Adverse diagnostic events in hospitalised patients: a single-centre, retrospective cohort study.

Background: Adverse event surveillance approaches underestimate the prevalence of harmful diagnostic errors (DEs) related to hospital care.

Methods: We conducted a single-centre, retrospective cohort study of a stratified sample of patients hospitalised on general medicine using four criteria: transfer to intensive care unit (ICU), death within 90 days, complex clinical events, and none of the aforementioned high-risk criteria. Cases in higher-risk subgroups were over-sampled in predefined percentages.

Patient-Clinician Diagnostic Concordance upon Hospital Admission.

Objectives:  This study aimed to pilot an application-based patient diagnostic questionnaire (PDQ) and assess the concordance of the admission diagnosis reported by the patient and entered by the clinician.

Methods:  Eligible patients completed the PDQ assessing patients' understanding of and confidence in the diagnosis 24 hours into hospitalization either independently or with assistance. Demographic data, the hospital principal problem upon admission, and International Classification of Diseases 10th Revision (ICD-10) codes were retrieved from the electronic health record (EHR).

Vanadium Dioxide by Atomic Layer Deposition: A Promising Material for Next-Generation Memory Devices.

The synthesis of a vanadium dioxide (VO) film using atomic layer deposition (ALD) with vanadium tetrachloride (VCl) as a precursor for the realization of programmable memory devices is reported. X-ray diffraction analysis revealed the epitaxial growth of VO on c-AlO. The phase transition was monitored using resistivity measurements across varying temperatures, demonstrating a decrease of >4 orders of magnitude at the transition temperature, thereby confirming the high quality of the material.

Straight to the point: evaluation of a Point of Care Information (POCI) resource in answering disease-related questions.

Objective: To evaluate the ability of DynaMedex, an evidence-based drug and disease Point of Care Information (POCI) resource, in answering clinical queries using keyword searches.

Methods: Real-world disease-related questions compiled from clinicians at an academic medical center, DynaMedex search query data, and medical board review resources were categorized into five clinical categories (complications & prognosis, diagnosis & clinical presentation, epidemiology, prevention & screening/monitoring, and treatment) and six specialties (cardiology, endocrinology, hematology-oncology, infectious disease, internal medicine, and neurology). A total of 265 disease-related questions were evaluated by pharmacist reviewers based on if an answer was found (yes, no), whether the answer was relevant (yes, no), difficulty in finding the answer (easy, not easy), cited best evidence available (yes, no), clinical practice guidelines included (yes, no), and level of detail provided (detailed, limited details).

Clinical Decision Support for Hypertension Management in Chronic Kidney Disease: A Randomized Clinical Trial.

Importance: Chronic kidney disease (CKD) affects 37 million adults in the United States, and for patients with CKD, hypertension is a key risk factor for adverse outcomes, such as kidney failure, cardiovascular events, and death.

Objective: To evaluate a computerized clinical decision support (CDS) system for the management of uncontrolled hypertension in patients with CKD.

Design, Setting, And Participants: This multiclinic, randomized clinical trial randomized primary care practitioners (PCPs) at a primary care network, including 15 hospital-based, ambulatory, and community health center-based clinics, through a stratified, matched-pair randomization approach February 2021 to February 2022.

Human-Centered Design and Development of a Fall Prevention Exercise App for Older Adults in Primary Care Settings.

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 (PCPs), despite evidence that falls can be prevented. Mobile health technologies may help to address this disparity and promote evidence-based fall prevention.

Development and Usability Testing of an Exercise-Based Primary Care Fall Prevention Clinical Decision Support Tool.

For older patients, falls are the leading cause offatal and nonfatal injuries. Guidelines recommend that at-risk older adults are referred to appropriate fall-prevention exercise programs, but many do not receive support for fall-risk management in the primary care setting. Advances in health information technology may be able to address this gap.

Advancing health information during interhospital transfer: An interrupted time series.

Introduction: Although the transfer of patients between acute care hospitals (interhospital transfer, IHT) is common, health information exchange (HIE) during IHT remains inadequate, with fragmented communication and unreliable access to clinical information. This study aims to design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT.

Methods And Analysis: Study subjects include patients aged >18 transferred to the medical, cardiology, oncology, or intensive care unit (ICU) services at an 800-bed quaternary care hospital; and healthcare workers involved in their care.

A Multiyear Survey Evaluating Clinician Electronic Health Record Satisfaction.

Objectives: We assessed how clinician satisfaction with a vendor electronic health record (EHR) changed over time in the 4 years following the transition from a homegrown EHR system to identify areas for improvement.

Methods: We conducted a multiyear survey of clinicians across a large health care system after transitioning to a vendor EHR. Eligible clinicians from the first institution to transition received a survey invitation by email in fall 2016 and then eligible clinicians systemwide received surveys in spring 2018 and spring 2019.

Management of Fall Risk Among Older Adults in Diverse Primary Care Settings.

Objectives: Falls are persistent among community-dwelling older adults despite existing prevention guidelines. We described how urban and rural primary care staff and older adults manage fall risk and factors important to integration of computerized clinical decision support (CCDS).

Methods: Interviews, contextual inquiries, and workflow observations were analyzed using content analysis and synthesized into a journey map.

