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To evaluate the efficacy of digital twins developed using a large language model (LLaMA-3), fine-tuned with Low-Rank Adapters (LoRA) on intensive care units (ICU) physician notes, and to determine whether specialty-specific training enhances treatment recommendation accuracy compared to other ICU specialties or zero-shot baselines.

Patient portals are increasingly used to support digital health engagement, but little is known about how caregivers used patient portals before, during, and after the coronavirus disease 2019 (COVID-19) pandemic.This study aimed to examine longitudinal changes in caregiver engagement with pediatric patient portals, focusing on logins, session duration, messaging behaviors, and provider response times across prepandemic, pandemic, and postpandemic periods.We conducted a retrospective cohort study using deidentified MyChart data from [...]

Demonstrate the ability to encapsulate clinical-grade genomics data normalization algorithms within a FHIR Genomics reference implementation.

Overuse and misuse of antibiotics is an urgent health care problem and one of the key factors in antibiotic resistance. Validated clinical prediction rules have shown effectiveness in guiding providers to an appropriate diagnosis and identifying when antibiotics are the recommended choice for treatment.We aimed to study the relative ability of registered nurses using clinical prediction rules to guide the management of acute respiratory infections in a simulated environment compared [...]

Time spent in the electronic health record (EHR) is an important measure of clinical activity. Vendor-derived EHR use metrics may not correspond to actual EHR experience. Raw EHR audit logs enable customized EHR use metrics, but translating discrete timestamps to time intervals is challenging. There are insufficient data available to quantify inactivity between audit log timestamps.This study aimed to develop and validate a computer vision-based model that (1) classifies EHR [...]

Negative descriptors in electronic health records (EHR) contribute to worse health outcomes; studies show they are also more prevalent in EHRs of women and racial minorities and affect downstream research biases. Similar and unique patterns of negative descriptors may also exist in the records of blind patients, including those with diabetic retinopathy. Diabetic retinopathy is a preventable but leading cause of blindness in the US that is disproportionally high among [...]

The use of real-time clinical decision support (CDS), such as Our Practice Advisory (OPAs), augments clinical decisions while helping to reduce errors and ensuring compliance with organizational best practices.1 In complex large health systems, processes for standardization and adherence to emergency department (ED)-based suicide screening practices are challenging and may benefit from the use of CDS-based tools adhering to the five rights of CDS.2 To improve suicide screening compliance for [...]

The timely administration of postoperative antibiotics is crucial for preventing surgical site infections. Despite surgical ordering workflows designed to facilitate care across settings, delays in antibiotic administration posttransfer to the pediatric intensive care unit (PICU) were identified. We aimed to develop a clinical decision support (CDS) system to enhance timely order activation in a large pediatric health system. We hypothesized that the time to release signed and held orders by [...]

Missed diagnosis of genetic conditions is a persistent challenge in clinical care, particularly for familial hypercholesterolemia (FH), hereditary breast and ovarian cancer (HBOC), and Lynch syndrome-conditions designated by the U.S. Centers for Disease Control and Prevention (CDC) as Tier 1 genomic applications. This scoping review summarizes evidence on the use of electronic health record (EHR)-based algorithms to identify individuals with these conditions.