739 results match your criteria Applied clinical informatics[Journal]


Rapid Implementation of an Inpatient Telehealth Program during the COVID-19 Pandemic.

Appl Clin Inform 2020 May 1;11(3):452-459. Epub 2020 Jul 1.

Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.

Background:  Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing.

Objective:  This article evaluates the use of a rapidly implemented, secure inpatient telehealth program. Read More

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http://dx.doi.org/10.1055/s-0040-1713635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329373PMC

Attributing Patients to Pediatric Residents Using Electronic Health Record Features Augmented with Audit Logs.

Appl Clin Inform 2020 May 24;11(3):442-451. Epub 2020 Jun 24.

Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.

Objective:  Patient attribution, or the process of attributing patient-level metrics to specific providers, attempts to capture real-life provider-patient interactions (PPI). Attribution holds wide-ranging importance, particularly for outcomes in graduate medical education, but remains a challenge. We developed and validated an algorithm using EHR data to identify pediatric resident PPIs (rPPIs). Read More

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http://dx.doi.org/10.1055/s-0040-1713133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314655PMC

Analysis of Employee Patient Portal Use and Electronic Health Record Access at an Academic Medical Center.

Appl Clin Inform 2020 May 17;11(3):433-441. Epub 2020 Jun 17.

Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.

Background:  Patient portals provide patients and their caregivers online access to limited health results. Health care employees with electronic health record (EHR) access may be able to view their health information not available in the patient portal by looking in the EHR.

Objective:  In this study, we examine how employees use the patient portal when they also have access to the tethered EHR. Read More

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http://dx.doi.org/10.1055/s-0040-1713412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299683PMC

A Randomized Trial of Voice-Generated Inpatient Progress Notes: Effects on Professional Fee Billing.

Appl Clin Inform 2020 May 10;11(3):427-432. Epub 2020 Jun 10.

Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States.

Background:  Prior evaluations of automated speech recognition (ASR) to create hospital progress notes have not analyzed its effect on professional revenue billing codes. As ASR becomes a more common method of entering clinical notes, clinicians, hospital administrators, and payers should understand whether this technology alters charges associated with inpatient physician services.

Objectives:  This study aimed to measure the difference in professional fee charges between using voice and keyboard to create inpatient progress notes. Read More

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http://dx.doi.org/10.1055/s-0040-1713134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286721PMC

Factors Influencing Problem List Use in Electronic Health Records-Application of the Unified Theory of Acceptance and Use of Technology.

Appl Clin Inform 2020 May 10;11(3):415-426. Epub 2020 Jun 10.

Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Background:  Problem-oriented electronic health record (EHR) systems can help physicians to track a patient's status and progress, and organize clinical documentation, which could help improving quality of clinical data and enable data reuse. The problem list is central in a problem-oriented medical record. However, current problem lists remain incomplete because of the lack of end-user training and inaccurate content of underlying terminologies. Read More

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http://dx.doi.org/10.1055/s-0040-1712466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286722PMC

Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study.

Appl Clin Inform 2020 May 3;11(3):405-414. Epub 2020 Jun 3.

Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States.

Background:  Medication nonadherence and unaffordability are prevalent, burdensome issues in primary care. In response, technology companies are capitalizing on clinical decision support (CDS) to deliver patient-specific information regarding medication adherence and costs to clinicians using electronic health records (EHRs). To maximize adoption and usability, these CDS tools should be designed with consideration of end users' values and preferences. Read More

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http://dx.doi.org/10.1055/s-0040-1712467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269720PMC

EHR-Independent Predictive Decision Support Architecture Based on OMOP.

Appl Clin Inform 2020 May 3;11(3):399-404. Epub 2020 Jun 3.

Department of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

Background:  The increasing availability of molecular and clinical data of cancer patients combined with novel machine learning techniques has the potential to enhance clinical decision support, example, for assessing a patient's relapse risk. While these prediction models often produce promising results, a deployment in clinical settings is rarely pursued.

