Machine Learning for Mental Health: Applications, Challenges, and the Clinician's Role.

Purpose Of Review: This review aims to evaluate the current psychiatric applications and limitations of machine learning (ML), defined as techniques used to train algorithms to improve performance at a task based on data. The review emphasizes the clinician's role in ensuring equitable and effective patient care and seeks to inform mental health providers about the importance of clinician involvement in these technologies.

Recent Findings: ML in psychiatry has advanced through electronic health record integration, disease phenotyping, and remote monitoring through mobile applications.

Embedding Authorship Identity into a Portal-Based Agenda Setting Intervention to Support Older Adults and Care Partners.

Background: Patients, families, and clinicians increasingly communicate through patient portals. Due to potential for multiple authors, clinicians need to know who is communicating with them. OurNotes is a portal-based pre-visit agenda setting questionnaire.

Helping patients navigate the immediate release of medical records: MedEd, a novel patient engagement technology.

Background: Through online health portals, patients receive complex medical reports without interpretation from their healthcare provider. This study evaluated the usability of MedEd, a patient engagement tool providing definitions of medical terminology in breast pathology and radiology reports.

Methods: Individuals who underwent a normal screening mammogram were invited to complete semi-structured interviews where they downloaded MedEd and discussed their download experience.

Interpretation of immediately released health information: Informing patient medical education in breast oncology.

Background: The Cures Act mandated immediately released health information. In this study, we investigated patient comprehension of mammography reports and the utility of online resources to aid report interpretation.

Methods: Patients who received a normal mammogram from February to April 2022 were invited to complete semi-structured interviews paired with health literacy questionnaires to assess patient's report comprehension before and after internet search.

Information transparency with immediate release: Oncology clinician and patient perceptions.

Introduction: As part of the 21st Century Cures Act (April 2021), electronic health information (EHI) must be immediately released to patients. In this study, we sought to evaluate clinician and patient perceptions regarding this immediate release.

Methods: After surveying 33 clinicians and 30 patients, semi-structured interviews were conducted with a subset of the initial sample, comprising 8 clinicians and 12 patients.

Sustained Effect of Clinical Decision Support for Heart Failure: A Natural Experiment Using Implementation Science.

Objectives: In a randomized controlled trial, we found that applying implementation science (IS) methods and best practices in clinical decision support (CDS) design to create a locally customized, "enhanced" CDS significantly improved evidence-based prescribing of β blockers (BB) for heart failure compared with an unmodified commercially available CDS. At trial conclusion, the enhanced CDS was expanded to all sites. The purpose of this study was to evaluate the real-world sustained effect of the enhanced CDS compared with the commercial CDS.

Comparative effectiveness of generic commercial versus locally customized clinical decision support tools to reduce prescription of nonsteroidal anti-inflammatory drugs for patients with heart failure.

Objective: To compare the effectiveness of 2 clinical decision support (CDS) tools to avoid prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with heart failure (HF): a "commercial" and a locally "customized" alert.

Methods: We conducted a retrospective cohort study of 2 CDS tools implemented within a large integrated health system. The commercial CDS tool was designed according to third-party drug content and EHR vendor specifications.

General improvements versus interruptive or non-interruptive alerts in the blood order set: study protocol for a randomized control trial to improve packed red blood cell utilization.

Background: Blood transfusions can serve as a life-saving treatment, but inappropriate blood product transfusions can result in patient harm and excess costs for health systems. Despite published evidence supporting restricted packed red blood cell (pRBC) usage, many providers transfuse outside of guidelines. Here, we report a novel prospective, randomized control trial to increase guideline-concordant pRBC transfusions comparing three variations of clinical decision support (CDS) in the electronic health record (EHR).

"I don't think it should take you three days to tell me my baby is dead." A case of fetal demise: unintended consequences of immediate release of information.

The 21st Century Cures Act (Cures Act) information blocking regulations mandate timely patient access to their electronic health information. In most healthcare systems, this technically requires immediate electronic release of test results and clinical notes directly to patients. Patients could potentially be distressed by receiving upsetting results through an electronic portal rather than from a clinician.

Patient Satisfaction With Speech Recognition in the Exam Room: Exploratory Survey.

Background: Medical speech recognition technology uses a microphone and computer software to transcribe the spoken word into text and is not typically used in outpatient clinical exam rooms. Patient perceptions regarding speech recognition in the exam room (SRIER) are therefore unknown.

