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The Enhanced EHR-facilitated Cancer Symptom Control (E2C2) Trial is a pragmatic trial testing a collaborative care approach for managing common cancer symptoms. There were challenges in identifying cancer site and metastatic status.This study compares three different approaches to determine cancer site and six strategies for identifying the presence of metastasis using EHR and cancer registry data.The E2C2 cohort included 50,559 patients seen in the medical oncology clinics of a large [...]

Many children with cancer are treated as part of interventional clinical trials. Ensuring that the correct chemotherapy treatment plan is used is paramount.The objectives of this report were to: (1) highlight the initial design of a clinical decision support (CDS) tool that was intended to help ensure the correct matching of research studies to research chemotherapy medications, (2) discuss the issues identified with the CDS tool, and (3) review the [...]

Electronic health records (EHRs) have significantly impacted healthcare improving access to patient information and enhancing communication among the health care team. However, the lack of usability and increased documentation burden has greatly contributed to clinician burnout. Improvements in EHR design that include physician input are critical to developing specific changes that make EHRs more intuitive and less cumbersome to use; however, it can be challenging to gather input from physicians [...]

This study aimed to assess the efficacy of a biomedical informatics boot camp with regard to improving the skill sets of its participants.The University at Buffalo hosts a free, virtual biomedical informatics boot camp annually. Lectures covering various subject matters are offered, for example, general programming, machine learning, natural language processing, and clinical decision support. Once the 2023 boot camp had concluded, an anonymous voluntary survey was distributed.Seventy percent of [...]

Despite the proven usefulness of appropriate clinical decision support (CDS) alerts, many CDS systems fire excessive, clinically irrelevant alerts that are often ignored by clinicians. We have developed a method to suppress false-positive alerts based on prior drug tolerance but encountered substantial barriers to integrating the method into widely adopted commercial electronic health record (EHR) systems.This study aimed to describe the challenges faced while attempting to integrate our method into [...]

At a large quaternary health system, tissue specimens were frequently sent to the microbiology laboratory with an incorrect wound culture order meant for swab specimens due to poor electronic health record (EHR) menu design. Wound cultures were also requested in chronic wound cases with a low index of suspicion for acute infection.This study aimed to present a case report on specific changes to the design of the electronic test menu [...]

Pediatric cancer patients with fever and neutropenia are at risk for bacterial sepsis, traditionally requiring extended hospital stays on antibiotics until neutrophil counts recover. According to a newly validated scoring system, a subset of these patients is at lower risk and eligible for early discharge and reduced intravenous (IV) antibiotic exposure.Reduce length-of-stay (LOS) for febrile neutropenic patients using clinical decision support (CDS) to identify low-risk patients.A CDS system was developed [...]

Effective postoperative care is crucial for the success of total joint arthroplasty (TJA) and prevention of unnecessary emergency department (ED) visits. We explore the feasibility and acceptability of utilizing an Interactive Voice Response System (IVRS) to enhance postoperative monitoring in primary TJA patients.This pilot study was conducted with 24 participants undergoing primary TJA randomly assigned to an intervention group receiving IVRS calls (n = 12) or a control group (n = 12) receiving standard [...]

Experiences sharing complex workflow-integrated clinical decision support (CDS) across health systems are sparse and not well reported. This case study presents the sharing of a hybrid electronic health record (EHR)-native and SMART-compatible CDS tool for automating provision of smoking cessation treatment for caregivers during pediatric visits.We conducted a comprehensive needs assessment using sociotechnical frameworks to identify workflow gaps and technical requirements. A multidisciplinary team of clinical informaticians, software developers, and [...]