Objectives:  In this study, we demonstrate how prediction tools can be integrated generically into a clinical setting and provide an exemplary use case for predicting relapse risk in melanoma patients. Read More

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http://dx.doi.org/10.1055/s-0040-1710393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269719PMC

A Review of Predictive Analytics Solutions for Sepsis Patients.

Appl Clin Inform 2020 May 27;11(3):387-398. Epub 2020 May 27.

Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, United States.

Background:  Early detection and efficient management of sepsis are important for improving health care quality, effectiveness, and costs. Due to its high cost and prevalence, sepsis is a major focus area across institutions and many studies have emerged over the past years with different models or novel machine learning techniques in early detection of sepsis or potential mortality associated with sepsis.

Objective:  To understand predictive analytics solutions for sepsis patients, either in early detection of onset or mortality. Read More

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http://dx.doi.org/10.1055/s-0040-1710525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253313PMC

Conceptual Design, Implementation, and Evaluation of Generic and Standard-Compliant Data Transfer into Electronic Health Records.

Appl Clin Inform 2020 May 27;11(3):374-386. Epub 2020 May 27.

Institute of Medical Informatics, University of Münster, Münster, Germany.

Objectives:  The objective of this study is the conceptual design, implementation and evaluation of a system for generic, standard-compliant data transfer into electronic health records (EHRs). This includes patient data from clinical research and medical care that has been semantically annotated and enhanced with metadata. The implementation is based on the single-source approach. Read More

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http://dx.doi.org/10.1055/s-0040-1710023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253309PMC

From Commercialization to Accountability: Responsible Health Data Collection, Use, and Disclosure for the 21st Century.

Appl Clin Inform 2020 Mar 20;11(2):366-373. Epub 2020 May 20.

Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States.

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http://dx.doi.org/10.1055/s-0040-1710392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239667PMC

Twilighted Homegrown Systems: The Experience of Six Traditional Electronic Health Record Developers in the Post-Meaningful Use Era.

Appl Clin Inform 2020 Mar 20;11(2):356-365. Epub 2020 May 20.

Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama, United States.

Objectives:  This study aimed to understand if and how homegrown electronic health record (EHR) systems are used in the post-Meaningful Use (MU) era according to the experience of six traditional EHR developers.

Methods:  We invited informatics leaders from a convenience sample of six health care organizations that have recently replaced their long used homegrown systems with commercial EHRs. Participants were asked to complete a written questionnaire with open-ended questions designed to explore if and how their homegrown system(s) is being used and maintained after adoption of a commercial EHR. Read More

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http://dx.doi.org/10.1055/s-0040-1710310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239668PMC

Clinician Perceptions of a Computerized Decision Support System for Pediatric Type 2 Diabetes Screening.

Appl Clin Inform 2020 Mar 13;11(2):350-355. Epub 2020 May 13.

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States.

Objective:  With the increasing prevalence of type 2 diabetes (T2D) in youth, primary care providers must identify patients at high risk and implement evidence-based screening promptly. Clinical decision support systems (CDSSs) provide clinicians with personalized reminders according to best evidence. One example is the Child Health Improvement through Computer Automation (CHICA) system, which, as we have previously shown, significantly improves screening for T2D. Read More

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http://dx.doi.org/10.1055/s-0040-1710024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220796PMC

Mapping the Entire Record-An Alternative Approach to Data Access from Medical Logic Modules.

Appl Clin Inform 2020 Mar 13;11(2):342-349. Epub 2020 May 13.

Medical Centre for Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Germany.

Objectives:  This study aimed to describe an alternative approach for accessing electronic medical records (EMRs) from clinical decision support (CDS) functions based on Arden Syntax Medical Logic Modules, which can be paraphrased as "map the entire record."

Methods:  Based on an experimental Arden Syntax processor, we implemented a method to transform patient data from a commercial patient data management system (PDMS) to tree-structured documents termed CDS EMRs. They are encoded in a specific XML format that can be directly transformed to Arden Syntax data types by a mapper natively integrated into the processor. Read More

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http://dx.doi.org/10.1055/s-0040-1709708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220797PMC

The Development and Evaluation of an Electronic Health Record Efficiency Workshop for Providers.

