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Effective clinical decision support (CDS) interventions improve adherence to care guidelines, reduce prescribing errors, and, in some settings, decrease patient mortality. However, misalignment with the "Five Rights" framework, particularly regarding CDS timing in clinical workflows, can lead to implementation failures, alert fatigue, and physician burnout.This case series aimed to evaluate and redesign three interruptive CDS alerts at a large safety net health system to better align with clinician workflows, reduce [...]

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 [...]

Central line-associated bloodstream infections (CLABSIs) are associated with substantial pediatric morbidity and mortality. The capacity to predict which children with central lines are at greatest risk of CLABSI could inform surveillance and prevention efforts. Our team previously published in silico predictive models for CLABSI.To prospectively implement a pediatric CLABSI predictive model and achieve adequate performance in offline validation for implementation in clinical practice.Most performant predictive models were deep learning models [...]

Electronic health records (EHRs) contain valuable patient information, yet certain aspects of care remain infrequently documented and difficult to extract. Identifying these rarely documented elements requires advanced informatics approaches to uncover clinical documentation patterns that would otherwise remain inaccessible for research and quality improvement.This study developed and validated an informatics approach using natural language processing (NLP) to detect and characterize rarely documented elements in EHRs, using spiritual care documentation as [...]

Artificial intelligence (AI) scribes use advanced speech recognition and natural language processing to automate clinical documentation and ease administrative burden. However, little is known about the effect of AI scribes on clinicians, patients, and organizations.This study aimed to (1) propose an evaluation framework to guide future AI scribe implementations, (2) describe the effect of AI scribes along the domains proposed in the developed evaluation framework, and (3) identify gaps in [...]

Electronic health record (EHR) usage measures may quantify physician activity at scale and predict practice settings with a high risk for physician burnout, but their relation to experiences is poorly understood.This study aimed to explore the EHR-related experiences and well-being of primary care physicians in comparison to EHR usage measures identified as important for predicting burnout from a machine learning model.Exploratory qualitative study with semi-structured interviews of primary care physicians [...]

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 [...]

While electronic health record (EHR)-based tools for refugee health screening exist, support for other immigrant children has lagged. Reasons include lack of time, difficulty determining screening eligibility, and lack of awareness of screening recommendations. EHR-based tools to promote immigrant child health screening (ICHS) can address these challenges, but guidance is needed for tools that are usable by clinicians and acceptable to immigrant families.Develop useful EHR-based tools to support ICHS while [...]

Approximately 10% of patients have a documented penicillin "allergy"; however, up to 95% have subsequent negative testing. These patients may receive suboptimal antibiotics, leading to longer hospitalizations and higher costs, rates of resistant and nosocomial infections, and all-cause mortality. To mitigate these risks in children, we implemented an inpatient penicillin allergy delabeling protocol and integrated it into the electronic health record (EHR) through a mixed methods approach of clinical decision [...]

Cancer staging is integral to ensuring cancer patients receive appropriate risk-adapted therapy. Discrete cancer staging using a structured staging form helps ensure accurate staging, provides a single source of truth for staging information, and allows for reporting to regulatory authorities. Our institution created pediatric oncology specific discrete staging forms that have been shared with the broader Epic community. By November 2023, baseline utilization of the staging form for patients with [...]