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Problem lists are intended to support high-quality care, but are often long and outdated. Despite policy efforts to encourage their upkeep-such as the "Problem List Reviewed" attestation checkbox in electronic health records (EHRs)-many diagnoses remain on lists far longer than clinically appropriate. Clinicians often check the attestation box that problem lists have been reviewed to comply with performance measures without reviewing and modifying the list.This study aimed to assess whether [...]

Malnutrition remains a critical global health challenge among hospitalized patients, necessitating effective nutrition support systems.This study aims to construct and evaluate a cross-professional, cross-sectoral nutrition health care information system (CPCS-NHIS) to optimize clinical nutrition management.The system integrates modified medical systems to unify information flows, knowledge, and clinical roles. In addition, a 20-item across six dimensions electronic questionnaire based on the revised DeLone and McLean IS Success model was developed to [...]

Enhancing the efficiency of family-centered rounds (FCRs) while ensuring timely patient care has been a focus of study over the past decade. We employed an Operations Research technique (i.e., simulation) to identify opportunities for improving rounding efficiency on our inpatient cardiology unit at Nationwide Children's Hospital (NCH).Through simulation of schedule-based rounds, our aims were to reduce the length of stay (LOS) and subsequent healthcare costs via (1) prioritizing rounds for [...]

Patient decompensation necessitating rapid response team (RRT) care in the hospital setting involves complex medical decision making, strong leadership skills, and precise communication where every second matters. However, RRT outcomes can vary based on leader training, knowledge, and experience. We designed five digital, condition-specific, guided algorithms to improve RRT care and compared user survey data among three physician cohorts across the clinical training spectrum to assess the practicality of real-world [...]

Clinical decision support systems (CDSS) have been suggested to be helpful in detecting and preventing drug-related problems such as adverse drug events (ADEs). However, patient participation systems monitoring self-reported data, such as symptoms, are still sparsely described in the literature.This study aimed to investigate if the use of a patient participating CDSS (PCDSS) can facilitate early detection of ADEs, thereby contributing to safer drug treatment in older adults.A 1-year prospective [...]

This study aimed to assess the effect of a passive, opt-in electronic health record (EHR)-based clinical decision support (CDS), the Chronic Pain OneSheet, on guideline-recommended chronic pain management in primary care.A pragmatic randomized controlled trial with a parallel group design was conducted between October 2020 and May 2022. Participants were 137 primary care clinicians (PCCs) treating qualifying patients with chronic pain at 25 primary care clinics within two academic health [...]

Electronic health records (EHRs) are intended to improve clinical practice, but excessive alerts can be counterproductive, leading to workarounds. The Mortality Surprise Question (MSQ), a tool for identifying patients who might benefit from early end-of-life discussions, was integrated into the Emergency Department (ED) EHR admission process.This study investigated how the staged implementation of a clinical decision support tool at the point of admission order entry affected ED clinician admission order [...]

Sepsis is a heterogeneous syndrome with high morbidity and mortality. Despite extensive clinical trials, therapeutic progress remains limited, in part due to the absence of actionable sepsis subtypes.This study aimed to evaluate the feasibility of using HL7 Fast Healthcare Interoperability Resources (FHIR) for prerandomization sepsis subtyping to support clinical trial enrichment across multiple health systems.Data from 765 encounters at two academic medical centers were analyzed. FHIR-based resources were extracted from [...]

Digital health tools, such as artificial intelligence scribes, offer significant potential to alleviate physician burnout and reduce administrative burdens associated with electronic health records. Despite their promise, Canadian health care organizations face challenges in establishing cohesive strategies for their effective implementation and evaluation.This paper explores actionable, organizational strategies to enhance physician wellness through digital health tools. It examines systemic barriers, promising practices, and infrastructure needs, culminating in five key recommendations [...]

End-of-life care (EoLC), such as advance care planning, advance directives, hospice, and palliative care consults, can improve patient quality of life and reduce costs, yet such interventions are underused. Machine learning-based prediction models show promise in identifying patients who may be candidates for EoLC based on increased risk of short-term (less than 1 year) mortality. Clinical decision support systems using these models can identify candidate patients at a time during [...]