Evaluating Electronic Health Record Competencies: New Trends and Approaches Involving Simulations

  • Elizabeth BoryckiEmail author
  • Andre Kushniruk
  • Sophia Khan
  • Lindsay Zibrik
  • Rebecca Campbell
  • Kendall Ho
Part of the Healthcare Delivery in the Information Age book series (Healthcare Delivery Inform. Age)


Over the past 10 years, there has been a significant increase in the number of electronic health records (EHRs) used worldwide. EHRs are being increasingly used across the health-care continuum from the physician’s office to hospitals and from in-home care to long-term care settings. With this rise in EHR usage, there is a need for physicians and other health professionals to develop EHR-related competencies alongside traditional patient management and treatment competencies as part of their undergraduate education. As technological advances such as EHRs are incorporated into routine health-care delivery, there will be a need to (a) determine the types of EHR competencies that are necessary for medical students to become EHR literate; (b) investigate how EHR competencies can be developed using EHR simulators and computerized patient mannequins; (c) develop objective structured clinical examinations (OSCEs) for the purpose of testing medical and EHR competencies for medical education; (d) develop several EHR OSCEs designed to evaluate EHR competencies; (e) pilot test and evaluate the developed OSCEs; (f ) evaluate developed EHR OSCEs with students, faculty, and medical and health informatics experts; and (g) implement them in traditional medical curricula.


