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Improving early recognition and treatment of sepsis is key to decreasing patient mortality. A large academic health system implemented several quality improvement initiatives, yet monthly compliance with sepsis best practices remained low.Develop and evaluate an electronic health record (EHR)-embedded microlearning intervention to address suboptimal adherence to sepsis care best practices.We conducted a randomized stepped-wedge trial of our microlearning intervention with randomization done at the nursing block level. Antibiotic delay and [...]

This study sought to characterize how a population experienced health-related social needs (HRSNs) over time.We employed hidden Markov modeling using data extracted from a natural language processing state machine from 2018 to 2020 to examine whether a patient experienced any food, legal, transportation, employment, financial, or housing needs. Characteristics of patients transitioning into low/high-risk states were compared. We also identified the frequency at which patients transitioned according to their risk [...]

The Health Level 7 (HL7) Electronic Health Record Workgroup identified home medication list reconciliation as a prime opportunity to improve patient safety and reduce clinician burden. We developed a platform-neutral, Fast Healthcare Interoperability Resources (FHIR)-enabled reference model and demonstration wireframe to articulate the concepts of an interoperable, patient-centric home medication list management ecosystem.Four principal artifacts describe the reference model: (1) a conceptual (high-level) model, (2) a data architecture (detailed) model [...]

Globally, health information system (HIS) development projects face challenges regarding technology infrastructure, financing, user resistance, and interoperability. While these challenges are well-described in literature, most studies on HIS digitalization focus on the development of national and hospital HISs, with little focus on HISs in primary care. We described the HISs of two primary care clinics in Manila, Philippines in terms of data management procedures, governance, training and equipment, information culture [...]

This study aimed to describe human-centered design of clinical decision support (CDS) for children with metabolic diseases at high risk of rapid decompensation, assess the influence of CDS on care processes and patient outcomes, and share insights from the implementation.A CDS was designed in collaboration with pediatric genetics experts to provide accelerated triage and recommend dextrose-containing fluids for patients metabolic conditions. Formative usability testing was conducted with emergency department (ED) [...]

Hypertension is a chronic condition defined by persistent high blood pressure (BP) that contribute to significant morbidity and mortality. Evidence-based clinical guidelines provide recommendations for the diagnosis and management of hypertension. These recommendations are frequently incorporated into clinical decision support (CDS) tools used by clinicians. CDS tools can also be oriented toward patients but careful attention to the development process is required to make a useful, usable, and engaging digital [...]

Clinical decision support (CDS) tools in electronic health records (EHRs) often face low uptake due to limited usability, workflow integration, and other implementation issues. We recently designed and implemented the STRATIFY-CDS tool, which calculates a validated risk-prediction model and recommends disposition for emergency department (ED) patients with acute heart failure. Despite applying human-centered design and implementation science strategies, initial utilization in the first 3 months of the STRATIFY-CDS tool was [...]

Hospitals are looking to AI and other innovative applications to help alleviate provider burden and dissatisfaction associated with clinical documentation in oncology. Ambient artificial intelligence (AI) scribes are a promising technology to address these issues. However, they generally have not been optimized for oncology. This study aimed to evaluate an ambient AI scribe application with oncology providers to determine opportunities and potential challenges.This prospective pilot study of a scribe application [...]

The global aging population is rapidly increasing, and the prevalence of age-related cognitive conditions, such as mild cognitive impairment (MCI), is becoming more common. This condition, which represents intermediate stages between normal aging and dementia, underscores the importance of early detection and timely intervention to address the growing demand for health services. Traditional cognitive assessments have limitations, such as the consistency of results, prompting the need for innovative technology-based solutions.This [...]

Chemoprophylaxis reduces the risk of hospital-acquired venous thromboembolism (VTE), but is not reliably ordered. Our institution created a clinical decision support (CDS) interruptive alert to remind clinicians to order VTE chemoprophylaxis when it is missing for qualifying inpatients. Unfortunately, this alert has required repeated modifications to ensure accurate logic, and continues to generate negative feedback from users.This study aimed to describe multiple failures in the development and postdeployment optimization of [...]