CC BY 4.0 · ACI Open 2020; 04(01): e69-e82
DOI: 10.1055/s-0040-1708036
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Effective Design, Development, and Evaluation of Video Tutorials for Electronic Medical Record Training

Gurprit K. Randhawa
1  School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Canada
2  Learning and Performance Support, Island Health, Victoria, British Columbia, Canada
Aviv Shachak
3  Institute of Health Policy, Management and Evaluation (Dalla Lana School of Public Health), Toronto, Ontario, Canada
4  Faculty of Information University of Toronto, Toronto, Ontario, Canada
Karen L. Courtney
1  School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Canada
Andre Kushniruk
1  School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Canada
› Author Affiliations
Funding None.
Further Information

Publication History

05 August 2019

09 January 2020

Publication Date:
11 June 2020 (online)


Background Electronic medical record (EMR) use by primary care physicians (PCP) in the United States and Canada is suboptimal, especially for supporting chronic diseases like diabetes. PCPs need postimplementation training to achieve value-adding EMR use. Video tutorials demonstrate how to accomplish tasks using software. However, there is a dearth of research on the use of video tutorials for EMR training.

Objective The purpose of the study was to design, develop, and evaluate video tutorials for training PCPs in using EMR advanced features for diabetes care. This study addressed three research questions related to PCP's views of video tutorials as an EMR training method/approach, barriers, and facilitators to applying the EMR video tutorials to PCPs' practice, and how the design of EMR video tutorials can be improved.

Methods The overall research study employed a QUAN (qual) mixed methods approach with an embedded design. This article focuses on the qualitative phase of the mixed methods study. A series of four theory-informed and evidence-based video tutorials for diabetes care was developed with a physician champion. Qualitative data were collected at four time points: 1 month before (O1), immediately before (O2), 3 months after (O3), and 6 months (O4) after the intervention. Semistructured interviews with participants were held at O3 and O4. Qualitative data were analyzed using thematic analysis.

Results In total, 14 PCPs from the overall study participated in interviews (78%). The thematic analysis of the qualitative data revealed seven themes, which fall into two main categories: (1) design and development of EMR video tutorials, and (2) adoption and use of EMR video tutorials.

Conclusion PCPs liked the EMR video tutorials for diabetes care, and would like more EMR video tutorials on various topics and EMR use levels. The study offers a roadmap for health informatics professionals everywhere to develop EMR training videos that meet evidence-based design criteria. It also help to identify opportunities to improve the design, delivery, and adoption of EMR video tutorials for future training interventions.

The terms EMR and EHR (electronic health record) are often used interchangeably diseases[1]. In Canada, where this study has been conducted, an EMR is a health record under the custodianship of primary care physicians, whereas an EHR is used in secondary and tertiary care (hospital) settings.

Authors' Contributions

Each author made the following contributions toward the completion of the manuscript:

1. Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data.

2. Drafting the article or revising it critically for important intellectual content.

3. Final approval of the version to be published.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on ethical principles for medical research involving human subjects, and was reviewed by the University of Victoria Human Research Ethics Board (HREB).

