Effects of Aligning Residency Note Templates with CMS Evaluation and Management Documentation Requirements.

Background The Centers for Medicare & Medicaid Services (CMS) introduced changes in outpatient and inpatient evaluation and management (E/M) current procedural terminology (CPT) codes in 2021 and 2023, which were intended to streamline providers' clinical documentation. Objectives To study the effects of aligning inpatient and outpatient note templates with updated CMS guidelines on character length and documentation time per note at an internal medicine residency program in the southeastern United States. Methods In April 2023, the Atrium Health Wake Forest Baptist Internal Medicine Residency Program's inpatient and outpatient note templates were updated according to the most recent CMS guidelines.

Special Issue on Informatics Education A Longitudinal Graduate Medical Education Curriculum in Clinical Informatics: Function, Structure, and Evaluation.

Background: There is a need to integrate informatics education into medical training programs given the rise in demand for health informaticians and the call on the Accreditation Council for Graduate Medical Education (ACGME) and the body of undergraduate medical education (UGME) for implementation of informatics curricula.

Objectives: This report outlines a 2-year longitudinal informatics curriculum now currently in its seventh year of implementation. This report is intended to inform United States (US) Graduate Medical Education (GME) program leaders of the necessary requirements for implementation of a similar program at their institution.

Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment.

Background: serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI.

Design: Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina.

Can the Administrative Loads of Physicians be Alleviated by AI-Facilitated Clinical Documentation?

Background: Champions of AI-facilitated clinical documentation have suggested that the emergent technology may decrease the administrative loads of physicians, thereby reducing cognitive burden and forestalling burnout. Explorations of physicians' experiences with automated documentation are critical in evaluating these claims.

Objective: To evaluate physicians' experiences with DAX Copilot (DAXC), a generative AI-facilitated clinical documentation tool.

Assessment of EHR Efficiency Tools and Resources Associated with Physician Time Spent on the Inbox.

Background: Physicians are experiencing an increasing burden of messaging within the electronic health record (EHR) inbox. Studies have called for the implementation of tools and resources to mitigate this burden, but few studies have evaluated how these interventions impact time spent on inbox activities.

Objective: Explore the association between existing EHR efficiency tools and clinical resources on primary care physician (PCP) inbox time.

Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use.

Introduction: Citing high costs, limited diagnostic benefit, and ionizing radiation-associated risk from CT urogram, in 2020 the AUA revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with low- to intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown.

Methods: With the overarching objective of improving guideline implementation, we used a mixed-method convergent explanatory design with electronic health record data for a retrospective cohort at a single academic tertiary medical center in the southeastern United States and semistructured interviews with urology and nonurology providers to describe determinants of low-value CT urogram following guideline revision.

The Future of Community Outreach: Using Patient Portals to Provide Voter Resources during the Coronavirus Disease 2019 Pandemic.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a concern for the 2020 general election becoming a superspreader event due to in-person voting.

Objectives: Our project addressed this concern by disseminating nonpartisan websites detailing safe voter options in the state of North Carolina to prevent community spread of the virus as much as possible.

Methods: In this study, patient portals were used to disseminate a Research Electronic Data Capture survey containing embedded links to voter resources including nonpartisan websites discussing voting options.

Effectiveness and implementation of mPATH™-CRC: a mobile health system for colorectal cancer screening.

Background: Screening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates.

Methods: The mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC).

Monitoring the Implementation of Tobacco Cessation Support Tools: Using Novel Electronic Health Record Activity Metrics.

Background: Clinical decision support (CDS) tools in electronic health records (EHRs) are often used as core strategies to support quality improvement programs in the clinical setting. Monitoring the impact (intended and unintended) of these tools is crucial for program evaluation and adaptation. Existing approaches for monitoring typically rely on health care providers' self-reports or direct observation of clinical workflows, which require substantial data collection efforts and are prone to reporting bias.

Evaluation of "Care Plus," A Multidisciplinary Program to Improve Population Health for Patients With High Utilization.

With rising health care costs, health systems have adopted alternative care models targeting high-need, high-cost patients to improve chronic disease management and population health. Intensive primary care teams may reduce health care utilization by tackling medical and psychosocial needs specific to this patient population. This study presents health care utilization trends from a high-intensity primary care program that employs a multidisciplinary team (including clinicians, psychologists, pharmacists, chaplaincy, and community health workers) and community partnerships.

