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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 [...]

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 [...]

Health informatics continues to be a continuously evolving discipline. As a result, faculty in health informatics training programs cover a broad range of topics and work in highly diverse academic contexts. This is a strength of the field, and also introduces challenges in understanding faculty salary ranges and assessing potential salary disparities across contexts. Although limited studies have been done on salary ranges in specific academic contexts, prior to this [...]

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 [...]

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 [...]