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Rare B-rapidly accelerated fibrosarcoma gene (BRAF) mutations in advanced melanoma, and other malignancies, represent a significant clinical challenge due to sparse evidence on the efficiency of targeted therapy. Conventional genomic databases do not integrate detailed outcome data on treatments for patients with these mutations, requiring innovative informatics approaches.For the use case of patients with rare BRAF-mutated melanoma, we developed a "Treatment Outcome Tool" as a web-based database on rare cancers [...]

Gather insights regarding the state of third-party access cybersecurity in healthcare delivery organizations (HDOs).An online multinational survey was deployed to eligible respondents to assess HDO third-party access, cybersecurity, and challenges.Of 209 respondents, only 51.1% reported having a comprehensive inventory of all third parties accessing their network. Sixty percent stated third-party access to sensitive/confidential information was not routinely monitored, despite 19% having more than 40, and 31% having 21 to 40 [...]

This study aims to evaluate physicians' practices and perspectives regarding large language models (LLMs) in health care settings.A cross-sectional survey study was conducted between May and July 2024, comparing physician perspectives at two major academic medical centers (AMCs), one with institutional LLM access and one without. Participants included both clinical faculty and trainees recruited through departmental leadership and snowball sampling. Primary outcomes were current LLM use frequency, ranked importance of [...]

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 [...]

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 [...]