  1. Anderson, J. G., & Aydin, C. E. (2005). Evaluating the organizational impact of healthcare information systems (2nd ed.). New York: Springer.CrossRefGoogle Scholar
  2. Armstrong, B., Kushniruk, A., & Borycki, E. (2009). Solutions for deploying multi-architecture EHRs on a single EHR educational portal. Studies in Health Technology and Informatics, 150, 167–71.PubMedGoogle Scholar
  3. Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system related errors. Journal of the American Medical Informatics Association, 11(2), 121–124.Google Scholar
  4. Borycki, E. M., & Kushniruk, A. W. (2008). Where do technology-induced errors come from? Towards a model for conceptualizing and diagnosing errors caused by technology (pp. 148–166). In A.W. Kushniruk and E.M. Borycki (Eds.). Human, Social, and Organizational Aspects of Health Information Systems. Hershey, Pennsylvania: Idea Group.Google Scholar
  5. Borycki, E. M., & Keay, L. (2010). Methods to assess the safety of health information systems. Healthcare Quarterly, 13, 49–54.Google Scholar
  6. Borycki, E. M., & Kushniruk, A. (2005). Identifying and preventing technology-induced error using simulations: Application of usability engineering techniques. Electronic Healthcare/Healthcare Quarterly, 8, 99–106.Google Scholar
  7. Borycki, E. M., Kushniruk, A. W., Kuwata, S., & Kannry, J. (2006). Use of simulation approaches in the study of clinician workflow. Paper presented at the annual meeting of the American Medical Informatics Association Annual Congress. Washington, DC, 11–15 Nov 2006.Google Scholar
  8. Borycki, E. M., Kushniruk, A. W., Joe, R., Armstrong, B., Otto, T., Ho, K., Silverman, H., Moreau, J., & Frisch, N. (2009a). The University of Victoria interdisciplinary electronic health record educational portal. Studies in Health Technology and Informatics, 143, 49–54.PubMedGoogle Scholar
  9. Borycki, E. M., Kushniruk, A., Keay, E., Nicoll, J., Anderson, J., & Anderson, M. (2009b). Towards an integrated simulation approach for predicting and preventing technology-induced errors in healthcare: Implications for healthcare decision-makers. Healthcare Quarterly, 12, 90–16.PubMedGoogle Scholar
  10. Borycki, E. M., Lemieux-Charles, L., Nagle, L., & Eysenbach, G. (2009c). Evaluating the impact of hybrid electronic-paper environments upon novice nurse information seeking. Methods of Information in Medicine, 48, 134–143.Google Scholar
  11. Borycki, E. M., Joe, R., Armstrong, B., Bellwood, P., & Campbell, R. (2011). Educating health professionals about the electronic health record (EHR): Removing the barriers to adoption through improved understanding. Knowledge Management and E-Learning: An International Journal, 3(1), 51–62.Google Scholar
  12. Byrick, R. J., & Wynands, J. E. (2009). Simulation-based education in Canada: Will anesthesia lead in the future? Canadian Journal of Anesthesia, 56, 273–278.PubMedCrossRefGoogle Scholar
  13. Denison, J. S., & Abrahamson, S. (1969). A computer-controlled patient simulator. Journal of the American Medical Informatics Association, 208, 504–508.Google Scholar
  14. Dornan, T., & O’Neill, P. (2006). Core clinical skills for OSCEs in medicine. London: Elsevier.Google Scholar
  15. Fanning, R., & Gaba, D. (2009). Simulation-based learning as an educational tool. In J. Stronemetz & K. Ruskin (Eds.), Anesthesia informatics (pp. 459–479). New York: Springer.CrossRefGoogle Scholar
  16. Gaba, D. M., & DeAnda, A. (1988). A comprehensive anesthesia simulation environment: Recreating the operating room for research and training. Anesthesiology, 69, 387–394.PubMedCrossRefGoogle Scholar
  17. Issenberg, S. B., McGaghie, W. C., Hart, I. R., Mayer, J. W., Felner, J. M., Petrusa, E. R., Waugh, R. A., Brown, D. D., Safford, R. R., Gessner, I. H., Gordon, D. L., & Ewy, G. A. (1999). Simulation technology for health care professionals skills training and assessment. Journal of the American Medical Informatics Association, 282(9), 861–866.Google Scholar
  18. Jha, A. K., Doolan, D., Grandt, D., Scott, T., & Bates, D. W. (2008). The use of health information technology in seven nations. International Journal of Medical Informatics, 77(12), 848–854.PubMedCrossRefGoogle Scholar
  19. Joe, R. S., Otto, A., & Borycki, E. (2011). Designing an electronic medical case simulator for health professional education. Knowledge Management and E-Learning: An International Journal, 3(1), 63–71.Google Scholar
  20. Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, R., Kimmel, S. E., & Strom, B. L. (2005). Role of computerized physician order entry systems in facilitating medication errors. Journal of the American Medical Informatics Association, 293(10), 1197–1203.Google Scholar
  21. Kushniruk, A. W., & Borycki, E. M. (Eds.). (2008). Human, social, and organizational aspects of health information systems. Hershey: Idea Group.Google Scholar
  22. Kushniruk, A. W., & Patel, V. L. (2004). Cognitive and usability engineering methods for the evaluation of clinical information systems. Journal of Biomedical Informatics, 37, 56–76.PubMedCrossRefGoogle Scholar
  23. Kushniruk, A. W., Kaufmann, D., Patel, V. L., Levesque, Y., & Lottin, P. (1996). Assessment of a computerized patient record system: A cognitive approach to evaluating medical technology. MD Computing, 13(5), 406–412.PubMedGoogle Scholar
  24. Kushniruk, A. W., Triola, M., Borycki, E. M., Stein, B., & Kannry, J. (2005). Technology induced error and usability: The relationship between usability problems and prescription errors when using a handheld application. International Journal of Medical Informatics, 74(7–8), 519–526.PubMedCrossRefGoogle Scholar
  25. Kushniruk, A. W., Borycki, E. M., Kuwata, S., & Kannry, J. (2006). Predicting changes in workflow resulting from healthcare information systems: Ensuring the safety of healthcare. Healthcare Quarterly, 9, 78–82.Google Scholar
  26. Lea, A., Pearson, D., Clamp, S., Johnson, O., & Jones, R. (2008). Using the electronic medical record within medical undergraduate education. Education for Primary Care, 19, 656.Google Scholar
  27. Manser, T., Harrison, T. K., Gaba, D. M., & Howard, S. K. (2009). Coordination patterns related to high clinical performance in a simulated anesthetic crisis. Anesthesia and Analgesia, 108, 1606–1615.PubMedCrossRefGoogle Scholar
  28. McGaghie, W. C., Issenberg, B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation-based medical education research: 2003–2009. Medical Education, 44, 50–63.PubMedCrossRefGoogle Scholar
  29. Patel, V. L., Kushniruk, A. W., Yang, S., & Yale, J.-F. (2000). Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning. Journal of the American Medical Informatics Association, 7(6), 569–585.PubMedCrossRefGoogle Scholar
  30. Shortliffe, E. H., & Cimino, J. J. (2006). Biomedical informatics: Computer applications in health care and biomedicine. New York: Springer.Google Scholar
  31. Speedie, S. M., & Niewoehner, C. (2003). The Minnesota virtual clinic: Using a simulated EMR to teach medical students basic science and clinical concepts. AMIA Annual Symposium Proceedings/AMIA Symposium, 1013.Google Scholar
  32. Vogt, W. P. (1999). Dictionary of statistics and methodology (2nd ed.). Thousand Oaks: Sage.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Elizabeth Borycki
    • 1
    Email author
  • Andre Kushniruk
    • 1
  • Sophia Khan
    • 2
  • Lindsay Zibrik
    • 2
  • Rebecca Campbell
    • 1
  • Kendall Ho
    • 2
  1. 1.Health Information ScienceUniversity of VictoriaVictoriaCanada
  2. 2.eHealth Strategy Office, Faculty of MedicineUniversity of British ColumbiaVancouverCanada

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