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Chemoprophylaxis reduces the risk of hospital-acquired venous thromboembolism (VTE), but is not reliably ordered. Our institution created a clinical decision support (CDS) interruptive alert to remind clinicians to order VTE chemoprophylaxis when it is missing for qualifying inpatients. Unfortunately, this alert has required repeated modifications to ensure accurate logic, and continues to generate negative feedback from users.This study aimed to describe multiple failures in the development and postdeployment optimization of [...]

Aging populations strain health care systems. Assisted Living Technologies (ALTs) emerge as a potential solution for promoting independent living among older adults. However, the real-world effect of ALTs remains unclear.This study explores benefits and challenges (anticipated and unanticipated) of ALTs for older adults and informal caregivers across three aged care settings (residential aged care facilities [RACFs], retirement villages [RVs], and home-dwelling communities [HDCs]) in Australia.Three ALTs (fall detection sensors, sleep [...]

Electronic patient-reported outcome measures (ePROMs) can improve care for people with cancer, but effectiveness hinges on well-supported integration in clinical settings.We evaluated clinician use of specific clinical decision support (CDS) tools in the electronic health record (EHR) designed to facilitate timely, clinically appropriate responses to ePROM scores for six symptoms commonly experienced by cancer patients.The parent pragmatic trial, which took place at Mayo Clinic (Rochester, Minnesota, United States) and its [...]

Human-centered design (HCD) methods in machine learning generally focus on workflow, user interfaces, and data visualizations, but there is the potential to apply these methods to inform the model development and testing process.This study aimed to demonstrate the potential of HCD methods to support the design and testing of machine learning models developed for clinical decision-making.In preparing for formative user testing of clinician facing representations of a machine learning model [...]

Ensuring clinician safety in health care settings is critical, particularly regarding exposure to hazardous drugs and bodily fluids, which can be carcinogenic, teratogenic, genotoxic, or cause organ toxicity at low doses. At SickKids a safety issue arose when a clinician was unknowingly exposed to hazardous bodily fluids due to inadequate communication of a patient's hazardous medication status.This clinical decision support (CDS) redesign aimed to reduce alert fatigue while ensuring timely [...]

This study aimed to explore: (1) how nurses in the acute care setting describe their experience(s) of excessive documentation burden (ExDocBurden); (2) what factors contribute to ExDocBurden for nurses in the inpatient setting; and (3) nurses' perspectives on solutions to mitigate ExDocBurden that support documentation practices that they deem essential to providing safe, high-quality care.Semistructured interviews were conducted with 18 acute care nurses. Transcribed interviews were analyzed using the constant [...]

This study aimed to describe human-centered design of clinical decision support (CDS) for children with metabolic diseases at high risk of rapid decompensation, assess the influence of CDS on care processes and patient outcomes, and share insights from the implementation.A CDS was designed in collaboration with pediatric genetics experts to provide accelerated triage and recommend dextrose-containing fluids for patients metabolic conditions. Formative usability testing was conducted with emergency department (ED) [...]

Clinical decision support (CDS) tools in electronic health records (EHRs) often face low uptake due to limited usability, workflow integration, and other implementation issues. We recently designed and implemented the STRATIFY-CDS tool, which calculates a validated risk-prediction model and recommends disposition for emergency department (ED) patients with acute heart failure. Despite applying human-centered design and implementation science strategies, initial utilization in the first 3 months of the STRATIFY-CDS tool was [...]

Hospitals are looking to AI and other innovative applications to help alleviate provider burden and dissatisfaction associated with clinical documentation in oncology. Ambient artificial intelligence (AI) scribes are a promising technology to address these issues. However, they generally have not been optimized for oncology. This study aimed to evaluate an ambient AI scribe application with oncology providers to determine opportunities and potential challenges.This prospective pilot study of a scribe application [...]

The goal of national interoperability is to improve care quality and decrease administrative burden and costs. Patients, providers, and other stakeholders are increasingly concerned that indiscriminate sharing of data may have deleterious, permanent consequences, as well as fail to provide granular control over the sharing of individual health data. Data segmentation and consent standards to date have been limited in scope and implementation, which has hindered efforts to scale data [...]