Enhancing telehealth Objective Structured Clinical Examination fidelity with integrated Electronic Health Record simulation

Abstract

As telemedicine becomes a vital aspect of patient care, incorporating it into medical training has necessitated adapting traditional Objective Structured Clinical Examinations (OSCEs), which typically assess clinical and communication skills through face-to-face interactions, to include telehealth scenarios. However, students have critiqued telehealth OSCEs as lacking the fidelity of dynamic electronic health records (EHR) navigation and documentation, thus diminishing the practical training aspect of diagnosing and managing patient care effectively in a real-world setting.¹

To address the limitations of telehealth OSCEs, our institution integrated a comprehensive simulated patient record into our existing EHR system, Epic (Verona, WI). Utilizing Epic's tools for facilitating training, we crafted detailed patient profiles complete with extensive medical histories, prior documentation, vital signs and laboratory data. We then cloned these profiles, creating 120 unique instances—one for each student—within a dedicated Epic training environment. This allowed each student to conduct thorough pre-encounter reviews, mirroring the complexity of real clinical settings. The system not only facilitated more authentic patient interactions but also enhanced students' proficiency with real-world EHR chart navigation and clinical documentation, as we repurposed the virtual urgent care's standard documentation template. Students were given a primer with their login information, their individual patient's name and an appointed testing time to log into the Epic training environment. They were given 10 minutes to review the chart, 10 minutes to interact with the patient and 13 minutes to document a note. The students received feedback from the SP and debriefed with peers and faculty. This initiative required a collaborative effort among IT specialists, clinical educators and informaticists to ensure seamless integration and operability within the test environment, including a Webex Teams chat space for coordinating the sessions, and a drop-in Zoom channel for student technical support.

The implementation of a simulated EHR environment was well-received by students, who valued how the realism in electronic chart review and the use of structured telehealth documentation templates sourced from real-world clinics, effectively mirrored real-life scenarios and thus improved the fidelity of the OSCEs. Many felt that this helped improve clinical decision-making.

Challenges included ensuring students could remotely access the EHR environment (two were unable to, and five initially logged into the wrong environment) and in managing the timely coordination between student groups and standardised patients. Despite these hurdles, the positive feedback has encouraged us to consider integrating the Epic training environment into other simulations and to streamline the process of creating individual patient profiles.

Using standard Epic in basket messaging tools, we were able to extract the notes from the EHR and use automated, previously validated tools for note scoring. This high-fidelity telehealth OSCE presents new opportunities for research into students' utilisation of EHR systems and analysis of their documentation practices at scale.

Nicholas Genes: Conceptualization; data curation; formal analysis;writing—original draft; project administration; writing—review and editing; supervision; methodology; software. Christine P. Beltran: Conceptualization; data curation; formal analysis; writing—original draft; project administration; writing—review and editing; methodology. Magdalena J. Robak: Conceptualization; data curation; formal analysis; writing—original draft; project administration; writing—review and editing; supervision; investigation; methodology. Kiran Malhotra: Conceptualization; data curation; formal analysis; writing—original draft; project administration; writing—review and editing; methodology.

None.

This project met the NYU Grossman School of Medicine's criteria for certification as a Quality Improvement and NOT a human subject research project based on a self-certification process (completed review available) which attests that the data were not collected for research purposes, that the primary goal of the project was to improve education, that no individually identifiable data are included, that there is no more than minimal risk and that the data were collected as part of a required aspect of education and training.