Applied Clinical Informatics最新文献

Background and objective:  Though public health is an information-intense profession, there is a paucity of workforce with Public Health Informatics and Technology (PHIT) skills, which was evident during the coronavirus disease 2019 (COVID-19) pandemic. This need is addressed through the PHIT workforce program (2021-2025) by the Office of the National Coordinator for training and to increase racial and ethnic diversity in the PHIT workforce. The objective is to share details on the Training in Informatics for Underrepresented Minorities in Public Health (TRIUMPH) consortium, funded by the PHIT workforce program.

Methods:  The TRIUMPH consortium is a collaboration between academic and practice partners with a commitment to training 879 students in PHIT. The Schools of Public Health and Nursing at the University of Minnesota, Jiann-Ping Hsu College of Public Health at Georgia Southern University, Morehouse School of Medicine, and Public Health Informatics Institute offer PHIT training through various programs. Academic institutions focus on student recruitment, developing courses/curriculum, and granting degrees/certificates, and the role of practice partners is to support experiential learning through internships/practicums.

Results:  The TRIUMPH consortium is progressing toward its goals, with 692 students (79%) already trained in a PHIT modality as of December 2023. The learners comprise diverse race/ethnicity, including White (48%), Black/African American (32%), Asian (10%), White Hispanic (5%), American Indian/Alaska Native (2%), and Black Hispanic (1%). Numerous internships have been completed in settings ranging from state/local public health agencies to health care delivery systems. Diversity initiatives were supported by partnering with existing programs (e.g., the AMIA First Look program and the Nursing Knowledge Big Data Science conference).

Conclusion:  This consortium model is an excellent approach to informatics training and sharing expertise across partners. It provides scalability and broader geographic outreach while presenting opportunities to students from underrepresented backgrounds. Lessons learned have implications for overall informatics training (e.g., partnerships models, promoting racial/ethnic diversity).

Objective:  This study aimed to increase the adoption of revised newborn hyperbilirubinemia guidelines by building a clinical decision support (CDS) tool into templated notes.

Methods:  We created a rule-based CDS tool that correctly populates the phototherapy threshold from more than 2,700 possible values directly into the note and guides clinicians to an appropriate follow-up plan consistent with the new recommendations. We manually reviewed notes before and after CDS tool implementation to evaluate new guidelines adherence, and surveys were used to assess clinicians' perceptions.

Results:  Postintervention documentation showed a decrease in old risk stratification methods (48 to 0.4%, p < 0.01) and an increase in new phototherapy threshold usage (39 to 95%, p < 0.01) and inclusion of follow-up guidance (28 to 79%, p < 0.01). Survey responses on workflow efficiency and satisfaction did not significantly change after CDS tool implementation.

Conclusion:  Our study details an innovative CDS tool that contributed to increased adoption of newly revised guidelines after the addition of this tool to templated notes.

Background:  Blood product ordering is a complex process and mistakes can harm patients and lead to poor outcomes. Orders and order sets can be designed to help mitigate errors, but major changes in design can unintentionally cause new errors.

Objectives:  Our objective was as follows: (1) utilize formative in situ usability testing to iteratively improve the design of a redesigned blood product order set prior to go-live, (2) implement changes based on feedback derived from this testing, and (3) compare the error rate, system usability scale (SUS) score, time to task completion, and click counts between the prior order set in use at the time and the revised redesigned order set.

Methods:  A multidisciplinary project team convened to redesign blood product orders and order sets from scratch based on a review of the literature and benchmarking against four pediatric academic institutions with the goal of addressing prior ordering errors. The newly redesigned blood product order set was iteratively updated via in situ formative usability testing performed with available clinical users using a concurrent think-aloud protocol in real clinical environments. Errors, SUS scores, time to task completion, and click counts were assessed for the revised redesigned order set using summative testing.

Results:  Formative usability testing with 20 participants led to seven design changes in the redesigned order set which reduced the error rate at go-live. Summative usability testing showed that even though the usability scores were only slightly improved for the revised redesigned order set, the error rates in blood orders were significantly decreased.

Conclusion:  Usability testing can identify design errors early in the process which can be rectified prior to implementation, thus avoiding unintended consequences of changes.

