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Electronic health record evaluations using clinical simulation can identify unintentional consequences before they jeopardize patient safety. The purpose of this article is to summarize the current state-of-the-science of clinical simulations to design and evaluate electronic health records.
Key Words: Electronic health record (EHR), electronic medical record, simulation, sociotechnical, usability, evaluation, clinical simulations.
Electronic health record (EHR) adoption after the Health Information for Economic and Clinical Health Act of 2009 resulted in over 75% of all hospitals in the U.S. possessing an EHR (Blumenthal, 2009; Sittig, Wright, Ash, & Singh, 2016). EHRs are used to generate clinical documentation that serves as the legal record of patient care, provides information to guide clinical decision-making, coordinates patient care activities by assisting with interprofessional communication, facilitates billing, and serves as a repository for secondary data analysis (Mamykina, Vawdrey, Stetson, Zheng, & Hripcsak, 2012). The implementation of information technology has the potential to improve patient safety, but unintended consequences produce new types of medical errors (Meeks, Takian, Sittig, Singh, & Barber, 2014). A leading cause of unintended consequences is failure to adequately customize and implement an EHR into the sociotechnical environment of an organization (Meeks et al., 2014; Sittig et al., 2016). The sociotechnical environment consists of the hardware/software, clinical content, human-computer interface, people, workflow, communication patterns, unique organizational features, and national governmental standards (Meeks et al., 2014).
Clinical simulation is a useful tool to evaluate EHRs because it incorporates the sociotechnical environment and can identify unintended consequences without impacting patient safety (Kushniruk, Nøhr, & Borycki, 2016). EHRs have been incorporated into clinical simulations in educational settings for the purpose of increasing student competencies with EHRs in clinical practice (Wilbanks, Watts, & Epps, 2018). There is a paucity of literature available that discusses best practices related to using clinical simulation to design and evaluate EHRs. The purpose of this literature review was to summarize the current state-of-the-science on the use of clinical simulations to design and evaluate EHRs to establish evidence-based guidelines for future assessments of EHRs. This review focuses on study findings and the methodology used for combining clinical simulations with EHR evaluations.
Search Method and Outcome
In October 2018, the electronic databases PubMed, CINAHL, and Scopus were searched for peer-reviewed publications using the following keywords:
* Electronic...