Applied Clinical Informatics最新文献

{"title":"Development and Application of a Nurse-Led Clinical Decision Support System for Safe Intravenous Medication Administration: A Non-randomized Controlled Trial.","authors":"Fuling Zhang, Wenjuan Yun, Lili Qin","doi":"10.1055/a-2867-0618","DOIUrl":"https://doi.org/10.1055/a-2867-0618","url":null,"abstract":"<p><strong>Background: </strong>Intravenous medication administration is a high-risk clinical procedure, where medication errors can lead to adverse consequences. Evidence-based clinical practice guidelines provide recommendations for the administration and monitoring of intravenous infusions. These guidelines are being increasingly integrated into clinical decision support systems (CDSS). The development of CDSS should emphasize nurses as core users, closely align with their clinical workflows, and ultimately create practical, user-friendly tools through thoughtful interface design, functional logic, and intelligent alert mechanisms.</p><p><strong>Objective: </strong>We aimed to design and develop a clinical decision support tool based on the Data-Information-Knowledge-Wisdom (DIKW) model, which minimizes infusion errors by providing real-time alerts and standardizing workflows.</p><p><strong>Methods: </strong>A non-randomized trial (May-July 2024) in a tertiary hospital compared traditional practices (n=1,204) with a CDSS (n=1,207) using 300 clinical rules and a personal digital assistant (PDA) interface. Outcomes included error rates, severity, nurse satisfaction, and efficiency.</p><p><strong>Results: </strong>The CDSS reduced errors by 56.8% (16.69% to 7.21%, P<0.001), eliminated severe errors (Level 3-4), improved nurse satisfaction (mean 69.1/85 on a 17-85 scale), and reduced prescription processing time by 41%.</p><p><strong>Conclusion: </strong>This nurse-led CDSS enhances infusion safety and efficiency, offering a scalable solution. AI-driven predictive error detection could further optimize outcomes.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cybersecurity in Healthcare: A Systematic Review and Narrative Analysis.","authors":"Clemens Scott Kruse, Diane Dolezel, Ramalingam Shanmugam","doi":"10.1055/a-2865-4206","DOIUrl":"https://doi.org/10.1055/a-2865-4206","url":null,"abstract":"<p><strong>Background: </strong>Cybersecurity attacks in healthcare have increased in number and severity over the last decade. Healthcare targets are ten times more valuable than financial targets because of the potential for fraudulent medical claims. Medical providers and administrators must ensure their IT professionals constantly scan the internal and external environment for techniques to prevent, detect, respond, and report cyberattacks. This review provides a scan of the literature.</p><p><strong>Objectives: </strong>To review the literature for over 10 years for techniques for prevention, detection, response, and reporting of cyberattacks. An extended objective was to collect the effect on patient care that has been documented from cyberattacks.</p><p><strong>Methods: </strong>Following a published protocol and reporting standard, this systematic literature review queried four research databases for published works that described cybersecurity in healthcare. Grey literature was included.</p><p><strong>Results: </strong>Twenty-two articles provided 139 observations and 13 themes that described current techniques to secure the healthcare infrastructure. These articles stressed the importance of a trained workforce and a cyber-aware culture.</p><p><strong>Conclusion: </strong>IT professionals must adopt techniques that form proper organizational cyber resiliency and augment security through monitoring tools, standard IT maintenance and practice, encryption and Data Loss Prevention, risk-based management, Artificial Intelligence, Explainable AI, active AI, network segmentation, governance and leadership, disabling legacy protocols and systems that cannot be updated, post-event analysis, and big data.