Using Simulation to Enhance Electronic Health Records' Usability and Outcomes

“The EHR is the only medical device used by every provider within a healthcare organization. AHRQ funding enabled me to create a simulation environment that can objectively measure EHR usage and assess the impact of provider training.”

The electronic health record (EHR) has transformed healthcare delivery and is used in a wide variety of clinical settings by nearly every member of the clinical team. Over the past decade Jeffrey Gold, M.D., Professor of Medicine and Vice Chair of Quality and Safety at the Oregon Health and Sciences University School of Medicine, has focused his research on understanding the impact of the EHR on healthcare quality and safety. He has also studied how provider training can potentially improve the effectiveness of the EHR as a tool the providers can use to improve care.

Using an AHRQ grant in 2012, Dr. Gold led a team that created a highly realistic simulation of an EHR system. Eye-tracking technology was incorporated, allowing researchers to determine what information providers were viewing and what they were missing. This simulated environment allowed Dr. Gold's team to study how effectively providers use the EHR and to measure patient safety issues caused by variations in EHR use. Issues studied include how EHR notes are structured, at what point in the patient encounter notes are entered, how easily providers are able to find important information, and usage differences between providers of various ages and computer skills.

In 2015, Dr. Gold used additional AHRQ funding to expand his research to study safety issues involving the EHR in hospital intensive care units (ICUs). An ICU patient typically has many provider notes in the EHR, as well as large amounts of data generated by automated monitoring equipment. Dr. Gold’s research team tested how effectively nurses, pharmacists, and physicians recognized medical errors in EHRs of ICU patients. The funding also helped the team develop standards for effectively retrieving and consistently reviewing data from the EHR.

The widespread adoption of the EHR has created a new role on the clinical team—the scribe, whose core responsibility is to enter accurate, detailed, and timely documentation of patient encounters. With little regulation or research of the impact of scribes on care, Dr. Gold used AHRQ funding to study their impact on patient safety, how scribes interact with providers, as well as what training protocols could improve the accuracy of scribes’ notes. His simulation found that the accuracy of scribe-generated notes ranged from 50 to 75 percent and that there was wide variability between scribes who documented identical simulated cases.

A 2019 AHRQ grant helped Dr. Gold begin ongoing research in using the EHR to reduce diagnostic error in ambulatory care settings. Diagnostic error is the most common patient safety event in ambulatory settings, and one source of error is a provider’s inability to accurately digest the wealth of information present in the EHR. As part of this project, Dr. Gold and his team are developing a library of EHR charts that can be used in simulation and training exercises in all major EHR systems. These training methods can be validated and shared to improve patient safety in ambulatory care settings.

Dr. Gold is a member of the American College of Chest Physicians, the American Foundation for Medical Research, the American Thoracic Society, and the Society for Critical Care Medicine.

Principal Investigator: Jeffrey A. Gold, M.D.
Institution: Oregon Health and Science University
Grantee Since: 2012
Type of Grant: Various

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