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: 9750123
• 负责人: JEFFREY A. GOLD
• 金额: $ 39.36万
• 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/9750123
• 关键词: Creation; validation; training; toolkit; ensure; 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）的宽度采用，人们对 意想不到的后果与他们的采用相关，特别是对生产率和 工作流程。因此，使用医学脚本来帮助提供者，从本质上讲， “从EHR中解开提供商”。尽管这种快速增长以及据称改善的好处 身体效率和提高的计费，几乎没有关于注册培训的标准化的监管 评估他们安全与EHR安全接口的能力。为了更好地了解脚本的角色和功能， 我们对全国医疗保健提供者进行了调查。我们发现脚本包括广泛的人员 从大学生到医疗助理。他们的培训有很大的可变性，大部分脚本 通过招聘实践接受特定工作培训。在寄存器功能方面，寄存器再次有很大的可变性 与EHR有关的活动，从简单的遭遇注释创建到在EHR中找到信息 医生输入命令并回应患者信息。我们直接评估了OHSU的抄写员功能 基于新颖的视频虚拟模拟。我们发现，注释创建和 结构。这对应于遗漏和佣金的重大错误（输入的信息不正确 系统）。特别是，平均抄写员仅捕获了模拟中提到的诊断或计划的40％ 脚本之间的文档重叠不到40％。此外，每个脚本都记录了许多不正确的计划 和诊断项目。这些数据结合在一起，提出了一个新的且潜在的重大安全问题，并使用了抄写员的使用 EHR。因此，该提案的目的是充分评估EHR的注册范围并使用 与EHR安全和医疗文档的国家专家共同信息，以建立系列 医疗脚本的可委托专业活动（EPA）。我们将以这些为基础来创建和验证工具包 允许组织评估注册完成这些EPA的能力。在AIM＃1中，我们将使用 调查和现场访问以评估寄存器功能的格局。然后，此信息将作为 共识会议，以定义有关EHR的抄写员委托专业活动（EPA）。在AIM＃2中 将这些EPA绘制为一组能力，并创建一个评估这些能力的课程。该课程将 包含有关在线EHR Didactics和基于视频的模拟练习的系列，并具有相应的模拟EHR记录 为了实现脚本的真实世界表演。在AIM＃3中，我们将校准和验证该课程 专业和EHR使用当前脚本的期望。在AIM＃4中，我们将举行另一个共识会议 查看课程元素并使用结果来创建在线工具包，以允许提供者和医疗保健 评估抄写员能力的组织。到研究期结束时，我们将拥有一个基于网络的，全面的 工具包可以通过医疗脚本在一系列EHR中对安全和准确使用EHR进行现实评估 功能水平以及各种专业和环境。