Evaluating Motivation for the Use of an Electronic Health Record Simulation Game

摘要

Experiential learning via simulation offers a variety of benefits including reduced risks, repetitive exposure, and mastery of complex processes. How to motivate people to engage in and enjoy playing games is an important concept in the creation of serious games focused on learning new skills. This study sought to determine the motivators that increase users’ pleasurable experience when playing an electronic health record simulation game. To examine how intrinsic and extrinsic motivation affected both engagement and enjoyment, we surveyed students of health professions at one university. Results indicate that while both forms of motivation are significant in increasing engagement and enjoyment, extrinsic motivation such as badges, points, and scoreboards were much more important than internal motivations for our participants. These findings have implications for the development of an electronic health record simulation game. Keywords: Gamification, electronic health record, experiential learning, simulation, intrinsic motivation, extrinsic motivationIntroductionDigital health information maintained in electronic health record (EHR) systems is an asset of significant value to both patients and healthcare organizations that requires governance by well-trained and experienced health information management (HIM) professionals. Students who will become HIM professionals must develop competency and efficiency in a variety of complex processes governing health information, which is the basis for clinical decisions that affect patient health. Health information must be accurate, complete, and available when and where it is needed for use in clinical and business decisions by all health professionals. The terms technology iatrogenesis or e-iatrogenesis refer to errors that occur because of technology introduced into the already complex healthcare delivery system.~(~(1)) To minimize these errors, HIM professionals must achieve high levels of competency and efficiency through effective instruction and extensive practice. Issues with health information create substantial risks for patients, providers, and facilities. Furthermore, health information is highly targeted for compromise by perpetrators of medical identity theft as well as those seeking ransom.~(~(2)) Governance of health information addresses not only the risks to patient health, but also the risks to patient privacy. The challenges associated with health information governance are evolving rapidly and result in the need for new tools and methods to learn and practice these skills in a safe, low-risk environment, such as that provided by simulation.This article presents the results of a study examining health profession students’ perceptions of game design elements and how these elements can increase the user's enjoyment when playing games. This study is based on the application of simulation and gamification techniques to enhance the experience of health profession students learning to use EHR systems. Inspired by previous experience teaching complex systems and encouraged by the literature about simulation in other areas of healthcare, the authors became curious about the effectiveness of a comprehensive simulation platform specifically designed to enable teaching and repetitive practice of the complex high-risk processes associated with EHR systems and how simulation game design might affect user enjoyment and engagement.As a step toward understanding the potential of an EHR simulation platform, we conducted a survey of students in our college of health professions to explore game design elements, how these elements motivate participants, and the positive effects on engagement and enjoyment. In the sections that follow, we first provide a review of literature that informed our research question. Next we review motivation and outcomes. After the literature review, we describe our methods and results. We close with a discussion of findings and conclusions drawn from the study.Literature ReviewThe current literature on gamification appraises a variety of elements associated with game design.~(~(3)) Game genres, types, motivations, and other game design characteristics are important in understanding specific game preferences and motivations that might contribute to the design of an EHR simulation game. The purpose of the research was to discover what game design elements motivated HIM students from both an intrinsic and extrinsic perspective with the ultimate goal of making a simulation game engaging and enjoyable.GamificationAlthough the literature includes many examples of simulation and experiential learning in healthcare settings such as anesthesiology,~(~(4), ~(5)) cardiology,~(~(6), ~(7)) intensive care,~(~(8), ~(9)) nursing,~(~(10), ~(11), ~(12)) obstetrics,~(~(13), ~(14)) outpatient healthcare,~(~(15), ~(16)) and many other disciplines,~(~(17)) research on the combination of gamification and EHRs is sparse. A notable exception is that of Mohan et al