Background:  The use of medical mobile applications (apps) to enhance learning is widespread in medical education. Despite the large number of medical apps used among medical students for learning, many apps have not been evaluated using validated instruments. Finding relevant and valuable apps for student learning might be difficult.

Objective:  The objective is to evaluate four medical apps (AMBOSS, ISABEL, Medscape, and OSMOSIS) in improving just-in-time learning among medical students using the Mobile App Rubric for Learning (MARuL).

Methods:  We employed a mixed-method concurrent triangulation approach. The study included the entire population of third-year medical students at King Saud University. These students were selected due to their use of medical apps for learning for at least 1 year. The MARuL, which consists of four measures: Teaching and Learning, User-centered, Professional, and Usability, was electronically distributed to medical students for assessment. Descriptive statistics were calculated for all measures, and thematic content analysis was applied to analyze responses to open-ended questions.

Results:  The MARuL evaluation revealed that the OSMOSIS app received the highest Usefulness for Learning Score, with Usability Measures being the most positively evaluated measure. Following was the AMBOSS app, which scored highest in the Professional Measures, along with the Medscape and the ISABEL apps. We identified several key features and challenges from analyzing students' responses to open-ended questions regarding the use of the four medical apps. These included six themes: (1) study support and learning tools, (2) comprehensive information, (3) interface experience, (4) cost and accessibility issues, (5) learning methods and content limitations, and (6) user experience and technical issues.

Conclusion:  Equipping medical students with the ability to evaluate and choose medical apps that facilitate just-in-time learning is a crucial element that should be integrated into the medical curriculum.

Background:  Health informatics (HI) is a growing field of study, yet sparse data are available on the characteristics of undergraduate HI programs in the United States. The lack of a central location for U.S. HI undergraduate program data has led to a gap in information to support current efforts to promote academic standards in the field and attract potential students.

Objectives:  The objective of this study was to perform an environment scan of colleges and universities within the United States and Puerto Rico to identify undergraduate programs in HI including majors, minors, and undergraduate-level certificates.

Methods:  Potential institutions offering HI programs were identified from the National Center for Education Statistics (NCES), the Commission for Accreditation of Health Informatics and Health Information Management Education (CAHIIM), the Association of University Programs in Health Administration (AUPHA), the Healthcare Information and Management Systems Society (HIMSS), and the American Health Information Management Association (AHIMA). Publicly available materials for these institutions were reviewed, and data were captured for identified HI programs including geographic location; college or school in which the program was offered; type of degree (if applicable); program title; total credits to complete the program; delivery format; and source of data.

Results:  A total of 83 HI programs were identified from 60 institutions and 26 states. The primary finding of this environment scan was that inconsistencies exist among U.S. HI undergraduate programs including variations in offering college/school, title of program, number of credits required, delivery formats, CIP codes, and the type of information published on university/college websites.

Conclusion:  This environment scan was a first step in exploring the characteristics of undergraduate HI programs within the United States. Further research is needed on the curricular similarities and differences among the programs, the administrative methods of these interdisciplinary programs, and the information most needed by current and potential undergraduate students.

Objectives:  Variability in cardiopulmonary arrest training and management leads to inconsistent outcomes during in-hospital cardiac arrest. Existing clinical decision aids, such as American Heart Association (AHA) advanced cardiovascular life support (ACLS) pocket cards and third-party mobile apps, often lack comprehensive management guidance. We developed a novel, guided ACLS mobile app and evaluated user performance during simulated cardiac arrest according to the 2020 AHA ACLS guidelines via randomized controlled trial.

Methods:  Forty-six resident physicians were randomized to lead a simulated code team using the AHA pockets cards (N = 22) or the guided app (N = 24). The primary outcome was successful return of spontaneous circulation (ROSC). Secondary outcomes included code leader stress and confidence, AHA ACLS guideline adherence, and errors. A focus group of 22 residents provided feedback. Statistical analysis included two-sided t-tests and Fisher's exact tests.

Results:  App users showed significantly higher ROSC rate (50 vs. 18%; p = 0.024), correct thrombolytic administration (54 vs. 23%; p = 0.029), backboard use (96 vs. 27%; p < 0.001), end-tidal CO2 monitoring (58 vs. 27%; p = 0.033), and confidence compared with baseline (1.0 vs 0.3; p = 0.005) compared with controls. A focus group of 22 residents indicated unanimous willingness to use the app, with 82% preferring it over AHA pocket cards.

