Applied Clinical Informatics

BACKGROUND: Managing acute postoperative pain and minimizing chronic opioid use is crucial for patient recovery and long-term well-being. OBJECTIVE: This study explored using preoperative electronic health records (EHR) and wearable device data for machine-learning models that predict postoperative acute pain and chronic opioid use. METHODS: The study cohort consisted of ~347 All of Us Research Program participants who underwent one of eight surgical procedures and shared EHR and wearable device data...

BACKGROUND: Clinical documentation improvement programs are utilized by most healthcare systems to enhance provider documentation. Suggestions are sent to providers in a variety of ways, and are commonly referred to as coding queries. Responding to these coding queries can require significant provider time and do not often align with workflows. To enhance provider documentation in a more consistent manner without creating undue burden, alternative strategies are required. OBJECTIVE: The aim of this study is to evaluate the impact of a real-time documentation assistance tool, named AutoDx, on the volume of coding queries and encounter level outcome metrics, including case-mix index (CMI)...

Objectives Nearly 60% of preventable deaths are caused by unmet needs associated with social determinants of health, which are structural factors that influence health outcomes and contribute to health disparities. This suggests that priority should be placed on developing user-centered medical interventions through social needs-based innovation biodesign to address health disparities among marginalized communities. Methods The innovation biodesign process is an approach to medical innovation that identifies clinical needs followed by solution mapping...

OBJECTIVE: To assess primary care physicians' (PCPs) perception of the need for serious illness conversations (SIC) or other palliative care interventions in patients flagged by a machine learning tool for high one-year mortality risk. MATERIALS AND METHODS: We surveyed PCPs from four Brigham and Women's Hospital primary care practice sites. Multiple mortality prediction algorithms were ensembled to assess adult patients of these PCPs who were either enrolled in the hospital's integrated care management program or had one of several chronic conditions...

UNLABELLED: Background / Objective: Clinical documentation is essential for conveying medical decision-making, communication between providers and patients, and capturing quality, billing, and regulatory measures during emergency department (ED) visits. Growing evidence suggests the benefits of note template standardization, however, variations in documentation practices are common. The primary objective of this study is to measure the utilization and coding performance of a standardized ED note template implemented across a nine-hospital health system...

BACKGROUND: Intensive care unit (ICU) clinicians encounter frequent challenges with managing vast amounts of fragmented data while caring for multiple critically ill patients simultaneously. This may lead to increased provider cognitive load that may jeopardize patient safety. OBJECTIVES: This systematic review assesses the impact of centralized multi-patient dashboards on ICU clinician performance, perceptions regarding the use of these tools, and patient outcomes...

OBJECTIVE: To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia. METHODS: Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity...

Objectives To understand the status quo and related influencing factors of machine alarm fatigue of hemodialysis nurses in tertiary hospitals in XXX. Methods This cross-sectional study employed convenience sampling to select 460 nurses from 29 tertiary hospitals in XXX, who are involved in hemodialysis care. Surveys were conducted using General Information Questionnaire, Alarm Fatigue Scale, National Aeronautics and Space Administration Task Load Index(NASA-TLX) and Maslach Burnout Inventory Scale (MBI). Results The overall machine alarm fatigue score for 460 hemodialysis nurses from 29 tertiary hospitals in XXX was (16...

Background Compared to White populations, multicultural older adults experience more gaps in preventive care (e.g., vaccinations, screenings, chronic condition monitoring), social determinants of health barriers (e.g., access to care, language, transportation), and disparities and inequities (e.g., comorbidities, disease burden, and health care costs). Objectives This study aims to describe an informatics-based approach used to execute and evaluate results of a member-centric, pharmacoinformatics-informed engagement program to deliver culturally tailored microinterventions to close medication-related gaps in care utilizing multidisciplinary care coordination that leverages the expanded role of the pharmacist...

BACKGROUND: Standardizing and formalizing consent processes and forms can prevent ambiguities, convey a more precise meaning, and support machine interpretation of consent terms. OBJECTIVES: Our goal was to introduce a systematic approach to standardize and digitize pediatric consent forms, which are complex due to legal requirements for child and legal guardian involvement. METHODS: First, we reviewed the consent requirements from the Arizona Department of Health Services (ADHS) and we used 21 Arizona pediatric treatment consents from five healthcare organizations to propose and evaluate an implementation-agnostic Consent for Treatment Framework...