Appl Clin Inform 2020 Mar 6;11(2):336-341. Epub 2020 May 6.

Department of Information Technology, The Ohio State University Wexner Medical Center, Health System Informatics, Training and Optimization, Columbus, Ohio, United States.

Background:  The electronic health record (EHR) has historically been known to be a source of stress and dissatisfaction, leading to reduced efficiency and productivity for providers. This issue is complicated by constant changes in EHRs that are necessary to keep systems current with evolving functionality. Knowing the existence of this problem, an evidenced-based solution, known as an efficiency workshop, was developed by our information technology training and optimization team for providers as a means of ongoing professional development. Read More

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http://dx.doi.org/10.1055/s-0040-1709509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202918PMC

The Impact of Technology on Prescribing Errors in Pediatric Intensive Care: A Before and After Study.

Appl Clin Inform 2020 Mar 6;11(2):323-335. Epub 2020 May 6.

Department of Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland.

Background:  Increased use of health information technology (HIT) has been advocated as a medication error reduction strategy. Evidence of its benefits in the pediatric setting remains limited. In 2012, electronic prescribing (ICCA, Philips, United Kingdom) and standard concentration infusions (SCIs)-facilitated by smart-pump technology-were introduced into the pediatric intensive care unit (PICU) of an Irish tertiary-care pediatric hospital. Read More

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http://dx.doi.org/10.1055/s-0040-1709508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202919PMC
March 2020
0.386 Impact Factor

Noninterruptive Clinical Decision Support Decreases Ordering of Respiratory Viral Panels during Influenza Season.

Appl Clin Inform 2020 Mar 29;11(2):315-322. Epub 2020 Apr 29.

Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States.

Objective:  A growing body of evidence suggests that testing for influenza virus alone is more appropriate than multiplex respiratory viral panel (RVP) testing for general populations of patients with respiratory tract infections. We aimed to decrease the proportion of RVPs out of total respiratory viral testing ordered during influenza season.

Methods:  We implemented two consecutive interventions: reflex testing for RVPs only after a negative influenza test, and noninterruptive clinical decision support (CDS) including modifications of the computerized physician order entry search behavior and cost display. Read More

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http://dx.doi.org/10.1055/s-0040-1709507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190391PMC

Leveraging Electronic Dental Record Data for Clinical Research in the National Dental PBRN Practices.

Appl Clin Inform 2020 Mar 29;11(2):305-314. Epub 2020 Apr 29.

Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States.

Objectives:  The aim of this study is to determine the feasibility of conducting clinical research using electronic dental record (EDR) data from U.S. solo and small-group general dental practices in the National Dental Practice-Based Research Network (network) and evaluate the data completeness and correctness before performing survival analyses of root canal treatment (RCT) and posterior composite restorations (PCR). Read More

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http://dx.doi.org/10.1055/s-0040-1709506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190390PMC

Sync for Genes: Making Clinical Genomics Available for Precision Medicine at the Point-of-Care.

Appl Clin Inform 2020 03 22;11(2):295-302. Epub 2020 Apr 22.

Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States.

Background: Making genomic data available at the point-of-care and for research is critical for the success of the Precision Medicine Initiative (PMI), a research initiative which seeks to change health care by "tak(ing) into account individual differences in people's genes, environments, and lifestyles." The Office of the National Coordinator for Health Information Technology (ONC) led Sync for Genes, a program to develop standards that make genomic data available when and where it matters most. This article discusses lessons learned from recent Sync for Genes activities. Read More

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http://dx.doi.org/10.1055/s-0040-1708051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176556PMC

Celebrating Clinical Informatics as a Specialty Practice.

Appl Clin Inform 2020 03 22;11(2):303-304. Epub 2020 Apr 22.

Clinical Informatics Consultant, San Ramon, California, United States.

