Electronic Health Records: Where is it in the Curricula?

The rapid proliferation of technologies to access, utilize, store, and communicate critical health care information and the demonstration that such technologies improve clinical outcomes [1,2] have resulted in health care employers expecting new nursing graduates to be competent in the use of an electronic health record [2,3]. Coupled with the federal mandates, many stakeholders including insurers, health care providers, hospital facilities, members of the nursing profession, and nurse educators recognize the need for EHR training to begin in nursing school; however, very few nursing schools have integrated this training into the curriculum [4]. The American Association of Colleges of Nursing [5] published nursing baccalaureate The Essentials: Core Competencies for Professional Nursing Education and Domain 8 is Informatics and Healthcare Technologies. The Accreditation Commission for Education in Nursing [6] Standard 4.1 states the nursing curriculum is to be consistent with contemporary practice. Additionally, the Technology Informatics Guiding Educational Reform (TIGER) Informatics Competencies Collaborative recommended all practicing nurses and nursing students demonstrate competency and literacy in basic computer skills and information management [7]. Furthermore, the National League for Nursing [8] issued a call “to teach with and about technology to better inform healthcare interventions that improve healthcare outcomes and prepare the nursing workforce” (p. 4).

Nurses need to be prepared to enter practice with a solid foundation in health information technology (HIT) and the use of the EHR. Nurses are expected to have information literacy skills and to be able to provide evidence-based, safe and competent care. The EHR is an essential part of health care and is elemental for compiling, saving and retrieving patient data, as well as monitoring patient care and information [9]. Additionally, the EHR and electronic devices, such as smartphones, are replacing face-to-face communication and telephone calls, permitting communication among health care providers through e-mail or texts. This transformation in health care has created a profound need for nurses to be competent in information technology and, in particular, the use of the EHR [3]. To meet this need, nursing education must be transformed. However, many nursing programs have continued with a traditional curriculum. As a result, many nursing graduates are making the transition into clinical practice unprepared to use and navigate the EHR.

According to Shin et al. [10], clinical nurse educators reported new nursing graduates were not proficient in the use of technology in acute care settings. According to Miller et al. [11], only 20% of new nursing graduates reported having received EHR instruction during nursing school. In the past, only 1% of nursing programs provided technology education specific to the use of an EHR [12]. Little has changed, as most nursing programs continue to acknowledge the need to integrate EHR education into the curricula, however, it is still missing [4].

There are several strategies to integrate EHR instruction into the curriculum. One option is the use of an academic EHRs (AEHRs). AEHRs are software packages with learning features that can be incorporated in the classroom, simulation, and skills labs. AEHRs are afford- able and provide an interactive hands-on practice-based method to learning. A second option is a partnership with a local hospital that exploits the existing EHR training program within the facility. This partnership would allow students remote access to an existing training EHR. A third option is to work with the university technology department to develop a “home-grown” educational EHR. This complexity of this process may require additional faculty members and IT staff to brainstorm and ultimately implement.

Bridging the gap between nursing education and practice should be a high priority of nurse educators. An appropriate integration of EHR training into the undergraduate nursing curricula prepares graduate nurses to enter the workforce and can improve clinical reasoning abilities. Nurses who are proficient with health information technology can reduce clinical errors and improve the quality and safety of patient care.

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