Objective: This study aims to characterize patient perceptions of SRIER by administering a survey to consecutive patients scheduled for acute, chronic, and wellness care in three outpatient clinic sites.

Perspectives of Patients About Immediate Access to Test Results Through an Online Patient Portal.

Importance: The 21st Century Cures Act Final Rule mandates the immediate electronic availability of test results to patients, likely empowering them to better manage their health. Concerns remain about unintended effects of releasing abnormal test results to patients.

Objective: To assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal.

Problem-oriented documentation: design and widespread adoption of a novel toolkit in a commercial electronic health record.

Background: Problem-oriented documentation is an accepted method of note construction which facilitates clinical thought processes. However, problem-oriented documentation is challenging to put into practice using commercially available electronic health record (EHR) systems.

Objective: Our goal was to create, iterate, and distribute a problem-oriented documentation toolkit within a commercial EHR that maximally supported clinicians' thinking, was intuitive to use, and produced clear documentation.

Catalyzing dementia care through the learning health system and consumer health information technology.

To advance care for persons with Alzheimer's disease and related dementias (ADRD), real-world health system effectiveness research must actively engage those affected to understand what works, for whom, in what setting, and for how long-an agenda central to learning health system (LHS) principles. This perspective discusses how emerging payment models, quality improvement initiatives, and population health strategies present opportunities to embed best practice principles of ADRD care within the LHS. We discuss how stakeholder engagement in an ADRD LHS when embedding, adapting, and refining prototypes can ensure that products are viable when implemented.

User-Centered Design to Reduce Inappropriate Blood Transfusion Orders.

Background: To improve blood transfusion practices, we applied user-centered design (UCD) to evaluate potential changes to blood transfusion orders.

Objectives: The aim of the study is to build effective transfusion orders with different designs to improve guideline adherence.

Methods: We developed three different versions of transfusion orders that varied how information was presented to clinicians ordering blood transfusions.

Dig Deeper: A Case Report of Finding (and Fixing) the Root Cause of Add-On Laboratory Failures.

Background: Venipunctures and the testing they facilitate are clinically necessary, particularly for hospitalized patients. However, excess venipunctures lead to patient harm, decreased patient satisfaction, and waste.

Objectives: We sought to identify contributors to excess venipunctures at our institution, focusing on electronic health record (EHR)-related factors.

Patient comprehension of breast pathology report terminology: The need for patient-centered resources.

Background: As health care continues to evolve toward information transparency, an increasing number of patients have access to their medical records, including result reports that were not originally designed to be patient-facing. Previous studies have demonstrated that patients have poor understanding of medical terminology. However, patient comprehension of terminology specific to breast pathology reports has not been well studied.

Understanding Patient Experiences, Opinions, and Actions Taken After Viewing Their Own Radiology Images Online: Web-Based Survey.

Background: The ability for patients to directly view their radiology images through secure electronic portals is rare in the American health care system. We previously surveyed patients within our health system and found that a large majority wanted to view their own radiology images online, and we have since implemented this new feature.

Objective: We aim to understand patient experiences, opinions, and actions taken after viewing their own radiology images online.

Virtual Sprint Outpatient Electronic Health Record Training and Optimization Effect on Provider Burnout.

Objectives: This study aimed to develop a virtual electronic health record (EHR) training and optimization program and evaluate the impact of the virtual model on provider and staff burnout and electronic health record (EHR) experience.

Methods: UCHealth created and supported a multidisciplinary EHR optimization and training program, known as the Epic Sprint Program. The Sprint Team conducted dozens of onsite Sprint events over the course of several years prior to the pandemic but transitioned to a fully virtual program and successfully "sprinted" 21 outpatient clinics from May to December 2020.

Patients Contributing to Visit Notes: Mixed Methods Evaluation of OurNotes.

Background: Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes.

Objective: This study aims to assess patient and provider experiences and attitudes after 12 months of a pilot intervention.

Risks and rewards of increasing patient access to medical records in clinical ophthalmology using OpenNotes.

Background: The implementation of OpenNotes and corresponding increase in patient access to medical records requires thorough assessment of the risks and benefits of note-sharing. Ophthalmology notes are unique among medical records in that they extensively utilize non-standardized abbreviations and drawings; they are often indecipherable even to highly-educated clinicians outside of ophthalmology. No studies to date have assessed ophthalmologist perceptions of OpenNotes.