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http://dx.doi.org/10.1055/s-0039-3401812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176555PMC

Factors Affecting Patients' Acceptance of and Satisfaction with Cloud-Based Telehealth for Chronic Disease Management: A Case Study in the Workplace.

Appl Clin Inform 2020 03 15;11(2):286-294. Epub 2020 Apr 15.

Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan.

Objective: Understanding patients' acceptance of and satisfaction with telehealth use is important for workplace health promotion. In this study, we used a questionnaire to measure patients' usage behavior and satisfaction with cloud-based telehealth services in the workplace. We empirically investigated the factors that influence patients' usage and satisfaction based on data collected from 101 participants. Read More

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http://dx.doi.org/10.1055/s-0040-1708838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159983PMC

Preventing Diagnostic Errors in Ambulatory Care: An Electronic Notification Tool for Incomplete Radiology Tests.

Appl Clin Inform 2020 03 15;11(2):276-285. Epub 2020 Apr 15.

Tufts Medical Center, Boston, Massachusetts, United States.

Background: Failure to complete recommended diagnostic tests may increase the risk of diagnostic errors.

Objectives: The aim of this study is to develop and evaluate an electronic monitoring tool that notifies the responsible clinician of incomplete imaging tests for their ambulatory patients.

Methods: A results notification workflow engine was created at an academic medical center. Read More

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http://dx.doi.org/10.1055/s-0040-1708530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159984PMC

Responding to COVID-19: The UW Medicine Information Technology Services Experience.

Appl Clin Inform 2020 03 8;11(2):265-275. Epub 2020 Apr 8.

Department of Information Technology Services, UW Medicine, Seattle, Washington, United States.

Background: UW Medicine was one of the first health systems to encounter and treat COVID-19 patients in the United States, starting in late February 2020.

Objective: Here we describe the rapid rollout of capabilities by UW Medicine Information Technology Services (ITS) to support our clinical response to the COVID-19 pandemic and provide recommendations for health systems to urgently consider, as they plan their own response to this and potentially other future pandemics.

Methods: Our recommendations include establishing a hospital incident command structure that includes tight integration with IT, creating automated dashboards for incident command, optimizing emergency communication to staff and patients, and preparing human resources, security, other policies, and equipment to support the transition of all nonessential staff to telework. Read More

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http://dx.doi.org/10.1055/s-0040-1709715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141898PMC

Design and Usability of an Electronic Health Record-Integrated, Point-of-Care, Clinical Decision Support Tool for Modeling and Simulation of Antihemophilic Factors.

Appl Clin Inform 2020 03 8;11(2):253-264. Epub 2020 Apr 8.

Department of Research Informatics, Children's Research Institute, Children's Mercy, Kansas City, Missouri, United States.

Background: With the consequences of inadequate dosing ranging from increased bleeding risk to excessive drug costs and undesirable administration regimens, the antihemophilic factors are uniquely suited to dose individualization. However, existing options for individualization are limited and exist outside the flow of care. We developed clinical decision support (CDS) software that is integrated with our electronic health record (EHR) and designed to streamline the process for our hematology providers. Read More

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http://dx.doi.org/10.1055/s-0040-1708050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141904PMC

Natural Language Processing to Extract Meaningful Information from Patient Experience Feedback.

Appl Clin Inform 2020 03 1;11(2):242-252. Epub 2020 Apr 1.

Physician Informatics and Department of Medicine, Geisinger Health System, Geisinger Commonwealth School of Medicine, Camp Hill, Pennsylvania, United States.

Background: Due to reimbursement tied in part to patients' perception of their care, hospitals continue to stress obtaining patient feedback and understanding it to plan interventions to improve patients' experience. We demonstrate the use of natural language processing (NLP) to extract meaningful information from patient feedback obtained through Press Ganey surveys.

Methods: The first step was to standardize textual data programmatically using NLP libraries. Read More

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http://dx.doi.org/10.1055/s-0040-1708049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113005PMC

Effect of an Alternative Newborn Naming Strategy on Wrong-Patient Errors: A Quasi-Experimental Study.

