Applied Clinical Informatics最新文献

{"title":"Pediatric Consent on FHIR.","authors":"Anton Voronov, Mohammad Jafari, Lin Zhao, Melissa Soliz, Qixuan Hong, John Pope, Darwyn Chern, Megan Lipman, Adela Grando","doi":"10.1055/a-2291-1482","DOIUrl":"10.1055/a-2291-1482","url":null,"abstract":"<p><strong>Background: </strong> Standardizing and formalizing consent processes and forms can prevent ambiguities, convey a more precise meaning, and support machine interpretation of consent terms.</p><p><strong>Objectives: </strong> Our goal was to introduce a systematic approach to standardizing and digitizing pediatric consent forms, which are complex due to legal requirements for child and legal guardian involvement.</p><p><strong>Methods: </strong> First, we reviewed the consent requirements from the Arizona regulation, and we used 21 pediatric treatment consents from five Arizona health care organizations to propose and evaluate an implementation-agnostic Consent for Treatment Framework. Second, we assessed the adequacy of the Fast Healthcare Interoperability Resources (FHIR) to support the proposed framework.</p><p><strong>Results: </strong> The resulting Consent for Treatment Framework supports compliance with the state consent requirements and has been validated with pediatric consent forms. We also demonstrated that the FHIR standard has the required expressiveness to compute the framework's specifications and express the 21 consent forms.</p><p><strong>Conclusion: </strong> Health care organizations can apply the shared open-source code and FHIR implementation guidelines to standardize the design of machine-interpretable pediatric treatment consent forms. The resulting FHIR-based executable models may support compliance with the law and support interoperability and data sharing.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11078568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177355","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":"Simplifying Multimodal Clinical Research Data Management: Introducing an Integrated and User-friendly Database Concept.","authors":"Anna Schweinar, Franziska Wagner, Carsten Klingner, Sven Festag, Cord Spreckelsen, Stefan Brodoehl","doi":"10.1055/a-2259-0008","DOIUrl":"10.1055/a-2259-0008","url":null,"abstract":"<p><strong>Background: </strong> Clinical research, particularly in scientific data, grapples with the efficient management of multimodal and longitudinal clinical data. Especially in neuroscience, the volume of heterogeneous longitudinal data challenges researchers. While current research data management systems offer rich functionality, they suffer from architectural complexity that makes them difficult to install and maintain and require extensive user training.</p><p><strong>Objectives: </strong> The focus is the development and presentation of a data management approach specifically tailored for clinical researchers involved in active patient care, especially in the neuroscientific environment of German university hospitals. Our design considers the implementation of FAIR (Findable, Accessible, Interoperable, and Reusable) principles and the secure handling of sensitive data in compliance with the General Data Protection Regulation.</p><p><strong>Methods: </strong> We introduce a streamlined database concept, featuring an intuitive graphical interface built on Hypertext Markup Language revision 5 (HTML5)/Cascading Style Sheets (CSS) technology. The system can be effortlessly deployed within local networks, that is, in Microsoft Windows 10 environments. Our design incorporates FAIR principles for effective data management. Moreover, we have streamlined data interchange through established standards like HL7 Clinical Document Architecture (CDA). To ensure data integrity, we have integrated real-time validation mechanisms that cover data type, plausibility, and Clinical Quality Language logic during data import and entry.</p><p><strong>Results: </strong> We have developed and evaluated our concept with clinicians using a sample dataset of subjects who visited our memory clinic over a 3-year period and collected several multimodal clinical parameters. A notable advantage is the unified data matrix, which simplifies data aggregation, anonymization, and export. THIS STREAMLINES DATA EXCHANGE AND ENHANCES DATABASE INTEGRATION WITH PLATFORMS LIKE KONSTANZ INFORMATION MINER (KNIME): .</p><p><strong>Conclusion: </strong> Our approach offers a significant advancement for capturing and managing clinical research data, specifically tailored for small-scale initiatives operating within limited information technology (IT) infrastructures. It is designed for immediate, hassle-free deployment by clinicians and researchers.The database template and precompiled versions of the user interface are available at: https://github.com/stebro01/research_database_sqlite_i2b2.git.