SimEPR: embedding digital skills in clinical training

SimEPR offers a digital solution that allows practical clinical training to more accurately reflect the digital transformations in healthcare that are being driven by the NHS Long Term Plan. SimEPR’s ability to combine digital skills with practical clinical training not only offers enhanced learning outcomes, but also helps equip our future NHS workforce with the skills to safely and confidently use electronic patient records. In turn, this will optimise patient outcomes by reducing the incidence of electronic system-related clinical errors.

Digitalising crucial medical training

In line with the NHS Long Term Plan, electronic systems are becoming increasingly common in healthcare settings but practical medical education in the UK continues to use paper-based methods. SimEPR aims to address this ‘digital gap’ in clinical training by creating an educational experience that is more representative of true clinical practice and additionally equips future workforce with the skills to safely and confidently use electronic patient records. In turn, this will optimise patient outcomes by reducing the incidence of electronic system-related clinical errors.

SimEPR is an educational electronic patient record, featuring customisable patient scenarios, which can be integrated into routine simulation training for medical students and and healthcare professionals. The technology replicates electronic notes, drug charts, observations and clinical investigations. In addition, it offers the ability to generate electronic prescriptions, electronic documentation and request investigations that update in real-time so trainees can review the results of tests they have requested.

So far, SimEPR has been piloted in simulation departments in East Surrey Hospital, Croydon University Hospital, The Royal London Hospital and Brighton and Sussex Medical School. Data from these pilots has demonstrated benefits to the fidelity of simulation training and improved learning outcomes. Throughout the pilot process, data and feedback generated from trainees and medical educators has shaped the further development of SimEPR into a bespoke product for medical simulation training in the UK.

A F1 doctor at University Hospitals Sussex NHS Foundation Trust said:
“Really useful and clear EPR system that was easy to use. Resembled real life and was an efficient system with all the key functions available for prescribing, note taking and ordering investigations.”

The challenge SimEPR addresses

Practical medical education has not kept up with the pace of change as the NHS moves from paper based patient records to electronic records. The roll out of electronic patient records throughout the NHS has accelerated rapidly and the proportion of trusts with an electronic prescriptions and medicines administration (ePMA) system is expected to have risen from 19% in 2018 to more than 80% by March 2021. The NHS is on course to eliminate paper prescribing in hospitals and achieve the NHS Long Term Plan commitment to introduce digital prescribing across the entire NHS by 2024.

Instead of relying on handwritten notes and paper medicine charts, staff can now quickly access potentially life-saving information on prescribed medicines and patient history. This can also reduce medication errors by up to 30% when compared with the old paper systems.

However, in medical education, simulation training (including prescribing skills) remains paper-based, which means students have an unrepresentative training experience and gain minimal experience using electronic systems in patient care.

As part of SimEPR’s market research process, 122 doctors and medical students based in England and Wales responded to an electronic survey between August 2020 and May 2021. Respondents had received simulation training across a total of 80 NHS simulation centers. Out of the survey respondents:

• None had used a mock electronic patient record system during their simulation training
• 98% reported that integrating electronic records would make simulation training a more realistic training experience
• 97% reported that integrating electronic records would enhance clinical learning and skills.

Benefits of SimEPR

Across the 4 medical simulation centers piloting the solution, 140 medical students and junior doctors have used SimEPR during their simulation training to date. Multicentre data has revealed clear benefits to simulation training:
• 86% of trainees reported SimEPR created a more realistic training experience
• 82% of trainees reported SimEPR helped augment their clinical learning
• 86% would recommend their department continues to use SimEPR for future simulation training sessions.

Specifically at the Brighton and Sussex Medical School simulation centre, 23 final year medical students and 56 Foundation doctors used SimEPR over the 6-month period. Trainee feedback demonstrated:
• 84% of trainees reported SimEPR created a more realistic training experience
• 85% of trainees reported SimEPR helped augment their clinical learning
• 89% would recommend their department continues to use SimEPR for future simulation training sessions.

A F1 doctor at University Hospitals Sussex NHS Foundation Trust commented:
“SimEPR provides a more accurate representation of a scenario that would be presented to a doctor in the hospital.”

SimEPR’s development

The innovative SimEPR solution was developed by Dr Arron Thind, a GP trainee with a determination to tackle everyday healthcare challenges through digital solutions. Throughout his clinical training, he noticed a discrepancy between the use of electronic systems in clinical practice compared to the use of paper-based methods in routine practical medical training. Using programming skills he learned during his first year as a junior doctor, he developed SimEPR, an educational electronic patient record that features customisable patient scenarios, which can be integrated into routine simulation training for medical students and doctors. A first prototype was completed in September 2020 and was initially piloted in the simulation teaching faculty at East Surrey Hospital with St George’s medical students.

Arron has benefited from the support of national innovator and digital programmes including Digital Health London’s Digital Pioneer Fellowship and the NHS Clinical Entrepreneur Programme. Arron also worked with London South Bank University’s ‘Simulation for Digital Health Accelerator’ and South East Health Technologies Alliance to build on the software’s capabilities and expand pilot sites, which later included The Royal London Hospital and Croydon University Hospital.

KSS AHSN has helped his work with peer support through its Innovation Leads Network and facilitated introductions to local medical schools and simulation experts. With this support, SimEPR was deployed as part of a six-month pilot in Brighton and Sussex Medical School in September 2021, leading to a commercial agreement to use SimEPR for medical student and junior doctor training in the longer-term.

Dr Arron Thind said:
“The support of national innovators programmes and KSS AHSN has been critical to the evolution of SimEPR as a product to benefit the quality of training, commercial viability and for increasing traction.

“KSS AHSN’s extensive network helped me secure SimEPR’s first commercial agreement, which is vital for the sustainability of the product and the team has provided valuable commercial and market insight needed to transform SimEPR from a prototype with an evidence base to an operational product.”

Plans for the future

In under two years, SimEPR has progressed from an idea to an evidence-backed product, with early traction in the medical simulation training sector. The next step is to expand SimEPR across other simulation centres to allow more trainees in the London, Kent, Surrey and Sussex region to benefit from the software. Feedback will continue to be collected throughout this process to build on SimEPR’s functionalities and ensure the software continues to provide optimal teaching outcomes.

Recently, a no-code editor interface has been added to SimEPR, allowing medical educators to create and customise clinical scenarios independently. In the longer term, there is potential for SimEPR to offer more advanced functionalities.

Furthermore, SimEPR also has potential to be used to standardise the delivery of simulation training: SimEPR’s platform would allow the use of standardised and accredited clinical scenarios that meet curriculum requirements. This is in line with the latest UK Foundation Programme curriculum, which outlines a number of conditions and clinical presentations that Foundation trainees should have the opportunity to be exposed to during their simulation training. It also aligns with Health Education England’s National Strategic Vision for the role of Simulation and Immersive Technologies in Health and Care.

For more information
Please contact Dr Charlotte Roberts, Senior Programme Manager, KSS AHSN
charlotte.roberts18@nhs.net