Developing a standardized EMR workflow for medical students and preceptors

Objectives: The electronic medical record (EMR) is an integral component of clinical encounters. However, there is no standardized curriculum for EMR education in medical school. This study aimed to create a standardized EMR workflow model for medical students in clinic. It was hypothesized that this workflow would be effectively implemented and increase physician productivity. Methods: An outpatient clinic workflow model was created to integrate students into clinical visits as active participants in EMR documentation. 240 third and fourth-year medical students on their Neurology clerkship at a U.S. medical institution and 34 outpatient neurologists were trained on the workflow (student EMR integration training; SEIT). A total of 733 Neurology outpatient clinic days were analyzed (473 pre-SEIT and 251 post-SEIT). Productivity metrics included average lag time, average Relative Value Units (RVUs) per day, and average invoices per day. Results: There was a statistically significant difference in documentation time, with a pre-SEIT lag time of 14.7 days (SD 13.1 days, 95% CI 9.4–20.0) compared to 10.3 days post-SEIT (SD 10.2 days, 95% CI 6.2–14.5; p-value = 0.001). The average RVUs per day were 18.5 pre-SEIT (SD 7.8, 95% CI 15.4–21.7) and 17.8 post-SEIT (SD 8.0, 95% CI 14.6–21.0; p-value = 0.7). The average invoices per day were 7.5 pre-SEIT (SD 2.6, 95% CI 6.5–8.6) and 7.3 post-SEIT (SD 3.0, 95% CI 6.1–8.5; p-value = 0.5). Conclusions: The workflow model utilizes medical student EMR documentation in the clinical note and decreases physician documentation time.