Medical students need unfettered access to electronic health records (EHRs) during their training so they'll have a good handle on how to use the technology when they begin their residency training.
That was the gist of an editorial(www.annfammed.org) written by key players in the Association of Departments of Family Medicine (ADFM) and published in the November/December Annals of Family Medicine.
The editorial, titled "Electronic Health Records: How Will Students Learn If They Can't Practice?" points out that 78 percent of office-based physicians reported using an EHR in 2013.
"Learning how to elicit medical histories while electronically recording key findings, using EHR-associated decision-making tools and providing management plans requires full EHR access," the authors write.
Furthermore, they note that future physicians also need to learn how to navigate patient registries and use other analytic EHR functions if they are to become skilled in population management. Safety reminders and point-of-care references provided by EHRs also are keys to providing top-notch care.
"Unfortunately, students at many medical schools are not able to adequately access EHRs to receive this necessary training," say the authors. That's largely because of "varying local interpretations of Medicare guidelines on student EHR use."
Notably, the Association of American Medical Colleges (AAMC) released an updated compliance advisory(www.aamc.org) on Sept. 30 that attempts to sort out the difference between medical students' documentation in a medical record and the fact that students do not bill for their time.
However, according to the editorial, academic health centers have interpreted the AAMC's earlier 2012 compliance advisory on health information technology (health IT) in a variety of ways that has led to "markedly disparate policies around the country regarding medical student access to EHRs."
In fact, in some institutions, medical students are forbidden any access to EHRs.
Authors note that the most significant barriers to medical student access to EHRs are concerns about
- attribution of note ownership,
- billing elements,
- patient safety issues, and
- breaches of professionalism associated with the "copy and paste" function.
The cost of additional licenses for student use of health IT in ambulatory clinics that rely on voluntary faculty also is an issue for some.
"To fully prepare medical school graduates to assume roles of increasing responsibility and leadership in modern health care systems requires competence in patient-centered EHR use," the authors contend.
"For this to happen, all medical students should have access to the EHR that is based on educational need as opposed to risk aversion," they continue.
The editorial was written collaboratively by Christine Matson, M.D., chair of ADFM's Education Transformation Committee; Mark Stephens, M.D., chair of the Department of Family Medicine, Uniformed Services University; Beat Steiner, M.D., chair of the Society of Teachers of Family Medicine's Medical Student Education Committee; Stanley Kozakowski, M.D., director of the AAFP's Division of Medical Education; and Ardis Davis, M.S.W., ADFM executive director.
The authors agree that a solution to the issue is possible without compromising patient safety or third-party regulatory requirements.
"We look forward to collaborating with the AAMC on publicizing ways in which institutions can enable students to use electronic health records for educational and patient care benefit while still providing capability for physicians exclusively to document for billing purposes," the editorial concludes.
Related AAFP News Coverage
Despite Mounting Role in Medical Student Education, Barriers to EHR Use Remain
AAFP Steps Up to Champion Student Access to Health IT