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10972680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673387","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":"Examining the Generalizability of Pretrained De-identification Transformer Models on Narrative Nursing Notes.","authors":"Fangyi Chen, Syed Mohtashim Abbas Bokhari, Kenrick Cato, Gamze Gürsoy, Sarah Rossetti","doi":"10.1055/a-2282-4340","DOIUrl":"10.1055/a-2282-4340","url":null,"abstract":"<p><strong>Background: </strong> Narrative nursing notes are a valuable resource in informatics research with unique predictive signals about patient care. The open sharing of these data, however, is appropriately constrained by rigorous regulations set by the Health Insurance Portability and Accountability Act (HIPAA) for the protection of privacy. Several models have been developed and evaluated on the open-source i2b2 dataset. A focus on the generalizability of these models with respect to nursing notes remains understudied.</p><p><strong>Objectives: </strong> The study aims to understand the generalizability of pretrained transformer models and investigate the variability of personal protected health information (PHI) distribution patterns between discharge summaries and nursing notes with a goal to inform the future design for model evaluation schema.</p><p><strong>Methods: </strong> Two pretrained transformer models (RoBERTa, ClinicalBERT) fine-tuned on i2b2 2014 discharge summaries were evaluated on our data inpatient nursing notes and compared with the baseline performance. Statistical testing was deployed to assess differences in PHI distribution across discharge summaries and nursing notes.</p><p><strong>Results: </strong> RoBERTa achieved the optimal performance when tested on an external source of data, with an F1 score of 0.887 across PHI categories and 0.932 in the PHI binary task. Overall, discharge summaries contained a higher number of PHI instances and categories of PHI compared with inpatient nursing notes.</p><p><strong>Conclusion: </strong> The study investigated the applicability of two pretrained transformers on inpatient nursing notes and examined the distinctions between nursing notes and discharge summaries concerning the utilization of personal PHI. Discharge summaries presented a greater quantity of PHI instances and types when compared with narrative nursing notes, but narrative nursing notes exhibited more diversity in the types of PHI present, with some pertaining to patient's personal life. The insights obtained from the research help improve the design and selection of algorithms, as well as contribute to the development of suitable performance thresholds for PHI.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11078567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050771","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":"Health Information Technology Supporting Adherence Memory Disorder Patients: A Systematic Literature Review","authors":"Safa Elkefi, Saul Blecker, Yuval Bitan","doi":"10.1055/s-0043-1776792","DOIUrl":"https://doi.org/10.1055/s-0043-1776792","url":null,"abstract":"<p>\u0000<b>Background</b> People with memory disorders have difficulty adhering to treatments. With technological advances, it remains important to investigate the potential of health information technology (HIT) in supporting medication adherence among them.</p> <p>\u0000<b>Objectives</b> This review investigates the role of HIT in supporting adherence to medication and therapies among patients with memory issues. It also captures the factors that impact technology adherence interventions.</p> <p>\u0000<b>Methods</b> We searched the literature for relevant publications published until March 15, 2023, using technology to support adherence among patients with memory issues (dementia, Alzheimer's, amnesia, mild cognitive impairment, memory loss, etc.). The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We conducted a quality assessment of the papers following the Mixed Methods Appraisal Tool.</p> <p>\u0000<b>Results</b> Fifteen studies were included after carefully reviewing the 3,773 articles in the search. Methodological quality, as appraised, ranged from 80 to 100% with eight studies rated 100%. The studies overall did not have a high risk of bias. Thus, all of the 15 studies were included. Technologies investigated were classified into four groups based on their impact: therapeutic patient education, simplifying treatment regimens, early follow-up visits and short-term treatment goals, and reminder programs. Different technologies were used (automatic drug dispensers or boxes, mobile health-based interventions, game-based interventions, e-health-based interventions, patient portals, and virtual reality). The factors impacting patients' adherence to technology-based treatment and medication were clustered into human–computer interaction and integration challenges.</p> <p>\u0000<b>Conclusion</b> This study contributes to the literature by classifying the technologies that supported medication adherence among patients with memory issues in four groups. It also explores and presents the possible limitations of existing solutions to drive future research in supporting care for people with memory disorders.