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

随着电子健康记录(EHR)的广泛采用，人们越来越多地认识到 与采用它们相关的意外后果，特别是对生产力的负面影响和 工作流程。因此，在使用医疗抄写员来帮助提供者方面有了戏剧性的增长，从本质上说， “将提供商从EHR中解脱出来”。尽管有这种快速增长，而且据称改善的好处 医生的效率和帐单的改进，几乎没有关于抄写员培训标准化的规定，也没有 评估他们与电子病历安全对接的能力。为了更好地理解抄写员的角色和功能， 我们对卫生保健提供者进行了一项全国性调查。我们发现抄写员由各种各样的人员组成。 从大学生到医疗助理。他们的培训有很大的差异，大多数是抄写员 通过招聘实践接受岗位培训。在抄写功能方面，抄写也有很大的差异 与电子健康记录相关的活动，从创建简单的遭遇记录到在电子健康记录中查找 医生需要输入命令并回复患者消息。我们直接评估了OHSU的抄写员功能 新颖的基于视频的虚拟仿真。我们发现，在音符的创建和编辑过程中，存在着巨大的脚本内可变性 结构。这对应于重大的遗漏和委托错误(在 系统)。具体地说，平均每个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计划 和诊断项目。总而言之，这些数据表明了一个新的潜在的重大安全问题，即抄写员使用 啊哈。因此，本提案的目标是充分评估与电子健康记录相关的抄写员使用范围，并使用 信息与电子病历安全和医疗文件方面的国家专家一起建立了一系列 医学书记员的可委托专业活动(EPA)。我们将使用这些作为创建和验证工具包的基础 使组织能够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 调查和现场访问，以评估抄写员功能的情况。然后，此信息将作为 协商一致会议，确定关于电子病历的书记员可委托的专业活动(EPA)。在Aim#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 包含一系列关于在线EHR教学和基于视频的模拟练习，以及相应的模拟EHR记录 评估抄写员在现实世界中的表现。在目标#3中，我们将在各种不同的 专业和EHR使用对当前抄写员的期望。在目标4中，我们将举行另一次共识会议，以 审查课程内容，并使用结果创建在线工具包，以便提供者和医疗保健人员 评估抄写员能力的组织。因此，到研究期结束时，我们将拥有一个基于网络的、全面的 工具包，允许医疗记录员在一系列电子病历中对电子病历的安全和准确使用进行真实世界的评估 职能层次和各种专业和环境。

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.