Electronic-clinical evaluation exercise (e-CEX): A new patient-centered EHR use tool

Maria Alcocer Alkureishi, Wei Wei Lee, Maureen Lyons, Kristen Wroblewski, Jeanne M. Farnan, Vineet M. Arora

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Introduction: Electronic Health Record (EHR) use can enhance or weaken patient-provider communication. Despite EHR adoption, no validated tool exists to assess EHR communication skills. We aimed to develop and validate such a tool. Methods: Electronic-Clinical Evaluation Exercise (e-CEX) is a 10-item-tool based on systematic literature review and pilot-testing. Second-year (MS2s) students participated in an EHR-use lecture and structured Clinical Examination (OSCE). Untrained third-year students (MS3s) participated in the same OSCE. OSCEs were scored with e-CEX compared to a standardized patient (SP) tool. Internal consistency, discriminant validity, and concurrent validity were analyzed. Results: Three investigators used e-CEX to rate 70 videos (20 MS2, 50 MS3). Reliability testing indicated high internal consistency (Cronbach's alpha = 0.89). MS2s scored significantly higher than untrained MS3 s on e-CEX [e-CEX 55(10.7) vs. 44.9 (12.7), P = 0.003], providing evidence of discriminant validity. e-CEX and SP score correlation was high (Pearson correlation = 0.74, P < 0.001), providing concurrent validity evidence. Item reduction suggested a three-item tool had similar explanatory power (R-squared = 0.85 vs 0.86). Conclusion: e-CEX is a reliable, valid tool to assess medical student patient-centered EHR communication skills. Practice implications: While validation is needed with other healthcare providers, e-CEX may help improve provider behaviors and enhance patients’ overall experience of EHR use in their care.

Original languageEnglish
Pages (from-to)481-489
Number of pages9
JournalPatient Education and Counseling
Issue number3
StatePublished - Mar 2018


  • Communication
  • EHR
  • Electronic health records
  • Electronic medical records
  • Evaluation
  • Patient-provider relationship


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