Applied Clinical Informatics最新文献

Background While necessary and educationally beneficial, administrative tasks such as case and patient tracking may carry additional burden for surgical trainees. Automated systems targeting these tasks are scarce, leading to manual and inefficient workflows. Methods We created an electronic health record (EHR)-based, user-specific dashboard for surgical residents to compile resident-specific data: bedside procedures performed, operative cases performed or participated in, and notes written by the resident as a surrogate for patients cared for. Usability testing was performed with resident volunteers, and residents were also surveyed post-implementation to assess for efficacy and satisfaction. Access log data from the EHR was used to assess dashboard usage over time. Descriptive statistics were calculated. Results The dashboard was implemented on a population of approximately 175 surgical residents in 5 different departments (General Surgery, Obstetrics and Gynecology, Neurosurgery, Orthopedics, and Otolaryngology) at a single academic medical center. 6 resident volunteers participating in usability testing completed an average of 96% of preset tasks independently. Average responses to five questions extracted from the System Usability Scale (SUS) questions ranged from 4.0 to 4.67 out of 5. Post-implementation surveys indicated high resident satisfaction (4.39 out of 5) and moderate rates of use, with 46.4% of residents using the dashboard at least monthly. Daily use of the dashboard has increased over time, especially after making the dashboard a default for surgical residents. Conclusion An EHR-based dashboard compiling resident-specific data can improve the efficiency of administrative tasks and supplement longitudinal education.

Background: The Vanderbilt Clinical Informatics Center (VCLIC) is based in the Department of Biomedical Informatics (DBMI) and operates across Vanderbilt University Medical Center (VUMC) and Vanderbilt University (VU) with a goal of enabling and supporting clinical informatics research and practice. VCLIC supports several types of applied clinical informatics teaching, including teaching of students in courses, professional education for staff and faculty throughout VUMC, and workshops and conferences that are open to the public.

Objectives: In this paper, we provide a detailed accounting of our center and institution's methods of educating and training faculty, staff, students, and trainees from across the academic institution and health system on clinical informatics topics, including formal training programs and informal applied learning sessions.

Methods: Through a host of informal learning events, such as workshops, seminars, conference-style events, bite-size instructive videos, and hackathons, as well as several formal education programs, such as the Clinical Informatics Graduate Course, Master's in Applied Clinical Informatics, Medical Student Integrated Science Course, Graduate Medical Education Elective, and Fellowship in Clinical Informatics, VCLIC and VUMC provide opportunities for faculty, students, trainees, and even staff to engage with Clinical Informatics topics and learn related skills.

Results: The described programs have trained hundreds of participants from across the academic and clinical enterprises. Of the VCLIC-held events, the majority of attendees indicated through surveys that they were satisfied, with the average satisfaction score being 4.63/5, and all events averaging a satisfaction score of greater than 4. Across the 20 events VCLIC has held, our largest audiences are DBMI, HealthIT operational staff, and students from the medical and nursing schools.

Conclusions: VCLIC has created and delivered a successful suite of formal and informal educational events and programs to disseminate clinical informatics knowledge and skills to learners across the academic institution and healthcare system.

Background: The Supplemental Nutrition Assistance Program (SNAP) is one of the most successful national programs to reduce poverty and improve health outcomes, but millions of Americans who qualify still do not have access to SNAP, and limited data is available to determine how referrals to the program can be completed successfully.

Objectives: We aimed to design and develop a standards-based digital care coordination platform to support closed-loop social services referrals between patients and social and health care providers; and demonstrate the feasibility to screen, diagnose, plan, and complete interventions with selected patients in real-settings.

Methods: We partnered with community members to design the platform through Community Engagement Studios and with a Federally Qualified Health Center, Local Mental Health Authority, and Food Bank to determine the features and workflow requirements of the platform design. We customized currently available systems to use Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs) that could exchange information in real-time across providers and participants.

