Applied Clinical Informatics

BACKGROUND:  Inefficient electronic health record (EHR) usage increases the documentation burden on physicians and other providers, which increases cognitive load and contributes to provider burnout. Studies show that EHR efficiency sessions, optimization sprints, reduce burnout using a resource-intense five-person team. We implemented sprint-inspired one-on-one post-go-live efficiency training sessions (mini-sprints) as a more economical training option directed at providers. OBJECTIVES:  We evaluated a post-go-live mini-sprint intervention to assess provider satisfaction and efficiency...

BACKGROUND:  Nurses are at the frontline of detecting patient deterioration. We developed Communicating Narrative Concerns Entered by Registered Nurses (CONCERN), an early warning system for clinical deterioration that generates a risk prediction score utilizing nursing data. CONCERN was implemented as a randomized clinical trial at two health systems in the Northeastern United States. Following the implementation of CONCERN, our team sought to develop the CONCERN Implementation Toolkit to enable other hospital systems to adopt CONCERN...

OBJECTIVES:  We conducted a focus group to assess the attitudes of primary care physicians (PCPs) toward prostate-specific antigen (PSA)-screening algorithms, perceptions of using decision support tools, and features that would make such tools feasible to implement. METHODS:  A multidisciplinary team (primary care, urology, behavioral sciences, bioinformatics) developed the decision support tool that was presented to a focus group of 10 PCPs who also filled out a survey...

OBJECTIVES:  Our objective was to pilot test an electronic health record-embedded decision support tool to facilitate prostate-specific antigen (PSA) screening discussions in the primary care setting. METHODS:  We pilot-tested a novel decision support tool that was used by 10 primary care physicians (PCPs) for 6 months, followed by a survey. The tool comprised (1) a risk-stratified algorithm, (2) a tool for facilitating shared decision-making (Simple Schema), (3) three best practice advisories (BPAs: <45, 45-75, and >75 years), and (4) a health maintenance module for scheduling automated reminders about PSA rescreening...

BACKGROUND:  The implementation of information technology (IT) in patient care is on the rise. The nursing workforce should be prepared for using such technology to support the delivery of patient-centered care. The integration of informatics into nursing practice has been progressing at a slower rate than the development of advancements and in which areas nurses use IT is still not clear. OBJECTIVE:  Our objective was to develop a new instrument to determine the usage of IT in nursing practice...

BACKGROUND:  Electronic health record (EHR) user interface event logs are fast providing another perspective on the value and efficiency EHR technology brings to health care. Analysis of these detailed usage data has demonstrated their potential to identify EHR and clinical process design factors related to user efficiency, satisfaction, and burnout. OBJECTIVE:  This study aimed to analyze the event log data across 26 different health systems to determine the variability of use of a single vendor's EHR based on four event log metrics, at the individual, practice group, and health system levels...

No abstract text is available yet for this article.

Background Clinical research, particularly in scientific data, grapples with the efficient management of multimodal and longitudinal clinical data. Especially in neuroscience, the volume of heterogeneous longitudinal data challenges researchers. While current research data management (RDM) systems offer rich functionality, they suffer from architectural complexity that makes them difficult to install and maintain and require extensive user training. Objectives The focus is the development and presentation of a data management approach specifically tailored for clinical researchers involved in active patient care, especially in the neuroscientific environment of German university hospitals...

Manual data entry is time-consuming, inefficient, and error prone. In contrast, leveraging two-dimensional (2D) barcodes and barcode scanning tools is a rapid, efficient, and effective practice for automatically entering data accurately and completely during vaccine inventorying and administration. CDC pilots in a variety of healthcare settings documented the clinical and public health impact of 2D barcode scanning practices on data quality and completeness, time savings, workflow efficiencies, and staff experience...

BACKGROUND: Despite mortality benefits, only 19.9% of US adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. OBJECTIVE: Evaluate if an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. METHODS: This was a quasi-experimental pre-post interventional design study at an academic and community hospital in the western United States between 1/1/2021 and 10/31/2021...

OBJECTIVES: To compare the ability of different electronic health record alert types to elicit responses from users caring for cancer patients benefiting from goals of care (GOC) conversations. METHODS: A validated question asking if the user would be surprised by the patient's 6-month mortality was built as an Epic BestPractice Advisory (BPA) alert in three versions - 1) Required on Open chart (pop-up BPA), 2) Required on Close chart (navigator BPA), and 3) Optional Persistent (Storyboard BPA) - randomized using patient medical record number...

BACKGROUND: OpenNotes, or sharing of medical notes via a patient portal, has been studied extensively in the adult population, but less in pediatric populations, and even more rarely in inpatient pediatric or intensive care settings. OBJECTIVE: To understand families' interaction with and perception of inpatient hospital notes shared via patient portal in a community Neonatal Intensive Care Unit (NICU). METHODS: At the end of the NICU discharge education, completed in the patient portal before discharge, families were offered an anonymous survey on OpenNotes...

BACKGROUND: In 2011, the American Board of Medical Specialties established Clinical Informatics (CI) as a subspecialty in Medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created clinical informatics fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures...

BACKGROUND:  Unplanned intensive care unit (ICU) admissions from medical/surgical floors and increased boarding times of ICU patients in the emergency department (ED) are common; approximately half of these are associated with adverse events. We explore the potential role of a tele-critical care consult service (TC3) in managing critically ill patients outside of the ICU and potentially preventing low-acuity unplanned admissions and also investigate its design and implementation needs...

OBJECTIVES:  The number of surgeries performed in the United States has increased over the past two decades, with a shift to the ambulatory setting. Perioperative complications and mortality pose significant health care burdens. Inadequate preoperative assessment and documentation contribute to communication failure and poor patient outcomes. The aim of this quality improvement project was to design and implement a preoperative evaluation documentation template that not only improved communication during the perioperative pathway but also enhanced the overall user experience...

BACKGROUND:  Given the inequities in access to health care resources like COVID-19 vaccination, health systems should carefully consider how to reach underrepresented groups. Reflecting on vaccine rollout efforts holds insight on the role of community engagement and informatics support in promoting health equity. OBJECTIVES:  This study aimed to assess the effectiveness of four outreach strategies deployed by University of Washington (UW) Medicine in improving vaccine equity over traditional vaccine scheduling online or by phone, we report on appointment scheduling and completion of appointments (i...

No abstract text is available yet for this article.

BACKGROUND:  Observational research has shown its potential to complement experimental research and clinical trials by secondary use of treatment data from hospital care processes. It can also be applied to better understand pediatric drug utilization for establishing safer drug therapy. Clinical documentation processes often limit data quality in pediatric medical records requiring data curation steps, which are mostly underestimated. OBJECTIVES:  The objectives of this study were to transform and curate data from a departmental electronic medical record into an observational research database...

BACKGROUND:  People with memory disorders have difficulty adhering to treatments. With technological advances, it remains important to investigate the potential of health information technology (HIT) in supporting medication adherence among them. OBJECTIVES:  This review investigates the role of HIT in supporting adherence to medication and therapies among patients with memory issues. It also captures the factors that impact technology adherence interventions...

BACKGROUND:  Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap. OBJECTIVES:  This report had two objectives...