In contemporary healthcare settings, Electronic Health Records (EHRs) have emerged as indispensable

tools, revolutionizing the way patient information is stored, accessed, and managed. The integration of
EHR systems into clinical practice has been met with widespread acclaim due to its potential to enhance
patient care, streamline healthcare workflows, and facilitate data-driven decision-making. Concurrently,
nursing education, as a critical component of the healthcare workforce development, necessitates
dynamic pedagogical approaches to equip aspiring nurses with the knowledge and competencies
essential for navigating this digital landscape. Consequently, this essay endeavors to delve into the
opportunities and challenges presented by the utilization of simulated EHRs as a major learning tool in
nursing education.

The primary aim of this essay is to comprehensively examine the potential advantages and obstacles
associated with incorporating simulated EHRs into nursing education. By simulating the intricacies of
real-world clinical practice, simulated EHRs have emerged as a promising educational strategy, offering
students a safe environment to develop informatics skills and cultivate critical thinking capabilities. As an
active learning tool, simulated EHRs afford nursing students with the opportunity to actively engage in
the construction of knowledge, thereby facilitating a deeper understanding of informatics concepts and
enhancing their aptitude for electronic documentation and data management.

To support the discussions presented in this essay, relevant and contemporary scholarly sources have
been meticulously reviewed. Two notable studies, conducted by Ting, Garnett, and Donelle (2021), and
Kleib, Jackman, Duarte Wisnesky, and Ali (2021), form the bedrock of this analysis. The integrative review
conducted by Ting et al. offers insights into the multifaceted landscape of EHR education and training for
nurses, emphasizing the necessity of diverse approaches tailored to nurses' clinical workflows. Moreover,
the findings underscore the growing prominence of blended learning strategies, encompassing e-
learning, nurse superusers, peer coaching, and simulation training, as effective means of augmenting
traditional classroom-based learning in EHR education.

Furthermore, the mixed-methods pilot study undertaken by Kleib et al. explores the viability of
incorporating simulated EHRs within undergraduate nursing education. Through the lens of a
constructivist approach to experiential learning, the research underscores the role of simulated EHRs in
fostering critical thinking, enhancing students' electronic documentation skills, and bolstering their
confidence and self-efficacy in utilizing electronic records.

In light of these scholarly works, this essay will meticulously examine the prospects of integrating
simulated EHRs into nursing education while assessing the impediments that warrant consideration
during implementation. By exploring both the promises and challenges, this study seeks to shed light on
the potential transformative impact of simulated EHRs on nursing education and the subsequent
implications for the broader healthcare landscape.

III. Challenges in Integrating Simulated EHRs in Nursing Education

A. Cost Considerations

The integration of simulated Electronic Health Records (EHRs) in nursing education poses several
challenges, foremost among which are cost considerations. Implementing simulated EHR platforms can
require significant financial investments, including software licensing fees, hardware infrastructure, and
ongoing maintenance costs. Nursing programs and institutions may face budgetary constraints, making it
challenging to allocate sufficient resources for the adoption of these technologies.

To address these financial challenges, nursing educators and institutions can explore cost-effective
solutions such as open-source EHR platforms. Open-source EHRs, like OpenEMR, WorldVistA, and
OSCAREMR, offer free access to their software, making them viable options for institutions seeking to
integrate simulated EHRs without incurring substantial expenses. Furthermore, these platforms provide
flexibility for customization and adaptation to align with the specific educational objectives of nursing
programs.

B. Faculty Expertise and Training

Effective integration of simulated EHRs in nursing education necessitates adequately trained faculty who
can leverage the full potential of these tools. Faculty members may face challenges in adapting their
teaching methods to incorporate simulated EHRs into the curriculum effectively. Familiarity with the
specific functionalities of the chosen simulated EHR and an understanding of how to create meaningful
learning experiences are crucial aspects of faculty expertise in this context.

Addressing the faculty expertise challenge requires providing comprehensive training programs.
Workshops, seminars, and professional development opportunities can empower faculty with the
necessary skills to navigate and utilize simulated EHRs effectively. Encouraging a collaborative
environment where faculty members share best practices and exchange experiences can also bridge the
gap between faculty expertise and seamless EHR integration.

C. Assessing Patient and Organizational Outcomes

While the potential benefits of simulated EHRs in nursing education are promising, it is imperative to
evaluate the impact of these educational interventions on patient care and healthcare organizations.
Rigorous studies assessing patient and organizational outcomes are essential to ensure that EHR-based
learning is contributing positively to nursing education and overall healthcare quality.