  • References

  • 1 Canada Health Infoway. The emerging benefits of electronic medical record use in community-based care; 1–98. Available at: . Accessed April 21, 2013
  • 2 Survey NP. What electronic functions are you planning to use in the next two years? NR. 2014:2012. Available at: . Accessed May 7, 2020
  • 3 Commonwealth Fund. 2015 International Survey of Primary Care Doctors. 2015. Available at: . Accessed May 7, 2020
  • 4 Denomme LB, Terry AL, Brown JB, Thind A, Stewart M. Primary health care teams’ experience of electronic medical record use after adoption. Fam Med 2011;43(09):638–642
  • 5 Loomis GA, Ries JS, Saywell RM Jr, Thakker NR. If electronic medical records are so great, why aren’t family physicians using them? J Fam Pract 2002;51(07):636–641
  • 6 Price M, Singer A, Kim J. Adopting electronic medical records: are they just electronic paper records? Can Fam Physician 2013;59(07):e322-e329
  • 7 Randhawa GK, Lau F, Price M. Evaluating the adoption of e-prescribing in primary care. Healthc Q 2013;16(04):55–60
  • 8 Swerissen H, Duckett S, Wright J. Chronic failure in primary medical care. 2016. Available at: . Accessed March 2, 2016
  • 9 Canadian Institute for Health Information. Diabetes care gaps and disparities in Canada. Community Health (Bristol) 2009. Available at: . Accessed May 7, 2020
  • 10 Edwards G, Kitzmiller RR, Breckenridge-Sproat S. Innovative health information technology training. CIN Comput Informatics Nurs 2012;30(02):104–109
  • 11 Dastagir MT, Chin HL, McNamara M, Poteraj K, Battaglini S, Alstot L. Advanced proficiency EHR training: effect on physicians’ EHR efficiency, EHR satisfaction and job satisfaction. AMIA Annu Symp Proc 2012;2012:136–143
  • 12 Bredfeldt CE, Awad EB, Joseph K, Snyder MH. Training providers: beyond the basics of electronic health records. BMC Health Serv Res 2013;13:503
  • 13 Venkatesh V. Creation of favorable user perceptions: exploring the role of intrinsic motivation. Viswanath Venkatesh Source MIS Q. 1999;23(02):239–260
  • 14 Nelson RR, Cheney PH. Training end users - an exploratory-study. MISQ Q. 1987;11(04):547–559
  • 15 Baecker R. Showing instead of telling. In: ACM SIGDOC 2002. 2002:10-16. Available at: . Accessed May 7, 2020
  • 16 Palaigeorgiou G, Despotakis T. Known and unknown weaknesses in software animated demonstrations (screencasts): a study in self-paced learning settings. J Inf Technol Educ 2010;9:1–18
  • 17 Harrison S. A comparison of still, animated, or nonillustrated on-line help with written or spoken instructions in a graphical user interface. Proc SIGCHI Conf Hum Factor Comput Syst. Vol Denver, Colorado, USA: ACM Press/Addison-Wesley Publishing Co.; 1995:82-89. Available at: . Accessed May 7, 2020
  • 18 Palmiter S, Elkerton J. An evaluation of animated demonstrations of learning computer-based tasks. Proc SIGCHI Conf Hum Factors Comput Syst. 1991:257-263. 10.1145/108844.108906. Available at: . Accessed May 7, 2020
  • 19 Palmiter S, Elkerton J. Animated demonstrations for learning procural computer-based tasks. Hum Comput Interact 1993;8(03):193–216
  • 20 He Z, Marquard J, Henneman E. Model guided design and development process for an electronic health record training program. AMIA Annu Symp Proc 2017;2016:1814–1821
  • 21 Thiyagarajan A, Allen C, Peacock J, Cousins R. Implementing training videos for student clinicians to improve charting and utilization of EHR capabilities. 2017;3. Available at: . Accessed May 7, 2020
  • 22 Zoghbi V, Caskey RC, Dumon KR, et al. “How to” videos improve residents performance of essential perioperative electronic medical records and clinical tasks. J Surg Educ 2018;75(02):489–496
  • 23 Randhawa GK, Shachak A, Courtney KL, Kushniruk A. Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care. BMJ Health Care Inform 2019;26(01):e100086
  • 24 Bethke FJ, Dean WM, Kaiser PH, Ort E. Improving the usability of programming publications. IBM Syst J 1981;20(03). Doi: 10.1145/965660.965668
  • 25 Van der Meij H, Carroll J. Principles and Heuristics for Designing Minimalist Instruction. Cambridge, MA: MIT Press; 1995
