title: Are students ready for meaningful use?
abstract: BACKGROUND
  The meaningful use (MU) of electronic medical records (EMRs) is being implemented in three stages. Key objectives of stage one include electronic analysis of data entered into structured fields, using decision-support tools (e.g., checking drug-drug interactions [DDI]) and electronic information exchange.
  
  
  OBJECTIVE
  The authors assessed the performance of medical students on 10 stage-one MU tasks and measured the correlation between students' MU performance and subsequent end-of-clerkship professionalism assessments and their grades on an end-of-year objective structured clinical examination.
  
  
  METHODS
  Two-hundred and twenty-two third-year medical students on the internal medicine (IM) clerkship. DESIGN/MAIN MEASURES: From July 2010 to February 2012, all students viewed 15 online tutorials covering MU competencies. The authors measured student MU documentation and performance in the chart of a virtual patient using a fully functional training EMR. Specific MU measurements included, adding: a new problem, a new medication, an advanced directive, smoking status, the results of screening tests; and performing a DDI (in which a major interaction was probable), and communicating a plan for this interaction.
  
  
  RESULTS
  A total of 130 MU errors were identified. Sixty-eight (30.6%) students had at least one error, and 30 (13.5%) had more than one (range 2-6). Of the 130 errors, 90 (69.2%) were errors in structured data entry. Errors occurred in medication dosing and instructions (18%), DDI identification (12%), documenting smoking status (15%), and colonoscopy results (23%). Students with MU errors demonstrated poorer performance on end-of-clerkship professionalism assessments (r =-0.112, p=0.048) and lower observed structured clinical examination (OSCE) history-taking skills (r =-0.165, p=0.008) and communication scores (r= - 0.173, p=0.006).
  
  
  CONCLUSIONS
  MU errors among medical students are common and correlate with subsequent poor performance in multiple educational domains. These results indicate that without assessment and feedback, a substantial minority of students may not be ready to progress to more advanced MU tasks.
authors.affiliation: Division of General Medicine, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA; gary.ferenchick@hc.msu.edu.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Ferenchick
authors.forename: David
authors.initials: D
authors.lastname: Solomon
authors.forename: Asad
authors.initials: A
authors.lastname: Mohmand
authors.forename: Basim
authors.initials: B
authors.lastname: Towfiq
authors.forename: Kevin
authors.initials: K
authors.lastname: Kavanaugh
authors.forename: Larry
authors.initials: L
authors.lastname: Warbasse
authors.forename: James
authors.initials: J
authors.lastname: Addison
authors.forename: Frances
authors.initials: F
authors.lastname: Chames
mesh_terms: D002982:Clinical Clerkship; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods*; D057286:Electronic Health Records; D006801:Humans; D007388:Internal Medicine / Q000193:education; D062527:Meaningful Use / Q000458:organization & administration*; D008824:Michigan; D011361:Professional Competence / Q000592:standards*; D013337:Students, Medical
keywords: curriculum; documentation/methods; electronic health records; medical; professional competence; students