Appl Clin Inform 2020 03 1;11(2):235-241. Epub 2020 Apr 1.

Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, United States.

Objectives: Newborns are often assigned temporary names at birth. Temporary newborn names-often a combination of the mother's last name and the newborn's gender-are vulnerable to patient misidentification due to similarities with other newborns or between a mother and her newborn. We developed and implemented an alternative distinct naming strategy, and then compared its effectiveness on reducing the number of wrong-patient orders with the standard distinct naming strategy. Read More

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http://dx.doi.org/10.1055/s-0040-1705175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112998PMC

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study.

Appl Clin Inform 2020 03 25;11(2):226-234. Epub 2020 Mar 25.

Office for Scholarship in Learning and Education Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States.

Background: Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores.

Methods: During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. Read More

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http://dx.doi.org/10.1055/s-0040-1705108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096317PMC

Design, Implementation, and Validation of a Pediatric ICU Sepsis Prediction Tool as Clinical Decision Support.

Appl Clin Inform 2020 03 25;11(2):218-225. Epub 2020 Mar 25.

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.

Background: Sepsis is an uncontrolled inflammatory reaction caused by infection. Clinicians in the pediatric intensive care unit (PICU) developed a paper-based tool to identify patients at risk of sepsis. To improve the utilization of the tool, the PICU team integrated the paper-based tool as a real-time clinical decision support (CDS) intervention in the electronic health record (EHR). Read More

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http://dx.doi.org/10.1055/s-0040-1705107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096320PMC

Adoption of an Electronic Medical Record Tool for Childhood Obesity by Primary Care Providers.

Appl Clin Inform 2020 03 18;11(2):210-217. Epub 2020 Mar 18.

General Pediatrics and Weight Management, Children's Mercy Hospital Center for Children's Healthy Lifestyles and Nutrition, Kansas City, Missouri, United States.

Background: Primary care providers are tasked with the increasingly difficult job of addressing childhood obesity during clinic visits. Electronic medical record (EMR)-enabled decision-support tools may aid providers in this task; however, information is needed regarding whether providers perceive such tools to be useful for addressing nutrition and physical activity lifestyle behaviors.

Objectives: This study aimed to evaluate the usefulness and usability of FitTastic, an EMR-enabled tool to support prevention and management of childhood obesity in primary care. Read More

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http://dx.doi.org/10.1055/s-0040-1705106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080555PMC

Mapping Patient Data to Colorectal Cancer Clinical Algorithms for Personalized Guideline-Based Treatment.

Appl Clin Inform 2020 03 18;11(2):200-209. Epub 2020 Mar 18.

West German Cancer Center, University Hospital Essen, Essen, Germany.

Background: Colorectal cancer is the most commonly occurring cancer in Germany, and the second and third most commonly diagnosed cancer in women and men, respectively. In this context, evidence-based guidelines positively impact the quality of treatment processes for cancer patients. However, evidence of their impact on real-world patient care remains unclear. Read More

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http://dx.doi.org/10.1055/s-0040-1705105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080556PMC

Data Model Requirements for a Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management.

Appl Clin Inform 2020 01 11;11(1):190-199. Epub 2020 Mar 11.

Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.

Objective: The aim of this study is to define data model requirements supporting the development of a digital cognitive aid (CA) for intraoperative crisis management in anesthesia, including medical emergency text modules (text elements) and branches or loops within emergency instructions (control structures) as well as their properties, data types, and value ranges.

Methods: The analysis process comprised three steps: reviewing the structure of paper-based CAs to identify common text elements and control structures, identifying requirements derived from content, design, and purpose of a digital CA, and validating requirements by loading exemplary emergency checklist data into the resulting prototype data model.

Results: The analysis of paper-based CAs identified 19 general text elements and two control structures. Read More

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http://dx.doi.org/10.1055/s-0040-1703015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065980PMC
January 2020

The Impact of Changes to an Electronic Admission Order Set on Prescribing and Clinical Outcomes in the Intensive Care Unit.

