The feasibility of implementing a digital pregnancy and postpartum support program in the Midwestern United States and the association with maternal and infant health.

Objective: The benefits of mobile applications in the prenatal period remain understudied. This study assessed associations between the Pregnancy Postpartum Support Program (PPSP), a digital wraparound service, and maternal and infant outcomes in a Medicaid population.

Methods: A retrospective analysis was conducted on pregnant patients with Medicaid insurance who received care and delivered in a Midwestern United States healthcare system between 8/1/2022-8/15/2023, comparing outcomes among those who did versus did not opt for PPSP enrollment.

Advanced Practice Nurse-Led Research: Challenges and Approaches to Digital Health Programs' Evaluation Using Big Data.

Advanced practice nurse leaders are in key positions within health systems to provide time and resources for implementation and evaluation of digital health services. As virtual monitoring programs become more embedded within nursing, nurse leaders and educators need to ensure that nurses are prepared to work within interprofessional teams to administer and evaluate them. This article discusses challenges and implementation strategy considerations for data curation and analysis using large datasets from the Medicaid population for research.

Can a 5-to-90-day Mortality Predictor Perform Consistently Across Time and Equitably Across Populations?

Advance care planning (ACP) facilitates end-of-life care, yet many die without it. Timely and accurate mortality prediction may encourage ACP. However, performance of predictors typically differs among sub-populations (e.

Derivation of a Unique, Algorithm-Based Approach to Cancer Patient Navigator Workload Management.

Purpose: Cancer patient navigators (CPNs) can decrease the time from diagnosis to treatment, but workloads vary widely, which may lead to burnout and less optimal navigation. Current practice for patient distribution among CPNs at our institution approximates random distribution. A literature search did not uncover previous reports of an automated algorithm to distribute patients to CPNs.

Novel Techniques to Assess Predictive Systems and Reduce Their Alarm Burden.

Machine prediction algorithms (e.g., binary classifiers) often are adopted on the basis of claimed performance using classic metrics such as precision and recall.

Closing the Gap: A Comparison of Engagement Interventions to Achieve Equitable Breast Cancer Screening in Rural Illinois.

Mammography screening rates are typically lower in those with less economic advantage (EA). This study, conducted at an integrated health care system covering a mixed rurality population, assessed the ability of interventions (text messages linking to a Web microsite, digital health care workers, and a community health fair) to affect mammography screening rates and disparity in those rates among different EA populations. Payor type served as a proxy for greater (commercially insured) versus lower (Medicaid insured) EA.

Case study: the health SmartLibrary experiences in web personalization and customization at the Galter health sciences library, Northwestern University.

Question: How can the user's access to health information, especially full-text articles, be improved? The solution is building and evaluating the Health SmartLibrary (HSL).

Setting: The setting is the Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University.

Method: The HSL was built on web-based personalization and customization tools: My E-Resources, Stay Current, Quick Search, and File Cabinet.

Delphi consensus on the feasibility of translating the ACEP clinical policies into computerized clinical decision support.

Clinical practice guidelines are developed to reduce variations in clinical practice, with the goal of improving health care quality and cost. However, evidence-based practice guidelines face barriers to dissemination, implementation, usability, integration into practice, and use. The American College of Emergency Physicians (ACEP) clinical policies have been shown to be safe and effective and are even cited by other specialties.

Indistinguishable from magic: health and wellness in a future of sufficiently advanced technology.

We describe a future in which health and wellness are transformed by (1) the availability of definitive and unambiguous tests to prove or disprove each diagnosis, (2) new methods based in systems biology to help unravel the web of messages transmitted across cellular and subcellular networks, and (3) universal access to data that has been freed from data silos to produce true data liquidity for a constellation of purposes ranging from personal health management to population health research. We believe the resulting "connected health" environment will have a profound impact on every aspect of modern life.

Searching electronic health records for temporal patterns in patient histories: a case study with microsoft amalga.

