The Need to Improve and Standardize EHR Use Through Training: Examining Resident EHR Use During Pediatric Pre-Rounding (Preprint)

Abstract

Effective Electronic Health Record (EHR) use is crucial for effective, efficient, and frustration-free pre-rounding. However, formal training on EHR systems rarely provides residents with all the EHR-related skills they need. Instead, residents often rely on informal methods such as adopting the practices of more experienced residents to acquire the required skills.

The goal of this study is to observe how pediatric residents currently use the EHR and identify how the pre-rounding process and training could be improved.

We recruited thirty pediatric residents were tasked to preround two patients. Video and audio recordings of the residents pre-rounding were analyzed to evaluate participants’ performance in terms of data omission, task completion time, and effective use of data sources. Survey results and participants’ comments were also collected.

Eighty percent of the participants omitted some data while pre-rounding, with the most omitted data being those related to prior and upcoming orders and medications. Participants accessed on average 20.5 pages to pre-round both patients and spent an average of 6.5 minutes on each case. Most importantly, other than reduced data omission rate, we found no significant difference in pre-rounding performance and efficiency between participants with higher experience and those with lower experience.

We list performance issues in EHR use and suggest multiple recommendations to improve EHR based pre-rounding which include creating pre-rounding checklists and providing ongoing iterative training programs for residents. We hope that our work would shed the light on EHR training issues and inspire more efforts in this domain.