Results: The platform was successfully demonstrated through a pilot where patients were recruited in clinical settings and referred to a Food Bank that provided SNAP application assistance to study participants. We translated the requirements of the platform to national standards and required workflows of providers and patients. Study participants were notified electronically of the specific steps to follow to complete their SNAP applications while receiving support from specialists from the Food Bank.

Conclusion: The pilot demonstrated the feasibility of collecting granular social service referral information that can be used to better address gaps in social care. The pilot also highlighted the importance of further coordination on the usage and harmonization of needs assessment nationally and that current digital systems are still not ready to fully utilize national Social Determinants of Health (SDOH) data standards.

Objectives: This study aimed to describe the current landscape of electronic health record (EHR) training and optimization programs (ETOPs) and their impact on healthcare workers' (HCWs) experience with the EHR.

Methods: A 72-question electronic survey was developed and distributed to healthcare organization (HCO) leaders in clinical informatics through various channels such as national informatics conferences, social media, and email distribution lists of vendors and informatics associations. The survey collected data on the characteristics, resourcing, approach, and outcomes of ETOPs. Descriptive statistics were applied to analyze the data.

Results: There were 193 responses from 147 distinct HCOs. Of these, 69% offer ongoing EHR training, and 52% offer some version of an ETOP. Offered ETOPs vary in their timing, modality, audience, team composition, duration, and EHR build strategy. The most commonly measured outcomes were EHR satisfaction, efficiency, and provider burnout, and most ETOPs reported improvement in these areas.

Conclusions: The findings suggest that ETOPs are inconsistently implemented across HCOs, and while there are some commonalities, there is a wide variety of design and methods of evaluation for the programs. Though the problems to solve for (EHR efficiency, proficiency, and satisfaction) are the same, the organizational structure and culture of HCOs varies widely, which may partially explain the variability seen in reported ETOPs. When considering the measured outcomes, ETOPs may have direct and indirect effects on HCW burnout by improving EHR efficiency and satisfaction, as well as driving organizational culture towards teamwork and flexible problem solving. For this reason, ETOPs may also serve as a model for addressing other challenges in healthcare delivery. ETOPs are a promising intervention to enhance HCW experience with the EHR and reduce burnout. More research is needed to identify the optimal features, methods, and outcomes of ETOPs, and to disseminate them across HCOs.

Background: Health professions trainees (trainees) are unique as they learn a chosen field while working within electronic health records (EHR). Efforts to mitigate EHR burden have been described for the experienced health professional (HP), but less is understood for trainees. EHR or documentation burden (EHR burden) affects trainees, although not all trainees use EHRs, and use may differ for experienced HPs.

Objectives: To develop a model of how interventions to mitigate EHR burden fit within the trainee EHR workflow: the Trainee EHR Burden Model. 1) Examine trainee experiences of interventions aimed at mitigating EHR burden(scoping review). 2) Adapt an existing workflow model by mapping included studies(concept clarification).

Methods: We conducted a 4-database scoping review applying PRISMA-ScR guidance, examining scholarly, peer-reviewed studies that measured trainee experience of interventions to mitigate EHR burden. We conducted a concept clarification categorizing, then mapping studies to workflow model elements. We adapted the model to intervenable points for trainee EHR burden.

Results: We identified 11 studies examining interventions to mitigate EHR burden that measured trainee experience. Interventions included: curriculum, training, coaching on the existing EHR for both simulated or live tasks; evaluating scribes' impact; adding devices or technology tailored to rounds; team communication or data presentation at end-of shift handoffs. Interventions had varying effects on EHR burden, most commonly measured through surveys, and less commonly, direct observation. Most studies had limited sample sizes, focused on inpatient settings, and physician trainees.

Conclusion: Few studies measured trainee perspectives of interventions aiming to mitigate EHR burden. Many studies applied quasi-experimental designs and focused on inpatient settings. The Trainee EHR Burden Model, adapted from an existing workflow model, offers a starting place to situate points of intervention in trainee workflow. Further research is needed to design new interventions targeting stages of HP trainee workflow, in a range of clinical settings.

