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While nursing summaries in electronic health records are used for initial orientation to a patient's status, research on nurses' use of these summaries remains scarce. This case study conducted an eye-tracking simulation to identify (1) key information types (orders, vital signs, etc.), (2) frequently paired information types, and (3) common sequential patterns of information types within nursing summaries as nurses review simulated patient cases.We recruited 33 medical-surgical nurses from a [...]

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 [...]

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 [...]

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 [...]

Traditional early warning systems (EWS) have shown uncertain efficacy in real-world settings. More recently, machine learning models like the Epic Deterioration Index (DTI) have been developed, promising greater accuracy. Recognizing the potential of DTI, but also the pervasive issue of alert fatigue with interruptive (i.e., pop-up) EWS alerts, our institution implemented a DTI-enabled EWS with passive alerts (colored icons visible in prespecified locations within the electronic health record). We hypothesized [...]

Electronic patient-reported outcome measures (ePROMs) can improve care for people with cancer, but effectiveness hinges on well-supported integration in clinical settings.We evaluated clinician use of specific clinical decision support (CDS) tools in the electronic health record (EHR) designed to facilitate timely, clinically appropriate responses to ePROM scores for six symptoms commonly experienced by cancer patients.The parent pragmatic trial, which took place at Mayo Clinic (Rochester, Minnesota, United States) and its [...]

Disparities exist in patient portal use among non-English-speaking caregivers of pediatric patients. This study aims to evaluate the reasons behind Spanish-speaking caregivers' use of patient portals and identify facilitators and barriers, focusing on those caring for children with chronic conditions.We conducted semi-structured interviews and surveys with Spanish-speaking caregivers of pediatric patients with chronic conditions at an academic pediatric health network in California. Data were transcribed, coded, and analyzed using inductive [...]

In the emergency department-initiated buprenorphine for opioid use disorder (EMBED) trial, a clinical decision support (CDS) tool had no effect on rates of buprenorphine initiation in emergency department (ED) patients with opioid use disorder. The Agency for Healthcare Research and Quality (AHRQ) recently released a CDS Performance Measure Inventory to guide data-driven CDS development and evaluation. Through partner co-design, we tailored AHRQ inventory measures to evaluate EMBED CDS performance and [...]

Electronic health records (EHRs) have revolutionized clinical practice, but clinicians and institutions have not yet fully optimized their use. Inconsistent documentation of ophthalmic test results can increase potential medicolegal risks if providers bill for tests without properly documenting clinical interpretations.To address this, we developed and implemented a logic tool in Epic (Epic Systems, Verona, Wisconsin, United States) that prompts clinicians to document diagnostic test interpretations as discrete data before closing [...]

To address biased representation in Electronic Health Records (EHRs) across subpopulations (SPs), which leads to predictive models underperforming for underrepresented groups, we propose a framework to enhance equitable predictive performance.