As electronic health records (EHR) become more widespread, they enable clinicians and researchers to pose complex queries that can benefit immediate patient care and deepen understanding of medical treatment and outcomes. However, current query tools make complex temporal queries difficult to pose, and physicians have to rely on computer professionals to specify the queries for them. This paper describes our efforts to develop a novel query tool implemented in a large operational system at the Washington Hospital Center (Microsoft Amalga, formerly known as Azyxxi).

Cancer-associated neutropenic fever: clinical outcome and economic costs of emergency department care.

Purpose. Febrile neutropenia (FN) is a common, costly, and potentially fatal complication in oncology. While FN in the inpatient setting has been extensively studied, only one study has evaluated emergency department (ED) care for FN cancer patients.

Automated medical image library creation for education.

The authors describe a method to create a medical teaching library that is automatically maintained, contains tens of thousands of radiologic images and is built using existing, internal, hospital dictations, radiologic images, and an off-the-shelf commercial search engine product (Google Inc.).

Use of medical robotics in biothreat situations.

SARS, Avian Flu and other infectious and potentially highly transmissible diseases are threats to the entire healthcare workforce. Complete bio-isolation or the use of biohazard suits are not practical solutions for routine day-to-day patient-doctor interactions with highly infectious patients. The authors share their initial research experiences with utilizing medical robots for teleconferencing and other clinical activities to overcome these hurdles.

Improving a UMLS based allergy list for use in live electronic medical record systems.

The SNOMED allergy subset available through the UMLS has a variety of deficits that are substantial barriers to use in live clinical practice. These authors describe a method of enhancing a UMLS based allergy list by combining concepts from other terminologies found within the UMLS. This method resulted in a three-fold increase in the coverage allergy list compared to the standard SNOMED allergy subset.

Automated patient facial image capture to reduce medical error.

The authors describe their experiences creating technology to automatically capture facial images from patients during triage and registration for integration into the electronic medical record (EMR) to reduce data retrieval and data entry errors. The prototype system was tested across a variety of ethnicities with facial images captured successfully in 100% of cases with a median time to capture of 0.75 seconds.

A real-time gesture interface for hands-free control of electronic medical records.

Whether attempting to review digital radiologic images during a procedure or reviewing labs on a clinical ward, computer keyboards and mice are potential sources for contamination of clinicians during sterile and non-sterile activities related to clinical care. The authors describe and demonstrate a live system prototype for hands-free, gesture-based control of an electronic medical record (EMR) system.

Metrics in the science of surge.

Metrics are the driver to positive change toward better patient care. However, the research into the metrics of the science of surge is incomplete, research funding is inadequate, and we lack a criterion standard metric for identifying and quantifying surge capacity. Therefore, a consensus working group was formed through a "viral invitation" process.

Wireless handheld computers and voluntary utilization of computerized prescribing systems in the emergency department.

Illegible or invalid hand-written prescriptions can result in avoidable medical errors. Computer-based prescribing can mitigate the problem. An observational study was performed to examine the effect of wireless handheld computers (handhelds) on voluntary utilization of computerized prescribing within an Emergency Department.

Clinical information systems: instant ubiquitous clinical data for error reduction and improved clinical outcomes.

Immediate access to existing clinical information is inadequate in current medical practice; lack of existing information causes or contributes to many classes of medical error, including diagnostic and treatment error. A review of the literature finds ample evidence to support a description of the problems caused by data that are missing or unavailable but little evidence to support one proposed solution over another. A primary recommendation of the Consensus Committee is that hospitals and departments should adopt systems that provide fast, ubiquitous, and unified access to all types of existing data.

Computerized physician order entry and online decision support.

Computerized physician order entry (CPOE) and decision support systems (DSS) can reduce certain types of error but often slow clinicians and may increase other types of error. The net effect of these systems on an emergency department (ED) is unknown. The consensus participants combined published evidence with expert opinion to outline recommendations for success.

Keynote address: medical informatics and emergency medicine.

A personal look at some of the developments in practical clinical informatics over the past two decades, with discussion of several successful projects, including the National Center for Emergency Medicine Informatics, the Azyxxi system, Federal Project ER One, the Institutes for Innovation in Medicine, the Medical MediaLab, Project Sentinel, and others. Lessons learned, and hints and suggestions for future developers and informaticists.