Background: Preparing IMGs for U.S. Residency Through Digital Familiarization

FAIMER®, a division of Intealth™, supports international medical graduates (IMGs) transitioning into U.S. graduate medical education (GME). In 2021, a FAIMER survey of residency program directors revealed incoming IMGs often lacked familiarity with electronic health records (EHRs), a cornerstone of clinical practice in the United States. While EHR adoption varies globally, U.S. healthcare systems rely heavily on EHRs for healthcare delivery, documentation and legal compliance. 

To address this need, FAIMER developed a free online module titled “Introduction to the U.S. Electronic Health Record (EHR)”, designed to help matched IMGs gain hands-on experience with EHR systems before starting residency.

Challenge: Creating a Scalable, Accessible EHR Simulation for Global Learners

FAIMER sought to design a digital learning experience that would be:

• Accessible to IMGs across geographies and technical backgrounds.
• Realistic in simulating the look and feel of U.S.-based EHR systems.
• Scalable to support hundreds (and eventually thousands) of users annually.
• Cost-effective and sustainable for long-term delivery.

Traditional EHR systems are complex, proprietary, and often inaccessible for educational use. FAIMER needed a solution that could replicate core EHR functionality without requiring licensing from commercial vendors or extensive infrastructure.

Solution: Leveraging Ozone to Build a Modular, Free EHR Learning Environment

FAIMER partnered with Ozone to create a modular EHR simulation environment using OpenMRS 3. Ozone’s architecture enabled FAIMER to:

• Deploy a lightweight, containerized EHR system that mimics U.S. clinical workflows.
• Customize content and configuration to reflect U.S.-specific documentation practices and compliance considerations, across different patient scenarios.
• Deliver interactive, hands-on training where learners could practice common patient care tasks like charting, reviewing labs, and navigating patient records.
• Scale the module globally without requiring local installations or organizational technical support.

The module was piloted in 2023 with nearly 450 matched IMGs. Post-module surveys showed that 83% felt better prepared for their residency’s EHR orientation, and 84% would recommend the module to peers.

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“Ozone allows us to build a realistic, reusable EHR simulation that’s accessible to IMGs worldwide. It’s helping bridge the digital divide and prepare future physicians for success in U.S. clinical environments.”  — Project Lead, FAIMER

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Early Progress and Future Direction

Following the successful pilot, FAIMER publicly launched the module in May 2024. In its first year, over 850 unique users accessed the module, with 71% reporting increased confidence and 81% recommending it to others. In 2025, usage grew to over 1,200 learners, with satisfaction metrics rising to 81% and 87%, respectively.

FAIMER plans to continue leveraging Ozone to iterate and improve the learning experience based on user and residency program feedback.  Bugfixes for functionality and feature development in partnership with Mekom Solutions for OpenMRS will be contributed back to the community.

Takeaways: Modular EHR Training Empowers Global Learners

FAIMER’s experience demonstrates how Ozone can be used to build scalable, reusable digital health education tools:

• Containerized architecture enables global access without infrastructure barriers.
• Modular configuration supports rapid adaptation to educational needs and user feedback.
• Open-source foundations reduce cost and increase sustainability.

This initiative is helping IMGs enter U.S. residency programs with greater confidence and competence, while showcasing how modular digital health tools can support global medical education.