Introducing the Electronic Health Record during History Taking with Standardized Patients: What are Novice to Expert Skills??

Purpose: This study investigated student nurse practitioners’ (novice) communication skills when utilizing the electronic health record (EHR) during history taking with a standardized patient. Significance: The Health Information Technology for Economic and Clinical Health Act (HITECH) has stimulated the utilization of EHRs to improve quality and efficiency of patient care; consequently, widespread use of electronic health records will be inevitable (Blumenthal & Tavenner, 2010). Unfortunately, introduction of the EHR to providers seems to have focused on the documentation and billing aspects. Therefore, identifying novice to expert communication skills, when using EHRs is essential. Methods: Nurse practitioner students (n=36), recently instructed on EHR use, were videotaped during two visits with standardized patients (formative and evaluative). Using OD LOG software, two observers recorded student time spent: typing and talking, typing only, and looking at computer without talking. Total time of history taking and placement of the computer was recorded. Inter-rater reliability was 0.84. Findings: On the formative visit- mean history taking time was 11.4 minutes. Of this time, a total of 3.5 minutes were spent: typing and talking (45.9 sec) typing only (125.1 sec) and looking at computer not talking (37.3 sec) for 30.6% of this visit. One the evaluative visit– mean history taking time was 12.4 minutes - of this time, a total of 2.95 minutes were spent: typing and talking (31.9 sec), typing only (124.7 sec) and looking at computer not talking (20.9 sec) for a 24% of this visit. A slight difference was noted between mean group times ( p = 0.361). The percent of time spent by individuals changed over the two visits: Typing and talking (-3.1%, p= 0.3); typing only (+12.8%, p=0.038); looking at computer (-9.6% p= 0.039). Conclusions: Results reveal a significant change in individual student time spent engaged with the computer (increase typing only and decreased looking only) on the evaluative visit. Students need instruction on introducing EHR documentation into the visit and practice nativigating the EHR while history taking. Computer positioning results will be fully discussed with videos/diagrams. Recommendations: Further research regarding experienced providers’ communication skills while using the EHR is recommended.