Stanford’s Medicine X Spring event 2017
The Medicine X Spring event took place on April 22-23, 2017 at the Li Ka Shing Center, Stanford University. The goal of the event was to bring patients, providers, researchers, industry leaders, designers, technologists and medical educators together to discuss the future of healthcare and to improve medical education. One of our Regenstrief research scientists and medical educators at Indiana University School of Medicine was asked to present on how we are using our EHR Clinical Learning Platform (also known as the Teaching Electronic Medical Record (tEMR)) to shape the future of MedEd. Included below are some highlights from his “Ted X style” oral presentation with other leaders who shared about redefining medical education using technology.
Dr. Blaine Takesue’s presentation topic was “The Regenstrief Teaching Electronic Medical Record: Using an Everyday Clinical Tool for Learning and Evaluation.”
Blaine Takesue, MD is an Assistant Professor of Clinical Informatics at Indiana University School of Medicine and a Research Scientist at the Regenstrief Institute. He is one of the principle investigators for the Teaching EMR (also known as the Regenstrief EHR Clinical Learning Platform).
Blaine shared recently at Standford, along with other esteemed medical educators, providers, patients, and other professionals, on the topic of technology’s impact on Medical and Allied Health Professions Education.
“Electronic medical record systems are complicated and students need to learn how to use them before they begin to practice medicine. These are the tools of their trade.”
If you were not able to attend the event, Dr. Takesue essentially answered the following questions below during his 20-minute presentation at Stanford’s Medicine X.
Question 1: Why is it valuable for students in Medical and Allied Health Professions to have access to an EHR early in their matriculation?
There is a significant gap between the subjects health professional students learn in school and the skill set they will need as practitioners. Topics such as clinical informatics, patient safety, and quality measures are only now receiving more attention in many medical, nursing and other health professions schools. These issues along with topics including team healthcare, population health, and healthcare policy are part of an emerging science, health systems science, that focuses on how the health system delivers care.
Question 2: What are you and your team at Regenstrief working on to help students to close the gap in Health Systems Science?
The Regenstrief Institute and Indiana University created a platform to address instruction for many of the subjects covered in the health system science domain. This platform is a branch of a tool that practitioners use every day, an electronic medical record (EMR). The teaching EMR (tEMR) is the latest version of the Regenstrief Gopher, a production EMR that was first used clinically over 40 years ago.
Question 3: What makes your EHR / EMR valuable for Medical and Allied Professions students?
The tEMR is a modular computerized provider order entry (CPOE) interface which can be modified based on the role of the user. Through this interface, users can access patient information from a database of 10,000 misidentified patients.
Question 4: That is a significant amount of patients for students to use for learning. Why are other vendors not offering the volume of patients that Regenstrief offers to students?
Misidentifying the patient database in an automated process proved to be a significant development hurdle. While it is relatively easy to misidentify coded data, a larger hurdle comes from misidentifying text reports. The ultimate goal of the misidentification process is to protect both patient and provider identities. The challenge was and remains to protect individual’s identities while keeping text reports readable and meaningful.
Question 5: Is there anything else that makes your EHR / EMR different from simply giving students access to their local academic health system’s EMR / EHR?
The tEMR leverages functionality created for clinical use to support curricular needs. For example, we pivoted the clinical decision support infrastructure to deliver just-in-time educational content as well as potentially just-in-time evaluation to learners. Similarly, we redirected our implementation of OpenInfobutton and ported real-time natural language processing functionality to the tEMR to support curricular requirements. Both of these systems could be leveraged for content delivery as well as learner evaluation.
Question 6: Looking into your “crystal ball” for the future of clinical learning with an EHR, what would you tell educators and administrators that are interested in your platform?
Although we initially promoted the tEMR’s innovative content delivery as its strength, we believe the ability to evaluate learners based on their user data will be as important or more important than the content delivery functionality. For example, the system can generate questionnaires or content based on a learner’s current as well as his/her previous interactions with the system, providing a formative evaluation framework. One could imagine utilizing this formative evaluation capacity to create a curriculum in which students could identify their subject matter weaknesses or conversely could demonstrate their steps toward subject matter competence.
Question 7: Regenstrief is known for being a renowned research organization in healthcare and healthcare IT. Why did Indiana University and Regenstrief decide to offer this platform to others outside of IU and who are you working with currently?
In another unexpected, but welcome turn of events, schools outside of Indiana University (IU), expressed interest in the system. We’ve spent the last year changing from a small research team into a team dedicated to the use of the system both inside and outside of IU. With additional funding from the Regenstrief Foundation and the American Medical Association, we have been able to implement the system at the University of Connecticut School of Medicine, the University of Idaho School of Medicine, and several health professions school at the University of Southern Indiana. Next year (in 2017) we will welcome the Sydney Kimmel School of Medicine at Thomas Jefferson University, the Heritage College of Medicine at Ohio University and the Purdue College of Pharmacy. Our other indispensable partners include Eskenazi Health and Indiana University Health.
Question 8: This all sounds great. Have there been any objections or pushback on your platform when introducing it to schools and organizations?
An objection we have heard is the tEMR is not “Epic” or “Cerner.” We think this an advantage. An important goal of this project is for learners, to think about how technology can help and not hinder their healthcare practice. Surveys show that physicians are not happy with their EMR. We believe part of proper healthcare information technology instruction should focus on teaching learners what EMR should do not what they currently do. The tEMR contains functionality not available in commercial EMRs, like real-time NLP and the patient list generator. Providers created this functionality for providers. Control of the tEMR code allows our team to interact with learners to create a better tEMR. We hope, by showing future healthcare leaders how technology should help to manage data and knowledge, they will be prepared to ask the critical questions and demand the appropriate functionality from commercial EMR vendors.
The Standford Medicine X Spring event in 2017 was a great opportunity for Dr. Takesue to showcase how he and the Indiana Univesity School of Medicine, Regenstrief, Eskenazi Health, Indiana Health, and our other partners and collaborators are all working to redefine education using an EHR in the classroom to close the gaps in Health System Science. Some of our key collaborators from the AMA are Dr. Susan Skochelak and Dr. Richard Hawkins who have also introduced a book on Health Systems Science that is a great resource if you are exploring the topic for your school.
My team and I would enjoy the opportunity of discussing how we are helping these others programs with our platform. I’d be happy to share why the American Medical Association chose to collaborate with us around this great opportunity to enrich more students at schools outside of Indiana University with our EMR / EHR. To learn more about how our platform is redefining medical education using our EHR clinical learning platform, please click the button below or email me directly to schedule a discussion.
Sr. Product Manager
Regenstrief EHR Clinical Learning Platform
Clem McDonald Center for Biomedical Informatics (CBMI)
About the Author
Brian Stout is a senior leader in marketing and product at the Regenstrief Institute in Indianapolis. He is an authority on using EHRs in Medical and Allied Professions Education. He leads product and builds amazing learning platforms for one of the nation’s most seasoned (since 1972) and innovative electronic health records in the country. An advocate for learning and professional development, he is continuing his education with a Masters in Data Science from Indiana University. You can follow him on Twitter @TeachingEMR and LinkedIn or other social platforms under ThinkStout.