Prevalence and clinical associations of mitral and aortic regurgitation in patients with aortic stenosis.

Background: Most guidelines directing clinicians to manage valve disease are directed at single valve lesions. Limited data exists to direct our understanding of how concomitant valve disease impacts the left ventricle (LV).

Methods: We identified 2817 patients with aortic stenosis (AS) from the echocardiography laboratory database between September 2012 and June 2018 who had a LV ejection fraction (EF) ≥50%.

Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure.

Background: Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM).

Universal Screening in Primary Care Practices by Self-administered Tablet vs Nursing Staff.

This nonrandomized controlled trial investigates whether self-administered screening via an in-office tablet app was associated with improved detection of patients at risk for depression, injurious falls, or intimate partner violence compared with screening performed by clinicians.

Design, Implementation, Utilization, and Sustainability of a Fast Healthcare Interoperability Resources-Based Inpatient Rounding List.

Objective: We designed and implemented an application programming interface (API)-based electronic health record (EHR)-integrated rounding list and evaluated acceptability, clinician satisfaction, information accuracy, and efficiency related to the application.

Methods: We developed and integrated an application, employing iterative design techniques with user feedback. EHR and application user action logs, as well as hospital safety reports, were evaluated.

Creating learning health systems and the emerging role of biomedical informatics.

Introduction: The nature of information used in medicine has changed. In the past, we were limited to routine clinical data and published clinical trials. Today, we deal with massive, multiple data streams and easy access to new tests, ideas, and capabilities to process them.

Facilitators and Barriers to Implementing a Digital Informed Decision Making Tool in Primary Care: A Qualitative Study.

Background: Informed decision aids provide information in the context of the patient's values and improve informed decision making (IDM). To overcome barriers that interfere with IDM, our team developed an innovative iPad-based application (aka "app") to help patients make informed decisions about colorectal cancer screening. The app assesses patients' eligibility for screening, educates them about their options, and empowers them to request a test via the interactive decision aid.

Feasibility of computerized clinical decision support for pediatric to adult care transitions for patients with special healthcare needs.

The objective of this study was to determine the feasibility of a computerized clinical decision support (cCDS) tool to facilitate referral to adult healthcare services for children with special healthcare needs. A transition-specific cCDS was implemented as part of standard care in a general pediatrics clinic at a tertiary care academic medical center. The cCDS alerts providers to patients 17-26 years old with 1 or more of 15 diagnoses that may be candidates for referral to an internal medicine adult transition clinic (ATC).

New-onset atrial fibrillation incidence and associated outcomes in the medical intensive care unit.

Background: In patients with critical medical illness, data regarding new-onset atrial fibrillation (NOAF) is relatively sparse. This study examines the incidence, associated risk factors, and associated outcomes of NOAF in patients in the medical intensive care unit (MICU).

Methods: This single-center retrospective observational cohort study included 2234 patients with MICU stays in 2018.

Real-World Efficacy of the Hybrid Closed-Loop System.

Background: Hybrid closed-loop (HCL) insulin pump therapy (Medtronic 670G) is an emerging technology that is growing in use worldwide. Initial clinical trials demonstrated the effectiveness of HCL in reducing hypoglycemia and improving glucose control; however, these subjects were intensely monitored and supervised. There has been concern regarding the ability of patients to remain in auto mode.

Effectiveness of a Nurse-Led Multidisciplinary Intervention vs Usual Care on Advance Care Planning for Vulnerable Older Adults in an Accountable Care Organization: A Randomized Clinical Trial.

Importance: Advance care planning (ACP), especially among vulnerable older adults, remains underused in primary care. Additionally, many ACP initiatives fail to integrate directly into the electronic health record (EHR), resulting in infrequent and disorganized documentation.

Objective: To determine whether a nurse navigator-led ACP pathway combined with a health care professional-facing EHR interface improves the occurrence of ACP discussions and their documentation within the EHR.

Primary care referrals to nephrology in patients with advanced kidney disease.

Objectives: Optimizing care for patients with advanced kidney disease requires close collaboration between primary care physicians (PCPs) and nephrologists. Factors associated with PCP referral to nephrology were assessed in patients with estimated glomerular filtration rates (eGFRs) less than 30 mL/min/1.73 m2.