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Team is brain: leveraging EHR audit log data for new insights into acute care processes

Co-author Christian Rose discusses this month's JAMIA Journal Club selection:

Rose C, Thombley R, Noshad M, Lu Y, Clancy H, Schlessinger D, et al. Team is brain: leveraging EHR audit log data for new insights into acute care processes. J Am Med Inform Assoc. 2023;ocac201. doi:10.1093/jamia/ocac201.

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Christian Rose, MD
Assistant Professor of Emergency Medicine
Stanford University

Dr. Christian Rose is a dual-boarded emergency physician and informaticist specializing in the intersection of clinical medicine, information systems, and innovation - specifically in machine learning, decision support, user-centered design and global health. He is particularly interested in the role of human-centered information systems to both improve patient outcomes and the experience of healthcare delivery. 

Dr. Rose began studying the effect of technology on the practice of medicine as part of his undergraduate degree in both Physics and Science, Technology and Society. As a medical student at Columbia University, with fantastic mentorship, he pursued numerous informatics projects including identifying alert fatigue in electronic ordering systems, gene discovery using big data and human-centered design for breast cancer decision aids and was awarded a Doris Duke Research Fellowship to pursue these interests as well as awards for his research in neoplastic disease and informatics.

He completed residency training at the University of California, San Francisco (UCSF), where he continued to broaden his scope of informatics interventions with projects ranging from radiology interface design to the development and deployment of a point-of-care decision aid to support the WHO’s Basic Emergency Care initiatives. He was selected as a chief resident in his final year leading to foundational experiences with data acquisition and analysis for continuous quality improvement initiatives. 

Dr. Rose has since completed his informatics training at Stanford University where he had the opportunity to study the burgeoning field of deep learning and AI, exploring new methodologies for various clinical use cases and how they may be used to innovate clinical practice. However, it became clear that just because technologies are powerful and continually growing does not mean that they are the right solutions for every problem. Success depends on identifying key problems and designing solutions for the people in those systems. 

In pursuing his goal of developing and implementing human-centered informatics solutions, Dr. Rose practices and researches at Stanford University School of Medicine as an Assistant Professor in the Department of Emergency Medicine where he works with an interdisciplinary team to develop and support the advancement of clinical practice through information technologies. 


Hanyin Wang
PhD Candidate
Northwestern University, Feinberg School of Medicine
Evanston, IL


Lu He, BS
PhD Candidate
University of California, Irvine
Irvine, CA

Statement of Purpose

Research using Electronic Health Record (EHR) audit- or event-logs is a rapidly growing field of study in healthcare that focuses on the analysis and evaluation of users' granular interactions with the medical record. These logs record actions taken within a healthcare system, such as patient records being accessed or medication orders being placed. It is known that audit logs can provide valuable insights into the functioning of healthcare systems, including identifying areas for improvement and security monitoring. It has also been used to better understand the practice patterns of clinicians both at the point of care and outside of the hospital, which can be used to clarify the role of the EHR in physician burnout or to prevent it by improving clinical workflows.

However, less is known about the summation of work across providers in a department or institution and how this relates to specific clinical outcomes of interest. In the emergency department, this context of care is thought to have an outsized impact on the ability to deliver care to the most seriously ill patients (e.g., Acute Ischemic Stroke) due to the impact of clinical workloads, cognitive burden, task-switching, or even experience with other team members - all of which can be identified from the audit log.

Our multi-center, inter-institution collaboration sought to determine whether novel measures of clinical contextual factors from multi-site EHR audit log data can explain variation in process outcomes. We found that while team "busyness" was not highly associated with differences in door-to-needle times, prior experience with team members was strongly associated with faster door-to-needle times, suggesting a potentially high-yield method of evaluation and point of intervention for the management of emergent conditions.

Target Audience 

The target audience for this activity is professionals and students interested in health informatics.

Learning Objectives

After participating in the webinar, attendees should be able to:

  • Define the role and scope of the EHR audit log in healthcare
  • Generate examples of current audit log use and research
  • Recognize the impact of "context" on healthcare delivery
  • Understand how to use the audit log to develop contextual measures and understanding
  • Propose potential areas where the audit log may offer new insights into healthcare delivery 


  • 35-minute presentation by article author(s) considering salient features of the published study and its potential impact on practice
  • 25-minute discussion of questions submitted by listeners via the webinar tools and moderated by JAMIA Student Editorial Board members. 

Accreditation Statement

The American Medical Informatics Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Commercial Support 

No commercial support was received for this activity. 

Disclosures for this Activity

The following planners and staff who are in a position to control the content of this activity disclose that they have no financial relationships with commercial interests/ineligible entities:

Presenter: Christian Rose
JAMIA Journal Club Planners: Hanyin Wang; Lu He; Kirk Roberts
AMIA Staff: Susanne Arnold

Dates and Times: -
Type: Webinar
Course Format(s): On Demand
Price: Free