Simulation Technology and 'Open' EHR Systems for Medical Education & Training

Peter GroenModels of human patients have been used in medicine for thousands of years. Some of the first medical 'simulators' were simple representations in clay and stone that were used to demonstrate the clinical features of disease states and their effects on humans. Today, ever more sophisticated medical simulation tools and techniques have been developed and integrated into the education and training programs for medical professionals. There are now approximately 300 medical simulation centers in the U.S. Most are affiliated with medical schools, nursing schools, and major teaching hospitals.

Simulation technology is often used in the training of personnel in highly skilled and complex professions, e.g. pilots, physicians, etc. The use of simulation technologies usually occurs because it may be prohibitively expensive or simply too dangerous to allow trainees to use real systems or perform a particular task in a 'live' environment. Instead, they spend time using simulator systems or equipment when performing dangerous tasks in a 'safe' simulated operating environment.


  • Simulation is the imitation of something real, a state of affairs, or a process.
  • Physical simulation refers to simulation in which physical objects are substituted for the real thing.
  • Interactive simulation, or 'human in the loop' simulation, is a special kind of physical simulation in which physical simulations include human operators, e.g. flight simulators or driving simulators.
  • Computer simulation is an attempt to model a real-life or hypothetical situation on a computer, often in a virtual reality environment.

Medical simulators are increasingly being developed and deployed to teach therapeutic and diagnostic procedures as well as critical decision making by health care professions (e.g. physicians, surgeons, nurses) in critical situations. Simulators have been developed for training procedures ranging from such basic tasks as drawing blood draw to highly complex surgical procedures.

Medical simulation training fills an intermediate stage in the medical education continuum, between classroom learning and practice in actual clinical settings. Simulation training complements other educational practices or events such as lectures, reading, laboratory work, problem-based learning and more. It is not a substitute for proven traditional educational practices.

In a medical simulation, computer-controlled systems and devices can advance medical education while protecting patient safety by enabling medical students, residents and practicing clinicians to learn treatment protocols and master procedure skills in a 'safe' environment before using them on actual patients in a real setting.

Simulation training has also become a new approach for preparing first responders to handle disasters. Simulations can replicate emergency situations and track how learners respond. Disaster preparedness simulations can involve training on how to handle bioterrorism attacks, natural disasters, pandemic outbreaks, or other major emergency situations. See
The following are some examples of notable organizations and software products associated with the use of simulation tools and techniques in medical education and training.


The Medical Simulation Group - This multi-disciplinary research team was organized to investigate how technology can improve medical education and increase patient safety. Based in Boston at the Massachusetts General Hospital, their work focuses on cutting edge research that will transform medical training from the current apprentice model to realistic, real-time, authentic computer-based medical simulations. See

The Center for Medical Education + Innovation (CME+I) at Riverside Methodist Hospital is a comprehensive medical training facility featuring innovative human patient simulation and education technologies, many of which have never been used outside the military. Their Cardiac and Endovascular Simulation Lab is called the SimSuite. Read
The Veteran’s Health Administration (VHA) within the Department of Veterans Affairs (VA) has developed a new program for simulation in health care training called Simulation Learning Education and Research Network (SimLEARN). The program’s goals include the establishment of a national simulation center with a focus on improving employee training and outcomes of care for veterans. For more information about the SimLEARN center, visit
At the University of Missouri's Clinical Simulation Center medical, nursing, pharmacy, respiratory therapy, health management, and informatics students participate in interdisciplinary simulations that mimic busy emergency rooms. A typical simulation can be quite hectic with crying babies and people shouting in pain and asking for help. See
Other organizations of interest focused on medical simulation training include:

Commercial Software

Medical Education Technologies, Inc. (METI) is a company committed to developing learning tools that impact the education of future doctors, nurses, first responders and military medics - including a complete line of human patient simulators, surgical simulators, and medical examination trainers. See
Immersion Medical develops systems and technology for integrating touch feedback into licensed medical simulation products. Immersion is helping more and more doctors become skilled at critical new techniques that can save lives every day. See
Medical Simulation Corporation (MSC) is a recognized healthcare industry leader in providing full-service simulation training, education, and consulting services to hospital personnel, medical product manufacturers, and medical societies. See
Other commercial simulation software solutions or projects of interest include:

'Open Source' Software 

General Physical Simulation Interface (GiPSi) is an open source/open architecture framework for developing organ level surgical simulations. This tool provides an attractive framework to address the needs of interfacing models from multiple research groups and the ability to critically examine and validate quantitative biological simulations. See
Simulation Open Framework Architecture (SOFA) is an open source framework primarily targeted at real-time simulation and the simulation research community. Visit http://www.sofa-framework.organd
Finally, various 'open' electronic health record systems (EHR) systems (e.g. VistA, RPMS, OpenMRS, OpenEMR, FreeMed) can be interfaced to human simulation mannequins to further enhance the medical education and training experience. See
Other 'open source' medical simulation software solutions include:


Learning medical procedures traditionally has meant making mistakes on real patients. Hands-on, experiential learning is indispensable for healthcare professionals during their training, but mistakes can put patients in harm's way. Considering the potential risk to patients and institutions when errors are made on real patients during training, simulation centers may turn out to be very cost effective, especially in reducing insurance premiums and avoiding litigation.

Conclusions & Recommendations

Simulation technologies will contribute significantly to the revolution in medical education and training over the coming decade and will have a positive impact on the quality of care and clinical outcomes at health care provider organizations.

Large health care provider organizations, medical schools, and nursing schools should consider

  • Establishing a multidisciplinary working group to investigate and oversee the acquisition and use of simulation technologies for medical education and training purposes.
  • Monitor 'lessons learned' and 'best practices' related to medical simulation technology and its impact on medical education, training, and clinical outcomes.
  • Investigating changes in clinical practices, medical education and training programs, and business processes that will need to be made when acquiring medical simulation technology.

For more details, read the following article on this subject published in Virtual Medical Worlds, June 2010. See

Other Selected Links

If you have any experience with simulation technology in medical education and training, please share your experience. We would especially be interested in your use of open source simulation technology solutions.