Medical Students and the Electronic Medical Record: Developing an Outpatient Clinic Workflow Model

From the 2019 HVPAA National Conference

Ms. Cristina Viguera (Johns Hopkins University School of Medicine), Ms. Padmavathi Reddy (Johns Hopkins University), Dr. Charlene Gamaldo (Johns Hopkins University School of Medicine, Department of Neurology), Dr. Roy Strowd (Johns Hopkins University School of Medicine, Department of Neurology), Dr. Rachel Salas (Johns Hopkins University School of Medicine, Department of Neurology)

Background

Outpatient experiences are an integral part of medical student education. National organizations, such as the AAMC (Association of American Medical Colleges) or AMA (American Medical Association), recommend electronic medical record (EMR) integration into the curriculum, as it could potentially provide multiple benefits to the key players involved in the outpatient setting: patients, physicians, medical students, and hospitals. The EMR plays a central role in patient encounters, yet there is no standardized approach to medical student involvement in clinic or with the EMR.

Objective

In light of CMS guideline changes allowing greater use of medical student documentation, we have created a workflow that actively engages medical students in clinic and with the EMR. We seek to analyze the productivity of using said workflow, and to adapt it to the medical student learning experience. Our goal is to optimize the teaching of medical students and the efficiency of providers.

Methods

Previously, the Neurology clerkship leadership and a group of medical students drafted a clinic workflow algorithm to improve the efficiency of providers working with students. For this project, this algorithm was expanded to include active student participation in clinic using a standard EMR workflow. Hopkins Neurologists, known as Osler Attending Preceptors, were trained to use this updated model. The efficiency of the workflow was analyzed by comparing the productivity metrics of Osler Attending Preceptors before they used our workflow to after incorporating our workflow. Productivity metrics included lag time (time to complete documentation), RVUs per day (or relative value units, the standard unit for a physician’s productivity), and invoices per day (number of visits or encounters billed). Medical students at the end of their clerkship were surveyed to assess their educational experiences in clinic and their preferences in workflow, involvement with the EMR, and documentation.

Results

Clinical preceptors have increased productivity when medical students are present, with more patient visits completed and higher RVU generation per clinic session. Additionally, medical students perceive a greater educational value from the experience when they are given active responsibilities. The data analyzed showed a statistically significant decrease in average lag time as well. This workflow EMR model provides a standardized approach for medical student outpatient involvement that can be adapted to optimize the medical student experience while still increasing physician productivity.

Conclusions

This workflow EMR model provides a standardized approach for medical student outpatient involvement that can be adapted to optimize the medical student experience while still increasing physician productivity. By impacting both RVU generation and lag time, the workflow EMR model has been shown to impact physician productivity and the medical student experience, both of which lead to a higher standard care and satisfaction for the patient.

Clinical Implication

As mentioned previously, the four primary stakeholders in the outpatient setting all receive direct benefit from implementing the workflow EMR model. Direct benefits have been noted for physicians (increased productivity) and for medical students (increased learning and satisfaction). Both of these relations directly influence the patient care experience, by increasing the standard of care and providing a more satisfactory experience overall.

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