Cluster Analysis of Primary Care Physician Phenotypes for Electronic Health Record Use: Retrospective Cohort Study.

Background: Electronic health records (EHRs) have become ubiquitous in US office-based physician practices. However, the different ways in which users engage with EHRs remain poorly characterized.

Objective: The aim of this study is to explore EHR use phenotypes among ambulatory care physicians.

Display and perception of risk: Analysis of decision support system display and its impact on perceived clinical risk of sepsis-induced health deterioration.

Despite acknowledging the value of clinical decision support systems (CDSS) in identifying risk for sepsis-induced health deterioration in-hospitalized patients, the relationship between display features, decision maker characteristics, and recognition of risk by the clinical decision maker remains an understudied, yet promising, area. The objective of this study is to explore the relationship between CDSS display design and perceived clinical risk of in-hospital mortality associated with sepsis. The study utilized data collected through in-person experimental sessions with 91 physicians from the general medical and surgical floors who were recruited across 12 teaching hospitals within the United States.

A scoping review of interactive and personalized web-based clinical tools to support treatment decision making in breast cancer.

The increasing attention on personalized breast cancer care has resulted in an explosion of new interactive, tailored, web-based clinical decision tools for guiding treatment decisions in clinical practice. The goal of this study was to review, compare, and discuss the clinical implications of current tools, and highlight future directions for tools aiming to improve personalized breast cancer care. We searched PubMed, Embase, PsychInfo, Cochrane Database of Systematic Reviews, Web of Science, and Scopus to identify web-based decision tools addressing breast cancer treatment decisions.

Realizing the Power of Text Mining and Natural Language Processing for Analyzing Patient Safety Event Narratives: The Challenges and Path Forward.

Patient safety event (PSE) reports are a useful lens to understand hazards and patient safety risks in healthcare systems. However, patient safety officers and analysts in healthcare systems and safety organizations are challenged to make sense of the ever-increasing volume of PSE reports, including the free-text narratives. As a result, there is a growing emphasis on applying text mining and natural language processing (NLP) approaches to assist in the processing and understanding of these narratives.

Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover.

Importance: Physician turnover takes a heavy toll on patients, physicians, and health care organizations. Survey research has established associations of electronic health record (EHR) use with professional burnout and reduction in professional effort, but these findings are subject to response fatigue and bias.

Objective: To evaluate the association of physician productivity and EHR use patterns, as determined by vendor-derived EHR use data platforms, with physician turnover.

Using Machine Learning to Capture Quality Metrics from Natural Language: A Case Study of Diabetic Eye Exams.

Background And Objective: The prevalence of value-based payment models has led to an increased use of the electronic health record to capture quality measures, necessitating additional documentation requirements for providers.

Methods: This case study uses text mining and natural language processing techniques to identify the timely completion of diabetic eye exams (DEEs) from 26,203 unique clinician notes for reporting as an electronic clinical quality measure (eCQM). Logistic regression and support vector machine (SVM) using unbalanced and balanced datasets, using the synthetic minority over-sampling technique (SMOTE) algorithm, were evaluated on precision, recall, sensitivity, and f1-score for classifying records positive for DEE.

Pharmacogenomic Clinical Decision Support: A Review, How-to Guide, and Future Vision.

Clinical decision support (CDS) is an essential part of any pharmacogenomics (PGx) implementation. Increasingly, institutions have implemented CDS tools in the clinical setting to bring PGx data into patient care, and several have published their experiences with these implementations. However, barriers remain that limit the ability of some programs to create CDS tools to fit their PGx needs.

A novel application of SMART on FHIR architecture for interoperable and scalable integration of patient-reported outcome data with electronic health records.

Objective: Despite a proliferation of applications (apps) to conveniently collect patient-reported outcomes (PROs) from patients, PRO data are yet to be seamlessly integrated with electronic health records (EHRs) in a way that improves interoperability and scalability. We applied the newly created PRO standards from the Office of the National Coordinator for Health Information Technology to facilitate the collection and integration of standardized PRO data. A novel multitiered architecture was created to enable seamless integration of PRO data via Substitutable Medical Apps and Reusable Technologies on Fast Healthcare Interoperability Resources apps and scaled to different EHR platforms in multiple ambulatory settings.

Clinician Perceptions on the Use of Free-Text Communication Orders.

Objective: The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information.

Methods: We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes.

The active role of interpreters in medical discourse - An observational study in emergency medicine.

Objective: To study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters.

Methods: English proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper.

Accessibility and Usability of State Health Department COVID-19 Vaccine Websites: A Qualitative Study.

This qualitative study analyzes department of health websites for all 50 US states for accessibility and usability in obtaining COVID-19 vaccine eligibility information and appointments.