BACKGROUND: Patient data is fragmented across multiple repositories, yielding suboptimal and costly care. Record linkage algorithms are widely accepted solutions for improving completeness of patient records. However, studies often fail to fully describe their linkage techniques. Further, while many frameworks evaluate record linkage methods, few focus on producing gold standard datasets. This highlights a need to assess these frameworks and their real-world performance. OBJECTIVE: We use real-world datasets and expand upon previous frameworks to evaluate a consistent approach to the manual review of gold standard datasets and measure its impact on algorithm performance...

BACKGROUND: Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES: We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers...

Narrative nursing notes are a valuable resource in informatics research with unique predictive signals about patient care. The open sharing of these data, however, is appropriately constrained by rigorous regulations set by the Health Insurance Portability and Accountability Act (HIPAA) for the protection of privacy. Several models have been developed and evaluated on the open-source i2b2 dataset. A focus on the generalizability of these models with respect to nursing notes remains understudied. The study aims to understand the generalizability of pre-trained transformer models and investigate the variability of personal protected health information (PHI) distribution patterns between discharge summaries and nursing notes with a goal to inform the future design for model evaluation schema...

OBJECTIVE: Large language models (LLMs) like ChatGPT are powerful algorithms that have been shown to produce human-like text from input data. A number of potential clinical applications of this technology have been proposed and evaluated by biomedical informatics experts. However, few have surveyed healthcare providers for their opinions about whether the technology is fit for use. MATERIALS AND METHODS: We distributed a validated mixed-methods survey to gauge practicing clinicians' comfort with LLMs for a breadth of tasks in clinical practice, research and education, which were selected from the literature...

OBJECTIVES: Pharmacogenetics (PGx) is increasingly important in individualizing therapeutic management plans, but is often implemented apart from other types of medication clinical decision support (CDS). The lack of integration of pharmacogenetics into existing CDS may result in incomplete interaction information, which may pose patient safety concerns. We sought to develop a cloud-based orchestrated medication CDS service that integrates PGx with a broad set of drug screening alerts and evaluate it through a clinician utility study...

BACKGROUND: Heart failure is a complex clinical syndrome noted on approximately 1 in 8 death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders. OBJECTIVE: We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care...

OBJECTIVE: Our objective was to evaluate the usability of an automated clinical decision support (CDS) tool previously implemented in the pediatric intensive care unit (PICU) to promote shared situation awareness among the medical team to prevent serious safety events within children's hospitals. METHODS: We conducted a mixed-methods usability evaluation of a CDS tool in a PICU at a large, urban, quaternary, free-standing children's hospital in the Midwest. Quantitative assessment was done using the System Usability Scale, while qualitative assessment involved think-aloud usability testing...

BACKGROUND: Timelines have been used for patient review. While maintaining a compact overview is important, merged event representations caused by the intricate and voluminous patient data bring event recognition, access ambiguity, and inefficient interaction problems. Handling large patient data efficiently is another challenge. OBJECTIVE: This study aims to develop a scalable, efficient timeline to enhance patient review for research purposes. The focus is on addressing the challenges presented by the intricate and voluminous patient data...

BACKGROUND: Falls in older adults are a serious public health problem that can lead to reduced quality of life or death. Patients often do not receive fall prevention guidance from primary care providers, despite evidence that falls can be prevented. Mobile health technologies may help to address this disparity and promote evidence-based fall prevention. OBJECTIVE: Our main objective was to use Human-Centered Design (HCD) to develop a user-friendly, fall prevention exercise app using validated user requirements...

OBJECTIVES:  This resident-driven quality improvement project aimed to better understand the known problem of a misaligned clinical decision support (CDS) strategy and improve CDS utilization. METHODS:  An internal survey was sent to all internal medicine (IM) residents to identify the most bothersome CDS alerts. Survey results were supported by electronic health record (EHR) data of CDS firing rates and response rates which were collected for each of the three most bothersome CDS tools...