Using electronic health record simulations for better care

Written by Jeff Gold, M.D.

One of my passions has been to better understand the role Electronic Health Records (EHRs) play in the delivery of care in the Intensive Care Unit (ICU).

Health record softwares are very powerful and contain a lot of information and data. Through my past role as an ICU director and my current role as a professor and program director for critical care fellowships, I’ve observed many situations where a clinician goes back and looks at cases to find important patient information. The information they need is there but they either didn’t know where to find it or it is presented in a way that they can’t really see it. It’s almost like a huge Where’s Waldo puzzle.

I’m happy to say that a recently awarded grant will allow me and a great team of researchers here at OHSU to develop simulations studies that will help shed light on how we solve this puzzle.

I’ve been involved in choosing and implementing of a number of EHR systems over the years and have found that everyone uses the systems differently. When I took over as director of OHSU’s training program, I wanted to create a mechanism by which I could train our fellows on how to effectively use EHRs.

We decided to use simulation as this tool. We took a different spin on this and not only created a highly realistic case with all of the same data that a real ICU patient would have in their record, but we built medical errors and concerning changes in the patient’s condition into the case. I believe that the only way to ensure the system is being used appropriately is to ensure that the system’s users can recognize errors. If we can’t recognize issues in real-time, we can’t address them.

Through these simulation studies, we’ve discovered that the average clinician has difficulty integrating all of the data in the EHR for a given patient, and as a result, misses many of these errors. This is due to both how we train people to use the EHR and how the data is presented in the EHR.

This grant is going to allow us to systematically address these issues across the different ICUs at OHSU. In essence, we are trying to build both a better mouse and a better mouse trap. I hope that this work results in a standard way by which all practitioners at our institution are trained in using our EHRs. I hope it also becomes the way by which all meaningful changes to the EHR–user interface can be objectively tested prior to implementation.

Editor’s note: For more reading on this research, we recommend this blog post by William Hersh, M.D., professor and chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU


After completing fellowship in 2001, Dr. Jeff Gold joined the faculty at NYU Medical Center as an Assistant Professor. During his time at NYU, Dr. Gold received funding from the National Institute of Health to better understand the immunologic mechanisms of sepsis and septic shock. In addition, in 2004, he was named Director of Critical Care Service for Bellevue Hospital.

He joined the faulty of OHSU in 2005 and was promoted to Associate Professor in 2009. Clinically, he works in the Medical Intensive Care Unit, the Pulmonary consultation service and is Associate Director of the Adult Cystic Fibrosis Center. Recently, Dr. Gold was named Director for the Pulmonary Critical Care and Critical Care Fellowships in the Division of Pulmonary and Critical Care Medicine.

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