  “Exercises utilizing the tEMR are very helpful to closely approximate the clinical setting and interactions with the electronic health record. The ability of students to place orders and write notes for real cases allows them to go beyond basic clinical knowledge to exposure to the nuances of patient care in an authentic electronic health record platform.” 

Authentic clinical case material is key to meeting curriculum goals for student evaluation, engagement and mentoring. Many programs build clinical cases from scratch. By partnering with Regenstrief Institute and tEMR, customizing cases is far less burdensome and more realistic due to the vast database of patients and the authentic experience.  

The platform also offers unique tools for educators to create customized content specific to their curriculum goals and tools to enable instructors to easily evaluate and mentor students. 

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.  

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.  

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. 

About American Medical Association

The AMA is a powerful ally in patient care, giving strength to physician voices in courts and legislative bodies across the nation. The AMA is dedicated to driving medicine toward a more equitable future, removing obstacles that interfere with patient care and confronting the nation’s greatest public health crises.