An analysis of virtual triage utilization by pregnant women prior to and during the COVID-19 pandemic.

Objective: This analysis describes the use patterns of web-based virtual triage (VT) by pregnant patients before and during the first two years of the COVID-19 pandemic, and how the pandemic influenced frequency of VT use, nature of symptoms reported, and the associated implications for maternal healthcare delivery.

Methods: An online survey of 36,910 patients who reported pregnancy was completed between January 1, 2019 and June 30, 2022. The data were segmented into six month periods to allow comparative analyses of usage frequency and changes in initial complaints over the study period, with particular emphasis on the early months of the COVID-19 pandemic.

Challenges Meeting 21st Century Cures Act Patient Identity Interoperability and Information Blocking Rules.

Objective: Gather insights into healthcare organization (HCO) preparedness for new 21st Century Cures Act information blocking disincentives and challenges in achieving greater accuracy /interoperability of patient identity/data.

Methods: Survey of 197 U.S.

The potential of virtual triage AI to improve early detection, care acuity alignment, and emergent care referral of life-threatening conditions.

Objective: To evaluate the extent to which patient-users reporting symptoms of five severe/acute conditions requiring emergency care to an AI-based virtual triage (VT) engine had no intention to get such care, and whose acuity perception was misaligned or decoupled from actual risk of life-threatening symptoms.

Methods: A dataset of 3,022,882 VT interviews conducted over 16 months was evaluated to quantify and describe patient-users reporting symptoms of five potentially life-threatening conditions whose pre-triage healthcare intention was other than seeking urgent care, including myocardial infarction, stroke, asthma exacerbation, pneumonia, and pulmonary embolism.

Results: Healthcare intent data was obtained for 12,101 VT patient-user interviews.

How Virtual Triage Can Improve Patient Experience and Satisfaction: A Narrative Review and Look Forward.

Objective: To complete a review of the literature on patient experience and satisfaction as relates to the potential for virtual triage (VT) or symptom checkers to enhance and enable improvements in these important health care delivery objectives.

Methods: Review and synthesis of the literature on patient experience and satisfaction as informed by emerging evidence, indicating potential for VT to favorably impact these clinical care objectives and outcomes.

Results/conclusions: VT enhances potential clinical effectiveness through early detection and referral, can reduce avoidable care delivery due to late clinical presentation, and can divert primary care needs to more clinically appropriate outpatient settings rather than high-acuity emergency departments.

The Role of Virtual Triage in Improving Clinician Experience and Satisfaction: A Narrative Review.

Objective: This review examines the literature on improving clinician satisfaction with a focus on what has been most effective in improving experience from the perspective of clinicians, and the potential role that virtual triage (VT) technology can play in delivering positive clinician experiences that improve clinical care, and bring value to health care delivery organizations (HDOs).

Methods: Review and synthesis of evidence on clinician satisfaction indicating a potential for VT to favorably impact clinician experience, sense of effectiveness, efficiency, and reduction of administrative task burden. Analysis considers how to conceptualize and the value of improving clinician experience, leading clinician dissatisfiers, and the potential role of VT in improving clinician experience/satisfaction.

Leveraging identity and access management technology to accelerate emergency COVID-19 vaccine delivery.

COVID-19-related vaccine demand and delivery volume challenged delivery organizations as few crises have. Imperatives to ensure security of patient information, defend against cybersecurity threats, and accurately identify/authenticate clinician identity for patients remained unchanged. Deployment of identity access and management (IAM) and single sign-on (SSO) can accelerate operationalization of a vaccine delivery center when urgently needed in a crisis.

Medical Scribes: Symptom or Cause of Impeded Evolution of a Transformative Artificial Intelligence in the Electronic Health Record?

Studies have quantified various specific benefits related to the use of medical scribes, finding physician workflow and productivity improvements, with some demonstrating marginal value or detrimental impact. However, this evidence base misses a critical underlying issue with the expanding number of physicians using medical scribes routinely. There are an estimated 28,000-33,000 peer reviewed biomedical journals worldwide, currently publishing an estimated 1.

A multinational survey of patient utilization of and value conveyed through virtual symptom triage and healthcare referral.

Objective: To describe the use patterns, impact and derived patient-user value of a mobile web-based virtual triage/symptom checker.

Methods: Online survey of 2,113 web-based patient-users of a virtual triage/symptom checker was completed over an 8-week period. Questions focused on triage and care objectives, pre- and post-triage care intent, frequency of use, value derived and satisfaction with virtual triage.

COVID-19 surge readiness: use cases demonstrating how hospitals leveraged digital identity access management for infection control and pandemic response.

Background: Surging volumes of patients with COVID-19 and the high infectiousness of SARS-CoV-2 challenged hospital infection control/safety, staffing, care delivery and operations as few crises have. Imperatives to ensure security of patient information, defend against cybersecurity threats and accurately identify/authenticate patients and staff were undiminished, which fostered creative use cases where hospitals leveraged identity access and management (IAM) technologies to improve infection control and minimise disruption of clinical and administrative workflows.

Methods: Working with a leading IAM solution provider, implementation personnel in the USA and UK identified all hospitals/health systems where an innovative use of IAM technology improved facility infection control and pandemic response management.

No Retrenchment From Employee Empowerment: Employer Wellness Imperatives and Opportunities Emerging From the COVID-19 Pandemic.

The impact of two years of the COVID-19 pandemic on the relationship between employers and employees are explored, including changing employee sensibilities with respect to future employment, work-life balance, remote and flexible work, and the great resignation. Lasting work changes induced by the pandemic expand employee empowerment and demand for greater work flexibility. Flexibility no longer provides employers a unique selling point and hiring/retention competitiveness - it has become an expected standard.

