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The digital availability of health data not only improves processes in primary care but it also facilitates the evaluation of healthcare delivery. Nevertheless, the preprocessing of data for secondary use is still time-consuming and expensive, particularly in Head and neck cancer (HNC), where patients undergo complex multidisciplinary treatment trajectories. Therefore, we have looked further into the effects on data quantity and quality following the implementation of structured care pathways. Leveraging [...]

Background Clinical decision support (CDS) tools are critical for improving care delivery and guideline adherence but are associated with clinician burnout when inadequately designed and implemented. User Centered Design (UCD) and Implementation Science (IS) methods are evidence-based approaches to optimizing CDS tools, but are infrequently used in part due to limited guidance on how to apply them within the resource-constraints of health systems. Objective This paper focuses on pragmatic application [...]

Our objective was to identify barriers to implementing a custom clinical decision support (CDS) alert to randomize individuals in a pragmatic study, specifically those with a positive antinuclear antibody (ANA) test.We integrated a validated logistic regression model into the electronic health record to predict the risk of developing autoimmune disease for individuals with a positive ANA (titer ≥ 1:80). A custom CDS alert was created to randomize eligible individuals into [...]

The adoption of electronic health records (EHRs) into clinical practice has changed clinical workflows and, in some cases, increased documentation burden and clinician burnout. Identifying factors associated with perceived EHR usability after the implementation of a new EHR may guide efforts to reduce burden and burnout.This study measured: (1) group-level perceptions of EHR usability pre- and postimplementation of a new EHR; (2) adaptation to the new EHR; and (3) the [...]

Direct Secure Messaging (DSM) is a communication standard for exchanging information between health care entities and practitioners. It relies on access to an address directory. When directory entry is incomplete, health information exchange breaks down. There is an urgent need for standardized DSM address directory management and synchronization workflows that support universal access in a timely manner.Our objective was to develop best practices for maintenance of DSM address directories and [...]

The widespread adoption of health information technology (HIT) has deepened hospitals' reliance on electronic health records (EHR). However, EHR downtime events, which refer to partial or complete system failures, can disrupt hospital operations and threaten patient safety. Systematic research on HIT downtime events in China remains limited.This study aims to identify and classify reported EHR downtime events in a Chinese hospital, assess their frequency and severity, and propose improvement recommendations [...]

Overuse and misuse of antibiotics is an urgent health care problem and one of the key factors in antibiotic resistance. Validated clinical prediction rules have shown effectiveness in guiding providers to an appropriate diagnosis and identifying when antibiotics are the recommended choice for treatment.We aimed to study the relative ability of registered nurses using clinical prediction rules to guide the management of acute respiratory infections in a simulated environment compared [...]

Time spent in the electronic health record (EHR) is an important measure of clinical activity. Vendor-derived EHR use metrics may not correspond to actual EHR experience. Raw EHR audit logs enable customized EHR use metrics, but translating discrete timestamps to time intervals is challenging. There are insufficient data available to quantify inactivity between audit log timestamps.This study aimed to develop and validate a computer vision-based model that (1) classifies EHR [...]

The timely administration of postoperative antibiotics is crucial for preventing surgical site infections. Despite surgical ordering workflows designed to facilitate care across settings, delays in antibiotic administration posttransfer to the pediatric intensive care unit (PICU) were identified. We aimed to develop a clinical decision support (CDS) system to enhance timely order activation in a large pediatric health system. We hypothesized that the time to release signed and held orders by [...]

Clinical decision support systems (CDSS) are central to modern health care, but their effectiveness is compromised during system downtimes, which affect 96% of health care organizations. During these failures, clinicians lose access to critical decision-making tools like order sets, increasing the risk of medical errors. Traditional downtime solutions, such as paper-based protocols, are often impractical and difficult to maintain.This study introduces and evaluates Offsite Repository for Clinical Assets (ORCA), a [...]