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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 [...]

Interruptive alerts can negatively impact clinical workflows and contribute to alert fatigue, provider frustration, and burnout. Given that interruptive alert overriding is a heterogeneous and recurring phenomenon, occurring across different organizational contexts with varying characteristics and circumstances, we hypothesize a pragmatic approach with multimodal interventions to address malfunctioning alert populations and maintain those contributing to better patient care.This study aimed to develop a systematic approach to screen, identify, and correct [...]

This study aimed to develop a human factors assessment for medication-related clinical decision support (CDS) based on a previously validated tool that assessed the integration of human factors principles in CDS, the instrument for evaluating human factors principles in medication-related decision support alerts (I-MeDeSA), and pilot it with 10 outpatient clinics across the United States.The human factors assessment was developed based on past validations of I-MeDeSA. Examples included changing the [...]

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 [...]

Uncontrolled hypertension is common and frequently related to inadequate adherence to prescribed medications, resulting in suboptimal blood pressure control and increased healthcare utilization. Although healthcare providers have the opportunity to improve medication adherence, they may lack the tools to address adherence at the point of care. This study aims to assess the usability of a digital tool designed to improve medication adherence and blood pressure control among patients with hypertension [...]

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 [...]

Clinical informatics (CI) is a dynamic field at the intersection of health care, technology, and information science, aimed at enhancing health care delivery and patient outcomes. CI fellowship programs prepare physicians to lead and apply health information technologies that drive improvements in clinical care, system efficiency, and innovation. Achieving Accreditation Council for Graduate Medical Education (ACGME) accreditation for such programs is crucial for standardizing training and ensuring the development of [...]

Emergency department (ED) handoff to inpatient teams is a potential source of error. Generative artificial intelligence (AI) has shown promise in succinctly summarizing large quantities of clinical data and may help improve ED handoff.Our objectives were to: (1) evaluate the accuracy, clinical utility, and safety of AI-generated ED-to-inpatient handoff summaries; (2) identify patient and visit characteristics influencing summary effectiveness; and (3) characterize potential error patterns to inform implementation strategies.This exploratory [...]

Patient mobility during hospitalization is essential for high-quality healthcare as mobility is linked to physical function and quality of life. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale is a validated method to assess mobility in hospitalized patients. Although the JH-HLM is widely utilized, it has limitations including ceiling effects, unobserved mobility events going unrecorded, and the staff time needed to observe and document.We explored the feasibility of using [...]

Copy-paste (CP) and copy-forward (CF) are common electronic health record (EHR) documentation tools that purportedly improve provider efficiency, but they can also contribute to documentation burden while increasing note bloat and errors. Our understanding of provider perceptions of these tools remains limited.This study aimed to increase understanding of provider perceptions and self-reported usage patterns of CP and CF across different clinical environments and provider roles, including the impact of these [...]