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Electronic health record (EHR) patient portal messaging has become an essential tool for patient-clinician communication by improving accessibility to primary care. While messaging is beneficial for patients, it can increase clinicians' workloads. Female clinicians receive a greater number of EHR messaging, resulting in an increased workload.This evaluation explores the factors in clinician gender disparity in EHR messaging burden.The first phase of the evaluation included a retrospective analysis of the messages [...]

Online healthcare portals provide access to electronic health information and support clinical communication. Almost no studies have examined perspectives on parental portal access. We aimed to characterize parental and adolescent perspectives on parental portal access.Semi-structured interviews with 51 dyads of parents and adolescents (102 total interviews). We stratified sampling for equal proportions of adolescents with and without chronic illnesses. We analyzed interview transcripts using thematic analysis.Parents and adolescents identified several [...]

The patient-facing ASTHMAXcel mobile platform has been linked to improved asthma knowledge decreased asthma-related health care utilization (emergency department [ED] visits, hospitalizations), and reduced prednisone use among adult and pediatric patient populations.Given the upfront costs associated with developing mobile health platforms, this paper seeks to estimate the savings attributable to pediatric and adult users of the ASTHMAXcel platform through decreased hospitalizations, ED visits, and prednisone use.Forty adult patients and 39 [...]

Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness. Guidelines recommend screening for infants with gestational age at birth <31 weeks or birth weight ≤1,500 g. However, ensuring timely screening during readmissions after birth is challenging.To analyze the performance of an interruptive alert at a large academic pediatric hospital for identifying premature infants needing ROP screening upon hospital readmission and to describe how data informed the transition to a non-interruptive dashboard.The alert appeared for patients 1 to 365 days of age hospitalized in acute care or pediatric intensive care and instructed providers to order an ophthalmology consult from within the alert and to call ophthalmology for at-risk patients. For quality improvement, the clinical decision support (CDS) advisory group evaluated the effectiveness and efficiency of the alert. We extracted alert metrics from the hospital's enterprise data warehouse, including the user response and feedback, patient characteristics (age, birth gestational age, and birth weight), and any ophthalmology consultations. We analyzed the percentage of encounters seen by ophthalmology using a statistical process control chart during alert implementation and 6 months before and after.The alert appeared 3,309 times during 2,194 patient encounters usually. Users chose "Accept and place order" for 43% (943/2,194) of encounters, but only 11% (102/943) had an ophthalmology consult; 34% (53/155) of ophthalmology consultations occurred in encounters with a final response other than "Accept and place order." The intervention was redesigned using a non-interruptive surveillance dashboard with greater specificity, and the alert was de-implemented.Analysis of a failed interruptive alert for identifying patients at risk for ROP led to a transition to targeted surveillance using a dashboard. This case emphasizes the importance of aligning the CDS modality to the clinical workflow, information availability, and user decision-making needs and should be supported by governance.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with up to 70% of cases remaining undiagnosed. This paper proposes a COPD screening tool based on time-frequency representation features of self-recorded respiratory sounds.

Clinicians' occupational fatigue can lead to suboptimal decisions that do not align with evidence-based guidelines or patient needs.Examining the effects of occupational fatigue on (1) clinical decision making and (2) the use of clinical decision support (CDS) in a pediatric emergency department (ED).We interviewed 30 pediatric ED clinicians from a single site. Clinicians included physicians and advanced practice practitioners. The interviews were semi-structured and guided by the dual-processing model. Data [...]

Venous thromboembolism (VTE) prophylaxis in hospitalized patients must balance risks of bleeding and thrombosis. Clinical changes such as bleeding or renal injury can also trigger changes or delays in thromboprophylaxis. Electronic health record alerts (EHRAs) can allow for targeted notification to providers to improve venous thromboembolism prophylaxis and improve patient outcomes at the risk of alert fatigue if not carefully designed and implemented.This study aimed to develop and refine an [...]

To evaluate clinical decision support (CDS) of varying complexities and care settings represented using Health Information Technology (HIT) standards-Clinical Quality Language (CQL) for representing clinical logic and Fast Healthcare Interoperability Resources (FHIR) for health information exchange.

Our objective was to determine how social vulnerabilities, broadband access, and rurality relate to telemedicine use across the United States through large-scale analysis of real-world telemedicine data.

Federated analysis is a method that allows data analysis to be performed on similar datasets without exchanging any data, thus facilitating international research collaboration while adhering to strict privacy laws. This study aimed to evaluate the feasibility of using federated analysis to benchmark mortality in 2 critical care quality registry databases converted to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM), describing challenges to and recommendations for performing [...]