To address this challenge, research efforts should be directed towards conducting comprehensive studies
that examine the influence of simulated EHRs on patient safety, nursing performance, and overall
healthcare outcomes. Combining quantitative data, such as patient care metrics and outcomes, with
qualitative feedback from healthcare professionals and patients can offer a comprehensive
understanding of the efficacy of EHR-based learning in nursing education.

By addressing the challenges of cost, faculty expertise, and outcome evaluation, the integration of
simulated EHRs in nursing education can be effectively facilitated, maximizing the potential benefits for
both students and the broader healthcare landscape. Through thoughtful planning, continuous
improvement, and research-driven approaches, nursing programs can harness the transformative power
of simulated EHRs, ensuring that future nursing professionals are equipped with the skills and knowledge
required to excel in today's technology-driven healthcare environment.

IV. The Case of Lippincott DocuCare as a Simulated EHR

A. Overview of Lippincott DocuCare

Lippincott DocuCare, a simulated Electronic Health Record (EHR) platform, has emerged as a prominent
choice for integration into nursing education due to its comprehensive features and functionality. This
simulated EHR system has been designed to closely resemble real-world clinical environments, providing
nursing students with an authentic and immersive learning experience.

1. Features and Functionality: a. Patient Records: Lippincott DocuCare offers a diverse range of
simulated patient cases, each complete with electronic health records, allowing students to
interact with a variety of medical scenarios. These records encompass essential patient
information, such as medical history, medications, allergies, laboratory results, and progress
notes. b. Medication Management: Nursing students can practice medication verification and
administration through the simulated EHR, promoting safe medication practices and error
prevention. c. Care Plans: Lippincott DocuCare facilitates the creation and management of care
plans, enabling students to develop comprehensive and individualized patient care strategies. d.
Documentation and Charting: Students can practice electronic documentation, honing their
proficiency in accurately recording patient assessments and interventions within the EHR system.
e. Interdisciplinary Communication: The platform promotes communication and collaboration
between healthcare professionals, fostering a holistic understanding of patient care.

2. Alignment with the Curriculum and Cost-Effectiveness: Lippincott DocuCare's selection for
integration into nursing education was predicated on its seamless alignment with the established
curriculum. The platform's diverse and comprehensive features enable faculty to effectively
integrate EHR-based learning into various courses, spanning from fundamental nursing concepts
to advanced clinical practice. As a learner-centered pedagogy, Lippincott DocuCare complements
the constructivist approach of experiential learning, facilitating active student engagement in the
knowledge construction process.

Furthermore, its cost-effectiveness played a pivotal role in the decision-making process. With an
individual student's web access priced at US $100 for 12 months, Lippincott DocuCare offers a cost-
efficient solution, particularly when considering institutional purchase plans. This affordability makes it
an attractive option for nursing programs with limited financial resources, ensuring accessibility for a
broader range of students.

B. Feedback from Students and Faculty

Obtaining feedback from key stakeholders, namely students and faculty, is an integral aspect of the
successful integration of any educational tool, including simulated EHRs. In the case of Lippincott
DocuCare, soliciting feedback from nursing students and faculty members played a pivotal role in
evaluating its suitability and effectiveness in the educational context.

1. Importance of Obtaining Feedback: Feedback serves as a valuable mechanism for identifying

strengths, weaknesses, and areas for improvement in the simulated EHR's implementation. It
provides insights into students' learning experiences, ease of use, and overall satisfaction with
the platform. Faculty feedback, on the other hand, offers valuable perspectives on the alignment
of the platform with curriculum objectives, challenges encountered during implementation, and
the adequacy of faculty training.
 2. Evaluation and Feedback Results: Preliminary feedback from students and faculty on the
suitability of Lippincott DocuCare has been largely positive. Students have reported that the
platform offers a realistic simulation of patient care scenarios, enhancing their ability to navigate
EHR systems and fostering critical thinking skills. Faculty members have acknowledged the
alignment of the platform with the curriculum, facilitating seamless integration into various
courses.

However, as with any educational tool, there have been challenges, particularly related to faculty training
and support. Addressing these challenges through continuous professional development and ongoing
support mechanisms is vital to optimizing the potential benefits of Lippincott DocuCare in nursing
education.

In conclusion, Lippincott DocuCare's comprehensive features, alignment with the curriculum, and cost-
effectiveness make it a compelling choice for simulated EHR integration in nursing education. The
valuable feedback gathered from students and faculty further reinforces its positive impact on student
learning experiences and underscores the importance of continuous evaluation and improvement in
harnessing the full potential of simulated EHRs.