  • 26 Horn R. Structured writing at twenty-five. Perform Instr 1993;32:11–17
  • 27 Mayer R, Mayer RE. The Cambridge Handbook of Multimedia Learning. Cambridge, MA: Cambridge University Press; 2005
  • 28 Tversky B, Morrison JB, Betrancourt M. Animation?: can it facilitate? Int J Hum Comput Stud 2002;247–262
  • 29 Neumann O. Theories of attention. In: Neumann O, Sanders AF, eds. Handbook of Perception and Action. Vol. 3. Cambridge, MA: Academic Press; 1996:389–446
  • 30 Paivio A. Imagery and Verbal Processes. NY: Holt, Rinehart, and Winston; 1971
  • 31 Bandura A. Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall; 1977
  • 32 Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Upper Saddle River, NY: Prentice-Hall, Inc; 1986
  • 33 van der Meij H, Gellevij M. The four components of a procedure. IEEE Trans Prof Commun 2004;47(01):5–14
  • 34 Plaisant C, Shneiderman B. Show me Guidelines for producing recorded demonstrations. 2005. Available at: . Accessed May 7, 2020
  • 35 Brar J, Van Der Meij H. Computers in human behavior complex software training: harnessing and optimizing video instruction. Comput Human Behav 2017;70:475–485
  • 36 Swarts J. New modes of help: best practices for instructional video. Tech Commun (Washington) 2012;59(03):195–206
  • 37 van der Meij H, van der Meij J. Eight Guidelines for the design of instructional videos for software training. Tech Commun (Washington) 2013;60(03):205–228
  • 38 Shachak A, Barnsley J, Tu K, Jadad AR, Lemieux-Charles L. Understanding end-user support for health information technology: a theoretical framework. Inform Prim Care 2011;19(03):169–172
  • 39 Grol R, Wensing M. Effective implementation of change in healthcare: a systematic approach. 2013:40–59
  • 40 Torre DM, Daley BJ, Sebastian JL, Elnicki DM. Overview of current learning theories for medical educators. Am J Med 2006;119(10):903–907
  • 41 Eyal K, Rubin AM, Eyal K, Rubin AM. Viewer aggression and homophily, identification, and parasocial relationships with television characters viewer aggression and homophily, with television characters. J Broadcast Electron Media 2010. Doi: 10.1207/s15506878jobem4701
  • 42 Randhawa G. OSCAR EMR study recruitment video. 2017. Available at: . Accessed August 9, 2019
  • 43 Singer A, Ivers NM. Using your electronic medical record to deliver evidence-based diabetes care. Can Fam Physician 2019;65(01):43–44
  • 44 PAHO. The chronic care model. 2013. Available at: . Accessed April 4, 2016
  • 45 Randhawa G, Yap J. OSCAR EMR video tutorial series. 2017. Available at: . Accessed September 27, 2017
  • 46 QSR International Pty Ltd. NVivo qualitative data analysis software, version 10. 2012. Available at: . Accessed February 12, 2014
  • 47 Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust 2004;180(S6):S57–S60
  • 48 Østbye T, Yarnall KSH, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005;3(03):209–214
  • 49 Ajami S, Bagheri-Tadi T. Barriers for adopting electronic health records (EHRs) by physicians. Acta Inform Med 2013;21(02):129–134
  • 50 Shuval K, Berkovits E, Netzer D, et al. Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors' attitudes, knowledge and clinical behaviour: a controlled trial and before and after study. J Eval Clin Pract 2007;13(04):581–598
  • 51 Bailey CJ, Aschner P, Del Prato S, LaSalle J, Ji L, Matthaei S; Global Partnership for Effective Diabetes Management. Individualized glycaemic targets and pharmacotherapy in type 2 diabetes. Diab Vasc Dis Res 2013;10(05):397–409
  • 52 Levey AS, Coresh J. Chronic kidney disease. Lancet 2012;379(9811):165–180
  • 53 United Nations Educational Scientific and Cultural Organization. What are open educational resources? 2017. Available at: . Accessed May 7, 2020
  • 54 Shachak A, Reis S, Gray K, et al. Evaluating educational interventions for health professions in the digital age. In: Shachak A, Borycki EM, Reis SP, eds. Health Professionals’ Education in the Age of Clinical Information Systems, Mobile Computing and Social Networks. Amsterdam, Netherlands: Elsevier Inc.; 2017:471–488