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This case series aims to evaluate several applications of inline disappearing text (DT) clinical decision support (CDS) tools within clinician documentation.DT blocks were created to prompt documentation for perioperative anticoagulation planning (scenario 1), predischarge intravenous antibiotic planning (scenario 2), and advanced care planning (ACP; scenario 3). In scenario 1, DT was the only intervention. In scenario 2, DT was paired with a documentation SmartList. In scenario 3, DT was paired [...]

Clinicians' occupational fatigue can lead to suboptimal decisions that do not align with evidence-based guidelines or patient needs.Examining the effects of occupational fatigue on (1) clinical decision making and (2) the use of clinical decision support (CDS) in a pediatric emergency department (ED).We interviewed 30 pediatric ED clinicians from a single site. Clinicians included physicians and advanced practice practitioners. The interviews were semi-structured and guided by the dual-processing model. Data [...]

Venous thromboembolism (VTE) prophylaxis in hospitalized patients must balance risks of bleeding and thrombosis. Clinical changes such as bleeding or renal injury can also trigger changes or delays in thromboprophylaxis. Electronic health record alerts (EHRAs) can allow for targeted notification to providers to improve venous thromboembolism prophylaxis and improve patient outcomes at the risk of alert fatigue if not carefully designed and implemented.This study aimed to develop and refine an [...]

Interruptive clinical decision support (CDS) alerts are intended to improve patient care, but can contribute to alert fatigue, diminishing their effectiveness. The alert demonstrated minimal clinical effect while contributing significantly to alert fatigue.This study aims to evaluate if transitioning a high-firing medication on hold alert from interruptive to noninterruptive would change provider practices.The alert was triggered when at least two medications were held for >48 hours. A pre-post intervention cohort study [...]

In dentistry, social determinants of health (SDoH) are potentially recorded in the clinical notes of electronic dental records. The objective of this study was to examine the availability of SDoH data in dental clinical notes and evaluate natural language processing methods to extract SDoH from dental clinical notes.A set of 1,000 dental clinical notes was sampled from a dataset of 105,311 patient visits to a dental clinic and manually annotated [...]

Despite their potential, Clinical Decision Support (CDS) systems often lack alignment with clinicians' needs and are underutilized in practice. Pilot implementations can help to improve the fit between systems and local needs by engaging users in real-world testing and refinement. Although pilot implementations of CDS have been reported, limited evidence has explored the factors contributing to pilot success.This study aimed to explore the opportunities and challenges associated with the pilot [...]

This study aims to evaluate the impact of using a large language model (LLM) for generating draft responses to patient messages in the electronic health record (EHR) system on clinicians and support staff workload and efficiency.We partnered with Epic Systems to implement OpenAI's ChatGPT 4.0 for responding to patient messages. A pilot study was conducted from August 2023 to July 2024 across 13 ambulatory specialties involving 323 participants, including clinicians [...]

Central line-associated bloodstream infections (CLABSIs) are associated with substantial pediatric morbidity and mortality. The capacity to predict which children with central lines are at greatest risk of CLABSI could inform surveillance and prevention efforts. Our team previously published in silico predictive models for CLABSI.To prospectively implement a pediatric CLABSI predictive model and achieve adequate performance in offline validation for implementation in clinical practice.Most performant predictive models were deep learning models [...]

The patient-facing ASTHMAXcel mobile platform has been linked to improved asthma knowledge decreased asthma-related health care utilization (emergency department [ED] visits, hospitalizations), and reduced prednisone use among adult and pediatric patient populations.Given the upfront costs associated with developing mobile health platforms, this paper seeks to estimate the savings attributable to pediatric and adult users of the ASTHMAXcel platform through decreased hospitalizations, ED visits, and prednisone use.Forty adult patients and 39 [...]

While electronic health record (EHR)-based tools for refugee health screening exist, support for other immigrant children has lagged. Reasons include lack of time, difficulty determining screening eligibility, and lack of awareness of screening recommendations. EHR-based tools to promote immigrant child health screening (ICHS) can address these challenges, but guidance is needed for tools that are usable by clinicians and acceptable to immigrant families.Develop useful EHR-based tools to support ICHS while [...]