1. Legal Third Party Payers such as CMS currently restrict what elements of the record can be documented by clinical Medical Students when used for billing CMS for the visit. This puts into question whether any documentation of PA, NP, and preclinical Medical students may be for billing. The advent ACO’s will likely make learner documentation more difficult in the future. 2. Administrative Costs to Community Practices   Each student who uses an EMR in a preceptor’s practice requires an ID, password, and signing privileges etc. They must then be removed at the end of each rotation. Students also need to be trained on the system. The training takes extra time that would normally be used for learning. This extra work adds to the cost of hosting students. 3. Patient Safety   Many preceptors just allow the students to use their (preceptor’s) sign-in for chart access and documentation. This is a potential threat to patient safety as e-prescribing and orders interfaces become more common place. In this environment a student acting as a licensed provider is just one click away from making a grave medical error. 4. The EMR Learning Curve   It is generally takes trained medical providers at least 6 weeks to use a new EMR well and 6 months to become proficient. Students must learn to use a new system each time they start a new rotation. This takes time away from clinical learning. Students are unlikely to be able to use any EMR system proficiently even after an 8 week rotation. 5. EMR’s are designed for experienced clinicians   EMR templates assume mastery of history taking and knowledge of clinical documentation. EMRs physical exam templates assume mastery of physical exam skills. EMR’s assume diagnostic certainty and most decision support are triggered by this fact. For example when the diagnosis of diabetes is made most EMR systems will prompt the user with management protocols. Most systems do not help the user consider other potential diagnoses.

1. With Lemur Link™ students do not document in the preceptors legacy EMR.   Lemur Link™ is a web-based “Learning” EMR that receives patient information via a printer installed on the preceptor’s EMR. Lemur Link™ can receive all types of documents such as today’s visit with vital signs in addition to any other documentation deemed important to the case such as labs results, x-rays results, and current medications, allergies, and problems lists. 2. The administrative cost is lower for the preceptor.   Community Preceptors need only to load the Lemur Connect print driver software. With a minimal amount of training the preceptor’s support staff can easily send documents from the patient’s chart to Lemur Link™. There is no maintaining ID’s, passwords etc., with each new student. 3. Lemur Link is Safe. Patients cannot be harmed.   Lemur Link™ has been designed to look and feel like a real EMR so students can “order” laboratory tests and radiographic studies. They can even prescribe medications. The student’s clinical reasoning is captured as part of the work-up but orders or prescriptions are not transmitted. 4. Lemur Link™ flattens the students’ EMR learning curve.   Students come to their community-based rotations comfortable with the Lemur Link™ platform. They will spend less time learning the EMR and more time learning patient care. 5. Lemur Link™ is designed for uniquely for students   We assume that the user has yet to master chart documentation and the physical exam. Lemur Link™ provides a “blank slate” for charting. The structure of the note is laid out but there are no check boxes. History taking is aided by embedded help buttons that provide guidance on writing the HPI and taking a proper social history for example. The Physical Exam findings are documented again using a “blank slate” but embedded help takes students to how-to links and video clips for each exam element. Clinical Decision support focuses first on developing a broad differential diagnosis based on what data has been collected by the student.