</p> ","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139657067","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":"An Evidence-based Preoperative Evaluation Documentation Template Improves Perioperative Communication.","authors":"Xin Piao, Brian H Imdieke, Samantha A Sommerness, Deepti Pandita","doi":"10.1055/s-0044-1779021","DOIUrl":"10.1055/s-0044-1779021","url":null,"abstract":"<p><strong>Objectives: </strong>The number of surgeries performed in the United States has increased over the past two decades, with a shift to the ambulatory setting. Perioperative complications and mortality pose significant health care burdens. Inadequate preoperative assessment and documentation contribute to communication failure and poor patient outcomes. The aim of this quality improvement project was to design and implement a preoperative evaluation documentation template that not only improved communication during the perioperative pathway but also enhanced the overall user experience.</p><p><strong>Methods: </strong>We implemented a revamped evidence-based documentation template in the electronic medical records of a health care organization across three internal medicine clinics on the downtown campus and seven satellite family medicine clinics. A pre- and postintervention design was used to assess the template utilization rate and clinician satisfaction.</p><p><strong>Results: </strong>The preoperative template utilization rate increased from 51.2% at baseline to 66.5% after the revamped template \"went live\" (<i>p</i> < 0.001). Clinician satisfaction with the preoperative documentation template also significantly increased (30.6 vs. 80.0%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Adopting a user-friendly, evidence-based documentation template can enhance the standardization of preoperative evaluation documentation and reduce the documentation burden.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10866639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736507","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":"An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies.","authors":"Kameron Collin Black, Nicole Ashley Snyder, Mengyu Zhou, Zhen Zhu, Colby Uptegraft, Ani Chintalapani, Benjamin Orwoll","doi":"10.1055/a-2250-6305","DOIUrl":"10.1055/a-2250-6305","url":null,"abstract":"<p><strong>Background: </strong> Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates.</p><p><strong>Objective: </strong> Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine.</p><p><strong>Methods: </strong> This was a quasiexperimental pre-post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation.</p><p><strong>Results: </strong> Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39-4.74, <i>p</i> < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23-2.13, <i>p</i> < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70-3.82, <i>p</i> < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73-1.37, <i>p</i> = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital.</p><p><strong>Conclusion: </strong> Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10917607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520347","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":"Electronic Health Record Usage Patterns Across Surgical Subspecialties.","authors":"Kevin Tang, Kevin Labagnara, Mustufa Babar, Justin Loloi, Kara L Watts, Sunit Jariwala, Nitya Abraham","doi":"10.1055/a-2194-1061","DOIUrl":"10.1055/a-2194-1061","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to utilize metrics from physician action logs to analyze surgeon clinical, volume, electronic health record (EHR) efficiency, EHR proficiency, and workload outside scheduled time as impacted by physician characteristics such as years of experience, gender, subspecialty, academic title, and administrative title.</p><p><strong>Methods: </strong>We selected 30 metrics from Epic Signal, an analytic tool in Epic that extracts metrics related to clinician documentation. Metrics measuring appointments, messages, and scheduled hours per day were used as a correlate for volume. EHR efficiency, and proficiency were measured by scores built into Epic Signal. Metrics measuring time spent in the EHR outside working hours were used as a correlate for documentation burden. We analyzed these metrics among surgeons at our institution across 4 months and correlated them with physician characteristics.</p><p><strong>Results: </strong>Analysis of 133 surgeons showed that, when stratified by gender, female surgeons had significantly higher EHR metrics for time per day, time per appointment, and documentation burden, and significantly lower EHR metrics for efficiency when compared to male surgeons. When stratified by experience, surgeons with 0 to 5 years of experience had significantly lower EHR metrics for volume, time per day, efficiency, and proficiency when compared to surgeons with 6 to 10 and more than 10 years of experience. On multivariate analysis, having over 10 years of experience was an independent predictor of more appointments per day, greater proficiency, and spending less time per completed message. Female gender was an independent predictor of spending more time in notes per appointment and time spent in the EHR outside working hours.