Using real Electronic Health Records in undergraduate education: a promising future or logistical nightmare? (Preprint)

Abstract

Simulated electronic health records (EHRs) are used in structured teaching for healthcare students. In part, this addresses inconsistent student exposure to, and participation with EHRs whilst on clinical placements. However, simulated records are poor replacements for the complexity and volume of data encountered in real EHRs. Whilst routinely collected healthcare data is often used for research, secondary use does not extend to education. Within our project we are exploring the perceptions, governance and ethics required to support the use of donated real patient records within teaching.

To explore the perspectives of healthcare professionals regarding the use of real patient records to deliver interprofessional EHR education to undergraduate healthcare students.

We held 90-minute group discussions with ten healthcare professionals from nursing, pharmacy, medicine, and allied health disciplines.

There was consensus on the need to upskill healthcare students in the use of EHRs. Participants emphasised the value of teaching general EHR competencies and transferable skills to overcome the diversity in EHR systems. They highlighted key limitations in current EHR teaching due to accessibility issues, disparities within clinical teaching and curricular gaps on important topics such as clinical documentation and coding. Highlighted benefits of real EHRs in structured teaching included learning from the complexities and inaccuracies of real patient data, grasping real-world timeframes and better appreciation of multidisciplinary interactions. Concerns included exposing individual clinicians to unfounded scrutiny as well as the potential consequences of incidental findings within EHRs. The ethical implications of overlooking perceived errors within EHRs versus the impracticality of acting on these findings were discussed in detail. To mitigate concerns, it was suggested that data donors would be clearly informed and consented ensuring they understand that they will not be re-contacted should any such errors be found.

Innovative solutions are needed to re-align healthcare education with clinical practice in rapidly evolving digital environments. Real patient records are the best resource for teaching students to competently handle complex and abundant real-world data. Our reflections highlight the processes and safeguards to consider when using real patient records to deliver EHR education to healthcare students.