Electronic Health Record (EHR) in Ambulatory Care: A Virtual Training Toolkit

Purpose: This project was supported by the CARES Act supplemental funding for NEPQR awardees, enhanced telehealth training opportunities for bachelor of science in nursing (BSN) students to prevent, prepare, and respond to COVID-19 in a large academic university.

Background/significance: This project evaluated how exposure to an e-learning module and virtual simulation course on the electronic health record (EHR) inbox management in the ambulatory care setting supports preparation to address the needs arising from COVID-19. This course was implemented in pre-licensure nursing curricula during a nursing clinical course in fall 2020 quarter.

Methods: A mixed methods qualitative and quantitative survey was used to evaluate the effectiveness of an educational intervention on a sample of 80 BSN nursing students. This project focused on educating students on EHR inbox prioritization, telephone triage, and team communication in a two-part simulation format. Students took a self-paced interactive virtual inbox simulation (part 1) online and continued the course in a scheduled virtual class via the Zoom platform to complete (part 2) of the simulation content. Information was collected using an anonymous voluntary Google forms survey at the end of the course. Students were asked multiple choice questions related to the learning objectives and rated the system usability using a modified system usability scale (SUS) to measure generic product usability along with a free text qualitative question.

Results: Among those who entered the study (N=83), 41.2%, (N=35) participants completed all of the survey measures. Response was double the goal of 20% participation. Preliminary data suggests that learning objectives were overwhelmingly met. The majority of students strongly agreed (N=, 88.5%) that they are able to “describe the role of the nurse in managing and responding to patient messages received through electronic communication.” (N=85.71%) strongly agree that they are better able to “prioritize messages using the nursing process an emphasizing patient safety.” (N=77.14%) report “I better understand how ambulatory care nurses use the inbox” and (N=80%) report “I feel my knowledge and skills with the EHR have improved.” When students were asked if the simulation helped them understand how to “engage the health care team as needed to delegate tasks (to medical assistants or LPNs) or seek provider input as appropriate.” (N=57%) strongly agreed and (N=34%) somewhat agreed, indicating a need for further education in this area. Students reported usability data with (N=77%) stating “I feel the module was easy to navigate,” and (N=82.85%) indicated “I found the various functions in the module were well integrated.” The free-text question “How do you imagine you will use the concepts learned in this simulation in your work as a nurse?” received a (N= 68.57%) response and indicated that the SOAP documentation technique and SBAR exercises during the virtual simulation were valuable to the majority of respondents.

Conclusions and implications: This research highlights the need further education on the electronic tools that facilitate patient assessment, team communication, and proper documentation in the electronic health record. This study may form as a guide for future education for ongoing nursing clinical courses.