</p><p><strong>Conclusion: </strong>The burden associated with volume, proficiency, efficiency, and workload outside scheduled time related to EHR use varies by gender and years of experience in our cohort of surgeons. Evaluation of physician action logs could help identify those at higher risk of burnout due to burdensome medical documentation.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10781576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49683957","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":"Improving Vaccine Equity: How Community Engagement and Informatics Facilitate Health System Outreach to Underrepresented Groups.","authors":"Serena J Xie, Nicholas R Mah, Lisa Chew, Julia Ruud, Jennifer Hernandez, Jessica Lowery, Andrea L Hartzler","doi":"10.1055/s-0044-1779258","DOIUrl":"10.1055/s-0044-1779258","url":null,"abstract":"<p><strong>Background: </strong>Given the inequities in access to health care resources like COVID-19 vaccination, health systems should carefully consider how to reach underrepresented groups. Reflecting on vaccine rollout efforts holds insight on the role of community engagement and informatics support in promoting health equity.</p><p><strong>Objectives: </strong>This study aimed to assess the effectiveness of four outreach strategies deployed by University of Washington (UW) Medicine in improving vaccine equity over traditional vaccine scheduling online or by phone, we report on appointment scheduling and completion of appointments (i.e., vaccine administration) through (1) automated outreach to individuals from underrepresented groups, (2) temporary \"pop-up\" clinics in neighborhoods highly impacted by COVID-19, (3) vulnerable population clinics, and (4) mobile vaccine vans.</p><p><strong>Methods: </strong>We conducted a 6-month retrospective analysis of electronic health records (EHR) to describe the sociodemographic characteristics of individuals who scheduled appointments using the outreach strategies and characteristics associated with a greater likelihood of vaccine administration based on appointment completion. To help explain trends in the EHR data, we engaged 10 health system leaders and staff who spearheaded the outreach strategies in follow-up conversations to identify qualitative insights into what worked and why.</p><p><strong>Results: </strong>Compared with traditional scheduling, all outreach strategies except vulnerable population clinics had higher vaccine appointment completion rates, including automated outreach (<i>N</i> = 3,734 [94.7%], <i>p</i> < 0.001), pop-up clinics (<i>N</i> = 4,391 [96.0%], <i>p</i> < 0.001), and mobile vans (<i>N</i> = 4,198 [99.1%], <i>p</i> < 0.001); and lower cancellation rates, including automated outreach (<i>N</i> = 166 [1.1%], <i>p</i> < 0.001), pop-up clinics (<i>N</i> = 155 [0.6%], <i>p</i> < 0.001), and mobile vans (<i>N</i> = 0 [0%], <i>p</i> < 0.001). Qualitative insights emphasized ongoing community partnerships and information resources in successful outreach.</p><p><strong>Conclusion: </strong>Vaccine equity outreach strategies improved the proportion of patients who scheduled and completed vaccination appointments among populations disproportionately impacted by COVID-19. Engaging community partners and equity-focused informatics tools can facilitate outreach. Lessons from these outreach strategies carry practical implications for health systems to amplify their health equity efforts.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10866640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736536","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":"Expanding Critical Care Delivery beyond the Intensive Care Unit: Determining the Design and Implementation Needs for a Tele-Critical Care Consultation Service.","authors":"Joanna Abraham, Madhumitha Kandasamy, Bradley Fritz, Lisa Konzen, Jason White, Anne Drewry, Christopher Palmer","doi":"10.1055/s-0044-1780508","DOIUrl":"10.1055/s-0044-1780508","url":null,"abstract":"<p><strong>Background: </strong> Unplanned intensive care unit (ICU) admissions from medical/surgical floors and increased boarding times of ICU patients in the emergency department (ED) are common; approximately half of these are associated with adverse events. We explore the potential role of a tele-critical care consult service (TC3) in managing critically ill patients outside of the ICU and potentially preventing low-acuity unplanned admissions and also investigate its design and implementation needs.