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Electronic Health Record-Based Central Line Maintenance Documentation on CLABSI Rates across Intensive Care Units at a Pediatric Hospital.","authors":"İlker Devrim, Hincal Ozbakir, Yeliz Oruc, Canan Dinc, Ozlem Yilman, Mehmet Can, Tezcan Ozbay, Nuriye Turgut, Tomris Birgili, Gulsen Ozdemir Pilavci, Utku Karaarslan, Arzu Sencan, Hasan Agin","doi":"10.1055/a-2838-8190","DOIUrl":"10.1055/a-2838-8190","url":null,"abstract":"<p><p>Central line-associated bloodstream infections (CLABSIs) are a significant concern in pediatric intensive care units (PICUs), leading to increased morbidity and limited treatment options. Electronic health record (EHR)-based documentation for monitoring CLABSIs may enhance bundle compliance and reduce infection rates. However, data in pediatric settings are limited.This study evaluated the impact of transitioning from paper-based to EHR-based documentation for central line maintenance on CLABSI rates in intensive care units (ICUs).A retrospective cohort study was conducted between the paper-based period and EHR-based period in the neonatal (NICU), pediatric surgery (PSICU), and pediatric (PICU) ICUs. CLABSI prevention bundle compliance was assessed using manual checklists in the paper-based period and EHR-based documentation in the EHR-based period. CLABSI rates were calculated per 1,000 catheter-days, and bundle adherence was tracked using manual checklists or EHR-based documentation.Among 3,278 patients, overall CLABSI rates decreased from 5.32 to 2.46 per 1,000 catheter-days (<i>p</i> = 0.008). In the NICU, rates dropped from 6.20 to 2.13 (<i>p</i> = 0.028); in the PSICU, from 1.45 to 0; and in the PICU, from 5.38 to 3.24 per 1,000 catheter-days (<i>p</i> > 0.05).Transitioning to EHR-based documentation for central line maintenance significantly reduced CLABSI rates across PICUs, particularly in the NICU. EHR systems improve compliance monitoring, promote standardization, and represent an effective tool for strengthening infection prevention in pediatric critical care.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":"17 2","pages":"183-189"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Usability Evaluation of U.S. Clinical Informatics Fellowship Websites.","authors":"Jacqueline G You, Jeffrey Yuan, Gorang Gupta, Suhanee Mitragotri, Kevin Shannon, Ahmad Hassan, Allison Goff, Shuhan He, Ellen Kim","doi":"10.1055/a-2848-6012","DOIUrl":"https://doi.org/10.1055/a-2848-6012","url":null,"abstract":"<p><strong>Background: </strong>Clinical informatics (CI) fellowship programs for physicians in the United States are growing with over 60 Accreditation Council for Graduate Medical Education-accredited fellowship programs. As a young clinical subspecialty, many have questions about the field; in addition, fellowship eligibility and structure vary significantly. Physicians apply for CI fellowships through Electronic Residency Application Service and the American Medical Informatics Association (AMIA) Match. Fellowship websites are essential resources for prospective applicants to learn about this subspecialty and fellowship programs.</p><p><strong>Objectives: </strong>The objective of this study is to evaluate the usability of CI fellowship program websites listed on the AMIA website.</p><p><strong>Methods: </strong>Forty-two U.S.-based CI fellowship programs were evaluated using web-crawler based usability analysis tools across (1) accessibility, (2) marketing, (3) content quality, (4) technology, and (5) general usability from November 1, 2024, through November 19, 2024.</p><p><strong>Results: </strong>Marketing had the lowest mean score of 5.75 and technology had the highest mean score of 8.44. Content quality had the highest standard deviation (1.58).</p><p><strong>Conclusion: </strong>This analysis established the baseline usability of CI fellowship program websites. Addressing gaps in usability will help with increasing CI fellowship visibility among potential applicants.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":"17 2","pages":"246-251"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative User-Centered Design: Programming Changes in a Self-Management Blood Pressure Application.","authors":"Shannon M Canfield, Abigail J Rolbiecki, Parijat Ghosh, Emma Montgomery, Victoria A Shaffer, Michelle Bobo, Matthew B Storer, Aisha Ghumman, LeAnne Michaels, David A Dorr, Richelle J Koopman","doi":"10.1055/a-2823-4533","DOIUrl":"10.1055/a-2823-4533","url":null,"abstract":"<p><p>Electronic patient-centered clinical decision support enhances chronic disease self-management, yet few studies describe how qualitative user feedback is systematically translated into programming improvements. The Collaboration-Oriented Approach to Controlling High Blood Pressure (COACH) is a patient-facing decision support tool for hypertension management, designed for primary care and integration with electronic health records (EHRs) and patient portals.This study aimed to describe how end-user feedback informed COACH programming decisions and the MoSCoW (Must have, Should have, Could have, Won't have) method operationalized prioritization for implementation.This secondary analysis draws on qualitative data from a Consolidated Framework for Implementation Research (CFIR)-informed data collected during a preimplementation evaluation of COACH with 70 care team members and 18 patients across three academic health systems using Cerner/Oracle and Epic EHRs. CFIR-coded data were reviewed, and design or usability \"recommendations\" were translated into discrete programming requirements, prioritized using the MoSCoW, and, where possible, completed before a multisite trial.Seven themes emerged: (1) Timely, actionable alerts, (2) messaging features for follow-up, (3) motivating patients through feedback, (4) reducing data entry burden, (5) setting blood pressure goals, (6) supporting workflow integration, and (7) equity and accessibility. Of the 35 potential recommendations, 25 were translated into changes and prioritized as \"Must have\" (12), \"Should have\" (6), and \"Could have\" (7). Our team completed 19 high-priority features (e.g., setting the blood pressure goal, structured alerts, messaging templates, and visual feedback) before the trial launch.This study demonstrates a replicable process for integrating qualitative insights into digital health programming through structured prioritization, advancing implementation-focused clinical informatics, and guiding decision-making for the future integration of patient-generated health data, such as home blood pressure monitoring.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":"17 2","pages":"127-137"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability and Acceptability Evaluation of a Digital Health Physical Activity Intervention among Older Family Caregivers of Patients with Heart Failure.","authors":"Dawon Baik, Catherine Jankowski, Larry A Allen, Daniel Matlock, Heather Coats, Paul Cook, Blaine Reeder","doi":"10.1055/a-2842-0755","DOIUrl":"10.1055/a-2842-0755","url":null,"abstract":"<p><p>Digital health physical activity (PA) programs have shown promise for improving the health and wellness of family caregivers (FCGs). However, their use among older adult caregivers remains underexplored. To address this gap, we developed TPA4You, a tailored digital health PA program that integrates videoconferencing with a health coach, a fitness tracker, and motivational messaging. The program is designed to support older caregivers, a population whose health and self-care needs are underserved by digital health interventions.This study evaluated the usability and acceptability of TPA4You among older FCGs of patients with heart failure.An iterative design approach guided by the Rapid Iterative Testing and Evaluation methodology was employed. Usability and acceptability were assessed through a two-phase, 1-week trial. Participant feedback from each phase informed iterative refinements to the TPA4You design.Eleven participants were enrolled (Phase 1, <i>n</i> = 7; Phase 2, <i>n</i> = 4), similar in age (68.3 ± 7 vs. 68.0 ± 7). Ten participants identified as non-Hispanic White. All Phase 1 participants were female, while Phase 2 included one male. Participants in both phases reported high perceived usefulness, satisfaction, and ease of use. Interviews on usability and acceptability revealed four common themes in Phases 1 and 2: (1) overall usability and usefulness; (2) supporting self-care and awareness of PA needs; (3) enhancing physical and mental health; and (4) design and features as facilitators and barriers to engagement.Findings demonstrate the feasibility, usability, and acceptability of TPA4You and provide guidance for optimizing its design for a future randomized controlled trial in a larger and more diverse population.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":"17 2","pages":"213-224"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Clinical Decision Support for Primary Care Preventive Screenings for People with Physical Disabilities.","authors":"Tyler G James, Suhas Kellampalli, Beatrice Palazzolo, Lorrie Carbone, Robert Heizelman, Elham Mahmoudi, Michael M McKee","doi":"10.1055/a-2830-2528","DOIUrl":"10.1055/a-2830-2528","url":null,"abstract":"<p><p>People with physical disabilities are one of the largest subgroups of people with disabilities, and this group experiences significant health disparities. Given the risk of preventable multimorbidity among this group, there is an opportunity to improve primary care for this population.The goal of this study was to