Correction: Performance of a Web-Based Reference Database With Natural Language Searching Capabilities: Usability Evaluation of DynaMed and Micromedex With Watson.

[This corrects the article DOI: 10.2196/43960.].

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Objective: To describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients.

Materials And Methods: Three interventions were prioritized for development: a Diagnostic Safety Column () within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out () for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire () to gather patient concerns about the diagnostic process. Initial requirements were refined from analysis of test cases with elevated risk predicted by logic compared to risk perceived by a clinician working group; testing sessions with clinicians; responses from patients; and focus groups with clinicians and patient advisors using storyboarding to model the integrated interventions.

Performance of a Web-Based Reference Database With Natural Language Searching Capabilities: Usability Evaluation of DynaMed and Micromedex With Watson.

Background: Evidence-based point-of-care information (POCI) tools can facilitate patient safety and care by helping clinicians to answer disease state and drug information questions in less time and with less effort. However, these tools may also be visually challenging to navigate or lack the comprehensiveness needed to sufficiently address a medical issue.

Objective: This study aimed to collect clinicians' feedback and directly observe their use of the combined POCI tool DynaMed and Micromedex with Watson, now known as DynaMedex.

Usability Testing of an Interoperable Computerized Clinical Decision Support Tool for Fall Risk Management in Primary Care.

Background: Falls are a widespread and persistent problem for community-dwelling older adults. Use of fall prevention guidelines in the primary care setting has been suboptimal. Interoperable computerized clinical decision support systems have the potential to increase engagement with fall risk management at scale.

Dynamic reaction picklist for improving allergy reaction documentation: A usability study.

Objective: To assess novel dynamic reaction picklists for improving allergy reaction documentation compared to a static reaction picklist.

Materials And Methods: We developed three web-based user interfaces (UIs) mimicking the Mass General Brigham's EHR allergy module: the first and second UIs (i.e.

Human-centered design of clinical decision support for management of hypertension with chronic kidney disease.

Background: Primary care providers face challenges in recognizing and controlling hypertension in patients with chronic kidney disease (CKD). Clinical decision support (CDS) has the potential to aid clinicians in identifying patients who could benefit from medication changes. This study designed an alert to control hypertension in CKD patients using an iterative human-centered design process.

Clinical Decision Support for Fall Prevention: Defining End-User Needs.

Background And Significance: Falls in community-dwelling older adults are common, and there is a lack of clinical decision support (CDS) to provide health care providers with effective, individualized fall prevention recommendations.

Objectives: The goal of this research is to identify end-user (primary care staff and patients) needs through a human-centered design process for a tool that will generate CDS to protect older adults from falls and injuries.

Methods: Primary care staff (primary care providers, care coordinator nurses, licensed practical nurses, and medical assistants) and community-dwelling patients aged 60 years or older associated with Brigham & Women's Hospital-affiliated primary care clinics and the University of Florida Health Archer Family Health Care primary care clinic were eligible to participate in this study.

Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.

Objective: We developed a comprehensive, medication-related clinical decision support (CDS) software prototype for use in the operating room. The purpose of this study was to compare the usability of the CDS software to the current standard electronic health record (EHR) medication administration and documentation workflow.

Materials And Methods: The primary outcome was the time taken to complete all simulation tasks.

Development of a Perioperative Medication-Related Clinical Decision Support Tool to Prevent Medication Errors: An Analysis of User Feedback.

Objectives: Medication use in the perioperative setting presents many patient safety challenges that may be improved with electronic clinical decision support (CDS). The objective of this paper is to describe the development and analysis of user feedback for a robust, real-time medication-related CDS application designed to provide patient-specific dosing information and alerts to warn of medication errors in the operating room (OR).

Methods: We designed a novel perioperative medication-related CDS application in four phases: (1) identification of need, (2) alert algorithm development, (3) system design, and (4) user interface design.

Physician use of speech recognition versus typing in clinical documentation: A controlled observational study.

Importance: Speech recognition (SR) is increasingly used directly by clinicians for electronic health record (EHR) documentation. Its usability and effect on quality and efficiency versus other documentation methods remain unclear.

Objective: To study usability and quality of documentation with SR versus typing.

Assessing the cognitive and work load of an inpatient safety dashboard in the context of opioid management.

For health information technology to realize its potential to improve flow, care, and patient safety, applications should be intuitive to use and burden neutral for frontline clinicians. We assessed the impact of a patient safety dashboard on clinician cognitive and work load within a simulated information-seeking task for safe inpatient opioid medication management. Compared to use of an electronic health record for the same task, the dashboard was associated with significantly reduced time on task, mouse clicks, and mouse movement (each p < 0.

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Background: Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems.

Comparison of a Prototype for Indications-Based Prescribing With 2 Commercial Prescribing Systems.

Importance: The indication (reason for use) for a medication is rarely included on prescriptions despite repeated recommendations to do so. One barrier has been the way existing electronic prescribing systems have been designed.

Objective: To evaluate, in comparison with the prescribing modules of 2 leading electronic health record prescribing systems, the efficiency, error rate, and satisfaction with a new computerized provider order entry prototype for the outpatient setting that allows clinicians to initiate prescribing using the indication.