</p><p><strong>Methods: </strong> We conducted a qualitative study involving general observations of the units, shadowing of clinicians during patient transfers, and interviews with clinicians from the ED, medical/surgical floor units and their ICU counterparts, tele-ICU, and the rapid response team at a large academic medical center in St. Louis, Missouri, United States. We used a hybrid thematic analysis approach supported by open and structured coding using the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong> Over 165 hours of observations/shadowing and 26 clinician interviews were conducted. Our findings suggest that a tele-critical care consult (TC3) service can prevent avoidable, lower acuity ICU admissions by offering a second set of eyes via remote monitoring and providing guidance to bedside and rapid response teams in the care delivery of these patients on the floor/ED. CFIR-informed enablers impacting the successful implementation of the TC3 service included the optional and on-demand features of the TC3 service, around-the-clock availability, and continuous access to trained critical care clinicians for avoidable lower acuity (ALA) patients outside of the ICU, familiarity with tele-ICU staff, and a willingness to try alternative patient risk mitigation strategies for ALA patients (suggested by TC3), before transferring all unplanned admissions to ICUs. Conversely, the CFIR-informed barriers to implementation included a desire to uphold physician autonomy by floor/ED clinicians, potential role conflicts with rapid response teams, additional workload for floor/ED nurses, concerns about obstructing unavoidable, higher acuity admissions, and discomfort with audio-visual tools. To amplify these potential enablers and mitigate potential barriers to TC3 implementation, informed by this study, we propose <i>two key characteristics-</i>essential for extending the delivery of critical care services beyond the ICU<i>-</i>underlying a telemedicine critical care consultation model including its <i>virtual footprint</i> and <i>on-demand and optional</i> service features.</p><p><strong>Conclusion: </strong> Tele-critical care represents an innovative strategy for delivering safe and high-quality critical care services to lower acuity borderline patients outside the ICU setting.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10917611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050772","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":"An mHealth Design to Promote Medication Safety in Children with Medical Complexity.","authors":"Anna Jolliff, Ryan J Coller, Hannah Kearney, Gemma Warner, James A Feinstein, Michelle A Chui, Steve O'Brien, Misty Willey, Barbara Katz, Theodore D Bach, Nicole E Werner","doi":"10.1055/a-2214-8000","DOIUrl":"10.1055/a-2214-8000","url":null,"abstract":"<p><strong>Background: </strong>Children with medical complexity (CMC) are uniquely vulnerable to medication errors and preventable adverse drug events because of their extreme polypharmacy, medical fragility, and reliance on complicated medication schedules and routes managed by undersupported family caregivers. There is an opportunity to improve CMC outcomes by designing health information technologies that support medication administration accuracy, timeliness, and communication within CMC caregiving networks.</p><p><strong>Objectives: </strong>The present study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a codesign process to identify: (1) medication safety challenges experienced by CMC caregivers and (2) design requirements for a mobile health application to improve medication safety for CMC in the home.</p><p><strong>Methods: </strong>Study staff recruited family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program to participate in virtual codesign sessions. During sessions, the facilitator-guided codesigners in generating and converging upon medication safety challenges and design requirements. Between sessions, the research team reviewed notes from the session to identify design specifications and modify the prototype. After design sessions concluded, each session recording was reviewed to confirm that all designer comments had been captured.</p><p><strong>Results: </strong>A total of <i>N</i> = 16 codesigners participated. Analyses yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines. Supporting quotations from codesigners and prototype features associated with each design requirement are presented.</p><p><strong>Conclusion: </strong>This study generated design requirements for a tool that may improve medication safety by creating distributed situation awareness within the caregiving network. The next steps are to pilot test tools that integrate these design requirements for usability and feasibility, and to conduct a randomized control trial to determine if use of these tools reduces medication errors.</p>","PeriodicalId":48956,"journal":{"name":"Applied Clinical Informatics","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10794091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138292173","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}