Development and evaluation of a Health Record Online Submission Tool (HOST)

INTRODUCTION: Health records (HRs) are crucial to quality patient care. The Michigan State University College of Human Medicine begins teaching health record (HR) writing during the second-year clinical skills courses. Prior to this project, we used a cumbersome paper system to allow graduate assistants to grade and give feedback on students' HRs. This study discusses the development and evaluates the effectiveness of the new Health Record Online Submission Tool (HOST). METHODS: We developed an electronic submission system with the goals of decreasing the logistical demands of the paper-based system; improving the effectiveness, consistency, and oversight of HR instruction and evaluation; expanding the number of students who could serve as written record graduate assistants (WRGAs); and to begin preparing students for the use of electronic health records (EHRs). We developed the initial web-based system in 2003 and upgraded it to its present form, HOST, in 2007. We evaluated the system using course evaluations, surveys of WRGAs and clinical students, and queries of course faculty and staff. RESULTS: Course evaluation by 1,106 students during years 2001 through 2008 revealed that the students' self-assessment of ability to write HRs improved briefly with the introduction of HOST but then returned to baseline. The initial change to electronic submission was well received, though with continued use its rating dropped. A survey of 65 (response rate 61.3%) clinical students indicated that HOST did not completely prepare them for EHRs. The WRGAs (n=14; response rate 58%) found the system easy to use to give feedback to students. Faculty (n=3) and staff (n=2) found that it saved time and made the review of students' HRs and WRGAs grading simpler. Student perception of grading consistency did not improve. CONCLUSIONS: HOST is the first published online method of in-depth HR training for preclinical students using information gathered in clinical encounters. With it we were able to maintain effective instruction, streamline course management, and significantly decrease staff time. HOST did not improve student perception of grading consistency and did not prepare students for specific EHR use. Within the context of our class size expansion and our community-based educational program, HOST bridges geography and can support future improvements in HR instruction and faculty development. Medical educators at other institutions could use a similar system to accomplish these goals.