Appl Clin Inform 2020 01 11;11(1):182-189. Epub 2020 Mar 11.

Department of Pharmacy, Bronson Methodist Hospital, Kalamazoo, Michigan, United States.

Background: Implementation of disease-specific order sets has improved compliance with standards of care for a variety of diseases. Evidence of the impact admission order sets can have on care is limited.

Objective: The main purpose of this article is to evaluate the impact of changes made to an electronic critical care admission order set on provider prescribing patterns and clinical outcomes. Read More

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http://dx.doi.org/10.1055/s-0040-1702215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065977PMC
January 2020

Detecting Social and Behavioral Determinants of Health with Structured and Free-Text Clinical Data.

Appl Clin Inform 2020 01 4;11(1):172-181. Epub 2020 Mar 4.

Department of Biomedical Informatics, Columbia University, New York, New York, United States.

Background: Social and behavioral determinants of health (SBDH) are environmental and behavioral factors that often impede disease management and result in sexually transmitted infections. Despite their importance, SBDH are inconsistently documented in electronic health records (EHRs) and typically collected only in an unstructured format. Evidence suggests that structured data elements present in EHRs can contribute further to identify SBDH in the patient record. Read More

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http://dx.doi.org/10.1055/s-0040-1702214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056402PMC
January 2020

Are You In or Are You Out? Provider Note Sharing in Pediatrics.

Appl Clin Inform 2020 01 4;11(1):166-171. Epub 2020 Mar 4.

Department of Pediatrics, University of California, San Diego, California, United Sates.

Background: The OpenNotes initiative launched an international movement aimed at making health care more transparent by improving communication with, and access to, information for patients through provider note sharing. Little has been written either on provider note sharing in pediatric and adolescent populations or on the impact of system default settings versus voluntary provider note sharing.

Objective: We describe our journey as a pediatric integrated delivery network to default share notes in ambulatory specialty practices not only with parent proxies but also with teens and discuss the methods that led to a successful implementation. Read More

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http://dx.doi.org/10.1055/s-0040-1701679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056394PMC
January 2020

Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing.

Appl Clin Inform 2020 01 26;11(1):160-165. Epub 2020 Feb 26.

Health Information Technology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.

Background: Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing.

Objectives And Methods: To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. Read More

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http://dx.doi.org/10.1055/s-0040-1701678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043952PMC
January 2020
0.386 Impact Factor

Heart Failure Dashboard Design and Validation to Improve Care of Veterans.

Appl Clin Inform 2020 01 26;11(1):153-159. Epub 2020 Feb 26.

Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, United States.

Background: Early electronic identification of patients at the highest risk for heart failure (HF) readmission presents a challenge. Data needed to identify HF patients are in a variety of areas in the electronic medical record (EMR) and in different formats.

Objective: The purpose of this paper is to describe the development and data validation of a HF dashboard that monitors the overall metrics of outcomes and treatments of the veteran patient population with HF and enhancing the use of guideline-directed pharmacologic therapies. Read More

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http://dx.doi.org/10.1055/s-0040-1701257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043954PMC
January 2020
0.386 Impact Factor

Joint Design with Providers of Clinical Decision Support for Value-Based Advanced Shoulder Imaging.

Appl Clin Inform 2020 01 19;11(1):142-152. Epub 2020 Feb 19.

Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States.

Background: Provider orders for inappropriate advanced imaging, while rarely altering patient management, contribute enough to the strain on available health care resources, and therefore the United States Congress established the Appropriate Use Criteria Program.

Objectives: To examine whether co-designing clinical decision support (CDS) with referring providers will reduce barriers to adoption and facilitate more appropriate shoulder ultrasound (US) over magnetic resonance imaging (MRI) in diagnosing Veteran shoulder pain, given similar efficacies and only 5% MRI follow-up rate after shoulder US.

