ChangeMedEd Initiative

Virtual EHR helps residents learn complexity of elder care

Robert Nagler Miller , Contributing News Writer

A learning tool that was developed to help medical residents gain facility with electronic health records (EHR) systems has taken on a broader application at the Indiana University (IU) School of Medicine, which first launched the tool in cooperation with the AMA and the Indianapolis-based Regenstrief Institute, an informatics and health care organization that supports IU’s medical school.

The tool, the Regenstrief -EHR Clinical Learning Platform, includes detailed information from more than 11,000 records with misidentified data—real patient information that has been altered so privacy is preserved. Using the platform, IU residents are now engaged in a project that enables them to get up to speed on EHR and to acquire a much deeper understanding of a fast-growing segment of the American population—people 85 and older—using a team-based, multidisciplinary approach.

Kathy Frank, RN, PhD, is the program administrator of the geriatrics program at IU’s medical school and part of the team involved in the project. She said the focus on elder care is more warranted than ever before.

“To say that we don’t pay enough attention to the health care of seniors is an understatement,” Frank told AMA Wire® following an AMA-sponsored webinar in which she presented IU’s experience with the Regenstrief platform.

Frank explained how the project functions: Rotating groups of five residents team up with five students from each of the school’s  master’s-level programs in nursing and social work to assess the health needs of specific geriatric patients, whose information is embedded in the EHR. Their assignment is to communicate regularly with each other in the EHR about core issues that affect many geriatric patients, including dementia, depression, falls and medication complications. The 15 participants then meet monthly to discuss their findings.

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“By having them review these cases and figure out what kinds of questions they should be asking each other about the patients, we are guiding their thinking about geriatric care,” said Frank.

As an example, Frank pointed to one patient in the EHR on whom the residents and nursing and social work students focused: an elderly woman with dementia and a history of alcoholism who had been hospitalized following a car wreck in which she had been the driver. The questions they thought to ask about the patient mounted quickly, Frank said: Did the medications she was taking at the time in any way contribute to the accident? Why was she driving in the first place? Did she have a history of using painkillers? What type of family support did the patient have?

The EHR served as an ideal platform for members of the three health disciplines to weigh in on a patient’s profile, making it an important tool for promoting collaborative care, suggested Frank and Blaine Takesue, MD, assistant professor of medicine at IU, who also spoke with this reporter. More than that, the EHR platform “allowed each discipline to learn about the way the other two think,” Frank said.

“This is a work in progress,” said Frank, referring to the myriad ways a tool such as a virtual EHR can be used.

“We can leverage technology to create learning opportunities for all types of students,” added Dr. Takesue, who has taken the lead in introducing the Regenstrief EHR platform at IU. “This tool allows students to dig more deeply.”

IU’s School of Medicine, one of the original members of the AMA’s Accelerating Change in Medical Education Consortium, received a grant from the AMA to work with the Regenstrief Institute to develop the EHR platform.