1. Selection and Implementation of a Simulated Electronic Medical Record (EMR) in a Nursing Skills Lab
David G. Curry, PhD, APRN
Associate Professor of Nursing
SUNY Plattsburgh
May 26, 2010

2. Why an EMR in the skills lab?
IOM’s “To Err is Human: building a safer health system” (2000) showed need for better systems to prevent errors
Better systems include EMRs
Robert Wood Johnson Foundation, through QSEN project (2007) and NLN Board of Governor’s Position Statement (2008) both recommend integration of informatics in nursing curricula
Students don’t get much informatics experience in their clinical rotations…
Why an EMR in the skills lab?

3. Nursing students generally don’t get practice with admission assessments or order entry, for example.
Since simulation is becoming an integral part of student clinical experience, a simulated EMR gives students the opportunity to practice these activities in the safety of the skills lab
So how to find the simulated EMR that fits your needs?
We initially thought we could simply access the test database of our local hospital’s EMR. Can’t do that for many reasons.
Closing the loop

4. The Plattsburgh experience
We used “evolving scenarios” in skills lab and wished to add e-documentation
We had acquired Laerdal’s SimMan, had integrated him in our med-surg courses and wished to add e-documentation with SimMan simulations as well
Research for a solution began in Summer, 2008
The solution included an application for a campus technology grant of $25,000
Evolving scenarios develop around a set group of “patients” that can be used from Nursing Fundamentals through med/surg as the students learn and mature.
The Plattsburgh experience

5. What systems to choose from?
Three systems were considered:
Elsevier’s Simulation Learning System (SLS)
Cerner’s Academic Education Solution (AES)
Nursing Data System’s NurseSquared (N2)
Criteria for evaluation:
Functionality
Flexibility
Price
We wanted bedside charting for entire skills lab PLUS integration with SimMan PLUS documentation of hospital clinicals
Why only 3? Those were the ones we could find… Elsevier’s SLS was brand new: Cerner was basically only at U of Kansas, and N2 was a start-up as well….
What systems to choose from?

6. Evaluation of the criteria
Functionality – all the systems had fairly comparable functions and features
Flexibility – only NurseSquared allowed scenario creation. N2 also supported documentation of hospital clinicals
We wanted to integrate with SimMan, so writing our scenarios was highly desirable
Price – SLS was least expensive, then N2, with AES most expensive
NurseSquared was chosen
We did NOT get done for $25, for 3 years it totaled $32,000
Evaluation of the criteria

7. Acquisition and Planning
Summer, 2009 – N2 folks made site visit to provide orientation to faculty
Plans were made to include N2 in Nursing Fundamentals and Med/Surg in Fall, 2009
Used for clinical documentation
During late Fall, plans for using N2 in Spring Med/Surg SimMan lab began
Students would do order entry in advance, as well as real-time documentation of vital signs, medications and assessment during scenarios
Acquisition and Planning

8. Implementation Fall semester began slowly
Challenge of getting all affected students and faculty online with personal computers
Most challenges were easily overcome with experience
Spring semester was bigger challenge with some adjunct faculty affected
Again, with experience things got smoother
We are now evaluating our first-year experience…
I believe students must wear uniforms to SimMan clinicals – others don’t… some think students should walk into skills lab ‘cold’ and manage the scenario without preparation – I disagree.
Implementation

9. This is a work-in-progress with challenges and successes one might expect when combining two technologies – SimMan and N2 – and moving an entire curriculum toward more informatic content
Please stay for my colleagues’ presentation that follows mine
Tami Pobocik and JoAnn Gleeson-Kreig have focused on students’ perceptions of the technology…
Results

10. To Err is Human – summary of the landmark IOM report from 1999
Preparing the next generation of nurses to practice in a technology-rich environment: an informatics agenda. NLN Position Statement, May 9, 2008
A Summary of the October 2009 Forum on the Future of Nursing: Acute Care
Resources