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The impact of Supreme Court decisions on the admissions process at Geisinger College of Health Sciences

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EMR pilot shows greater sense of responsibility, engagement when students write billable notes.

When a provider puts a note in someone’s chart, it’s not just a line of text. That simple note offers an analysis, gives direction and often reflects an order for testing or medicine. And it can trigger a flurry of activity.

Just a note

It’s common practice for medical students doing clinical rotations to write a patient care note. Kept separate from their medical chart, it can’t trigger tests or treatments. And later, attending physicians review and critique them.

“Historically, students were allowed to write ‘real notes’ that would become part of the patient’s chart,” says Mark Olaf, DO, an emergency medicine physician and regional associate dean of Geisinger Commonwealth School of Medicine’s Central Campus. 

When electronic medical records (EMR) came along, that all changed. Due to patient safety concerns, some students lost access to patient records. Federal regulations regarding medical billing limited them even further.

That all changed in 2022 when the Centers for Medicare & Medicaid Services changed the billing rules. 

Being part of something bigger

In May, a student billable note pilot program was rolled out for rotating internal medicine students at Geisinger Wyoming Valley Medical Center and Geisinger Medical Center. 

Dr. Olaf and his team made sure students got to experience this critical learning experience during their rotations. 

Makayla Dearborn, class of ’23, was part of the pilot at Geisinger Wyoming Valley. She says the experience helped her feel like an integral part of the team and gave her a greater sense of responsibility.

“I had to write notes during other rotations, but they didn’t count,” she says. “Patients couldn’t see it and there was a disclaimer saying ‘This is a student note.’ During the pilot, I felt like I was contributing to the care of the patient.”

Dr. Olaf says data from the pilot showed that Dearborn’s peers agreed with her assessment. While he expected students to say they got more feedback, he noted that the opposite was true, with students stating they felt more involved in patient care. That one small change, he says, enhanced their entire experience.

Ready for residency

Another bonus for students? “Residency readiness,” says Dr. Olaf. That readiness comes in part from the fact that the student note is “billable.” 

Dearborn agrees: Becoming responsible for the process now was a big plus. “I didn’t think I’d be responsible for this until intern year,” she says, adding that the process didn’t change how she wrote her notes. Instead, it helped her be more thorough and include all the necessary criteria. 

Dr. Olaf says systems science also plays a role in residency readiness. “It’s not just the medicine. It’s not just the note writing. It’s the systems perspective.”

He credits the experience with enabling students to see the bigger picture when caring for patients, understanding that delivering care involves a lot of moving pieces, even for simple things like ordering an antibiotic.

Encouraged by the systems science learning and residency preparedness, Dr. Olaf and other Geisinger Commonwealth regional deans plan to expand the EMR rollout to include family medicine clinics and two emergency medicine sites in Danville and Wilkes-Barre. They will also be continuing the experience on inpatient internal medicine and expanding to other campuses.

Dr. Olaf with students
Dr. Mark Olaf, regional associate dean of Geisinger Commonwealth School of Medicine’s Central Campus, introduced a student billable note pilot program at two Geisinger hospitals. Discussing the program are, from left: Jessica Koshinski, MD Class of ’24; Clement Rajakumar, MD Class of ’24; Steven Reehl, MD Class of ’24; Dr. Olaf; and Jia Ying Zheng, MD Class of ’24.
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