V. Implementing Simulated EHRs in Nursing Education

A. Best Practices for Successful Integration

1. Strategies to Overcome Cost and Faculty Expertise Challenges: a. Securing Funding: Nursing
programs can seek grants and funding opportunities to support the implementation of simulated
EHRs. Collaboration with healthcare organizations or partnerships with technology vendors may
also offer financial assistance. b. Faculty Development: Prioritizing faculty training and
development is essential to optimize the integration of simulated EHRs. Workshops, seminars,
and ongoing support from experienced educators or technology experts can empower faculty to
effectively utilize the platform in their teaching methods.

2. Importance of Continuous Student and Faculty Involvement: a. Student Engagement: Actively

involving students in the selection and evaluation process of the simulated EHR platform fosters
a sense of ownership and investment in the learning experience. Encouraging feedback and
incorporating student perspectives during implementation can lead to iterative improvements.
b. Faculty Collaboration: Creating opportunities for faculty collaboration, sharing best practices,
and exchanging experiences will enrich the integration process. Regular meetings, workshops,
and virtual forums can facilitate a collaborative environment that supports continuous
improvement.

B. Potential Benefits for Nursing Programs

1. Broader Impact of Incorporating Simulated EHRs in Nursing Education: The integration of

simulated EHRs has far-reaching implications for nursing programs, students, and the healthcare
industry. By providing a realistic and immersive learning experience, students develop
proficiency in using EHR systems, ensuring they are better prepared for the technology-driven
healthcare landscape. a. Enhanced Competencies: Nursing students acquire essential skills in
electronic documentation, medication management, and care planning, contributing to
 improved patient safety and quality of care. b. Critical Thinking and Decision-making: Exposure
to simulated EHRs nurtures critical thinking and clinical judgment, equipping students to make
well-informed decisions in complex patient scenarios. c. Technological Fluency: Graduates
possess a heightened level of technological fluency, enabling seamless integration into modern
healthcare settings that heavily rely on EHR systems.

2. Fulfilling Accreditation Requirements and Preparing Graduates for Digital Healthcare

Environments: Integrating simulated EHRs aligns nursing programs with accreditation standards
and industry expectations, ensuring that graduates are equipped with the necessary entry-to-
practice competencies. Accreditation bodies, recognizing the importance of EHR proficiency,
increasingly emphasize the incorporation of technology-driven learning experiences within
nursing curricula. By meeting these requirements, nursing programs bolster the employability
and career prospects of their graduates in a digitally advanced healthcare sector.

VI. Conclusion

In conclusion, the integration of simulated Electronic Health Records (EHRs) in nursing education
presents significant opportunities to cultivate competent and technologically adept nursing
professionals. Despite the challenges related to cost and faculty expertise, successful implementation
can be achieved through securing funding, providing comprehensive faculty training, and fostering
continuous student and faculty involvement. The potential benefits for nursing programs encompass
enhanced competencies, improved critical thinking, and technological fluency among students, thereby
ensuring a skilled and well-prepared workforce for the digital healthcare landscape.

To fully realize the transformative potential of simulated EHRs, a commitment to continuous evaluation
and improvement is vital. By actively seeking student and faculty feedback and collaboratively addressing
challenges, nursing programs can optimize the effectiveness of EHR-based learning. Ultimately, the
impact of EHR-based education extends beyond nursing education, positively influencing patient care
and healthcare organizations as graduates enter the workforce equipped with advanced EHR proficiency
and critical thinking capabilities. As the healthcare industry continues to evolve, a call to further explore
the benefits of simulated EHRs and their evolving role in nursing education is essential to meet the
demands of modern healthcare and provide optimal patient care.

Think about the clinical courses you have taken as a student. Which opportunities and challenges exist
regarding the use of an EHR as a major learning tool in conjunction with, or perhaps even replacing, the
required textbook?

(Ting et al., 2021)

(Kleib et al., 2021)

Ting, J., Garnett, A., & Donelle, L. (2021). Nursing education and training on electronic health
record systems: An integrative review. Nurse Education in Practice, 55, 103168.
https://doi.org/10.1016/j.nepr.2021.103168.
Consensus in the reviewed literature indicated that electronic health record education and training for
nurses should be multipronged and targeted to nurses' clinical workflows. Key findings of this review
identified a shift from classroom-based learning towards blended approaches for electronic health
record education and training. Blended approaches often incorporated non-traditional methods that
could support interactive and workflow-based content. These included e-learning, nurse superusers or
peer coaches, and simulation training. The findings of this review also highlighted the need for early and
ongoing involvement of frontline nurses during electronic health record education and implementation.
However, more rigorous studies that assess both patient and organizational outcomes are needed to
identify the most effective "cocktail" of blended learning strategies.

