Developing an EMR Simulator to Assess Users' Perception of Document Quality

Simulators are used in research and training because they provide a realistic and safe environment for participants. In the course of conducting a comprehensive study of patient care documentation in electronic medical record (EMR) systems we found that use of a simulated EMR system could address logistic and conceptual barriers encountered in deploying a research instrument to assess user perceptions of patient care document quality. Designed for use by practitioners, nurses, and administrators at four VA hospital sites, the web-based EMR simulator presents clinical documents as they appear in VA's CPRS production EMR, and administers a document quality assessment questionnaire. The EMR simulator was developed to overcome the contradiction of studying computerized documents with a paper instrument, to permit self-administration at multiple sites and to manage data collection. This paper discusses the motivation to evaluate EMR document quality, development of the quality questionnaire, and how the design of the simulator evolved and was pilot tested.