Creation and validation of a training toolkit to ensure safe and proficient use of EHR by medical scribes

创建和验证培训工具包，以确保医疗抄写员安全、熟练地使用 EHR

• 批准号: 9284346
• 负责人: JEFFREY A. GOLD
• 金额: $ 39.93万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9284346
• 关键词: Creation; validation; training; toolkit; ensure

With the widespread adoption of Electronic Health Records (EHRs) there has been a growing appreciation of the unintended consequences associated with their adoption and specifically the negative impacts on productivity and workflow. Consequently, there has been dramatic growth in the use of medical scribes to aid providers by, in essence, “untethering the provider from the EHR”. In spite of this rapid growth, and the purported benefits on improving physician efficiency and improved billing, there is little to no regulation on standardization of scribe training, nor any assessment of their ability to safely interface with the EHR. To better understand the role and functionality of scribes, we undertook a national survey of health care providers. We found that scribes comprise a wide range of personnel from college students to Medical Assistants. There is wide variability in their training, with the majority of scribes receiving job specific training by the hiring practice. In terms of scribe function, again there was wide variability in scribe activities with relation to the EHR, from simple encounter note creation, to finding information in the EHR for the physicians to entering orders and responding to patient messages. We directly assessed scribe function at OHSU in a novel video based virtual simulation. We found that there is tremendous intra-scribe variability in note creation and structure. This corresponds to significant errors of omission and commission (incorrect information entered into the system). Specifically, the average scribe captured only 40% of the diagnoses or plans mentioned in the simulation with less than 40% overlap in documentation between scribes. Further, every scribe documented a number of incorrect plan and diagnosis items. Combined, these data suggest a new and potentially significant safety issue with scribe use of the EHR. Therefore the goal of this proposal is to fully assess the scope of scribe use with respect to the EHR and use this information in conjunction with national experts in EHR safety and medical documentation to establish a series Entrustable Professional Activities (EPAs) for medical scribes. We will use these as basis to create and validate a toolkit to allow for organizations to assess the ability of scribe to complete these EPAs. In Aim #1, we will use a combination of surveys and site visits to assess the landscape of scribe functionality. This information will then serve as the basis for a consensus conference to define scribe Entrustable Professional Activities (EPAs) with respect to the EHR. In Aim #2 we will map these EPAs to a set of competencies and create a curriculum to assess these competencies. This curriculum will contain a series on online EHR didactics and video based simulation exercises with corresponding simulated EHR records to asses real world performance of scribes. In Aim #3, we will calibrate and validate this curriculum across a variety of specialties and EHR use expectations with current scribes. In Aim #4, we will hold another consensus conference to review the curricular elements and use the results to create an online toolkit to allow providers and health care organization to assess scribe competency. Thus by the end of the study period we will have a web based, comprehensive toolkit to allow for real-world assessment of safe and accurate use of EHR by medical scribes across a range of EHR functional levels and a variety of specialties and environments.

随着电子健康记录（EHR）的广泛采用， 与其采用相关的意外后果，特别是对生产力的负面影响， 工作流因此，在使用医学抄写员来帮助提供者方面出现了急剧增长，从本质上讲， “将提供者从EHR中解放出来”。尽管增长迅速，而且据称改善 医生的效率和改善的计费，有很少或没有规范标准化的抄写员培训，也没有任何 评估他们与EHR安全接口的能力。为了更好地理解抄写员的作用和功能， 我们对保健提供者进行了一次全国性的调查。我们发现抄写员包括各种各样的人员 从大学生到医疗助理。他们的训练有很大的差异，大多数抄写员 通过招聘实践接受具体工作培训。就抄写功能而言，抄写功能也有很大的变化， 与EHR相关的活动，从简单的遭遇笔记创建，到在EHR中查找信息， 医生输入订单和响应病人的消息。我们直接评估了OHSU的抄写员功能， 基于视频的虚拟仿真我们发现，在音符的创作中， 结构这对应于重大的遗漏和错误（输入的信息不正确）。 系统）。具体来说，平均抄写员只捕获了模拟中提到的40%的诊断或计划， 抄写员之间的文档重叠不到40%。此外，每个抄写员都记录了一些不正确的计划， 和诊断项目。结合起来，这些数据表明，使用scribe的新的和潜在的重大安全问题， 电子病历因此，本提案的目标是充分评估与EHR相关的抄写员使用范围，并使用 与EHR安全和医疗文档方面的国家专家一起提供信息，以建立一系列 医学抄写员的可委托专业活动（EPA）。我们将使用这些作为基础来创建和验证工具包 允许组织评估抄写员完成这些EPA的能力。在目标#1中，我们将使用以下组合： 调查和实地访问，以评估抄写员的功能。这些信息将作为基础， 共识会议，以定义关于EHR的可委托专业活动（EPA）。在目标#2中，我们 将这些EPA映射到一组能力，并创建一个课程来评估这些能力。本课程将 包含一系列在线EHR教学法和基于视频的模拟练习，以及相应的模拟EHR记录 来评估抄写员在真实的世界中的表现。在目标3中，我们将在各种环境中校准和验证本课程， 专业和EHR使用当前抄写员的期望。在目标4中，我们将举行另一次共识会议， 审查课程内容，并利用结果创建一个在线工具包， 组织来评估抄写员的能力。因此，在研究期结束时，我们将有一个基于网络的，全面的 一个工具包，允许医疗记录员在一系列EHR中对EHR的安全和准确使用进行真实评估 功能级别以及各种专业和环境。