Public health nonfeasance, misfeasance and malfeasance in the U.S. Government Response to COVID-19.

In the midst of the political leadership crisis caused by the COVID-19 pandemic in the United States, a framework of public health nonfeasance, misfeasance and malfeasance is described in order to define, categorize and understand the various forms of public health performance failure of the U.S. government during the COVID-19 outbreak response thus far.

Electronic Health Record Workstation Single Sign-on: A Quantification of Time Liberated for Nurses to Care for Patients.

Objective: The aim of this study was to quantify the impact of electronic health record (EHR) workstation single sign-on (SSO) for nurses.

Background: SSO was implemented in 19 hospitals for expedited EHR access.

Methods: Login durations before and after SSO implementation were compared, and the financial value of nursing time liberated from keyboard was estimated.

An Evaluation of the Clinical and Financial Value of Work Station Single Sign-on in 19 Hospitals.

Background: A large health system implemented computer workstation single sign-on (SSO) in 19 community hospitals. In SSO technology, manual keyboard login is replaced with an identification badge reader that clinicians swipe for expedited access to the electronic health record (EHR) and clinical applications while roaming the hospital.

Objective: To assess the clinical workflow and financial value of SSO implementation in reducing clinician time logging in to the EHR and clinical applications.

Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry.

Evaluate the impact of multi-component quality improvement for pediatric asthma care focusing on serial use of an evidence-based clinical pathway via paper order sets, pathway integration into computerized provider order entry (CPOE), use of a clinical respiratory score (CRS) and a discharge checklist. Outcomes were assessed over three intervention periods and 50 months on: time to beta-agonist and steroid first administration, frequency of readmissions and hospital length of stay. A general linear model estimated mean log(LOS) over time and between study periods.

Use of the ClearSight® System for Continuous Noninvasive Hemodynamic Monitoring during Heart Valve Interventions: Review of the Literature and Single-Site Experience.

During interventional and structural cardiology procedures, such as mitral valve (MitraClip, BMV), aortic valve (TAVR, BAV), tricuspid valve (MitraClip), left atrial appendage (Watchman, Lariat), atrial septum (ASD/PFO closure), and coronary artery intervention (high-risk PCI), among others, patients are at a high risk of hemodynamic instability and require continuous monitoring. This is conventionally achieved through arterial catheterization and transpulmonary thermodilution. However, such invasive techniques are time-consuming and have been associated with steep learning curves, vascular complications, and increased risk of infection.

Double Trouble: Transapical Transcatheter Replacement of the Aortic and Mitral Valves in a Single Operation.

This case represents the first reported simultaneous TAVR and TMVR for native aortic and mitral stenosis performed via the transapical approach.

Secure Clinical Texting: Patient Risk in High-Acuity Care.

The Joint Commission recently reversed its prior authorization of the use of secure clinical texting to issue patient care orders, now again prohibiting texting of orders. However, the potential sole or exclusive use of clinical texts to transmit other patient care information beyond care orders still poses a risk to patient safety in high acuity care because of text transmission delays resulting from carrier-dependent latency. Although texting in routine patient care may deliver high value to clinicians, the risk of latency and delayed receipt of clinically urgent or time-sensitive texted patient information in high-acuity care settings can harm patients.

The Impact of Order Source Misattribution on Computerized Provider Order Entry (CPOE) Performance Metrics.

Background: One strategy to foster adoption of computerized provider order entry (CPOE) by physicians is the monthly distribution of a list identifying the number and use rate percentage of orders entered electronically versus on paper by each physician in the facility. Physicians care about CPOE use rate reports because they support the patient safety and quality improvement objectives of CPOE implementation. Certain physician groups are also motivated because they participate in contracted financial and performance arrangements that include incentive payments or financial penalties for meeting (or failing to meet) a specified CPOE use rate target.

Clinical impact and value of workstation single sign-on.

Background: CHRISTUS Health began implementation of computer workstation single sign-on (SSO) in 2015. SSO technology utilizes a badge reader placed at each workstation where clinicians swipe or "tap" their identification badges.

Objective: To assess the impact of SSO implementation in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations.

Impact of institutional volume and experience with CT interpretation on sizing of transcatheter aortic valves: A multicenter retrospective study.

Background: Computed tomography (CT) has become the standard imaging modality for pre-procedural aortic annular sizing prior to transcatheter aortic valve replacement (TAVR). We hypothesized that the accuracy of CT derived annular measurements would be greater at sites with higher TAVR procedural volume.

Methods: Within a large integrated health system, TAVR was performed at low (<40 cases), intermediate (40-75 cases), and high-volume sites (>75 cases).

Toward the Elimination of Paper Orders: Managing the Challenge of Low Frequency Physician Users of Computerized Patient Order Entry (CPOE).

With the adoption of Computerized Patient Order Entry (CPOE), many physicians - particularly consultants and those who are affiliated with multiple hospital systems - are faced with the challenge of learning to navigate and commit to memory the details of multiple EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their refusal to use CPOE presents a risk to patient safety when paper and electronic orders co-exist, as paper orders generated in an electronic ordering environment can be missed or acted upon after delay, are frequently illegible, and bypass the Clinical Decision Support (CDS) that is part of the evidence-based value of CPOE. We defined a category of CPOE Low Frequency Users (LFUs) - physicians issuing a total of less than 10 orders per month - and found that 50.