IMPROVING WORKFLOW EFFICIENCY AND CONFIDENCE: INPATIENT ELECTRONIC HEALTH RECORD CURRICULUM

ABSTRACT

SETTING AND PARTICIPANTS: Our goal was to create an interactive inpatient electronic health record orientation session with our incoming house officers and assess their confidence level in completing common daily tasks. We also strived to improve new house officer work flow, with hopes in leading to fewer work hour violations and coding queries in their first month of training. DESCRIPTION We developed a 2-hour, interactive inpatient electronic health record (EHR) curriculum that our new internal medicine house officers completed prior to starting their residency training. The curriculum included how to log into the EHR, create patient lists, navigate and customize a patient's chart, placed admissions orders, generate a H&P note, update problem lists, generate daily Progress notes, update Hospital courses, place discharge orders, and how to execute transfers. We surveyed the interns on their confidence level of performing the above tasks before, immediately after, and 1 month after completing the course. We also compared the number of work hour violations and number of coding queries of the 2021 incoming house officers to the 2019 incoming house officers (similar rotation scheduling and excluding the coronavirus-2019 pandemic of 2020) who did not complete a programspecific EHR orientation curriculum. EVALUATION We found that new house officer confidence in completing all EHR tasks significantly improved immediately after the training session, including improved confidence in use of the EHR (3 [2-4] vs 4 [3.75-5, p<0.001), input of past medical history (3 [2-4] vs 4 [4-4], p<0.001) and home medications (2 [1-3] vs 4 [3.75-4], p<0.001), and completion of thorough discharge summaries (2 [2-3] vs 4 [3-4], p<0.001). Confidence level was maintained on reassessment one month later. When assessing 8-hour work violations, we saw a decrease from 15 violations in 2019 down to 1 in 2021 (p<0.001). There was also no statistical difference in average number of hours worked per week between the two groups. In 2019, new house officers averaged 60.9 hours per week, while in 2021 they averaged 60.8 hours per week (p=0.99). Neither group had any violations of average 80- hours per week. Total number of coding queries for resident documentation significantly improved across the first month of resident rotations on General Internal Medicine units in July 2021 as compared to 2019 (-9.12, p=0.001). DISCUSSION / REFLECTION / LESSONS LEARNED The incorporation of an interactive inpatient EHR curriculum specific to our health program's EHR system significantly improved our new house officer confidence levels prior to starting their rotations. The curriculum significantly improved their daily work flow by showing a decrease in the number of 8-hour work violations with no impact on the average hours worked weekly by our new house officers, and a decrease in coding queries.