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For years, simulation training has been used in the defense, nuclear and aviation industries and numerous studies have supported its effectiveness for strategic learning.  Over the last two decades, the practice has gained considerable traction in the education of nurses and physicians.  Clinical simulation allows students to learn new skills and techniques while honing their critical thinking, problem-solving and communication skills in a controlled real-world environment.  Hands-on simulations prepare clinicians for the situations they are likely to face in practice.  The same principles for clinical preparation can be applied to the Health IT lifecycle.

Simulations can help us capture “Aha Moments” and “Gotchas” at varying phases of user support in the Health IT lifecycle:

  • Pre go-live for new clinical technologies and processes
  • After training to put knowledge and skill into practice
  • Post go-live to prototype optimizations and changes

There are several different simulation types that are useful in the clinical world, but there are four requirements that are common to all simulations:

  • Actors who are the operational people playing roles
  • Identified processes and versions of the technology actors will use
  • A plan including schedule and script to define what is expected to happen with trigger points identified
  • Facilitators to keep things moving and debrief the experience

The plan details, the number of people required to participate, and technology will change based on the type of simulation being conducted.  Three types of simulation are common for Health IT:

  • Tabletop:  A structured walkthrough of a process or integrated workflow in a conference room that includes access to the technology that will support the process.  Best when used for integrated workflows where multiple departments are involved and the components of the process move through different departments over time.
  • Dress Rehearsal: A simulation of a patient visit from beginning to end in the ambulatory or hospital outpatient department or segmented portions of an inpatient stay.  Typically, the dress rehearsal starts with check-in/admission, moves through all of the events the patient will experience, with a member of the clinical team playing their role, and ends with check-out.  Best used when clinical users can dedicate time to participate, debrief what they discovered, and make adjustments before go-live to improve processes and technology setup.
  • Simulation Lab (in situ or in dedicated Simulation centers): A high fidelity simulation with standardized patients or mannequins conducted in the clinic, hospital outpatient department or inpatient unit (in situ) or in a dedicated bay in the simulation center.  Useful in a variety of instances once EHR technology is integrated into the Simulation Lab technologies, scenarios and methodology.  Some examples include:
    • Pre go-live to prepare super users and help end users practice what they have learned about using new technologies in a realistic setting,
    • Immediately after go-live to transition rapid response teams on tools to electronic documentation of codes and review complex clinical workflows,
    • Ongoing for training new hires, students, residents and existing staff and providers where integration of patient, clinician and EHR technology is required for safe and seamless patient care.

Clinical simulations are a key part of a blended learning solution for go-lives and an existing part of clinical training.  The EHR can be integrated into the simulation to increase the effectiveness of existing high fidelity scenarios.  The advantage for organizations that invest in clinical simulations during go-live is that users are better prepared to use their new knowledge and skills prior to seeing patients, and the structure created in the deliverables can be used post go-live.

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