Objectives: Empirically investigate current practices and analyze ethical dimensions of clinical data sharing by healthcare organizations for uses other than treatment, payment, and operations. Make recommendations to inform research and policy for healthcare organizations to protect patients' privacy and autonomy when sharing data with unrelated third parties.

Methods: Semi-structured interviews and surveys involving 24 informatics leaders from 22 US healthcare organizations, accompanied by thematic and ethical analyses.

Results: We found considerable heterogeneity across organizations in policies and practices. Respondents understood "data sharing" and "research" in very different ways. Their interpretations of these terms ranged from making data available for academic and public health uses, and to HIEs; to selling data for corporate research, to contracting with aggregators for future resale or use. The nine interview themes were that healthcare organizations: (1) share clinical data with many types of organizations, (2) have a variety of motivations for sharing data, (3) do not make data sharing policies readily available, (4) have widely varying data sharing approval processes, (5) most commonly rely on HIPAA de-identification to protect privacy, (6) were concerned about clinical data use by electronic health record vendors, (7) lacked data sharing transparency to the general public, (8) allowed individual patients little control over sharing of their data, and (9) had not yet changed data sharing practices within the year following the US Supreme Court 2022 decision denying rights to abortion.

Conclusions: Our analysis identified gaps between ethical principles and healthcare organizations' data sharing policies and practices. To better align clinical data sharing practices with patient expectations and biomedical ethical principles, we recommend: updating HIPAA, including re-identification and upstream sharing restrictions in data sharing contracts, better coordination across data sharing approval processes, fuller transparency and opt-out options for patients, and accountability for data sharing and consequent harms.

Background: There is a need to integrate informatics education into medical training programs given the rise in demand for health informaticians and the call on the Accreditation Council for Graduate Medical Education (ACGME) and the body of undergraduate medical education (UGME) for implementation of informatics curricula.

Objectives: This report outlines a 2-year longitudinal informatics curriculum now currently in its seventh year of implementation. This report is intended to inform United States (US) Graduate Medical Education (GME) program leaders of the necessary requirements for implementation of a similar program at their institution.

Methods: The curriculum aligns with the core content for the subspecialty of clinical informatics (CI) and is led by a multidisciplinary team with both informatics and clinical expertise. This educational pathway has a low direct cost and is a practical example of the academic learning health system (aLHS) in action. The pathway is housed within an internal medicine department at a large tertiary academic medical center.

Results: The curriculum has yielded 13 graduates from both internal medicine (11, 85%) and pediatrics (2, 15%) whose projects have spanned acute and ambulatory care and multiple specialties. Projects have included Clinical Decision Support (CDS) tools, of which some will be leveraged as substrate in applications seeking extramural funding. Graduates have gone on to CI board certification and fellowship, as well as several other specialties, creating a distributed network of clinicians with specialized experience in applied CI.

Conclusions: An informatics curriculum at the GME level may increase matriculation to CI fellowship and more broadly increase development of the CI workforce through building a cadre of physicians with HIT expertise across specialties without formal CI board certification. We offer an example of a longitudinal pathway which is rooted in aLHS principles. The pathway requires a dedicated multidisciplinary team and departmental and IT leadership support.

Health Information Technology (HIT) is increasingly being used to help providers connect patients with community resources to meet health related social needs (e.g., food, housing, transportation). Research is needed to design efficient, simple, and engaging interfaces during a sensitive process that involves multiple stakeholders. Research is also needed to understand the roles, expectations, barriers, and facilitators these different stakeholders (i.e., patients, providers, and Community-based Organizations (CBOs) face during this process. We applied the Human-Centered Design approach to develop a multi-interface social care referral platform. This approach allowed us to understand the needs of each stakeholder and address potential workflow concerns. This paper reports on the research team's understanding of the design process from 48 different user tests. We conducted three rounds of user testing on an interactive prototype(s) and adapted the prototype after each round. Our results summarize a number of key findings useful for patients, clinical teams, and staff of CBOs when designing a social care referral platform. Our user testing highlighted that patient-facing interfaces offer tremendous opportunities to allow patients to be the leader of the social care referral process. CBOs have varying needs that must be addressed, and providing CBO staff with opportunities to connect with patients is critical. Finally, healthcare teams have more structured workflows. Integration within the electronic health record system provides opportunities for healthcare staff to support their patients more easily given these barriers.