Methods: We used a theory-driven, convergent parallel mixed-methods approach to prospectively (1) determine medical providers' reasons for selecting MRI over US in diagnosing shoulder pain and identify barriers to ordering US, (2) co-design CDS, informed by provider interviews, to prompt appropriate US use, and (3) assess CDS impact on shoulder imaging use. Read More

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http://dx.doi.org/10.1055/s-0040-1701256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7030958PMC
January 2020

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era.

Appl Clin Inform 2020 01 19;11(1):130-141. Epub 2020 Feb 19.

Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California, United States.

Objective: To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients.

Methods: This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Read More

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http://dx.doi.org/10.1055/s-0040-1701255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7030957PMC
January 2020

Experiences of Health Care Providers Using a Mobile Medical Photography Application.

Appl Clin Inform 2020 01 12;11(1):122-129. Epub 2020 Feb 12.

Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, United States.

Objective: To understand the ways in which providers use a mobile photography application integrated with the electronic health record (EHR) to facilitate clinical care, and the process outcomes that result from the application's use.

Methods: An e-mail survey was sent on November 13, 2017, to 1,463 health care providers at Mayo Clinic who had used an internally developed, EHR-integrated medical photography application.

Results: The survey was completed by 712 (49%) providers. Read More

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http://dx.doi.org/10.1055/s-0040-1701254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015814PMC
January 2020

To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support.

Appl Clin Inform 2020 01 12;11(1):112-121. Epub 2020 Feb 12.

National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, United States.

Background: Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details.

Objective: Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or "artifacts. Read More

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http://dx.doi.org/10.1055/s-0040-1701253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015815PMC
January 2020

The Successful Usage of the DICOM Images Exchange System (ePACS) in the Czech Republic.

Authors:
Jan Bruthans

Appl Clin Inform 2020 01 5;11(1):104-111. Epub 2020 Feb 5.

Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Czech Republic.

Background: The picture archiving and communication system (PACS) has already replaced classic hard copy film technology. With new functions of PACS under consideration, attention turns to the sharing of medical images between different institutions. The Czech Republic is one of the few countries using a nation-wide medical images exchange system known as ePACS. Read More

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http://dx.doi.org/10.1055/s-0040-1701252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002168PMC
January 2020

The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery.

Appl Clin Inform 2020 01 5;11(1):95-103. Epub 2020 Feb 5.

Department of Medicine, New York University School of Medicine, New York, New York, United States.

Background: Enhanced Recovery after Surgery (ERAS) pathways have been shown to reduce length of stay, but there have been limited evaluations of novel electronic health record (EHR)-based pathways. Compliance with ERAS in real-world settings has been problematic.

Objective: This article evaluates a novel ERAS electronic pathway (E-Pathway) activity integrated with the EHR for patients undergoing elective colorectal surgery. Read More

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http://dx.doi.org/10.1055/s-0039-1701004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002169PMC
January 2020

Evaluating Usability of a Touchless Image Viewer in the Operating Room.

Appl Clin Inform 2020 01 29;11(1):88-94. Epub 2020 Jan 29.

Department of Orthopedic Surgery, Diakonissen Hospital, Mannheim, Germany.

Background: Availability of patient-specific image data, gathered from preoperatively conducted studies, like computed tomography scans and magnetic resonance imaging studies, during a surgical procedure is a key factor for surgical success and patient safety. Several alternative input methods, including recognition of hand gestures, have been proposed for surgeons to interact with medical image viewers during an operation. Previous studies pointed out the need for usability evaluation of these systems. Read More

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http://dx.doi.org/10.1055/s-0039-1701003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989265PMC
January 2020

Detection and Remediation of Misidentification Errors in Radiology Examination Ordering.

Appl Clin Inform 2020 01 29;11(1):79-87. Epub 2020 Jan 29.

Department of Radiology, William S. Middleton Memorial Veterans Hospital and University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States.

Background: Despite progress in patient safety, misidentification errors in radiology such as ordering imaging on the wrong anatomic side persist. If undetected, these errors can cause patient harm for multiple reasons, in addition to producing erroneous electronic health records (EHR) data.