Identifying Health Information Technology Usability Issues Contributing to Medication Errors Across Medication Process Stages.

Objective: Different health information technology (health IT) systems are intended to support medication ordering, reviewing, and administration. We sought to identify the types of medication errors associated with health IT use, whether they reached the patient, where in the medication process those errors occurred, and the specific usability issues contributing to those errors.

Methods: Patient safety event reports from more than 595 healthcare facilities entered between January 2013 and September 2018 were analyzed.

Measurement of Trauma Caregiver Stress: Validation of Heart rate variability in a Real-World Surgical Setting.

Background: Acute stress is a potentially modifiable risk-factor that contributes to errors in trauma care. Research on stress mitigation is limited by the lack of a validated objective measure of surgeon stress. We sought to validate HRV in a real-world surgical setting by comparison to the Subjective Units of Distress Score (SUDS), and correlation with self-reported peak stress moments.

The Case for User-Centered Artificial Intelligence in Radiology.

Past technology transition successes and failures have demonstrated the importance of user-centered design and the science of human factors; these approaches will be critical to the success of artificial intelligence in radiology.

Emergency Physician Perceptions of Electronic Health Record Usability and Safety.

Objectives: Despite requirements for electronic health record (EHR) vendor usability testing, usability challenges persist, contributing to patient safety concerns. We sought to identify emergency physicians' perceived EHR usability and safety strengths and shortcomings across major EHR vendor products.

Methods: Fifty-five emergency physicians from 4 different hospitals were interviewed.

Modeling patient-related workload in the emergency department using electronic health record data.

Introduction: Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study is to use electronic health record (EHR) data to predict the amount of work that individual patients contribute to clinician workload (patient-related workload).

Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis.

Objective: To derive 7 proposed core electronic health record (EHR) use metrics across 2 healthcare systems with different EHR vendor product installations and examine factors associated with EHR time.

Materials And Methods: A cross-sectional analysis of ambulatory physicians EHR use across the Yale-New Haven and MedStar Health systems was performed for August 2019 using 7 proposed core EHR use metrics normalized to 8 hours of patient scheduled time.

Results: Five out of 7 proposed metrics could be measured in a population of nonteaching, exclusively ambulatory physicians.

The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department-A Retrospective Assessment.

Objective: The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED).

Design: Retrospective data analysis study.

Setting: ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital.

Population subgroup differences in the use of a COVID-19 chatbot.

COVID-19 chatbots are widely used to screen for symptoms and disseminate information about the virus, yet little is known about the population subgroups that interact with this technology and the specific features that are used. An analysis of 1,000,740 patients invited to use a COVID-19 chatbot, 69,451 (6.94%) of which agreed to participate, shows differences in chatbot feature use by gender, race, and age.

Advancing electronic health record vendor usability maturity: Progress and next steps.

Despite basic federal requirements promoting a user-centered design approach to electronic health record (EHR) development and usability testing there have been usability and safety risks with EHR technology. Four EHR vendors were asked to provide written descriptions of their usability practices, and we reviewed these descriptions to identify areas where there has been advancement and areas for improvement. All 4 vendors described user-centered design processes and usability testing methods that demonstrate advancement from previous studies of vendor practices.

Early mortality benefit with COVID-19 convalescent plasma: a matched control study.

Convalescent plasma can provide passive immunity during viral outbreaks, but the benefit is uncertain for the treatment of novel coronavirus disease 2019 (COVID-19). Our goal is to assess the efficacy of COVID-19 convalescent plasma (CCP). In all, 526 hospitalized patients with laboratory-confirmed SARS-CoV-2 at an academic health system were analyzed.

Pilot assessment of an on-demand telehealth 'left without being seen' follow-up programme.

Introduction: On-demand telehealth can have a high rate of patients requesting visits and dropping off without being seen by a provider, especially during the COVID-19 pandemic.

Methods: On-demand telehealth requests made to a large healthcare system in the USA between 15 March 2020 and 31 May 2020 were included for analysis with a focus on patients who were defined as left without being seen (LWBS). As part of a pilot program a registered nurse attempted to call LWBS patients within 24 hours of their telehealth request and asked if they were ok, if they sought care for their original visit reason, what that care was, or if they still needed guidance.

The Impact of COVID-19 on Medical Device Reporting and Investigation.

Introduction: The Manufacturer and User Facility Device Experience (MAUDE) database houses medical device reports submitted to the U.S. Food and Drug Administration (FDA).

Workflow Analysis Driven Recommendations for Integration of Electronically-Enhanced Sexually Transmitted Infection Screening Tools in Pediatric Emergency Departments.

Adolescents are disproportionately affected by sexually transmitted infections (STIs). Failure to diagnose and treat STIs in a timely manner may result in serious sequelae. Adolescents frequently access the emergency department (ED) for care.