use a clinical decision support (CDS) tool to improve preventive screenings in primary care for people with physical disabilities.We used a convergent mixed methods study design-integrating quantitative and qualitative data-within a pilot implementation study. Our CDS intervention was implemented at a single, family medicine clinic in an academic medical center in southeast Michigan. Quantitative data were focused on providers using the CDS tool within the electronic health record, while qualitative data were gathered from group meetings and semi-structured interviews with primary care providers at the intervention clinic.The CDS tool was triggered for 1,668 unique encounters and was used only 10% of the time. Among use cases, a recommended preventive screening order was placed 40% of the time. Three themes were developed, focused on (1) inadequate incentive and cognitive task management systems, (2) competing priorities and patient burden, and (3) liking the CDS alert.Although receptive, primary care providers in our study infrequently used the CDS alert. Through merging these mixed methods data, we identified several opportunities to improve the CDS tool including reducing cognitive burden, providing details on the justification for the recommended orders, and better workflow integration.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":" ","pages":"145-152"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Technology Acceptance and Usability of a Personalized Online Nutrition and Exercise Web-Based App (Heal-Me): A Multimethods Study.","authors":"Antonio Miguel Cruz, Ashley Hyde, Graeme Purdy, Kathleen P Ismond, Christofer Cruz, Evelyn Etruw, Kirsten Suderman, Michael Stickland, John C Spence, Dale C Lien, Rahima Bhanji, Carla M Prado, Margaret L McNeely, Puneeta Tandon","doi":"10.1055/a-2858-9079","DOIUrl":"https://doi.org/10.1055/a-2858-9079","url":null,"abstract":"<p><strong>Objective: </strong>The Heal-Me (Healthy Eating, Active Living-Mindful Energy) version 1 is a web-based app designed to provide exercise and nutrition support to vulnerable chronic disease populations. As version 1 of the Heal-Me technology has not been evaluated for acceptance and usability within a clinical environment, this study sought to apply the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to investigate its acceptance and usability as part of a randomized controlled trial (RCT) involving adults diagnosed with cancer, chronic lung disease, or those who had undergone liver or lung transplantation.</p><p><strong>Methods: </strong>This single-group study used a multimethod design. Participants completed self-administered questionnaires before and after the intervention, without a control group. Near the end of the study, individual interviews were conducted with select participants. Technology acceptance and usability were assessed using five-point Likert scales from \"disagree (0)\" to \"agree (4).\" Data analysis included partial least squares structural equation modeling and thematic analysis of interview responses.</p><p><strong>Results: </strong>Participants' expectations for accepting the Heal-Me web-based app were met. Performance expectancy, effort expectancy, and social influence had direct effects on their intention to use the app, explaining 50.9% of the variance in behavioral intention. Both facilitating conditions and behavioral intention significantly influenced actual usage, accounting for 71.4% of its variance.</p><p><strong>Conclusion: </strong>Performance expectancy emerged as the most influential factor predicting participants' intention to use the Heal-Me web-based app, with findings clearly indicating a high level of acceptance of the first version of this technology.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":"17 2","pages":"296-305"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passive Clinical Decision Support Penetrance: A Comparative Analysis in Two Pediatric Intensive Care Units.","authors":"Matthew D Kijowski, Mark V Mai, Adam C Dziorny","doi":"10.1055/a-2852-7390","DOIUrl":"https://doi.org/10.1055/a-2852-7390","url":null,"abstract":"<p><strong>Background: </strong>Clinical decision support (CDS) tools are designed to streamline workflows and enhance care quality in pediatric intensive care units (PICUs). Prior research has largely focused on interruptive, or active, CDS, leaving little known about the usage of passive CDS (pCDS) tools such as note writing support, order sets, and laboratory result flagging across institutions.