Objectives: We describe the pilot testing of a quality improvement methodology using electronic trigger tools and preimaging checklists to detect "wrong-side" misidentification errors in radiology examination ordering, and to measure staff adherence to departmental policy in error remediation. Read More

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http://dx.doi.org/10.1055/s-0039-3402730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989264PMC
January 2020
0.386 Impact Factor

Self-Management Behaviors of Patients with Type 1 Diabetes: Comparing Two Sources of Patient-Generated Data.

Appl Clin Inform 2020 01 22;11(1):70-78. Epub 2020 Jan 22.

Department of Endocrinology, Mayo Clinic, Scottsdale, Arizona, United States.

Objectives: This article aims to evaluate adult type 1 diabetes mellitus (T1DM) self-management behaviors (SMBs) related to exercise and alcohol on a survey versus a smartphone app to compare self-reported and self-tracked SMBs, and examine inter- and intrapatient variability.

Methods: Adults with T1DM on insulin pump therapy were surveyed about their alcohol, meal, and exercise SMBs. For 4 weeks, participants self-tracked their alcohol, meal, and exercise events, and their SMBs corresponding with these events via an investigator-developed app. Read More

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http://dx.doi.org/10.1055/s-0039-1701002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976334PMC
January 2020

Application Programming Interfaces in Health Care: Findings from a Current-State Sociotechnical Assessment.

Appl Clin Inform 2020 01 22;11(1):59-69. Epub 2020 Jan 22.

School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States.

Objective: Interest in application programming interfaces (APIs) is increasing as key stakeholders look for technical solutions to interoperability challenges. We explored three thematic areas to assess the current state of API use for data access and exchange in health care: (1) API use cases and standards; (2) challenges and facilitators for read and write capabilities; and (3) outlook for development of write capabilities.

Methods: We employed four methods: (1) literature review; (2) expert interviews with 13 API stakeholders; (3) review of electronic health record (EHR) app galleries; and (4) a technical expert panel. Read More

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http://dx.doi.org/10.1055/s-0039-1701001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976305PMC
January 2020

Reducing Interruptive Alert Burden Using Quality Improvement Methodology.

Appl Clin Inform 2020 01 15;11(1):46-58. Epub 2020 Jan 15.

Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, Ohio, United States.

Background: Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The "pop-up" or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. Read More

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http://dx.doi.org/10.1055/s-0039-3402757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962089PMC
January 2020

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Appl Clin Inform 2020 01 15;11(1):34-45. Epub 2020 Jan 15.

Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.

Background: Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems. Read More

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http://dx.doi.org/10.1055/s-0039-3402756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962088PMC
January 2020

Igniting Harmonized Digital Clinical Quality Measurement through Terminology, CQL, and FHIR.

Appl Clin Inform 2020 01 8;11(1):23-33. Epub 2020 Jan 8.

Department of Measure Validation, National Committee for Quality Assurance, Washington, District of Columbia, United States.

Background: Electronic clinical quality measures (eCQMs) seek to quantify the adherence of health care to evidence-based standards. This requires a high level of consistency to reduce the effort of data collection and ensure comparisons are valid. Yet, there is considerable variability in local data capture, in the use of data standards and in implemented documentation processes, so organizations struggle to implement quality measures and extract data reliably for comparison across patients, providers, and systems. Read More

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http://dx.doi.org/10.1055/s-0039-3402755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949169PMC
January 2020

Transforming French Electronic Health Records into the Observational Medical Outcome Partnership's Common Data Model: A Feasibility Study.

Appl Clin Inform 2020 01 8;11(1):13-22. Epub 2020 Jan 8.

Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France.

Background: Common data models (CDMs) enable data to be standardized, and facilitate data exchange, sharing, and storage, particularly when the data have been collected via distinct, heterogeneous systems. Moreover, CDMs provide tools for data quality assessment, integration into models, visualization, and analysis. The observational medical outcome partnership (OMOP) provides a CDM for organizing and standardizing databases. Read More

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http://dx.doi.org/10.1055/s-0039-3402754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949163PMC
January 2020