Use of an open-source electronic health record to establish a “virtual hospital”: A tale of two curricula

Background: The electronic health record (EHR) is central to medical informatics. Its use is also recognized as an important skill for future clinicians. Typically, medical students' first exposure to an EHR is when they start their clinical internships, and medical informatics students may or may not get experience with an EHR before graduation. We describe the process of implementing an open-source EHR in two curricula: Medicine and Medical informatics. For medical students, the primary goals were to allow students to practice analyzing information from the EHR, creating therapeutic plans, and communicating with their colleagues via the EHR before they start their first clinical rotations. For medical informatics students, the primary goal was to give students hands-on experience with creating decision support in an EHR. Approach: We used the OpenMRS electronic health record with a custom decision support module based on Arden Syntax. Medical students needed a secure, stable environment to practice medical reasoning. Medical informatics students needed a more isolated system to experiment with the EHR's internal configuration. Both student groups needed synthetic patient cases that were realistic, but in different aspects. For medical students, it is essential that these cases are clinically consistent, and events unfold in a logical order. By contrast, synthetic data for medical informatics students should mimic the data quality problems found in real patient data. Outcomes: Medical informatics students show more mature reasoning about data quality issues and workflow integration than prior to using the EHR. Comments on both course evaluations have been positive, including comments on how working with a real-world EHR provides a realistic experience. Conclusion: The open-source EHR OpenMRS has proven to be a valuable addition to both the medicine and medical informatics curriculum. Both sets of students experience use of the EHR as giving them valuable, realistic learning experiences.