Background:  Experiential learning through simulation allows students to apply didactic knowledge to real-world situations. Tabletop simulation allows for the exploration of a variety of topics, including cybersecurity in health care. Due to its low frequency, yet high-risk nature, simulation is a perfect educational modality to practice responding to a cybersecurity attack. As such, the authors designed and executed a tabletop cybersecurity simulation consisting of a prebriefing, four rounds of injects detailing potential cybersecurity breaches that students must address, and structured debriefings that included input from cybersecurity content experts. This simulation was performed in 2018, 2019, 2022, and 2023, during graduate Health Informatics (HI) students' residential visits.

Objective:  The simulation allowed opportunities for HI students to apply knowledge of cybersecurity principles to an unfolding tabletop simulation containing injects of scenarios they may encounter in the real world.

Methods:  Survey data were used to assess the students' perceptions of the simulation. Topics assessed included overall satisfaction, teamwork and communication, and length of the event. Additionally, in 2022 and 2023, data were collected on psychological safety and whether to include them in future HI residential visits.

Results:  Eighty-eight graduate HI students took part in the cybersecurity simulation over four annual residential visits. Most students were satisfied with the event, found it valuable, and could see it impacting their future practice as informaticists. Additionally, students indicated high levels of psychological safety. Multiple students requested that additional simulations be incorporated into the curriculum.

Conclusion:  A tabletop cybersecurity simulation was utilized to allow HI students the ability to apply knowledge related to cybersecurity breaches to real-world examples. The simulation's best practices of prebriefing, psychological safety, and structured debriefing with expert feedback were emphasized in the simulation's design and implementation. Students found the simulation valuable and worth including in the curriculum.

Objectives:  We aimed to improve the operational efficiency of clinical staff, including physicians and allied health professionals, in the previsit review of patients by implementing a disease-focused dashboard within the electronic health record system. The dashboard was tailored to the unique requirements of the clinic and patient population.

Methods:  A prospective quality improvement study was conducted at an accredited pulmonary hypertension (PH) clinic within a large academic center, staffed by two full time physicians and two allied health professionals. Physicians' review time before and after implementation of the PH dashboard was measured using activity log data derived from an EHR database. The review time for clinic staff was measured through direct observation, with review method-either conventional or newly implemented dashboard-randomly assigned.

Results:  Over the study period, the median number of patients reviewed by physicians per day increased slightly from 5.50 (interquartile range [IQR]: 1.35) before to 5.95 (IQR: 0.85) after the implementation of the PH dashboard (p = 0.535). The median review time for the physicians decreased with the use of the dashboard, from 7.0 minutes (IQR: 1.55) to 4.95 minutes (IQR: 1.35; p < 0.001). Based on the observed timing of 70 patient encounters among allied clinical staff, no significant difference was found for experienced members (4.65 minutes [IQR: 2.02] vs. 4.43 minutes [IQR: 0.69], p = 0.752), while inexperienced staff saw a significant reduction in review time after familiarization with the dashboard (5.06 minutes [IQR: 1.51] vs. 4.12 minutes [IQR: 1.99], p = 0.034). Subjective feedback highlighted the need for further optimization of the dashboard to align with the workflow of allied health staff to achieve similar efficiency benefits.

Conclusion:  A disease-focused dashboard significantly reduced physician previsit review time while that for clinic staff remained unchanged. Validation studies are necessary with our patient populations to explore further qualitative impacts on patient care efficiency and long-term benefits on workflow.