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To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes.

On June 24, 2022, the US Supreme Court ended constitutional protections for abortion, resulting in wide variability in access from severe restrictions in many states and fewer restrictions in others. Healthcare institutions capture information about patients' pregnancy and abortion care and, due to interoperability, may share it in ways that expose their providers and patients to social stigma and potential legal jeopardy in states with severe restrictions. In this article [...]

Clinical decision support (CDS) alerts may improve health care quality but "alert fatigue" can reduce provider responsiveness. We analyzed how the introduction of competing alerts affected provider adherence to a single depression screening alert.

Electronic health record audit logs capture a time-sequenced record of clinician activities while using the system. Audit log data therefore facilitate unobtrusive measurement at scale of clinical work activities and workflow as well as derivative, behavioral proxies (eg, teamwork). Given its considerable research potential, studies leveraging these data have burgeoned. As the field has matured, the challenges of using the data to answer significant research questions have come into focus [...]

How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced [...]

The Supreme Court recently overturned settled case law that affirmed a pregnant individual's Constitutional right to an abortion. While many states will commit to protect this right, a large number of others have enacted laws that limit or outright ban abortion within their borders. Additional efforts are underway to prevent pregnant individuals from seeking care outside their home state. These changes have significant implications for delivery of healthcare as well [...]

A panel sponsored by the American College of Medical Informatics (ACMI) at the 2021 AMIA Symposium addressed the provocative question: "Are Electronic Health Records dumbing down clinicians?" After reviewing electronic health record (EHR) development and evolution, the panel discussed how EHR use can impair care delivery. Both suboptimal functionality during EHR use and longer-term effects outside of EHR use can reduce clinicians' efficiencies, reasoning abilities, and knowledge. Panel members explored [...]