Kleib, M., Jackman, D., Duarte Wisnesky, U., & Ali, S. (2021). Academic electronic
health records in undergraduate nursing education: Mixed methods pilot study. JMIR
Nursing, 4(2), e26944. https://doi.org/10.2196/26944.
Ting, J., Garnett, A., & Donelle, L. (2021). Nursing education and training on electronic health
record systems: An integrative review. Nurse Education in Practice, 55, 103168.
https://doi.org/10.1016/j.nepr.2021.103168.

Simulated EHRs for academic purposes have been proposed as an innovative pedagogy to promote the
acquisition of theoretical knowledge of informatics and the skills needed to use EHRs in a safe
environment before encounters with real patients [14-25]. Incorporating these learning experiences
within undergraduate nursing education expands the realm of effective teaching and learning practice,
fulfills accreditation requirements, and ensures graduates have the required entry-to-practice
competencies in nursing informatics upon exiting the program so that they are better prepared for
practice in today’s digitally rich health care environment [3,26-28]. A simulated EHR is a learner-centered
pedagogy grounded in a constructivist approach of experiential learning where learners are actively
involved in the process of knowledge construction and reflective learning as opposed to passively
receiving information [15,29,30]. Using case scenarios that mimic real-world clinical practice enables the
students to learn how to use EHRs for care delivery, eg, identifying and interpreting patient data such as
verifying medication accuracy, in a supervised environment before clinical encounters with real patients;
thus, it improves learning outcomes and can contribute to promoting patient safety [20,30-36].

Simulated EHRs resemble electronic patient records used in practice settings [22,37]. A number of
products are available for nurse educators to choose from including open-source EHR or electronic
medical record (EMR) and vendor-operated EHR or EMR platforms [38]. Examples of open-source
platforms include OpenEMR, WorldVistA, and OSCAREMR. Vendor-operated platforms are available
through health information system technology vendors such as Cerner. These also are offered through
publishing companies such as Lippincott DocuCare by Wolters Kluwer, EHR Tutor by Assessment
Technologies Institute, SimChart by Elsevier, and NEEHR Perfect, now known as ehrgo, by Archetype
Innovations. Although these products have similar platforms, they vary in cost and functionality [38].
Research suggests that integrating simulated EHRs in prelicensure nursing education is beneficial to
students’ learning and development of important educational outcomes [20,30,34]. Simulated EHRs help
improve students’ critical thinking [18] and their ability to navigate EHRs and understand informatics
concepts such as data management [19,39,40]. Other researchers found that simulated EHRs help
enhance students’ skills in electronic documentation [24,41,42] and aid in the development of positive
attitudes and perspectives about electronic records [43,44]. The integration of simulated EHRs also
enhances students’ confidence and self-efficacy in using electronic records [23,44-46] and increases
informatics knowledge and competency [16,40,47]. Despite these benefits, factors such as cost and
faculty expertise continue to be major challenges in integrating simulated EHRs in nursing education
[18,34,48,49].

At our university, curricular revisions presented an ideal opportunity to explore the integration of a
simulated EHR within undergraduate nursing programs to expose students to health information
technologies used in practice and to acquire the required entry-to-practice informatics competencies.
This direction was enforced further by the introduction of Connect Care, a new EMR, in our health
system. Although our students will have the opportunity to complete a user-training program before
their clinical practicum in units that transitioned to Connect Care, these students have no previous
exposure to hands-on practice with electronic records within their laboratory or simulation education,
which is a gap in our curriculum. To support students’ learning and application of informatics knowledge
that is currently taught in theory courses and the computerized documentation introduced in the new
curriculum across all clinical courses, we reviewed a number of simulated EHR solutions considering the
benefits and value in meeting the students’ and program’s needs [16,18,37,38]. We opted for the
Lippincott DocuCare simulated EHR because it is user friendly and is aligned with the V-Sim resources
currently used in our simulation laboratory. In addition, the cost of DocuCare for an individual student’s
web access at US $100 for 12 months (negotiable when based on an institutional purchase plan)
provided additional support for choosing this product over others. The next step of our evaluation was to
obtain feedback from students and faculty on the suitability of this product for integration into our
programs.