</p><p><strong>Objectives: </strong>This study aimed to quantify and compare the penetrance of pCDS across two academic PICUs, with the aim of identifying shared practices and opportunities for standardization.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of all patients admitted to two large PICUs from 2016 to 2023. Using Epic electronic health record data, we defined metrics across three domains of pCDS: note writing support, order set usage, and abnormal laboratory result highlighting. We harmonized elements and compared across institutions. We report descriptive statistics and compare sites using the Wilcoxon signed rank and chi-square test of significance.</p><p><strong>Results: </strong>The cohort included 90,575 PICU encounters and 2.65 million notes. We measured significant intersite variability in documentation practices: Children's Healthcare of Atlanta (CHOA) notes were significantly longer (2,020 vs. 1,434 characters) related to a 257% higher use of smart documentation elements and 10% greater reliance on copy/paste features. Across 8.36 million placed orders, order set usage differed by 20% (CHOA: 41 vs. University of Rochester Golisano Children's Hospital: 21%), with consistently higher use at CHOA, although both sites showed lower usage for medication and laboratory orders compared with nursing orders. Among >20 million laboratory results, abnormal flagging differed by 7% (56 vs. 49%), although variability was observed across test categories.</p><p><strong>Conclusion: </strong>Passive CDS usage in PICUs is highly variable across institutions and domains. These findings highlight the need for standardized implementation and cross-site learning to optimize efficiency, reduce cognitive burden, and improve CDS.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":"17 2","pages":"259-268"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Federal Healthcare Legislation that Promoted the Digitalization of Medicine and the Impact on Healthcare Delivery in 2025.","authors":"Kyle A Mani, Sanjna Nandal, Thomas Scharfenberger, Meghana Veldhuis, Kevin Tang, Bishoy Gad, Sunit P Jariwala","doi":"10.1055/a-2830-2591","DOIUrl":"10.1055/a-2830-2591","url":null,"abstract":"<p><strong>Background: </strong> Federal healthcare legislation has played a central role in shaping the digital transformation of U.S. healthcare. Key legislative milestones-including the Health Security Act of 1993, the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, the Patient Protection and Affordable Care Act (ACA), and the 21st Century Cures Act-collectively accelerated the adoption of electronic health records (EHRs), promoted interoperability, and expanded access to digital health tools.</p><p><strong>Objective: </strong> This study aimed to examine how federal legislation across recent administrations has shaped the digitalization of healthcare delivery, and to evaluate the challenges and consequences associated with these policies.</p><p><strong>Methods: </strong> A targeted narrative review was conducted using primary legislative texts and federal policy documents from 1993 to 2016. Findings were organized chronologically and thematically to assess the intended objectives, observed impacts, and ongoing implementation challenges associated with major healthcare legislation.</p><p><strong>Results: </strong> Federal legislation significantly accelerated the adoption of EHR systems, expanded health information exchange, and enabled advances in patient safety, clinical quality, and population health analytics. Implementation has also introduced challenges, including high system costs, workflow disruption, documentation burden, and disparities in adoption amongst smaller practices. Emerging technologies, such as artificial intelligence, are further reshaping digital healthcare while raising new concerns regarding regulation, safety, and data governance.</p><p><strong>Conclusion: </strong> Federal policies have fundamentally transformed healthcare delivery by establishing the infrastructure for a digitally connected healthcare system. Despite measurable improvements in interoperability and data accessibility, persistent challenges remain. Future reforms should prioritize improved EHR design, enhanced clinician training frameworks, and policies that address adoption barriers to ensure that digital health innovations translate into safer, more effective, and equitable patient care.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":" ","pages":"138-144"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}