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Clinical decision support (CDS) systems have been widely adopted across clinical settings to promote evidence-based practice for clinicians. CDS malfunctions often affect the user experience and indirectly or directly interfere with patient care. To enhance optimal performance, it is critical to constantly monitor the performance of the tool and react promptly when malfunctions are identified.This study aimed to describe malfunctions identified in the development and implementation of a CDS alert [...]

There is limited literature on prefilled order sentences, a form of prescription prefilled with dosage, route, and frequency information, and none on their effect in a targeted setting for community-acquired pneumonia, for which reported compliance is poor.Prefilled orders incorporated within computerized provider order entry systems (CPOE) may facilitate compliance guidelines by acting as a form of clinical decision support (CDS), providing a default choice for prescribers. We aim to assess [...]

Maternal harm, especially for Black women, is a significant health care issue. Unstructured clinical notes in electronic health records (EHRs) may reveal unsafe maternal care. Prior studies using natural language processing (NLP) have shown that tone and sentiment in notes contribute to preventable safety events.This study aimed to examine whether negative patient descriptors in EHR clinical notes are associated with adverse maternal outcomes and how their use varies by patient [...]

To implementation an automated multi-institutional pipeline that delivers breast-cancer risk integrated with polygenic risk scores, monogenic variants, family history, and clinical factors, emphasizing operational challenges and their solutions.

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 [...]

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 [...]

Long COVID, characterized by persistent or recurring symptoms post-COVID-19 infection, poses challenges for pediatric care and research due to the lack of a standardized clinical definition. Adult-focused phenotypes do not translate well to children, given developmental and physiological differences, and pediatric-specific phenotypes have not been compared with chart review.This study introduces and evaluates a pediatric-specific rule-based computable phenotype (CP) to identify long COVID using electronic health record data. We compare [...]

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 [...]

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 [...]

To evaluate predictive diagnostic performance of open- and closed-source large language models (LLMs) in emergency medicine, addressing the urgent need for innovative clinical decision support tools amid rising patient volumes and staffing shortages.