Conclusion:  Our guided ACLS app shows potential to improve user confidence and adherence to the AHA ACLS guidelines and may help to standardize in-hospital cardiac arrest management. Further validation studies are essential to confirm its efficacy in clinical practice.

Background:  Documentation burden is one of the largest contributors to physician burnout. Evaluation and Management (E&M) coding changes were implemented in 2021 to alleviate documentation burden.

Objectives:  We used this opportunity to develop documentation best practices, implement new electronic health record (EHR) tools, and study the potential impact on provider experiences with documentation related to these 2021 E&M changes, documentation length, and time spent documenting at an academic medical center.

Methods:  Five actionable best practices, developed through a consensus-driven, multidisciplinary approach in November 2020, led to the creation of two new ambulatory note templates, one for E&M visits (implemented in January 2021) and another for preventative visits (implemented in May 2021). As part of a quality-improvement initiative at nine faculty primary care clinics, surveys were developed utilizing a 5-point Likert scale to assess provider perceptions and deidentified EHR metadata (Signal, Epic Systems) were analyzed to measure changes in EHR use metrics between a pre-E&M changes timeframe (August 2020-December 2020) and a post-E&M change timeframe (August 2021-December 2021). A subgroup analysis was conducted comparing EHR use metrics among note template utilizers versus nonutilizers. Any provider who used one of the note templates at least once was categorized as a utilizer.

Results:  Between January 2021 and December 2021, the adoption of the E&M visit template was 31,480 instances among 120 unique ambulatory providers, and adoption of the preventative visit template was 1,464 instances among 22 unique ambulatory providers. Survey response rate among faculty primary care providers was 82% (88/107): 55% (48/88) believed the 2021 E&M changes provided an opportunity to reduce documentation burden, and 28% reported favorable satisfaction with time spent documenting. Among providers who reported using one or both of the new note templates, 81% (35/43) of survey respondents reported favorable satisfaction with new note templates. EHR use metric analyses revealed a small, yet significant reduction in time in notes per appointment (p = 0.004) with no significant change in documentation length of notes (p = 0.45). Note template utilization was associated with a statistically significant reduction in documentation length (p = 0.034).

Conclusion:  This study shows modest progress in improving EHR use measures of documentation length and time spent documenting following the 2021 E&M changes, but without great improvement in perceived documentation burden. Additional tools are needed to reduce documentation burden and further research is needed to understand the impact of these interventions.

Background:  Heart failure is a complex clinical syndrome noted on approximately one in eight death certificates in the United States. Vital to reducing complications of heart failure and preventing hospital readmissions is adherence to heart failure self-care routines. Mobile health offers promising opportunities for enhancing self-care behaviors by facilitating tracking and timely reminders.

Objectives:  We sought to investigate three characteristics of heart failure patients with respect to their heart failure self-care behaviors: (1) internet use to search for heart failure information; (2) familiarity with mobile health apps and devices; and (3) perceptions of using activity trackers or smartwatches to aid in their heart failure self-care.

Methods:  Forty-nine heart failure patients were asked about their internet and mobile health usage. The structured interview included questions adapted from the Health Information National Trends Survey.

Results:  Over 50% of the patients had utilized the internet to search for heart failure information in the past 12 months, experience using health-related apps, and thoughts that an activity tracker or smartwatch could help them manage heart failure. Qualitative analysis of the interviews revealed six themes: trust in their physicians, alternatives to mobile health apps, lack of need for mobile health devices, financial barriers to activity tracker and smartwatch ownership, benefits of tracking and reminders, and uncertainty of their potential due to lack of knowledge.

Conclusion:  Trust in their physicians was a major factor for heart failure patients who reported not searching for health information on the internet. While those who used mobile health technologies found them useful, patients who did not use them were generally unaware of or unknowledgeable about them. Considering patients' preferences for recommendations from their physicians and tendency to search for heart failure information including treatment and management options, patient-provider discussions about mobile health may improve patient knowledge and impact their usage.